Should I see a psychologist?

Psychologists treat psychological concerns or issues through conversation, observing your thoughts and actions, and helping you think through your reactions to events in your life.  

They meet with their patients regularly, and it is an emotionally intimate relationship. They do not require a specific diagnosis but instead work with their clients to help them be more comfortable with themselves and others. 

If you are asking yourself ‘should I see a psychologist?’, the answer is yes! 

Just about anyone could benefit from a good therapy session, and psychologists often have other psychologists that they see to help themselves maintain a healthy state of mind!

What to look for in a psychologist

You need to have a psychologist who is accepting of your total identity, and you need to be able to be comfortable talking about who you are on a very deep level.  

They need to understand what aspects of your identity are not a problem to be fixed, but a healthy part of who you are.

For example, if a person is transgender, or questioning their gender identity, they need to see a doctor who is trans-friendly and doesn’t view gender identity concerns as a mental health problem, but rather as a less-common but very legitimate form of self-expression.  

For people who are bisexual, their therapist needs to be aware of bisexuality and accept it as an independent sexual identity, as opposed to a ‘phase’ or ‘part of the coming-out process’.

Even if the gender identity or sexual orientation is not the primary reason for going to therapy, it is essential that the therapist is able to understand that those identities are not an issue in and of themselves.  

The same holds true for religious beliefs, including atheism and agnosticism, lifestyle choices, and most larger aspects of identity that may not be in societal ‘norms’ but is still a mentally and emotionally healthy way to view the world.

Examples of dysfunctional identities include terms related to abuse, or acknowledged conditions in the DSM V(bearing in mind that at one point homosexuality and other currently accepted norms have had points where they were considered mental illness).

Psychologists do not need to share these identities with their patients, but they do need to respect them, and not try to ‘fix’ the identity.  

Finding a good psychologist or therapist can be very challenging.   

You are looking for help at a point in time where you know your judgment is compromised in some way, and you know you’ll be sharing very intimate details of your life with a relative stranger.  

So the first consideration is likely to be what I mentioned above: does this doctor recognize that my healthy identities are healthy?

If the answer to that question is a definite no, they are not the therapist for you.  If, on the other hand, their perspective is unknown, it’s time to continue in your selection process.

Some identity-based communities have  ‘recommendations’ list of identity-friendly therapists, so please check for that resource. 

If there isn’t one in your case, you may be able to ask other members of your community if they have a recommendation. 

If there is a recommended psychologist or therapist, try them first, especially if they accept your insurance.

Finding an FND-friendly Psychologist

For my folks with Functional Neurological Disorder, it is hard to find a psychologist who specializes in FND. 

Ask around in FND communities, like FND Hope, and see if you can find a recommendation.  If there are no FND-aware therapists in your area, look for psychologists who specialize in trauma or PTSD.  

There is a lot of overlap between PTSD and FND if your condition was triggered by trauma or if your symptoms strongly respond to psychological triggers.

Following the conversion disorder theory, your symptoms are usually viewed as a physical expression of your emotional stress.  

You and your psychologist can make a lot of progress viewing your symptoms as a form of emotional expression, which just means our symptoms will often occur in response to an emotional trigger(sometimes without feeling any emotions).

For example, my therapist and I have learned that if I get symptomatic when we discuss a topic, it’s worth delving into because there is something unresolved or stressful there.

As you find your triggers, you and your therapist can work on resolving the trauma involved in creating the triggers, and/or finding the best possible method for you to soothe yourself out of symptoms when they are triggered.

There are some people whose FND appears spontaneously generated or as a response to physical trauma. For them, a therapist can still be helpful, in helping them figure out how to manage their symptoms and how to mentally and emotionally adjust to their sudden disability.

Another thing to look into is therapists who focus on the cognitive school of thought. Cognitive-behavioral therapy(CBT) is often used for people with FND, and if you are not severe enough to need that training, the cognitive school of thought can help.   

Once you find a therapist who seems like they may be a good match, it’s time to set up that appointment.

How to search for a Psychologist

This process is similar to the hunt for a primary care physician or for an appropriate specialist.  If you do not have a recommendation, use your insurance to find available psychologists in your area.  Look into their reputation information from HealthGrades and similar programs. See if you can find any reviews on your available options.  

Many good psychologists will list their specialties or preferred areas of support on their site, so you should be able to learn that without calling in most cases.  

 If you can’t, or your concern isn’t addressed, then you can call the office. Find out if they work with people who share your identity and/or concerns and/or diagnosis.

Calling for appointments

When you call to make an appointment, think about how you are treated and how quickly they can schedule you. Some therapists do work alone, in which case you will be leaving them a message with your questions. 

Many therapists have a secretary or a scheduler.  Be aware of how quickly they respond to your initial call, and how long it takes to be seen.  If it takes more than one full business day to return your phone call, you might consider looking elsewhere.

If you can get seen within a day or two of your first communication, the therapist might not have a lot of regular clients.  That’s a good reason to approach the appointment with caution.

Unless they recently moved into the area, added hours, or had another large scale change, they might not be the best option. Take the appointment, but you just had a possible red flag.  Once you go to the appointment, you should have a better idea.

If they schedule you within 1-3 weeks, that’s a better sign. That often means that their office runs somewhat efficiently(especially an appointment within one or two weeks) and bodes well for you being able to see the psychologist regularly. 

