# Counselor selection is overwhelming



## Rocky Mountain Yeti

As I mentioned in a couple threads, counseling is now on the table for me.

A quick background note:
My wife has been seeing a Internal Behavioral Health Consultant who is a PhD Psychologist. Her issues came back to me and so I was invited in for a session of my own. Great guy. The focus, though, was how my not sleeping is affecting my wife. He began exploring health and behavior modification that might help me sleep (including severe sleep apnea), as well as deal with my rapidly climbing blood pressure. Great guy, good suggestions (I think, time will tell).

My wife was present until the last couple minutes when I asked for a few minutes alone with him. In under 5 minutes, I downloaded quite a bit on him, covering most of what you have already heard in my other posts. 

He said I seriously need to get some counseling... specifically from someone who specializes in marital relationships and sex. Makes sense to me. 

But holy crap! Even in a moderate sized city, there are about a gazillion of these characters. How does one choose? I did a search on this site on how to choose a counselor and precious little came up. So anything anyone else would like to add at this point, I'm all ears.

The psychologist I met with gave me a referral sheet with a half dozen names. Of the few that had websites, none impressed me. (I'm often not impressed with the referrals coming from within the military health community which is where I start as I have lifetime benefits as a military retiree). So I started researching other options, and was quickly swamped. 

How to narrow it down? I know my insurance is unlikely to cover marriage counseling, but with his referral, some might. However, insurance is a minor consideration for me. I can certainly afford to do this out of pocket, and actually kind of prefer it that way. Cost is a very minor consideration relative to results.


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## Shoyoself

I (and friends and family) have had great luck with the therapist locator on psychology today. 

You can add in filters to your search for all sorts of things, from specialties to religious beliefs to insurance accepted. Once you narrow it down, I’ve found that from looking at their picture and reading their bio can give a pretty good idea on if it’s someone you would feel comfortable talking with. 

You might not be able to tell for sure if you will get the right one, but you can definitely eliminate a lot of the ones that will not work for you.


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## Thor

That's a tough question. My ex is a psychologist, so I've known a lot of them socially and of course gone to various IC/MC along the way.

I think I would tend to weed out the very old and very young. The philosophy from 30 years ago was not congruent with the TAM philosophy on most things. Lots of things we'd call serious breaches of trust today were considered acceptable behavior in the past. Lots of rug sweeping and lots of telling husbands to do the dishes more often.

But the really young crowd today has a philosophy of non-judgmentalism and weak boundaries which imo are not healthy in marriages.

Also I would look carefully at what the therapist has as specialities. Many will have personal interests they specialize in, but those don't pay the rent very well, so they also do general IC/MC. That isn't a problem. The problem is their bias or personal issues, which you may glean from their specialties. A woman who specializes in adults with child sex abuse or rape traumas might herself be a victim, and that could prejudice her view of male sexuality. Someone who indicates a specialty working with ptsd may work with a lot of vets and thus might have insights helpful to your situation if your service (deployments, etc) may be a factor in your issues.

Ph.D. vs Masters isn't that important if the person has say 10+ years of experience and has additional certifications such as marriage and sex therapy. A middle aged Masters level LMFT & AASECT is likely to be much more competent than the newly minted Ph.D. with no extra certifications.

Look at their philosophy. Behavioral vs cognitive vs other. You probably have an idea of how you learn and what style of leadership you work well with. Do you like to read books? Do you want the therapist to explain things to you so you know the underlying concepts, or do you like to go out on the ledge and trust what they tell you to do will work? A cognitive therapist will explain things to you and try to get you to understand why you do/think the things you do. The behavioralist will tell you to do X,Y,Z and don't worry about understanding why.

Do you want the therapist to be a bit of a hard ass, challenging you and telling you directly how things are, or do you prefer a softer touch who will lead you to your own conclusions? I liked it when the therapist would challenge me because I would have to think about it. I don't take it personally. It makes me work to either agree or disagree. If you tend to be reactive then you wouldn't like the confrontational style therapist.

Will your wife be going with you at times? If so, think about whether a male or female therapist might be better for her.

Your W's therapist's referrals are probably going to be similar in approach to him. If you think he is good then I would start with his list. Call a few of them to ask what their philosophy and approach is with someone with your kinds of issues. You'll get a good feel pretty quickly yay or nay.


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## Rocky Mountain Yeti

Good stuff @Thor

I think I would mix up your latter criteria a bit. Hardass, yes, but not telling me what to think, but rather being a hardass challenging me in general as well as challenging me to reach my own conclusions. That's the hard part to glean from online "marketing" pages. The stuff about checking the resume is relatively easy.

And my wife doesn't like hardasses.


