Tag:

psychotherapy

Upcoming Conference Alert! Psych Congress 2019

This post is sponsored by Psych Congress.

Psych Congress 2019 has an amazing lineup of talks/speakers!

‘What to do when an antidepressant is effective, but your patient has sexual dysfunction’ and ‘Top 5 issues clinicians should know about ketamine therapy’ — these are just a few of the talks I plan to attend at the upcoming Psych Congress annual conference (Oct. 3-6 in San Diego). Psychiatry is truly a fascinating and evolving field, so it’s important to stay up to date with the latest research, innovations, and treatment strategies!

Here’s a couple more interesting talks I’ve circled on the conference schedule (just to name a few):

CBD, A Scientific and rational examination of its risks & benefits in psychiatry.

Is Bipolar Disorder under-diagnosed or over-diagnosed?

Stimulant Use Disorder, Clinical Issues and treatment challenges.

Perinatal Psychopharmacology.
Opioid Overdoses & Addiction, Recent Advances in Treatment & Prevention.

If there’s any topics you’re interested in learning more about, drop a comment below & I’ll be sure to share what I learn in a future post!

Also, if you’re interested in attending, be sure to click here and register! Hope to meet and see some of you there!

September 25, 2019 0 comment

Featured

“Going To Therapy as a Psychiatrist Didn’t Just Help me. It Helped My Patients.”

written by freudandfashion

When I decided to pursue a career as a psychiatrist during medical school, I never fathomed that I would have to address my own mental health. After all, as a physician I’m supposed to help others, but not the other way around right?

When we consider the stigma of mental health, in some ways it’s starting to improve as people start to become more open to share their mental health struggles. However, I come from two backgrounds where the stigma of mental health remains quite high — first, culturally as a minority woman, and second, as a physician where fear exists in regards to potential negative consequences of seeking treatment.

Yet, despite the stigma, I grew to discover the significant, life-changing impact that seeking support from a therapist can have. And I know many of you out there have had similar experiences, or perhaps have contemplated making an appointment, but are hesitant due to the stigma (trust me, I know how you feel).

Check out the article I wrote for Healthline HERE to read more about why I sought therapy and how the experience of seeing a therapist made me a better person and ultimately, a better psychiatrist for my patients.

January 23, 2019 0 comment

Featured

Video: A Psychiatrist Goes To Therapy

written by admin

(SEE VIDEO BELOW)

Not many people talk about being in therapy, but as a psychiatrist, it’s my goal to break the stigma of seeing a therapist because it can be an amazing source of support. In this quick video, I talk about my therapy journey and how it has helped me grow into the person and physician that I am today.

Note: I originally created this video for my IGTV on my Instagram (@freudandfashion), so I apologize for the quality! Let me know your own thoughts about psychotherapy in the comments below! Thanks for watching.

September 30, 2018 1 comment

Psychiatry

6 Things To Say (And Not Say) To Someone Who Is Grieving

written by freudandfashion

{Na Pali Coast, Kauai, Hawaii}

I always struggle with grief this time of year. Among other stressors, this month also marks the 14th year death anniversary of my grandfather, whom I was extremely close to. You’d think that after fourteen years, the grief wouldn’t hit me so hard, yet it still does. Grief is one of the most difficult emotions we experience as humans, yet is also one of the most commonly misunderstood.

Below are some actions and statements that I’ve found most helpful both personally and professionally in my office when I have patients coping with grief. I initially drafted this post last week while in a combined state of anger and sadness (predominantly anger) related to grief. I contemplated deleting the initial draft, which I titled “Things You Should Never Say To Someone Who Is Grieving.” However, since I try to maintain authenticity on my blog, I decided to leave the section I wrote while in an angered state, particularly because people frequently experience anger, yet often internalize and feel too ashamed to express the emotion. People need to recognize that grief does not consist of only sadness. Grief is a complex emotional roller-coaster that may involve one or a combination of emotions such as anger, rage, sadness, guilt, depression, joy, denial, shock, disbelief, confusion, frustration, exhaustion, apathy, numbness…(I think you get the point).

