Finding a Good Doctor/Therapist

[Trad England]

I have not seen any mental health professional in over three years. And even then that was just one visit. My medical doctors have been continuing my Zoloft and occasionally Xanax prescriptions without question for many years. 

Honestly, I am not sure if I have a chemical imbalance, emotional disorders, trauma from childhood or I am just a lazy bum. If I were to find someone to conduct a true analysis to find out just what the heck is wrong with me, who would I see ? I am in the USA so the choices are counselors, Psychologist or Psychiatrists. Here is my issue with each:

Counselors usually have just a masters degree and are often more messed up more than I am. The colleges are pumping out kids with degrees hanging up their shingles every day. At 66 years of age and my own masters degree, I really don't want to be meeting with someone 25 years old. I don't think they could relate. 

Psychologists: Not even sure about these. Are they enhanced counselors? They have a PhD so are called doctors, but what can they do? I've not had experiences with them before.

Psychiatrists:  They subscribe pills. And if that doesn't work, they subscribe more pills. Everything is medical to them, not emotional or spiritual. 

Who can figure me out objectively and develop a course of action to improve my life?

I sincerely appreciate anyone who takes the time to answer and hope that you day is going good.

Trad

[Atra]

Hi @Trad England. Hope you had a decent weekend and that you have had some peace and rest from symptoms. 

You seem to have given a lot of thought to the state of your mental health care, I'll take a crack at responding to your questions/concerns. 

On 8/15/2019 at 3:39 PM, Trad England said:

If I were to find someone to conduct a true analysis to find out just what the heck is wrong with me, who would I see ?

I get how you feel. I suffered with treatment-resistant depression for many years, my depression was unresponsive to all the medications in the various combinations they were prescribed. I doubted my diagnoses, doubted my doctors and myself. 

Now, if you're going to ask the question above it will do you no good at all if you're merely collecting evidence that psychology cannot help you. I'm not speaking of skepticism, doubt is perfectly fine. What I mean is justifying an a priori conclusion that you cannot be helped, viewing the landscape through the distorted lens of depression. I have no idea if that's what you're doing. I know that I have done exactly this and it got me nowhere.

On 8/15/2019 at 3:39 PM, Trad England said:

Counselors usually have just a masters degree and are often more messed up more than I am.

You realize the first part of the statement has nothing to do with the second part, the second part is a hasty generalization and in any case, neither constitutes a reason that a therapist cannot help you with your problems. It's clear to me that the idea of working with a therapist who is decades younger than you is a non-starter. That's okay, go to a therapist who has some gray hairs. I do (I'm 49).

The masters degree, the age of the therapist, the type of therapy they specialize in - all are important. But the single most important thing with regard to success is the relationship between the patient and the therapist.

On 8/15/2019 at 3:39 PM, Trad England said:

Psychologists: Not even sure about these. Are they enhanced counselors?

Psychologists have a PhD and you're correct, in general they are experts in counseling psychology (some do research but that's not relevant to this discussion).

Psychiatrists can specialize in counseling and some counsel patients but for the most part, their function is new patient intake and diagnosis, case management and pharmacotherapy - managing the medicines. Visits with them are 15-20 minutes tops and maybe just once every three months after a period of evaluation. 

On 8/15/2019 at 3:39 PM, Trad England said:

Everything is medical to them, not emotional or spiritual. 

Yes, that's their role. They don't root around in you trying to find underlying trauma and other reasons for emotional dysregulation.

On 8/15/2019 at 3:39 PM, Trad England said:

Who can figure me out objectively and develop a course of action to improve my life?

I think the confusing and impersonal healthcare system that we all barely get by on may be responsible for the misapprehension of what your mental health care ought to be. The answer to this question is you - you're the one who is going to have the realizations and then make the changes to improve your life. Everyone else involved in your care exists only to help you get there. How?

As you know, brain scans, blood tests, medical instruments of any kind do not aid psychology they way they do general internal medicine. Psychology relies on gathering information supplied by the patient - who mostly isn't readily supplying it - but not because we are just being difficult.

This is how I define psychotherapy. Therapy is a process (long, cannot be short) and it requires a therapeutic relationship. Like with a physician, this relationship is personal and requires privacy. But a therapeutic relationship is also built upon mutual trust, candor, and an overlap of learning by both clinician and patient. It's the learning that takes so much time. It is unlike any other medical or transactional relationship you can name.

