Sometimes you know SOMETHING is wrong but you don’t know what will help. You keep going back and forth wondering if you need support for your mental health. When you finally decide that you do need some help, you get overwhelmed by all the options, don’t know what or who you need, and end up shutting down. I’ve heard this pattern a lot. Keep reading to get a clear explanation of some of the TYPES of services available (not all from me!), and how they might fit you.
This is for people who have some ideas of what they want to get from talking to a professional about their concerns. They probably have some idea of what their concerns are and might have some insight into their problem. For example, you might know that you worry a lot more than other people and seem to worry about everything. You can’t stop overthinking things and it is starting to get in the way of living. Then we would know to focus on anxiety in counseling and check for any trauma that might be related to your anxiety. Counseling is the right place for you. For this you are looking for a professional counselor, clinical social worker, marriage and family therapist, psychotherapist, or psychologist. (explaining the difference in these would need another blog post!)
On the other hand, if you just know that something is wrong but have no idea what (or have too many ideas!) you might not want to jump right into counseling. If counseling has not worked for you in the past and you aren’t sure why, maybe don’t start with counseling until you identify what the problem was. If professionals have thrown many different diagnoses at you, try getting an accurate diagnosis first. Which leads to the next type of service –
Admittedly, some of my bias is going to come out here because I LOVE testing. I don’t think everyone needs it though, as you can see above. A counselor can figure out a “working” diagnosis for many people which is likely to be accurate. But sometimes it gets tricky. If the counselor doesn’t have experience with your diagnosis, they might miss it. Or you might be one of those people who have a lot of overlapping symptoms that can look like other diagnoses. You might even have new, worrisome symptoms such as feeling like things aren’t real or feeling very paranoid. Testing is also what you want if you think you’ve been misdiagnosed or are worried that something else is being missed, like Autism. People get testing for other brain-based concerns such as dementia, learning disorders, and intellectual disability too. My preference and advice for people looking for an evaluation is to find someone who is thorough. Especially when you are worried that something has been missed or something is wrong with you – you don’t want this to be brief, rushed, and full of screening checklists. It should include an interview, observations, testing/measurement with reliable and valid tools, and ways of getting information from other sources with your consent. A full explanation of what is involved in a psychological evaluation is at another one of my blog posts- here. For this service you are most likely looking for a psychologist or neuropsychologist. Still not what you need? Maybe you are thinking about -
Medication Management (psychiatry)
Ok, now my bias is really going to show so I’ll just be straightforward with it. I believe medication is very beneficial for some people. I also believe it is not for all people, and unless things are bad enough that you can’t benefit from or get to counseling it might not be the best first option. This is because for some problems, such as anxiety, we know most people who start medication will end up not engaging in counseling and won’t learn the lifelong strategies for coping. That being said, I believe in each person’s ability to make informed decisions for themselves about what treatment they want and need.
You need medication management if you are looking for someone to prescribe a medicine to help you feel better. Most medicines for mental health concerns help people feel “moderately better” as told to me repeatedly by a psychiatrist I used to work with professionally. This means it is not a miracle cure. So yes, medicine can make you less depressed, less anxious, less sad, hear less voices, be less paranoid but it generally does not make most people with mental health disorders 100% symptom free. Knowing this is important for managing your expectations for what medicine can do for you. Of course, you should always talk to whoever is prescribing your medicine for what you should expect and important things like potential side effects. So if you are wanting medicine to get yourself to testing or counseling, to supplement your counseling, or for your primary treatment, medication management is what you are looking for. Depending on the complexity of your concerns, you might be able to get what you need from your medical provider. If not, look for a psychiatrist or psychiatric nurse practitioner.
Now, you “just” have to find the right person.
There are a lot of ways to find a mental health provider such as personal recommendations, google search, and therapy directories. Here in Boise I’ve heard a lot of people unfamiliar with directories, but a lot of counselors and psychologists are on them - check out sites like Therapy Den or Psychology Today where you can filter out the ones that don’t fit your needs. The important part is finding the right person for YOU. The relationship you have with your counselor is one of the most important parts of counseling success so please, if you find yourself with a counselor that you do not feel comfortable with either address the problem with them or switch! So, when you are looking, I have some tips/questions to ask yourself.
Do they offer a free brief consultation (usually no more than 20 minutes)?
This is more common for people who are not in-network with insurance companies and not at huge agencies– these are people who want to make sure that together you make a good fit for their service. Sometimes they find you need someone else because they can’t do what you need; if that is the case they often will have someone they can refer. In that phone call you can usually tell if someone is going to be a good match for you or not just by how you feel by the end of it.
Do they have some expertise or experience in the issue you want to address?
Yes, mental health providers are trained broadly, but they do their best work when in their area of passion and expertise. Some are also trained specifically to work with a certain diagnosis or population. I see it like getting my hair cut by the right person. All hairstylists can cut hair but nobody without experience or training in curly/wavy hair is gonna touch mine!
Does the way they schedule fit with your schedule?
Some counselors keep a consistent weekly appointment, others have a little flexibility, and others will never see you at a consistent day and time – what do YOU need? The same is true for psychiatrists and psychiatric nurse practitioners, although they likely will not see you weekly except possibly at the start. Psychologists usually either do a a full day of interviewing and testing or split it into two days. They might give immediate feedback or wait until the report is finalized. What is your preference?
Are you looking for a certain type of counseling or medication management?
Some people with trauma histories are very specifically looking for EMDR, but not all counselors are doing it. If you have anxiety there is a good chance cognitive behavioral therapy (CBT), exposure therapy, or mindfulness-based practices would be a good fit for you. Some psychiatrists or psychiatric nurse practitioners work in a way that includes some counseling while others only check on symptoms and side effects.
Do they specialize in your age group?
This might be more or less important to you but some people say they see all ages yet clearly based on their profile, website, or office primarily see a specific age group or type of person such as kids, 20-somethings, moms, retirees (see how this lost could keep going?). The same is true with medication management, especially if you are taking a child - you want to know they are knowledgeable about treating kids!