Since people often feel clueless about what to say to someone who is grieving (trust me, I struggle sometimes with what to say as well), I hope that you will consider the following when you or someone you know is experiencing grief:

Things You Should NOT Say To Someone Who Is Grieving:

1. “It’s been ___ days/weeks/months/years already…you should be over it by now.” Grief has no timeline. The closer a relationship someone has with the deceased, the longer it may take to overcome the painful emotions. As one of my amazing readers (whom I learned a lot from since he shared his experience with losing a child) pointed out: grief never fully goes away, but rather becomes more tolerable.

2. “Just try not to think about it.” Telling someone not to think about losing someone is like telling someone not to be human.

3. “‘So-and-so’ has already moved on…you should too.” Comparisons are terrible because each individual person has their own process of experiencing grief.

4. “Just be strong.” Saying this statement actually does the opposite and evokes a sense of weakness for not being able to overcome such strong emotions that may feel outside of one’s control.

5. “I know how you feel. My ____ died…” Don’t even try to make the difficult situation more about you. I once sought support from a peer and confided in my sadness only to have her shift the focus to herself and her past losses (and she was a psychotherapist!). Though I’m sure her intentions were good, a part of me wanted to punch her in the face for wasting my time and energy.

6. “He/she is in a better place now.” I’m a little mixed about this statement because it can be comforting if used in a thoughtful way, but annoying if said generically as a reflex response. For example, when my grandmother passed away, I felt comforted when a relative said “She’s in a better place now with your grandpa in heaven” because my relative knew of my grandparents’ enduring love for each other having been married for >50 years, in addition to our spiritual beliefs. However, when an acquaintance says the statement in a generic manner, it doesn’t feel genuine at all.

Bottom line — don’t say anything to someone who is grieving unless you truly, wholeheartedly mean it. If it doesn’t feel authentic to you when saying it, then it most definitely won’t feel authentic to the person who is grieving. And if you’re not good at verbally communicating your thoughts, then read on to see how your actions can be just as helpful (if not more).

Helpful Things To Do/Say To Someone Who Is Grieving:

1. Just be present. Actions speak louder than words, especially during such a difficult time when grief tends to be a very isolating experience. Being present shows that you’re aware of how difficult the experience is and that you won’t let them go through it alone.

2. Give a hug. Several years ago, I was sitting in a lecture during residency when I received news that my grandmother passed away. During the state of shock, I truly appreciated when my co-residents gave me hugs especially knowing that there was nothing they could say to make me feel better at that moment. Giving me a hug showed that they acknowledged the news and wanted to show that they cared.

3. “If you ever need to talk to someone, I’m here for you.” Again, showing your support and offering your help when needed demonstrates that you care.

4. “I’m so sorry to hear the news” or “I’m so sorry about your loss.” Often, when people don’t know what to say, they may avoid saying anything at all to the person grieving. Avoidance is one of the worst things to do to someone who is grieving because one might assume that you don’t care, which most likely isn’t the case. Saying something as simple as this statement acknowledges that you’re aware and recognize the impact of the person’s loss.

5. “I’ll be thinking/praying for you and your family/ (anyone else known to be deeply impacted by the loss).” Expressing that your thoughts (or prayers if the person is religious/spiritual) are with someone shows that you know this is a difficult/tough time for everyone involved.

6. “I know I can’t say anything to take the sadness away, but just know that I’ll be here to support you.” This is such a true statement — nothing you say can bring the deceased back to life nor take the pain away, so offering your support and presence speaks volumes to someone who is struggling during bereavement.

February 23, 2016 22 comments

Featured Guest Blogger

How a Nurse Practitioner Living With Bipolar Disorder Takes Control In the Workplace

written by freudandfashion

I first came across Ann Roselle, an acute care nurse practitioner, via Twitter after reading the extremely personal and brave post that she wrote for the online magazine, Ravishly, which poignantly highlights the humiliation she experienced during one of her numerous psychiatric hospitalizations. Given the stigma that surrounds mental illness, many may feel ashamed to disclose their diagnoses (especially as a professional in the medical field). However, Ann writes so openly about living with postpartum onset bipolar disorder as a guest contributor on several websites and in her blog, Bipolar&Me. She dispels the misconception that people diagnosed with bipolar disorder can’t live fulfilling lives, have a successful career, balance numerous roles and responsibilities (wife, mom of 3 boys, mental health advocate, blogger, to name a few), AND cope with the fluctuations in mood characteristic of bipolar disorder. I am a huge fan of Ann’s writing and am honored to have her contribute to my blog as she discusses her commitment to maintaining stability in her personal and professional life.