The therapy room is meant to be a safe chamber where a patient's feelings can be felt and expressed without the usual fear of social and physical consequences. For therapy to be effective, the patient has to be willing to learn how to tap into feelings and express them (most of us find this difficult to do) but it is not necessary to know why he's feeling them.

The therapist knows that people don't easily open up and there's no way to pop the hood to have a look inside. A therapist is trained to observe verbal and non-verbal signs that indicate underlying beliefs and assumptions that may of may not be accurate. The therapist will also help contextualize feelings that arise.

Contrary to most people's idea of what therapy is for, not everyone has a hidden trauma or pathological behavior, or diagnostic manual condition that needs fixing. Many people go just to learn how to identify feelings we have in our bodies and learn how to express them in a better way than we do. 

I want to spend some words detailing how important that is.

Most of us never had a safe environment in which to learn how to deal with strong emotions let alone a role model who could show us something like conflict resolution that didn't involve shouting, hitting, breaking or isolating. But we can learn how and practice this in the safety of the therapy chamber.

As I already mentioned, it's the learning that takes the most time.

Therapy is an uncomfortable experience in so many ways. It must be uncomfortable because it's growth and growth is painful. We have learned behaviors that have got us through life like, shutting down our emotions, punching out or icing out people when we're bothered, censoring our speech and denying our needs - we will do one or more of these until we blow up. Maybe these behaviors worked for almost all of our lives but now, for some reason, these same skills are getting in the way of us being happy or thriving or just getting by. That's when they become a problem. 

I must apologize for the really long reply and if I was insensitive in my word choice I'm also truly sorry. It's very difficult to explain succinctly because I never had a relationship where I felt totally safe to feel strong emotions and to talk about them, rather than go nuclear. So, I first had to learn that such a relationship was possible with a therapist before I could actually work on what was bothering me. Does that make any sense?

[Epictetus]

Hi Trad,

     I'm glad you posted your questions because I think a lot of people have struggled with the same questions.  I know I have. 

    For me, personally, cognitive therapy psychologists helped me the most.  I realize this type of therapy is not everyone.  It is a very problem solving approach where the model is teacher/student rather than doctor/patient. 

    One of the creators of this type of therapy used it on himself when he was a psychiatrist and professor. 

    Sometimes in therapy there can be a sense that the therapist is in some sense, overtly or covertly, looking down on the patient.  The therapist is the professional.  The patient is the one with problems.  There can be a kind of authoritarian aspect of this.  In cognitive therapy, when it is done well and with compassion and empathy, . . . the sessions are more collaborative.  The therapist offers ideas for the client to try, ideas that have helped others.  Some things help or don't.  And it goes on from there. 

     One of the great cognitive therapists was a professor named David Burns.  He wrote a book called "Feeling Good."  It is a self-help book where someone motivated can try out cognitive therapy techniques for problem solving in their own lives.  To be quite honest with you, I was helped more by books by cognitive therapists than by face to face therapy with cognitive therapists.

       Different people are helped by different types of therapy.  I was once helped a lot by an elderly woman who was simply a counselor.  Unfortunately, empathy and compassion are not things that can be taught in the university.  A wise and compassionate and empathetic therapist can be really helpful regardless of his type of therapy or what college degrees he or she has.  If a person lacks wisdom and empathy, even effective therapeutic principles and techniques can sometimes prove unhelpful. 

     I think you might find some helpful information by Googling "How to Select a Therapist" on the internet.  Since I can only speak of my own painfully limited and fallible experiences, I hope you get many, many responses to your post.  I wish you only the best!  I hope you will continue to post on the Forums.  Your posts help so many people here!

- epictetus

[Trad England]

Atra and Epictetus, thank you both very much for taking the time to write in response to my question. Both of your posts were filled with useful information that I can act upon. I cannot thank you enough.

Thank God, the last ten days have been good. Such a relief to be out of those blues. I will take your guidance and continue to work on this.

Thank you again,

Trad

[ladysmurf]

Like others said, I think experience, not necessarily if they went to the BEST SCHOOL in the world, like some of them like to brag... (read reviews online) and how you connect with the person is what matters.

[Pullmaney]

I really hope that you will find answers to your questions here and understand if you have any problems

[Marigioshi]

I am very familiar with this situation since my sister also took antidepressants for several years