The new forums will be named Coin Return (based on the most recent vote)! You can check on the status and timeline of the transition to the new forums here.
The Guiding Principles and New Rules document is now in effect.
Questions about Therapists (What to look for, confidentiality, etc)
Riale
I'm a little slowRegistered User regular
I'm a little slowRegistered User regular
For quite a while I've been considering seeing a therapist to deal with some issues (mainly depression, anxiety and intense mood swings). I've always managed to discourage myself from seeking any help, but things are getting worse now and I really think it's time I sought one out.
That being said, I haven't had much experience with all this before, and what little I have had was very negative. I'm not really sure what to expect on a few accounts, and I was hoping someone here could shed a little light on how things go.
First and foremost, does anyone have suggestions on where to look for therapists? Are individual practices better than state run facilities? I know that my state medical insurance covers some therapy, and I know I could get in to see a local guy, but I'm not sure what quality of care I'd receive. I'm on a budget, but if it means getting someone good who will genuinely help, I'm not afraid to spend money.
Secondly, what's the scoop with confidentiality? I know that legally there are some things they have to report (EG: If I say I'm going to kill someone/do something illegal), but how far does this stretch? As a completely hypothetical example, if I said I had fantasies in the past of X or Y illegal thing, is it possible for it to land me in any trouble? How far is too far, when it comes to disclosing things you've done in the past?
What should I look for in a therapist? Are there any telltale signs of one who just isn't up to snuff? My last attempt to seek help was many many years ago when I was quite young, and it went absolutely horribly. The therapist was surprisingly rude and condescending, and it really discouraged me from looking any further.
Part of the problem is the town I live in is very conservative and religious. My views are on the other extreme end of the spectrum, and I'm worried that I'll find someone who just wants to change me into what's considered the social 'norm' around here, rather than provide any real help.
I don't know, maybe I'm crazy. Does anyone here have any advice?
That being said, I haven't had much experience with all this before, and what little I have had was very negative. I'm not really sure what to expect on a few accounts, and I was hoping someone here could shed a little light on how things go.
First and foremost, does anyone have suggestions on where to look for therapists? Are individual practices better than state run facilities? I know that my state medical insurance covers some therapy, and I know I could get in to see a local guy, but I'm not sure what quality of care I'd receive. I'm on a budget, but if it means getting someone good who will genuinely help, I'm not afraid to spend money.
Secondly, what's the scoop with confidentiality? I know that legally there are some things they have to report (EG: If I say I'm going to kill someone/do something illegal), but how far does this stretch? As a completely hypothetical example, if I said I had fantasies in the past of X or Y illegal thing, is it possible for it to land me in any trouble? How far is too far, when it comes to disclosing things you've done in the past?
What should I look for in a therapist? Are there any telltale signs of one who just isn't up to snuff? My last attempt to seek help was many many years ago when I was quite young, and it went absolutely horribly. The therapist was surprisingly rude and condescending, and it really discouraged me from looking any further.
Part of the problem is the town I live in is very conservative and religious. My views are on the other extreme end of the spectrum, and I'm worried that I'll find someone who just wants to change me into what's considered the social 'norm' around here, rather than provide any real help.
I don't know, maybe I'm crazy. Does anyone here have any advice?
Riale on
0
Posts
First off, a shrink should never try to conform you to any local norm. If you think this is happening, or if you think those are the motives he/she has, find a new shrink. There really aren't any telltale signs. You can see the diplomas, have one or two general conversations with them, maybe even get a reference from another patient (if they offer) but that's about it. The only one that can decide if the therapist is right for you is you.
Second, IANAL, but I believe everything you would talk about would be covered by patient doctor confidentiality, even stuff you "fantasized" about doing. If you actually did something, or were accused and arrested of it. They could subpoena the doctor, whom would then have to tell his/her information about you. They're not just going to run out and call the cops though if you say, "sometimes I think about killing my boss and becoming a columbian drug lord..."
Finally, You're not crazy. Crazy would just be to run out, get a bunch of booze or pills, and self medicate. Crazy would be to continue knowing that you think you might have problems and not talking to a professional about them. Don't feel embarrased or nervous about talking to a therapist, it's why they are there.