——————————————————–

“It’s stylish to talk about mental health, especially how we maintain our own.” As a nurse practitioner who lives with a serious mental illness, bipolar I disorder to be exact, how could I not fall in love with a blog with a psychiatrist who talks so frankly about mental health and her practice?

I am a surgical nurse practitioner, specializing in cardiac surgery. I am fortunate enough to be able to be open about my disorder in the workplace. I had fears initially about being open, however with time I believe it has proven to be a positive experience. In my case, living with bipolar disorder never proved troublesome with my training as I was diagnosed after I had been in active practice for six years. So, the questions that beg to be asked are — How does my illness impact my patients or influence my interactions with them? And how do I maintain stability with full-time employment in a stressful environment?

First, it starts with the moment you accept that you have an illness. That you have an illness you are going to need to learn to manage as one manages any chronic illness. And, I won’t lie — accepting the diagnosis is hard. I didn’t want to accept my diagnosis for a long time. I cried and mourned the vision of the life that I thought I was going to have, that I was supposed to have, thinking everything changed in the moment I received my diagnosis. It took a long time for me to realize nothing had actually changed and that the life I wanted and envisioned was still there waiting for me to seize it.

Part of my seizing the day, so to speak, was to commit myself to doing what I needed to do and stop fighting with my treatment team. Stop fighting the need for medication. To stop being the non-compliant patient I would roll my very eyes about as a practitioner. I showed up for appointments, attended groups faithfully in the early days, and took my medications. I played with my diet trying to find a proper nutritional balance. I quit drinking on a regular basis. I became fanatical about ensuring proper sleep hygiene and getting rest. I fully admit that I am not great about the exercise piece as my work hours limit my ability to get to a gym on workdays and I am so busy with my family on days off. I’ll get there, though. Exercise helps mood and I feel infinitely better on the days I’m physically active.

Now, what about nursing practice you ask? What about those patients? Ultimately, if you are in treatment (on meds, working with a therapist, a prescriber, or even have a support group to fall back on) and stable, the disorder has no bearing on your practice. None. I hold the view my bipolar disorder is a chronic manageable condition no different than diabetes or hypertension. I learned (and am still learning) to manage my moods in the same vein that a diabetic learns to count carbohydrates and manage their blood sugar.

Emotionally, I have always had the ability to hold myself together for the hours I am at work and dealing with patients. My patients will never know I carry this diagnosis. I may fall apart once I get home and feel safe to do so, but never within the walls of my employment. I also make it a rule that no matter what happens, no matter the co-morbid psychiatric diagnosis my cardiac patients may carry, I never reveal myself to them. They come for cardiac care and not to hear my story. I do find I have become more empathetic to those who carry psychiatric diagnoses. I discourage staff from saying inappropriate and stigmatizing things both in and out of earshot of patients. There is a huge difference in a patient who is emotionally labile because of a mood disorder and a patient who is emotionally labile trying to cope with their physical illness. I view it as my responsibility to help staff understand such a critical difference. Emotional lability in and of itself does not a bipolar make. I make sure my patients’ home medication regimens are adhered to as closely as possible. And when a patient is acutely decompensating in terms of their mood or mental status, I make sure that medically we have dotted our I’s and crossed our T’s before calling the psychiatry consult service.

I’m not perfect. I have days I need to take a time out and walk away. This is beyond the usual code blue that may have been upsetting for staff or seeing a patient I really cared about suffer from a devastating complication. I have colleagues who respect that need and allow me the moments I need to compose myself and come back calm and ready to do my job.

I am fortunate to do what I do. And I am fortunate to be able to practice with both the patient and provider perspective.

While I am only human, at the end of the day, I think all those I encounter are better for it.

For more of Ann Roselle’s writings, check out her blog, Bipolar&Me. You can also find her on Twitter and Facebook.

October 27, 2015 7 comments

Personal therapy

Weekly Insights

written by freudandfashion

{Ventura, California}

I am a perfectionist (sometimes to a fault) and most of my writing is edited at least 10 times until each and every word is as perfect as can be (at least in my mind). One of the reasons that I don’t post more frequently is due to my perfectionism, because I’d much rather NOT post than write anything that doesn’t meet my standards. So I am trying really hard to let go of my strong inner self-critic. Even during residency, my psychiatry supervisors would find me at the clinic after hours typing notes documenting my patient visits. However, the reason I was there late was not due to having a pile of tasks to complete — it was because I took way too long typing and perfecting each note.

