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How to Start Therapy

A couple weeks ago, I asked for ideas on Facebook – our church is planning a short series of workshops on Mental Health, and I asked my friends for ideas for workshop topics.  This will be my first of several posts which will address those topics.

“How do you start therapy?”

Insurance

  1. If you have insurance, then you will need to check to see what requirements the insurance company has.  In my experience, it is rare for insurance companies to require referrals or authorizations for mental health treatment, but it is possible.
  2. Most insurance companies will strongly encourage you to see someone who is in their network of providers.  This DOESN’T mean that you can’t see someone who is out-of-network, but you will probably have to pay a lot more to do that.  Your insurance company may give you access to a list of in-network providers; or if you have a provider in mind, then you can verify that that person is in your network.

Finding a therapist

  1. Once you are set with insurance, then you can contact the therapist to set up a first appointment.  Some therapists will have waiting lists, others won’t.  Some therapists may offer a free phone conversation, in which you can ask questions and try to get a feel for the therapist.
  2. Therapists will often advertise that they specialize in certain kinds of therapy, issues, or client populations.  However, just because you may not fit within those specialties, that doesn’t mean that this therapist won’t be a good fit for you, as a client.
  3. Just like with any professional, if you have one or more sessions with a therapist and it doesn’t seem like a good fit for you, then you can make a change.

Evaluations

Especially with kids, it can be helpful to have an evaluation to make sure you are getting a correct diagnosis.  School systems often require an official diagnosis, of ADHD for instance, before they will agree to work with a child’s family to provide accommodations (these accommodations come of the form of a 504 Plan, for students staying in the General Education population full-time, or an Individualized Education Program, IEP, for Special Education accommodations).  Some private practices will do these evaluations in-house, whereas others will refer you to other local doctors or to one of the big hospital systems, like Beaumont or Henry Ford Health.

“What about a crisis?  What do you do then?”

  1. If you or a loved one is having thoughts of hurting yourself or hurting someone else (“suicidal or homicidal ideation” is the technical term), then you should not wait before going to an Emergency Room.  In Southeast Michigan, U-M Hospital has a Psychiatric ER, specifically for these kinds of emergencies.  If you don’t want to go all the way to Ann Arbor, then any local ER will do.
  2. Other reasons why you might want to go to the hospital include severe symptoms like suddenly hearing voices or experiencing hallucinations, not being able to sleep or eat, or not being able to communicate.
  3. If you are not physically capable of getting yourself or a loved one to the hospital, especially if the person is becoming violent, then don’t hesitate to call 911 for help.

“What about medication?”

This is a big question, without an easy answer.  Many people find medication to be helpful, over either the short term or the long term.  Clients often see the best outcomes when they participate in therapy AND take medication, NOT one or the other.

  1.  I often tell clients that medication can take the edge off of their symptoms, so that they have enough relief to be able to do the challenging work of therapy.  It’s hard to work on yourself and work on your relationships when you aren’t sleeping well, for instance.  Making your daily life easier, over the short term, can be a great first step toward making long-term changes.
  2. I also often tell clients to try to think of their mental health like they would think of their physical health – If high blood pressure or diabetes or migraines ran in your family’s genetics, then you would probably not hesitate to take the appropriate medication, to help.  So why hesitate with your mental health?  Social stigma around mental health has improved a great deal in recent decades, but we still have a ways to go.
  3. With all that said, primary care doctors have often rushed to prescribe medication for symptoms of anxiety and depression, when the patient was probably just experiencing sadness or tension related to one of any number of challenging but normal life events – the death of a loved one, the loss of a job, a break-up or divorce, or another life transition.  In circumstances like these, it may be helpful to start therapy, but to wait a few months before starting medication, to see if your symptoms improve naturally, over time.

These answers will probably raise more questions, so please reach out to me!

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