SOME OBSERVATIONS AND REASSURANCE
When searching for a helping professional, there are a few other roadblocks you may come across. In the following pages, we’ll explore some common complaints, pushbacks, and irritations I’ve encountered from clients, colleagues, friends and family about the field of therapy over the years.
The Complexities of the Mental Health System
The mental health system in the US is currently in flux. What is status quo today (2019) will most likely undergo a host of changes, most of which we cannot predict. That said, I believe the general issues I address below will still be relevant for the foreseeable future and therefore will require navigation.
One of the major complexities that we should address is the issue of diagnosis, which (perhaps surprisingly) is related to payment. The term, diagnosis, may need a little technical explanation. Mental health diagnostic criteria come from an industry tool called the Diagnostic Statistical Manual (DSM) that presents agreed-upon criteria and standards for every mental health diagnosis. When seeking therapy, people often want to use their insurance to pay for it. This is perfectly understandable. Insurance coverage comes with a small catch, however. In order for insurance companies to cover treatment, they need to see a diagnosis from the therapist.
Now why is this complicated? Because mental health and medical health norms/practices are always changing, we can’t be sure (at least, not for long) how or if prior conditions will be an issue for the consumer in the future. To clarify, prior conditions are diagnoses (it could be anything, but depression or anxiety are two of the most common) that stay on an individual’s medical record. The risk involves who may access such information (future employers, volunteer organizations, military, licensure boards, school, etc.) as well as what they might do with said information. For instance, we can envision a scenario in which an employer chooses not to hire based solely on prior conditions, regardless of excellent qualifications.
For example, a survey of medical doctors from all 50 states revealed that over half of them believed they themselves may meet DSM criteria for a mental health diagnosis but avoided seeking treatment for fear of it being reported to their medical board.100
So you may be thinking, “Well, if doctors meet criteria for a mental health diagnosis, shouldn’t their board know about it and do something?” To which I would answer, “Maybe.” I’ll explain with the following example, an amalgam of scenarios I personally witnessed as a therapist.
Chad, a middle-aged doctor, was going through a divorce. He’d been in love with his wife for 20 years and they had two wonderful children. The separation sent Chad into a deep sadness. As a result, he struggled with his work, his friendships, and his efforts to redefine his post-divorce identity as a father, partner, etc. Chad’s transition was tough, but not unlike that of anyone else going through a similar life loss. He decided to seek therapy for emotional support and to learn ways to cope with his hardship. Based on his initial interview and his preference to use his insurance, the therapist diagnosed him with depression. To be clear, the therapist had reviewed the DSM’s definition of depression and had confirmed that Chad met the criteria. Over a period of six months or so, Chad made great progress in therapy, continued to adjust to his new circumstance, and closed out his meetings with his therapist. Subsequently, Chad no longer met the criteria for depression, but his diagnosis stayed with him.
The complexities here are vast. Would it have been better for Chad if the therapist had not given him the diagnosis? Does Chad actually have a biological predisposition to clinical depression? Is Chad just a normal guy, who, in dealing with life-altering circumstances, needed some temporary support? Would it be fair that Chad’s diagnosis stay on his record like a blemish throughout his professional career, potentially precluding future opportunities? Is it reasonable to assume a therapist can accurately understand someone’s experience enough to offer a diagnosis after just one meeting with them? Some of these questions surely require a deeper understanding of the clinical nuances of depression, but I think you probably get my point: these issues are not easily resolved and can lead to real distress. Needless to say, the mental health and medical health systems could use an overhaul.
As a would-be consumer, you should know the complications of the mental health system before you enter it. I encourage you to discuss the issue of diagnosis with any therapist with whom you consider working.
Busting the Myth that Therapy Sucks
The stigma around seeking help or guidance is a somewhat unusual cultural phenomenon. It is certainly influenced by gender, geography, cultural background, and socioeconomic class. It should come as no surprise that promoting therapy as a cultural norm and reducing the stigma around it increases the numbers of those who seek it out.101 I hope the following examples from my own career will help you overcome any reservations you may have about seeking help.