During my training, I recall a free association exercise that my psychoanalytically-trained Program Director had us do as part of an intro to psychoanalytic theory. Free association is a psychotherapy technique where a patient talks or writes freely about whatever comes to mind in relation to a specific topic, with the goal of bringing unconscious thoughts to the forefront or the emergence of repressed memories, which can provide valuable insight of a patient’s problems.

So, with this exercise in mind, here goes my attempt at free associating by typing nonstop for 3 minutes whatever comes to my mind regarding the following topic: lessons learned from this week. And, go:

that it’s extremely hard to say goodbye to several of my patients. a part of me wants to take all of my patients with me to my practice, though I know that it’s probably in some of their best interest to stay within a system with resources to monitor them more closely.

I am sad and exhausted usually by the end of clinic because i didn’t realize saying goodbye would be harder than I thought.

i hate feeling lazy when I get home, but I’m so tired that all I want to do sometimes is lay on the couch and watch shark tank, hotel impossible, or other reality tv-type shows mostly because I don’t want to think. But then I feel bad because I feel like I should be cleaning my house, writing a blogpost, exercising, going grocery shopping, going out for a run, or anything else that makes me feel like i’m not being useless.

i wish I had the energy i once did because I feel guilty knowing that I need rest, need more sleep, get injured when working out, takes me longer to recover from workouts and pretty much anything that makes me aware that i’m getting older.

i look at other bloggers and wish that I blogged more often like them, wish it didn’t take me so long to write wish that i could go eat a cheesecake or something that was fattening and sweet like a lot of skinny bloggers posting food shots on their social media sites as if they actually eat those things. how much of reality is blogging anyway, how can we believe anything that people actually write or say and how i can we tell if someone is being authentic or not. i can’t be fake and maybe that’s why it’s so hard for me to write yet at the same time I don’t know how my image will be perceived and that takes editing that i wish i didn’t have to do.

Thought of the Week: Interesting that my recurrent body image issues and fear of judgment appeared in this post. Perhaps a sign that I should process this material with my therapist?

September 26, 2015 20 comments

Psychiatry

Overcoming Social Anxiety

written by freudandfashion

{Claremont, California}

To continue my series on conquering our fears (see Part 1 here), Part 2 consists of one of the more common phobias: Social Phobia. I struggled with social anxiety since childhood (as I discussed in a previous post) and often felt uncomfortable in any situation that involved interacting with people. It wasn’t until six years ago during my psychiatry residency training that I finally gained control of my symptoms. Some of the common thoughts that would race through my mind:

– “Are people judging my appearance?”

– “What should I say so that I don’t sound stupid?”

– “Hurry up and say something so that people don’t think I’m shy and quiet”

– “What I said was so stupid, they must think I’m an idiot”

– “What excuse can I give to avoid going to the event?”

My social anxiety dominated a huge part of my daily life.

If you also struggle with social anxiety, the following are some steps you can take to work towards overcoming your fear:

1. Avoid Avoidance

One of my supervisors always emphasized “avoiding avoidance” in application to overcoming all forms of anxiety, and the statement definitely applies to social situations. The more you avoid, the more you reinforce your anxiety symptoms. Sure, it might be far less anxiety-provoking in the moment to stay at home, but how will you cope with anxiety-provoking situations in the long run? Social anxiety impacts all facets of daily life, from something as common as participating in a regular conversation or going to the grocery store to giving a talk at work.

An example of avoiding avoidance: one of my patients rarely left her home during the day (and would run errands only at night to avoid the crowds) due to social phobia, except to attend her appointments with me. Therefore, in order to encourage avoiding avoidance during the day, I made sure she scheduled weekly, daytime appointments with me in order to challenge her fears of running into people during the day.

2. Climb the social anxiety “ladder”

If you don’t have too much difficulty with shyness and feel motivated enough to expose yourself to a series of social situations, then create a list of approximately 10 situations and rank them in terms of level of anxiety (1 = lowest anxiety situation, 10 = highest anxiety situation). Start with #1 and work your way up. And be sure not to skip because you run the risk of getting too overwhelmed and exacerbating your anxiety, which could lead to increased discouragement, self-doubt, and feelings of failure.

