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October 12, 2009
Ask the Mental Health Guru
Gail Tager is a marriage and family therapist from Sierra Madre, California, with two decades of experience. Here, she answers five of the most common questions regarding mental health, ranging from how to find the best therapist to how to figure out when and whom to tell others about your struggles.
Some people recommend that you “interview” several therapists or psychiatrists before settling on the person who fits best. What are the best ways to go about interviewing a health care professional.
The first thing I would do is go on referrals from other people who’ve had successful therapy. The second thing I would do is look at the therapists’ credentials: whether or not they are licensed, where they went to school, that sort of thing. The third thing would be to find out the type of therapy they do. Are they trained to do short-term therapy that focuses on thoughts and behaviors that are troubling a person in the present, such as cognitive behavioral therapy, or is their orientation toward long-term therapy focused on childhood and events in the past? Another important factor is the financial aspect.
One possible source of a good referral is your primary care physician. Lastly, I think your gut feeling is very important. How do you feel when you go into the office? Does it feel safe? Is the therapist focused on you or is he or she interrupting the session to take calls? It’s really important to feel that you would be able to develop trust with your therapist.
With the new therapist, you should go for more than one visit, probably at least two or three in a row. This will help you make a more informed decision about whether the therapist is the right one. On the first visit, you might be so anxious that it will be hard to tell if you are going to feel comfortable.
If you’re in the midst of a bad depression or series of panic attacks or a manic episode, it can be important to get immediate help. This means you might not be able to shop for the right health care provider at that moment. Is it okay to start with one doctor or therapist and later change to another who might be a better fit?
Absolutely. In fact, at any point during therapy if you feel you are not progressing then try another therapist. Your current therapist should be supportive about the transfer. If the therapist is really resistant, then it’s often more about the therapist than you.
I would look at the timing of when you want to leave the old therapist, too. Most of the time when people want to leave it’s when they are feeling stuck, when they feel like they’re going in circles. Sometimes a good reason for leaving is if therapy has just become too comfortable and it has stopped being a challenge.
If you’re in the middle of crisis, though, or have been dealing with something that is very challenging and emotional, that could be a signal that the desire to leave is less about liking the therapist than wanting to avoid what is painful.
Getting proper exercise, eating well, following a regular schedule and having good sleep habits have been proved in studies to help with most mental illnesses, yet it can be difficult to find the energy and motivation to do all these things. What do you suggest to help a person develop healthier habits?
It’s really important to take baby steps. I mean, what depressed person wants to exercise? A therapist or person who is acting as a support system shouldn’t lecture the person or dictate from a list. It’s much better for the people who are struggling with illness to come up with actions they think they can actually accomplish.
Exercise is probably the hardest, so I might start with healthier eating. If they’re eating too much, or too much junk food, I’d explore with them when they are most vulnerable. Is it late at night? What kinds of things could they do instead of eating that would sooth them?
For some people, the first step may just be getting out of bed, or opening the shades. For others it could be a walk around the block.
When a person is feeling particularly depressed or having frequent panic attacks, it can make it hard to be around people. Do you have any tips for how to make social interactions less uncomfortable?
First of all, you should focus on small, low-key situations with mellow people. It’s not wise to spend time with people who are going to be asking lots of questions.
One good suggestion would be to spend time with another person where talking isn’t necessary, such as going to a movie. If this is one of the first outings after becoming isolated, it’s a good idea to sit at the end of the aisle, where it’s easy to get up and leave if things get too intense. In fact, having an escape plan, and making sure that leaving is okay with the person you’re hanging out with, is really important. It has to always be okay to leave if you feel uncomfortable. Another suggestion is to meet someone at the location where you’ll be hanging out. Drive yourself. Don’t be dependent on someone else. And don’t try to take on too much all at once. Take baby steps.
Mental illness carries such a huge stigma. What are some of the best ways to figure out who needs to know if you’re experiencing a mental illness, and what are some of the best ways to share that kind of information?
I think that the only people who really need to know are the people who are intimately involved in your life. They should be people you can rely on to be totally supportive. If there’s a question about how helpful and supportive a person might be, even if it is a close family member, then telling him or her the specifics of what’s going on can turn out badly.
Some of it also depends on how severe the illness is. If you are really disabled, it might be necessary to tell more people, such as an employer or someone at school. It’s usually best in those situations to tell the human resource person or a school counselor rather than a boss or a teacher.