Throwing the Baby Out with the Bathwater
You may have heard some version of the old complaint, “I tried therapy once and didn’t like it.” As is the case with any social interaction (dating or friendship, for instance), the particular connection you have with your therapist is a crucial factor to consider. Research shows that the right fit with a helping professional is one of the best predictors of positive change.102
It may take some time and effort to find a therapist you connect with. Unfortunately, it often happens that when clients don’t connect with a new therapist, they quit and then chalk up their experience to the general ineffectiveness of all therapy. I believe that for the sake of finding the right fit, clients should take advantage of the opportunity to analyze what didn’t work with their interactions. A poor connection may be due to several factors, including differences in communication style, cultural differences, or generational differences. It may be that the therapist pushes the client too hard (or not hard enough), or that the client does not understand the importance of connection as a key to success. Clients may also mistakenly assume that the therapist has some kind of cure-all wisdom to unveil to them. In such circumstances clients may ignore their own intuition, which is usually a mistake. It is the therapist’s job to enable the client’s own wisdom to come forward, not to tell the client how to live.
Therapists are like any other professional: there are great ones, good ones, and some who shouldn’t be in the field at all. To give you perspective, imagine that a plumber you hire does a bad job. Would you discount the profession of plumbing altogether or simply call a different plumber? Therapy is no different. If you have a negative experience, don’t give up. Don’t assume the process sucks just because it didn’t work out the first time. There is likely to be a therapist out there who is right for you. At the end of this chapter I’ve added tools intended to expedite this discovery process.
“Therapy Doesn’t Work”
When clients assume that therapy is wasting their time because after a handful of sessions they haven’t seen the immediate results they were expecting, they fail to consider the element of time. Changing behavior, perspective, or habits sometimes takes time. And patience. Going to a few therapy sessions and quitting after not seeing immediate results is like working out a few times, failing to lose twenty pounds, and giving up.
Clients should know how to get the most out of working with a therapist. Having a discussion early in the therapy process about what you hope to gain and should expect from the experience is critical for optimal results. Thankfully, many therapists do start this way. But don’t be afraid to ask questions if you find yourself in a situation in which the process is not perfectly clear.
It is also important to understand the basic parameters of a therapy session. Each time you meet with a therapist, it is typically for no more than an hour. Even if you meet weekly, it is obviously a limited period. Furthermore, strategies discussed in therapy require time for proper implementation and practice at home or in the workplace to achieve desired results. It doesn’t matter how long or frequently you meet wit
h a therapist, if you don’t apply and practice the new insights you gain, any change that results will be limited.
There may be times when clients continue to attend appointments, even though they feel that nothing is changing for them. In such circumstances it is helpful to bring up these feelings of discouragement for discussion with your therapist. Don’t be afraid to ask questions or challenge your therapist. It’s okay to disagree; sometimes disagreement offers the opportunity to work through conflict in a way you haven’t experienced before. Perhaps together you can discover what, if anything, has been missing. Or perhaps you’re not giving yourself enough credit for the work you’ve already put in and the progress you’ve already made.
My Problems aren’t Serious Enough for Therapy
We all experience problems as we move through life. We all struggle with stress, fear, hope, desire for love, relationship challenges, and insecurity. Therapy can benefit anyone and everyone, not just those confronting severe and urgent problems. Fortunately, many people see therapy as an opportunity to self-actualize, gain self-knowledge, process something confusing, and determine what is most valuable to them. The bottom line is that therapy doesn’t just help to pull you out of the trenches; it can also push you toward your goals.
Therapy is an open platform for exploring whatever you decide is important. I repeat, whatever YOU decide is important. People seek guidance and empowerment through therapy for a variety of reasons, and the significance of those reasons should be determined solely by the individual who is seeking such guidance.
We can reduce the stigma of therapy by recognizing and accepting a few simple statements.
1) It’s okay to examine who we are.
2) It’s okay to explore what is working and what isn’t working in our life.
3) It’s okay to want to make changes to better ourselves and get support along the way.
CHAPTER 22 ACTIVITY
In this chapter, you have learned more about therapy. Now, it’s time to consider some questions that will help you in your search for a therapist, should you decide to see one. Answer the questions below and use this as a resource when exploring your options.
OUTLINE YOUR VALUES
Name three things that stand out to you in this chapter:
What kind of location would be the best fit for you?
How did you come to this conclusion?
Do you have insurance and have you considered using it to cover costs? Yes / No
How do you feel about having a diagnosis?
Begin the online search here:
Good Therapy 103
Psychology Today 104
(Good Therapy and Psychology Today are online search platforms that allow you to search for therapists by location, gender, insurance panel, and many other factors.)