For example, my hierarchy would look something like this:

1 = speak to the cashier at the grocery store

2 = go to the bank after work when it’s busy

3 = attend a new exercise class at the gym

(I’m skipping #4 – 9 for the sake of brevity)

10 = Give a talk/lecture to a large group of people (#10 should be a goal to work towards)

3. Get a self-help manual, workbook, or internet-based self help program for social anxiety

Cognitive behavioral therapy (CBT) is one treatment modality shown to be effective for social anxiety disorder. One study found that an internet-based self-help program helped university students with social phobia and public-speaking fears. CBT examines the engrained, negative patterns of thinking (for example, “everyone at the party is judging me” or “anything I say is going to sound stupid”) in order to modify and challenge these irrational thoughts/beliefs. CBTrequires commitment, a lot of homework, and practice of the techniques in order to be successful. After all, the origins of such distorted ways of thinking have likely been engrained since childhood.

The following is a list of recommended resources (if you are currently seeing a therapist, please be sure to run the resources by them before using):

The Shyness & Social Anxiety Workbook

In The Spotlight, Overcome Your Fear of Public Speaking & Performing (for public speaking anxiety)

Overcoming Social Anxiety: Step By Step (Audio/Video Series)

3. Work on self-acceptance and feeling comfortable with being less than perfect

This is something I definitely struggle with, especially since much of our social anxiety centers around our fears of being judged and wanting to maintain a “close to perfect” image, yet at the sacrifice of openly being ourselves. How many times have you been at a meeting or lecture and are hesitant to ask a question or verbalize an opinion, but then someone else speaks up and says the exact same thought before you (this has happened to me numerous times)? Or maybe you have a fear of doing something embarrassing in front of a group of people? Recognize that your opinion is just as valuable as others and that as a human, something clumsy or embarrassing is bound to happen from time to time (even celebrities have major televised fail moments).

4. Seek help from a competent mental health professional

Seeking support from a professional who specializes in anxiety disorders is always an excellent option especially if your social anxiety is preventing you from enjoying and/or moving forward in life.

So, how did I overcome my social anxiety? Well, I went into a field that forced me to learn more about myself, started seeing a psychotherapist, participated in group therapy with my co-residents (a requirement in my residency program, which I believe should be mandated in all programs), exposed myself to situations that challenged and forced me to learn to cope with being in uncomfortable group and public settings (becoming chief resident was among the more challenging roles, yet provided the most growth), among other things. Not to say you have to do ALL these exact same steps to conquer your fear, but that’s the process I underwent in order to feel confident and comfortable being myself in social settings. And yet I STILL have to put in work on a regular basis to prevent my anxiety from getting the best of me (one of the reasons I’m in a weekly psychotherapy group). I took a one year break from therapy after graduating from residency and noticed that my ability to work through my anxiety didn’t come as easily, which motivated me to restart group psychotherapy last year.

Medications can help alleviate your symptoms, but fully gaining control and overcoming the anxiety for the long term requires work, so you have to be willing to expose yourself to uncomfortable situations, willing to keep learning, and willing to face and challenge your fears on a regular basis.

If you also struggle with social anxiety, would love to know which techniques you find most helpful to cope with social situations.

Photo by Marlon Santos

July 30, 2015 11 comments

Psychiatry

Conquer Your Fears (Part 1)

written by freudandfashion

{Lake Tahoe, California}

At the request of one of my awesome readers, I am writing a post on conquering our fears. Being an ENFP personality type (Extroverted, Intuitive, Feeling, Perceiving), I interpreted this in a more global, existential sense: getting over the fears and barriers that may interfere with moving forward in life and/or discovering one’s life purpose. However, others may be more interested in something more specific such as the treatment of specific phobias and social phobia, so I will be writing on conquering symptoms of those diagnoses in future posts next week.

Every psychotherapist has their own style, but the following are questions that I may ask my patients when it comes to conquering some of their biggest fears (if they can even put a name to what their biggest fears are because oftentimes, people are not even sure of what they’re afraid of):

1. Identify your fear. Once you’ve identified your biggest fear (ie, when it comes to a certain situation, such as pursuing a new job, finding love, etc), what is the very 1st thought that comes to mind if I was to ask you to close your eyes and think of the following question: When it comes to _______ (insert goal here), what is the one thing you are most afraid of??

