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Getting Therapy that Works for You
by Colleen Laing

Life takes its toll on all of us. Course offerings at the school of hard knocks include violence, emotional loss, poor health, economic struggles, discrimination, rocky relationships and a troubled childhood. All of this can lead to stress; and occasionally to mental health problems.

When life spins out of control or a pattern of thoughts, feelings or behaviors reduces our ability to function or our quality of life, psychotherapy can help, but it’s hard to make sound decisions when you are not of sound mind. Self-loathing, apathy or dread are common when women suffer from mental health problems, and this immobility combines with the stigma of needing therapy, high cost of mental health services, and general lack of knowledge about effective treatments to create a potent set of barriers to seeking help. Learning how to overcome those barriers and finding help can bring your life back into balance.

WOMEN AND MENTAL HEALTH

Women are often resilient, but grappling with financial, family and work pressures can become overwhelming. Women experience higher rates of mental health problems than men and are more likely to experience depression and anxiety. Factors that increase women’s risk for depression can begin in adolescence, where the stresses of emotional and sexual maturation are often internalized. As adults, the stress of working while doing most of the housework and childrearing can contribute to depression, as can women’s greater rates of poverty and vulnerability to sexual violence.

Differences in how women and men process information can also affect mental health. According to Doctor Dianne Chambless, director of clinical training in the psychology department at the University of Pennsylvania, “Women are more likely to ruminate when something happens to them. We dwell on our inner worlds and that can be too much.” Some of the greater prevalence of depression in women may be due to gender bias in treatment. Doctors diagnose more women than men as being depressed, even if the men have similar scores on standardized depression screening tests or the same symptoms.

ANXIETY AND DEPRESSION

Anxiety and depression account for the majority of mental health problems women experience, and are twice as common in women as men. They can often be effectively addressed through therapy.

Everyone feels depressed from time to time, but a major depression is characterized by ongoing feelings of hopelessness, an inability to experience pleasure, changes in appetite or sleep patterns, irritability, apathy and persistent thoughts about death or suicide. Fifty to 70 percent of patients with major depression are successfully treated with either therapy or antidepressants and more by combining the two. According to Chambless, “depression is a problem for which there are a number of helpful treatments. The problem with depression is that many people relapse. Cognitive behavioral therapy is the approach we have the most evidence for and we know it does help prevent relapse.”

Anxiety problems include panic disorder, phobias, obsessive-compulsive disorder and post-traumatic stress. Anxiety disorders cause fear and stress that seems out of proportion to actual events. Common symptoms include dread, rapid heartbeats, trembling, dizziness, perspiration and shortness of breath.

Feeling anxious is perfectly normal in some situations. In panic disorder, however, instead of fearing a situation, the affected person begins to fear their reaction to it. As a result, people begin to limit their activities — the fear alone can trigger more frequent attacks. Research findings indicate that cognitive behavioral therapy is the most effective treatment tested at present for anxiety disorders.

The techniques used in cognitive behavioral therapy include working with a therapist to consciously examine thoughts and record the specifics of one’s day-to-day life in order to establish a more balanced picture. A behavioral approach could be to involve a patient in activities they formerly enjoyed to increase social connection, or to build tolerance for anxiety-provoking situations.

Another approach that some studies have shown to be effective in alleviating depression is psychodynamic therapy, which focuses on helping the patient gain insight into unconscious needs and desires that influence their thinking and behavior. Understanding the origin of one’s needs can help a client cease destructive or maladaptive behavior patterns. Psychodynamic therapy is intended to resolve the conflicts that give rise to depression rather than treating its manifestations.

Interpersonal therapy has also been shown in some studies to be effective in addressing depression. In interpersonal therapy clients work to resolve conflicts in relationships, both personal and professional. In addition to these types of therapies, there are many more available to treat a multitude of mental health issues, and many therapists will use either a specialized technique or an eclectic blend of approaches based on their experience and training.

PAYING FOR THERAPY

Fear of cost can prevent women from seeking therapy, but Washington’s mental health parity law has begun requiring insurers to provide the same coverage for medical and mental health services in co-pays, out-of-pocket maximum limits and conditions on the number of visits allowed. Once fully implemented in 2010, insured people will have the same coverage for mental health and medical care.

Prior to contacting a therapist, find out if your insurance includes mental health coverage and whether or not you need pre-approval before scheduling a visit, how many visits per year are covered, and what sort of deductible and co-pay you should expect.