Google search
Possible search terms:
Therapist
Counselor
Psychotherapist
Marriage and family therapist
Substance abuse counselor
Terms by condition/location
Example: Depression; Counseling; Asheville, NC
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How to Choose a Coach, Therapist, or Other Helping Professional
This chapter will help you find the right helping professional. Many people ask me what distinguishes one kind of therapist or coach from another and how to choose the most appropriate one. Since we already know a little about the four main disciplines therapists work within and where to find a therapist, let’s look at a few more criteria for choosing a therapist or other helping professional.
Just to rehash a bit, when someone is going to see a professional for some kind of personal development, the therapist or professional is going to be listed as one of the following:
Psychiatrist
Psychologist
Social worker
Counselor
Marriage & family therapist
Life/Leadership/Executive/Career/Personal Development Coach
Side note about mentorship: If you are looking for a mentor in business, fitness, finance, etc., the principles in this section apply. Remember, the search for a helping professional is just as much about asking yourself hard questions as it is about asking them of candidates. The clearer you are about what exactly you’re looking for, the greater the likelihood that you will find the person who best suits those needs.
Even though no licensure is required to be a coach, I add it into the mix because it’s a relevant and valid choice for many people. Full disclosure, I’m currently a coach and have previously been a therapist. In my role as a coach, I see just as much positive change in clients and organizations I serve as I did when practicing as a therapist. The main distinction is that in coaching and consulting work, people are typically addressing different kinds of life changes than in therapy. (More about this in the next chapter.)
In your search for a helping professional, keep in mind that one of the strongest determinants of success is the fit of the working relationship.
The question then becomes, “How do I decide if this professional is a good fit for me?”
As a preliminary step, you can do an online search. As mentioned in the last chapter, if you’re looking for a therapist, I recommend two websites: www.psychologytoday.com and www.goodtherapy.com, which offer helpful platforms to search for therapists by specialty, location, insurance provider, etc. You can also visit individual practitioner or group practice websites to read bios and reviews. To get a more personal sense of the therapist, try a phone call. Most therapists offer free introductory calls. Finding the right coach can be a little more difficult, we’ll dive into that in the next chapter.
Here are four questions to help you identify the right fit when speaking with or meeting with a prospective helping professional:
1. How does this person communicate?
When you speak to a prospective helping professional, consider what kind of communicator he/she is and if his/her style is compatible with yours. Some people appreciate more direct interaction, some prefer a more inquisitive or curious nature, while others work best with someone who will listen for longer stretches, allowing more time for quiet reflection.
2. What is their philosophy about growth and change, and does this philosophy align with mine?
While there are many theories about what elicits change and what leads to progress, working with someone who shares your basic philosophy is often beneficial. For example, if a helping professional believes change comes from working through someone’s past issues to uncover the meaning behind behaviors (in order to better manage them in the future) and you identify with this, then perhaps this is a great fit.
Alternatively, some people approach changes from a forward-facing perspective, according to which strengths are identified and built upon and past stories and behaviors are examined only briefly. Perhaps his approach would serve you better.
It is up to you to determine what is congruent with your philosophy and sensibilities.
Take the time to evaluate your philosophy to be sure it is one that serves you well. For instance, if you believe that looking back at your history is irrelevant and that you’ve always avoided doing so, consider for a moment that your belief might just be covering up a blind spot or excusing something you fear or find painful. If such is the case, the belief may be impeding self-understanding and personal growth. (See Section 7 about beliefs, Chapter 5 about intuition, and Chapter 13 about fear.)
3. Are the service details in line with your desires?
Don’t neglect to consider all of the details of the prospective helping professional’s services. Some of these details may include price, location, availability, experience, and practice modality. Modalities are specific ways of approaching certain client concerns. For example, certain practitioners focus on addiction with the modality I mentioned in Chapter 17, Motivational Interviewing. This modality helps clients overcome ambivalence about positive change making by exploring p
otential risks and rewards. I would recommend that you find a therapist, coach or helping professional who has experience with the issue that you would like to address. Reading about the person’s background and asking questions for clarification will give you a better sense of compatibility.
4. How do you feel when you are speaking with this person or in their presence?
When you are with this person, consider asking yourself the question, “How do I feel in this moment?” Feeling at ease, comfortable, curious, or eager to share with this person are strong indications that this could be a good fit. Of course, while first impressions can say a lot, they are not foolproof. It often requires two or three meetings or phone calls to get a clear idea of compatibility. Combining your intuition with these fundamental questions should add a sense of security to your decision-making. Bottom line: trust yourself, ask questions, and be honest.
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