Once aware of the biggest barrier/fear getting in the way of your goal, being consciously aware of this fear puts you more in control.

2. Origins of the fear. Where do you think this fear stems from? Have you experienced a similar, familiar sense of fear in your past or during your childhood?

Having a certain level of fear is normal because the reaction helps identify danger and take action to protect, but when the fear becomes excessive, there’s usually an origin to such fears based on past experience. Recognizing the connection with your past and how irrational the fear is in the present time can be enough for one to take action towards handling the fear more effectively this time around.

3. Take the next step. What small steps can be taken to slowly start working towards overcoming your fears?

For example, someone who is afraid of heights may start by going up to the roof of lower level buildings and working their way up to whatever their end goal might be to conquer the fear of heights (ie, skydiving, looking down while at the top of the empire state building, etc). Or, someone who is afraid of pursuing their dream career might start out by researching how to achieve the career, reach out to others to get advice, or start submitting applications to obtain the educational requirements or job experience needed to improve chances of getting their dream job.

4. Be open to disappointments and any challenges that come along the way. Fear of failure is a common barrier towards taking risks in life. Overcoming fears takes time and practice, so try to be as open as possible to learning and growing from the process. Surround yourself with those who support you in your goals and failures, and motivate you to stay on track. Wanting to give up is a normal feeling (I’ve experienced this numerous times, especially in the process of becoming a doctor) and NOT a sign of weakness.

But each time you get overwhelmed by the fear, ALWAYS REMEMBER and believe in yourself enough to recognize that you have a choice: either have power over your fears, or give power to your fears. So visualize the end goal, look your fear straight in the eye and say “f*** you, I’m the one in control” (yes, I’ve actually told some of my patients to say this).

July 23, 2015 4 comments

Personal Psychiatry

Being Me

written by freudandfashion

{Chino, California}

My group therapy session last week left me feeling rejected, embarrassed, sad, self-conscious, and angry (all in that order). Somehow, I became the focus during group and the subject matter stirred up emotions of being an outcast preteen, which I thought I’d outgrown. I didn’t have very many friends in elementary school. Kids often made fun of me and singled me out for various reasons (one was related to race since there weren’t very many Asians at my school at the time). I clearly still remember the boy who called me names as I was shooting hoops by myself on the playground as he repeatedly told me to go back home to China (I am Filipino). Apparently, as I experienced during group therapy, the memory still effects me with just as much emotion today as it did when I was a kid, which sounds ridiculous especially since I’m a grown adult who has accomplished so much in my life. Yet, I’m sure we all have memories as a child that we either vividly recollect, suppress, or completely block out of our minds due to the pain they once caused. As much as I hated having these feelings come to the surface, I trusted in the therapeutic process and knew that re-experiencing the emotions would lead to greater insight.

Now that one week has passed, I felt different going back into my group therapy session this weekend. I was able to consciously separate the feelings I had as a kid from the grown adult I am today. During group, I shared the wave of my emotions I had experienced in the interim, as well as how my cultural background and traditional upbringing impacts my communication with others (ie, in Filipino culture, assertiveness is often viewed as being arrogant and disrespectful, whereas in American culture, assertiveness is often expected and rewarded). The outcome was a sense of validation from my group cohort, for they wanted to understand the reasons why it’s so hard for me to talk and express my opinion during group. Sure, I had to feel like crap and relive components of the hurtful experience, but the outcome is that I’m able to distinguish how those deeply ingrained feelings continue to impact my interactions with others today (ie, fear of feeling misunderstood, withholding my opinion due to fear of being judged, feeling prone to scrutiny, etc). There’s something therapeutic about being consciously aware of the origins of your emotions, whereas prior to this exchange, I felt out of control of the emotions as they were triggered. I realize that I’m not the self-conscious, shy kid I used to be. During my latest group therapy session, I recognized my ability to let down the walls that I had built to protect myself from criticism/judgment. The ultimate outcome = feeling more open to being myself.

As a result of this experience, I have even greater respect for those in therapy. It’s not easy processing painful emotions and many have experienced far more difficult and traumatic events in their lives compared to me. For anyone who believes that therapy is designed to make you feel good after each and every session, you’re wrong. Therapy takes far more work and courage than anyone can even imagine.

