Help Wanted: a Good Therapist - The Wallstreet Journal
Friday, March 16th, 2012Amid Increasing Choices, How to Know What Treatments Work, When to Move On
By MELINDA BECK
Therese Borchard likens herself to Goldilocks of the mental-health world: She tried six psychiatrists before she found one that was “just right.” One learned she was a writer and asked for help with a book proposal. Another put her on sleeping pills, ignoring her history of substance abuse. One even wanted to try hypnotic regression by candlelight to address unresolved childhood issues.
Ryan Snook
Finally, No. 7 diagnosed bipolar disorder, found medication that was effective, helped her to be less hard on herself and “salvaged the last crumb of my self-esteem,” says Ms. Borchard, who writes the popular “Beyond Blue” blog on Beliefnet.com.
The search for the right therapist can be baffling—and it comes at a time when would-be patients are feeling most vulnerable.
Patients who aren’t sure what’s wrong with them can be stumped about the type of therapist to call and ill-equipped to evaluate what they’re told during treatment. How well a therapist’s personal style matches a patient’s individual needs can be critical. But experts also say that patients shouldn’t be shy about pressing their therapist for a diagnosis and setting measurable goals.
It can be one of the most important relationships in life, yet choosing a therapist is often baffling for patients. Melinda Beck on Lunch Break discusses how to go about finding one and insuring you and your shrink are a good fit.
David Palmiter, a public-education coordinator for the American Psychological Association (APA), likens good therapy to going to a good restaurant: “You should be able to peer into the kitchen and see what they’re doing.”
About 3% of Americans had outpatient psychotherapy in 2007—roughly the same as in 1998—although the percentage taking antidepressants and other psychotropic drugs rose sharply, according to an analysis in the American Journal of Psychiatry last year. The same study found that the average number of visits dropped from nearly 10 in 1998 to eight in 2007.
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By some estimates, one-quarter of the U.S. population has some kind of diagnosable mental illness. But many don’t believe they need help, don’t know how to get it, think they can’t afford it or that it won’t be effective. There’s also the lingering stigma attached to seeing a “shrink.”
Approaches
There are many types of therapy, including:
- Cognitive-behavioral therapy.Identifies and changes harmful thinking patterns; may involve gradual exposure to whatever is causing fears.
- Interpersonal therapy.Explores how relationships involving grief, isolation, conflict or changing family roles contribute to psychological problems.
- Psychoanalysis.Emphasizes how the unconscious mind influences behavior and how the past affects the present.
Numerous clinical trials have shown that various forms of psychotherapy, with or without medication, can help ease depression, anxiety and other disorders. One oft-quoted analysis of 2,400 patients found that 50% improved measurably after eight sessions, and 75% improved after six months in therapy. Still, that doesn’t mean that any given therapist will be effective for any particular patient.
One issue for prospective patients is that therapists generally specialize in one treatment approach and tend to see patients’ problems through that lens. A cognitive-behavioral therapist will focus on changing patients’ negative thinking patterns, while a psychoanalyst will want to probe more deeply into how the past is affecting current issues.
Some clinics and university mental-health centers offer consultations to help evaluate which treatment might be best. “Patients shouldn’t have to decide this by themselves,” says Drew Ramsey, an assistant clinical professor of psychiatry at New York’s Columbia University, who says he loves to play “shrink matchmaker.”
Once in treatment, both the therapist and the patient should be familiar enough with each other by the third session to know if it’s a good fit, experts say.
“Some people need a therapist who gives them instructions and assignments, and some people hate that. Some people need a therapist who is basically silent and lets them talk,” says Betsy Stone, a psychologist in Stamford, Conn.
Dr. Stone says she can often tell even in the first session if the fit isn’t right. “I like to push patients pretty hard, because I want them to get their money’s worth, and some people are just too fragile,” she says. “Then I say, ‘I’m not the right therapist for you, but I’ll help you find someone else.’ ”
Increasingly, therapists are collaborating with patients on a treatment plan rather than remaining aloof and omniscient. “I encourage patients to look up the science for themselves. How can they do that if they don’t know what terms to search for?” says Dr. Palmiter.
Effective therapy can be difficult at times—particularly when the patient is exploring painful thoughts or fears. “A good therapist should give you comfort and discomfort at the same time. They should make you feel understood but challenged,” says Dr. Stone.
Distinguishing that from having an uncomfortable relationship with the therapist can be tricky. “If you leave therapy every week feeling worse than when you went in,” says Dr. Bufka, “it’s probably not the right place for you.”
Studies show that patients often hesitate to break it off because they don’t want to hurt the therapist’s feelings or seem ungrateful. “But believe me, we’re used to it—and it’s a very valuable thing to hear,” says Dr. Palmiter.
Even close relationships sometimes fail to get at the right issues. Victoria Maxwell, 44, an actress and blogger from Half Moon Bay, British Columbia, says she worked with a therapist for 2½-years as a teenager and liked her enormously. But she never made much progress, because the therapist didn’t recognize Ms. Maxwell’s underlying bipolar disorder. “I became a really insightful depressed person. But it wasn’t helping my depression,” she says.
Years later, after several hospitalizations, a nurse referred Ms. Maxwell to an older psychiatrist. She initially thought they’d be a bad fit—but found he was the only one who believed she could have both a profound spiritual experience and bipolar disorder. “I trusted him, so I was willing to try what he suggested, which included medication,” she says. “I wouldn’t be where I am today without his help and understanding.”
Setting measurable goals is crucial for knowing whether a therapy is working. In Ms. Maxwell’s case, her psychiatrist said, “I think you’re capable of moving out of your parents’ home, living with roommates and driving a car—and I was,” she says.