If you lack mental health insurance and cannot afford a provider’s usual fee, options do exist. University psychology programs offer clinics, such as the UW’s Psychological Services and Training Center at 206-543-6511 and web.psych.washington.edu/clinic, where graduate student therapists practice under close supervision of faculty. Some private providers offer sliding fee scales for the uninsured.

SELECTING A THERAPIST

Therapists and counselors in Washington can have a variety of backgrounds. The Washington Department of Health requires all mental health professionals except registered counselors to have a master’s or doctoral degree and hundreds, sometimes thousands, of hours of supervised practice. Registered counselors need only submit brief statements about themselves and take a four-hour HIV/AIDS training course.

Mental health professionals recommend that clients select providers with extensive training and experience. Doctor Janine Jones is a licensed psychologist with a private practice in Seattle, For A Child, LLC, and is an assistant professor at the University of Washington Department of Educational Psychology. Jones cautions that “there is a risk of being misdiagnosed, and treatment based on a misdiagnosis can do more harm than good. Untrained counselors may also be less prepared for crisis management.”

There are several ways to locate a therapist: You may use a list of insurance-approved providers; seek recommendations from your physician, trusted friends or relatives; or consult an online or phone database. Some databases charge therapists for a listing or only list their own members, so you may wish to consult more than one resource (see sidebar).

Once you have a few provider referrals, check their credentials and complaint records using the Washington State Department of Health database at fortress.wa.gov/doh/hpqa1/Application/Credential_Search/profile.asp. Enter the provider’s name to locate a credential number that you can click on to check for any complaints upon which action was taken.

Before contacting a therapist, make some notes about the nature of your problem. Is it a longstanding difficulty in your ability to function that affects several areas of your life, or a specific threat, conflict or loss that has you temporarily stuck? The former may require more long-term therapy, while the latter may require only brief input from an objective third party. Next, identify your goals for therapy: are there specific symptoms such as thought patterns or behaviors you wish to resolve? Finally, do you have a preference among the various therapeutic approaches?

When you have a short list of prospective therapists, call one or a few to discuss your needs and goals and learn about their experience and approach. Issues to raise include:

Theoretical orientation: Either ask about their treatment philosophy or describe your problem and ask how they might address it. Inquire whether they have been in therapy themselves.

Experience: How long have they been in practice; do they usually see adults, children, couples; what types of problems do they usually work on?

Logistical issues: Ask about their fees, which insurance providers they accept, whether they will bill your insurance, if they are accepting new clients, and whether they have times available that mesh with your schedule.

Personal Concerns: If you have concerns about whether a therapist will support your religious beliefs, sexual orientation or other personal issue, ask them whether they are comfortable and prepared to be supportive.

For therapy to succeed you will need to build a trusting relationship and disclose very personal information. Dr. Sam Alibrando, psychologist and author of Follow the Yellow Brick Road: How to Change for the Better when Life Gives You its Worst, and who defines therapy as an “emotionally competent encounter with a formative, healthy person,” says, “healing takes place as we internalize the relationship with the therapist — the relationship is the most curative factor.” He cautions clients to avoid therapists who need to be liked, try to do more than is realistic or blame or judge the client. Jones suggests “listening to your own inner voice — are you comfortable sharing, do they do a lot of listening or do they interrupt?”

Often an adult can obtain adequate information to make an initial decision about a therapist by phone, but parents seeking care for children should schedule a consultation so the child can form an opinion about their personal preference. When selecting a therapist for a child, parents should ask providers what age children they usually see, discuss legal issues such as consent and confidentiality policies, and find out how often the parent is expected to participate in therapy. Parents or patients wishing a consultation should expect to pay for the therapist’s time or use one of their insurance-covered visits.

OUTCOMES

The best way to keep treatment on track is to confirm at the outset that you and your therapist share treatment goals, and then monitor your progress toward those goals. Clients should feel like their therapist “gets” them — that a connection exists — within the first few sessions. Within a month or two a client should have a sense of movement or change. “Even if you’re watching yourself do the same behaviors at least you’re watching yourself,” says Alibrando, who also cautions patients not to expect miracles. “My issues that I had at 20 are still my issues at 50, but I understand them better and have better control over them.”

Seeking help for mental health issues is not easy, but effective therapists can assist their clients in overcoming stumbling blocks and help them become more themselves.

Colleen Laing is a Seattle-based freelance writer and principal in Laing Communications, producing writing solutions for Northwest public, nonprofit and education agencies.

©2007 Caliope Publishing Company