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Considerations on Entering Therapy

Getting help in a timely manner is possible—here are a few ways to approach the matter.

Few questions are asked as often: How do I find a therapist? And few questions are more crucial. Getting help in a timely manner is absolutely essential not just to relieve a current episode of depression but to prevent what otherwise likely becomes a recurring disorder.

Still, inside that initial question lurks another, more urgent one. People are not asking strictly about the mechanics of finding a therapist, although many do want to know that too. What they really seek to know is, how do they find someone who can actually exert some traction to help pull them out of the pit of depression.

The question is on target, for not just any warm body will do. First, depression is a complex disorder and certain kinds of treatment have proven more effective than others; one must ascertain beforehand that a mental health professional employs methods known to work.

Second, depression imposes some limitations on those actively in its grip; it is the nature of the beast to impair cognitive functioning and to induce passivity. Consequently, the depressed need search strategies that overcome their own debility.

* The fastest and most reliable way to find a good therapist is to ask a friend or someone you respect who has been helped by therapy. People you trust with helping you make other decisions can help with this one too, observes psychologist Bernardo Carducci, Ph.D., of Indiana University Southeast. Asking a friend relieves the burden on your judgment, while your friend's success provides a clear indicator that what the therapist does actually works against depression.

"One needs a therapist with a track record of helping people who have the kind of problem you do," contends Lori Gordon, Ph.D. "They have to be known for their effectiveness in helping with the kind of problem you have and achieving the kind of goal you are seeking."

A second-best referral source is your family doctor. Whichever route you take, ask prospective therapists whether they've treated depressed people before, and how often they have done so.

* Professional credentials are necessary. Call (or check online) the state licensing board of whichever professional you select to make sure that the therapist is licensed. Also check to make sure there's no history of legal or ethical complaints lodged against the therapist.

* But credentials alone are an insufficient index of qualifications. A therapist's knowledge of depression, personal values, state of mind, and cumulative wisdom all count because they are your springboards to recovery.

Although conventional wisdom holds that psychotherapy is a value-free enterprise, that is a myth, insist eight of the 10 seasoned experts consulted for this article. As Frank S. Pittman III, M.D., a psychiatrist in private practice in Atlanta, puts it: "Most psychotherapy is really about values. It's about the value dilemmas of ordinary people trying to lead a life amidst great personal, familial, and cultural confusion."

The best way to discover the values of a therapist is to ask people who have been to the therapist. "Ask your friend, 'when you tell your therapist what you just told me, that you're leaving your job, what is your therapist's response?'"

After checking credentials, says Ellen McGrath, Ph.D., gauge the life experience of the therapist. Ask yourself whether he or she has lived enough according to values you respect to know about life and love independent of their theoretical orientation.

"Most patients can judge the therapist firsthand," offers psychiatrist Peter D. Kramer, M.D. "Their social judgment is not impaired; they know who's sitting across from them even when depressed. A therapist should show wisdom, courtesy, insight, perhaps a touch of brilliance, and a good measure of patience and equanimity."

* Seek a therapist who is open to deploying all the tools proven to work against depression. Ask a prospective therapist what kinds of treatment he or she employs.

"Studies show that a combination of medication and psychotherapy is the best treatment for depression," observes Rick Strassman, M.D., a psychiatrist in private practice in Taos, New Mexico. "The results are better, quicker, and longer-lasting." Unfortunately, he notes, while psychiatrists are the only mental health professionals who can prescribe drugs, they are often no longer trained to do psychotherapy.

After getting medication under control, he reports, "most patients are interested in doing psychotherapeutic work. I'm doing more psychotherapy than I thought I'd be doing."

* Perhaps the best question you can ask a prospective therapist is, why am I depressed? The answer will tell you as much about the therapist as about you.

What should you look for in an answer? Comprehensive understanding and wisdom. "Depression is a chemical state, and you can get into it by a physical route or a psychological route or by the circumstances of your life," says Atlanta's Dr. Pittman.

"Running around angry all the time will depress you. Drinking alcohol daily and not getting any exercise will depress you. Doing things that make you feel guilty will depress you. A therapist who can explain that simply and honestly is likely to have the resources to help you through what you are going through."

Psychiatrist Strassman says he usually tells questioners, "It's how some people respond to stress. Some develop ulcers, some get headaches, some develop high blood pressure, others get depressed. I tell them that medications affect the biology while therapy can help identify stresses and provide more options for dealing with them."

The breadth of view should extend to the treatment program. Ideally, says Dr. Carducci, therapy should include strategies for helping you become more connected to the community. It is therapeutic to be more involved in the lives of other people.

* Before you commit to one therapist, speak with several different ones. Ask if you can arrange to have the initial consultation for free or at a reduced rate.

* Choose a therapist who is happy. "Most people are not happy because they don't know how to be happy. They haven't learned those skills," says Dr. Pittman. You need to learn them from someone who has them and uses them. "A depressed person should not at all costs go to a depressed therapist any more than an alcoholic should go to a drunk therapist," he warns.

* Ask a prospective therapist how long you can expect the treatment to last. "As a seasoned professional," says Indiana's Dr. Carducci, "the therapist should be able to tell you. Don't accept statements to the effect that "it's too hard to say since everybody is different." View vagueness and uncertainty with caution.

* Expect to play an active role in your own treatment. You need to understand your own personality and interaction patterns so you can learn to manage yourself in a way that allows you to function successfully. "This is the basic job everyone has in life," says Dr. Pittman.

* Choose a therapist who challenges you. At the very least, a therapist must have you identify something that went wrong and why you think it went wrong.

"Therapies that activate people do better," observes Blues Buster's Michael Yapko, Ph.D. "Look for therapists who give you assignments, things to do or to read, little experiments to conduct." You also want a therapist who takes an active role in teaching you the skills you need for managing life and its inevitable stresses.

As Dr. Kramer sees it, a therapist should not be too eager to please. "A little empathy should go a long way. At the same time, the therapist should not be too rough on you. But you should not get away with too much either."

* A good therapist has not only the necessary skills and character but the necessary optimism that you will get through. Don't settle for anything less.

For more, see the Therapy Center and the national and international Directory.