I believe the best currently available treatments for anxiety tend to be cognitive-behavioral or behavioral therapy; that generally means you'd want to see a clinical psychologist if possible, though other practitioners (e.g. accredited counsellors or social workers) may be qualified to offer the same therapy. There are several different treatments currently recognized as being effective for depression: medication prescribed by a psychiatrist, cognitive-behavioral or interpersonal therapy provided by a psychologist, counsellor or social worker, and even electroconvulsive therapy. So what you're looking for from a GP is a referral to a practitioner that can provide a therapy that effectively addresses one or more of your concerns. My personal tilt would be towards a clinical psychologist offering CBT, but I'm biased, given that I have a bachelors degree in Psych. Also, I'm not qualified to offer a diagnosis or even professional-level advice, especially not over teh Intarwebs; that's what the GP is for.
I haven't touched on the mood swings you mentioned, because I'm guessing they're more secondary compared to the depression and anxiety. But for all I know, you're actually bipolar and what you really need is appropriate medication from a psychiatrist to stabilize your mood. Once again, the initial referral your GP gives you is going to be far more accurate than I ever could be.
Statutes vary from state to state, and from country to country, so it really depends where you live. Generally, anything you've already done would fall under doctor-patient confidentiality. If you did something pretty heinous, something for which the statute of limitations is indefinite, or pretty long and not yet expired, then it's possible that the therapist would divulge information to the police. Even then, they could lose their license to practice in their field, even if public sentiment was that they did the "right" thing. The confidentiality of the doctor-patient relationship is taken pretty seriously.
If you fantasized about doing something illegal, screw it, that you should feel free to tell them. If it's something you really, really ought not to do (e.g. murderous rampage), then the therapist's goal is going to be to get you to a point where you don't want to do that thing. That's the best outcome for everyone involved: you, the therapist, and the public at large. It may take time to build trust with your therapist to the point where you can feel comfortable divulging stuff like this, so take your time. A good therapist should be able to make you feel comfortable sharing such information with them, and they need you to do so in order to be able to effectively help you.
It's important to note that the term "therapist" is very broad, and is often not specifically protected by law. I can't call myself a doctor, because I don't have a PhD. I can't call myself a clinical psychologist, because I don't have a PhD in clinical psychology plus the necessary year of residency. However, in many jurisdictions I could hang a shingle outside my door and call myself a therapist. Your best bet is to read up on the NIMH website, and understand what sorts of practitioners are qualified to provide the kind of therapies that are effective for your problems. In general, I'm thinking a psychiatrist for any kind of antidepressants, a clinical psychologist for CBT or IT, or a counsellor or social worker who's specifically trained and qualified to provide CBT or IT.
There have been no clinical studies to my knowledge on the effects of taking up a faith on either depression or anxiety. Maybe it helps, maybe it hurts, who knows. But unless your therapist has a robust set of clinical data to back up his assertion that praising Jesus will help you, I say feel free to ask for a second opinion.
1) Go get help. You might think you don't need it or whatever, but being able to talk things out with someone who has no connection to you or anyone you know is very helpful.
2) When looking for a therapist, remember that the goal here is for them to help you by listening to you talk about stuff. Key thing here is that you need to be comfortable talking to them about anything that's troubling you. Don't be afraid to shop around, spend the time required to find a therapist that you're comfortable dealing with.
3) Confidentiality: Essentially, unless you tell them 'I killed this person' or 'I am going to kill this person' you'r in the clear. There are a few other corner cases, but before you start any sessions the therapist will give you a sheet detailing what's up with it. For example, I've discussed drug use with therapists in the past with no problem, as well as 'psychotic urges' (aka man this makes me want to kill people).
4) If a therapist tries to convert you, they're not doing their job.
You want to find one that you trust and who's style fits your own. Not every therapist is alike or will be equally effective in helping you. To find the right therapist for you, get a list from somewhere, could be a counseling center, webpage, or even the yellow pages. Then, start calling them. You can describe your problem, what you're looking for, and also ask about their rates. Usually this call lasts no more than 5 to 10 minutes and you don't have to pay for it. Then, pick the therapist that feels right for you and schedule an appointment.
On confidentiality:
It's been awhile since I read the defining case, but I know that in California, if you share your intention or the therapist has good reason to believe that you may be a threat to another individual, they have to report to prevent the harm to the other individual. Not knowing the details of your fantasies, it's hard to say where they will fall. You can also ask the therapist you chose what the law is regarding this in your state.