Photo by Marlon Santos

May 26, 2015 12 comments

Psychiatry therapy

Choose Your Therapist

written by freudandfashion

The one thing that has made me the most self-aware, insightful, and empathetic towards others, especially my patients? Psychotherapy. Everyone can benefit from going to therapy. I probably refer 80% of my patients to a psychotherapist, especially since I believe that the best treatment plans consist of more than just medications (or may benefit from therapy alone, depending on the case). When choosing a therapist for myself, I was fortunate to have a trustworthy former supervisor refer me to two great therapists since I first started therapy during residency, though I realize that most people don’t have the luxury of having a go-to person to help them navigate their local mental health resources. I pride myself and put effort into referring my patients to therapists whom I believe will be a good fit. If you’re wondering whether or not you’re ready for therapy, I wrote a previous post that addresses that question here.

The following are some guidelines/tips that I use when choosing a therapist for my patients or suggestions I would give friends/relatives if they were looking for one themselves:

Keep in mind that the most crucial factor for effective therapy is the connection you have with your therapist. The connection is important for feeling safe, developing trust, and creating a mutual understanding of your goals in therapy. Even if the therapist listed trained at the most elite programs or was Dr. Phil himself, if the connection doesn’t develop over time, then it’s best to move on to a different therapist.
If you see a psychiatrist and feel that he/she knows you pretty well…Ask them for a therapist referral based on your history and goals in treatment. Note: if your psychiatrist does NOT know you very well and solely focuses on medications and symptoms, then see bullet points below. I work part-time for a Health Maintenance Organization (HMO) where we have designated therapists/case managers (who may or may not know the patient/client) make the referral, yet I’ve made efforts to connect with the contracted therapists so that I have a sense of their therapeutic style to gauge which therapists would work best with my patients.
If you have a friend or family member currently in therapy…Ask if they’d be open to inquiring with their therapist to provide any recommendations for you (Note: make sure your friend/relative actually likes their therapist and trusts their recommendation).
Nuts & Bolts:
- if it’s important to see a therapist who accepts your insurance:
  - take a look at the in-network provider list, or search online directories such as Psychology Today (there’s a section under the profile of accepted insurance plans) and research information on the therapists online. I recently gave a close friend the gift of psychotherapy sessions as a birthday present (yes, I try to be both creative & meaningful with my gift-giving ideas) and since I didn’t live in the area, I resorted to an online therapist search.
- Whether or not you need to see an in-network provider, when narrowing down your list, consider the following:
  - Gender preference
  - Photograph – this is not intended to be superficial. Since having a connection is important, you’d likely want your therapist to appear like someone you can feel comfortable sitting across from and opening up to.
  - Location – if transportation is a crucial component, then limit your search to local therapists. I personally drive one hour to see my therapist in Los Angeles, but I’m okay with the distance because I’m willing to drive further in order to see my therapist, who came highly recommended, versus seeing someone questionable, yet closer.
  - Cost – if on a budget, there are several therapists who offer discounted fees on a sliding scale dependent on your income. If you’re a student, be sure to look into your school’s counseling and psychological services (usually covered if you pay for student health benefits). If you work for a large employer, they may have Employee Assistance Programs (EAPs) that provide confidential counseling services for their employees. However, if choosing to pursue out-of-network providers, mental health professionals in private practice may charge anywhere from $50 to over $200 a session depending on location, credentials, and experience, though cost can be greater in larger, metropolitan areas (for example, in Los Angeles, a psychiatrist who provides both medication management and psychotherapy may charge around $400/hour).
When in doubt, try it out. Yes, I’ll admit that some of my referrals haven’t worked out, but for the most part, the initial experience may solidify even more which qualities you prefer in a therapist. I’ve even had a few patients request to see a a different psychiatrist other than me for specific reasons (usually because I look too young) and that’s okay because this is your treatment and we each have our preferences. When you meet for the first time, take note of how you feel while interacting with the therapist (do you feel invited to share, does the therapist have a genuine interest in understanding you, does the therapist seem invested in working with you to help determine the issues impacting you the most?). Keep in mind that just like any relationship, building the therapeutic relationship may take some time, but as long as there’s forward movement in the process, then I hope you commit and stick with it!

Any other comments or suggestions?? If any of you are in therapy, I would love to hear of tips/information you found helpful when choosing a therapist, or, if you’re a mental health professional, I truly welcome your thoughts on how to choose a therapist as well!

April 22, 2015 13 comments

Newer Posts

Older Posts