If when you call they can’t fit you in for 3 weeks or more, they are likely highly booked or overbooked and seeing them regularly will likely be a challenge. That will make them less desirable in terms of scheduling, so unless they seem like by far the best candidate, you might want to go to somebody more available.

Insurance concerns

Make sure you know any limits your insurance have around the frequency of therapist visits – if you have a larger list, you might need to take more time with the process if your insurer has a weekly cap on appointments.

Therapy of this sort is covered under mental health supports, which sometimes is referred to as ‘behavioral health/managment’ or other slightly cringe-worthy titles.

It’s still worth investigating, no matter what they call it, it’s still some form of coverage.

Also, be aware that many insurance companies are especially bad at keeping their lists of available therapists up to date, so you may need to make a lot of calls just to find a few options.

A lot of therapists charge $100 or more per appointment, so make sure you know your insurance company’s rules on that front, and stay within those rules so this process is not too expensive.  

Some insurance companies will cover the costs upfront, leaving you with a copay(at the time of appointment) or a residual fee(a small portion of the bill that they don’t cover).

Other companies have you pay at the appointment and then reimburse you a percentage of your costs. You will need to send them the receipt from each appointment, and the processing may take a while.

When I worked with a plan like that, I think the whole cycle took about a month, but I ended up paying maybe $30 or so a session.

Make appointments with as many therapists that fit your criteria as you can(given time, financial, and energy constraints), and evaluate them at the first appointment. 

You should at least reach out to 5 or 6 different psychologists if you do not have a recommendation. 

It is possible that some of them will rule themselves out after the phone call. 

Make sure you actually go in and see at least two options, so you can compare them. 

Some insurance companies want you to tell them who your psychologist or therapist is(some only let you have one at a time). If that is the case, just keep calling and ‘updating’ before each appointment, so you will be covered. I had to do that, and while it was annoying, I did get reimbursed for each one.

Finding a good therapist is a lot of work, but if you are thorough, you likely will have somebody you can see for years – so this is a search that should not occur often. I had one therapist I saw for 10 years, and the psychologist I’m seeing now is one I first saw in 2002. 

The first appointment: it’s like a blind date

The first appointment with a therapist is really more of a job interview or a blind date than anything else.  

You are talking to this person to see if their mindset complements yours well. You need to evaluate if you feel comfortable with them and if they respect you.  

Have a set of questions written down ahead of time around their views on their relationship with their patient, and the philosophy behind their work.

Give them a history of why you are there.  Watch how they respond to your information. Be sure to share any identities that could spark a negative reaction.  If he or she has a negative response, they likely won’t be as helpful as you’d like. If they are reassuring or neutral, you probably are in the right place.

It’s much better to get it out there and know right away than to devote a lot of time to see that therapist only to later learn that you are incompatible.  Think about how you feel talking to them, and how comfortable you are revealing yourself to them.

A psychologist is going to know you very well, and help you adjust your thinking, so it’s essential that you know that they aren’t going to view your baseline identity as something that is broken.  

It’s much better to know early if the therapist has a bias against you, and not see him or her, than it is to learn it later after you have invested a lot of money, time, and energy into somebody who is not a correct fit.

How to decide

The therapist you feel the most trust or respect for is your best candidate. 

It is normal to feel a bit nervous meeting a therapist for the first time, especially if you aren’t used to seeing psychologists – it’s outside your comfort zone.  

See how they react to that – if they leave you feeling a bit reassured, or more hopeful when you leave the office, that’s a good sign.

If you leave the appointment feeling a bit overwhelmed with what you need to do, that’s not great, but not terrible either.  

If you leave the office feeling uncomfortable or frightened, that’s not a good sign and unless the fear is around seeing any therapist, you likely should not return to that doctor.

You can, if needed, go ‘doctor shopping’ for a month or two – making appointments with therapists, and interviewing them at the first appointment to see if they are compatible with you.  

 If you aren’t sure what to say, write yourself a ‘cheat sheet’ before the appointment so you make sure that you don’t leave out anything important.

Set regular appointments

Once you have the right therapist, work towards making regular appointments with them. 

Appointments weekly to every two weeks is appropriate, though the first month or so of seeing the therapist you likely won’t have a standing appointment time, as they need to go through their schedule and figure out how to fit you in.  

If you are in particularly rough shape and your insurance will cover it, they might see you more than once a week for a while to help you regain some mental/emotional balance.

My experience

Following these steps, I have had a couple of uncomfortable first appointments, but the psychologists who got second appointments were ones I was comfortable with.  

They were able to accept me for who I was and help me to solve the issues I was there for, without turning any other aspects of my life into issues.

I only actually had to do the psychologist shopping process once, and the second one I chose was a referral from a colleague of my neurologist’s.  

Should I see a psychologist? 

Yes, you should.  What you focus on will vary, but anyone willing to listen and act on advice can benefit from conversations with psychologists.  As a patient, it’s essential that your therapist recognize and respect your personal identity, including any aspects of who you are that are outside of societal expectations(gender identity, religion, recreational and lifestyle habits, for example). 

Make sure those details come out on the first visit so you can gauge their reactions, and move on if they cannot respect your identity.  Once you trust your psychologist, they can really start to help you improve your life.  To grow, and develop a healthier state of mind, it is vital that you find a therapist who is compatible with you. It is not just about ‘finding a good therapist’ it’s about finding a therapist who is good for you.

I wish you the best on your hunt!