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## happiness27

Rocky Mountain Yeti said:


> As I mentioned in a couple threads, counseling is now on the table for me.
> 
> A quick background note:
> My wife has been seeing a Internal Behavioral Health Consultant who is a PhD Psychologist. Her issues came back to me and so I was invited in for a session of my own. Great guy. The focus, though, was how my not sleeping is affecting my wife. He began exploring health and behavior modification that might help me sleep (including severe sleep apnea), as well as deal with my rapidly climbing blood pressure. Great guy, good suggestions (I think, time will tell).
> 
> My wife was present until the last couple minutes when I asked for a few minutes alone with him. In under 5 minutes, I downloaded quite a bit on him, covering most of what you have already heard in my other posts.
> 
> He said I seriously need to get some counseling... specifically from someone who specializes in marital relationships and sex. Makes sense to me.
> 
> But holy crap! Even in a moderate sized city, there are about a gazillion of these characters. How does one choose? I did a search on this site on how to choose a counselor and precious little came up. So anything anyone else would like to add at this point, I'm all ears.
> 
> The psychologist I met with gave me a referral sheet with a half dozen names. Of the few that had websites, none impressed me. (I'm often not impressed with the referrals coming from within the military health community which is where I start as I have lifetime benefits as a military retiree). So I started researching other options, and was quickly swamped.
> 
> How to narrow it down? I know my insurance is unlikely to cover marriage counseling, but with his referral, some might. However, insurance is a minor consideration for me. I can certainly afford to do this out of pocket, and actually kind of prefer it that way. Cost is a very minor consideration relative to results.


re: sleep apnea - Are you on a CPAP? My husband is working that out right now and, while it's a worthwhile endeavor, it's taking awhile to get everything just right with the right type of mask. He's got a beard and mustache so will probably end up with the pillow mask. He said it makes a HUGE difference in how he feels getting quality sleep. 

Do you have TRICARE FOR LIFE?

They actually do pay a portion of the fee for counseling (at least TRICARE has in the past for us at times when we used it.) Every so-many sessions, the counselor has to reapply for extension of sessions but it's not that big of a deal. However: I know we did out of pocket finally at some point to avoid giving the insurance company access to information the therapist might have to provide. Just didn't like the insurance company having that much access to personal info.

If you can pay for your own, I wouldn't limit myself to what the other therapist has suggested. So many therapists have websites, I guess you already know, and maybe they even have feedback these days. 

(Does he not consider himself qualified to work with you?}

Sometimes you do have to scope out a number of different therapists to get the one that works for you. What I feel like I can suggest is: DON'T SETTLE EVER. Get the person who is pro-active and really *gets* you and acts like he is interested in moving you into a happy place. I strongly suggest a man for a man - and I'll eat my hat if I'm wrong on that. Have probably 6 therapists over the years and only one (this last one) was a really good one. We found him because of his credentials and his stated approaches on his website - and then meeting with him several times to get a feel for his enthusiasm level. We needed someone with a positive attitude who gave homework and books to read and ideas and skills. Somebody who cared and gets you but also gives you different ideas and viewpoints - like: what is black and white thinking? what is your personality type? what is the cycle of negative thinking? 

A therapist should leave you with the thinking that somebody *gets* you but is also a mentor. Also, you want a therapist that works for you - not one that works for just your wife. If one works for your wife and not you, then you should go elsewhere. It's nice if one works for both of you but more important if you are seeking a therapist for you that that therapist clicks with YOU.


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## Rocky Mountain Yeti

happiness27 said:


> re: sleep apnea - Are you on a CPAP? My husband is working that out right now and, while it's a worthwhile endeavor, it's taking awhile to get everything just right with the right type of mask. He's got a beard and mustache so will probably end up with the pillow mask. He said it makes a HUGE difference in how he feels getting quality sleep.
> 
> Do you have TRICARE FOR LIFE?
> 
> They actually do pay a portion of the fee for counseling (at least TRICARE has in the past for us at times when we used it.) Every so-many sessions, the counselor has to reapply for extension of sessions but it's not that big of a deal. However: I know we did out of pocket finally at some point to avoid giving the insurance company access to information the therapist might have to provide. Just didn't like the insurance company having that much access to personal info.
> 
> If you can pay for your own, I wouldn't limit myself to what the other therapist has suggested. So many therapists have websites, I guess you already know, and maybe they even have feedback these days.
> 
> (Does he not consider himself qualified to work with you?}
> 
> Sometimes you do have to scope out a number of different therapists to get the one that works for you. What I feel like I can suggest is: DON'T SETTLE EVER. Get the person who is pro-active and really *gets* you and acts like he is interested in moving you into a happy place. I strongly suggest a man for a man - and I'll eat my hat if I'm wrong on that. Have probably 6 therapists over the years and only one (this last one) was a really good one. We found him because of his credentials and his stated approaches on his website - and then meeting with him several times to get a feel for his enthusiasm level. We needed someone with a positive attitude who gave homework and books to read and ideas and skills. Somebody who cared and gets you but also gives you different ideas and viewpoints - like: what is black and white thinking? what is your personality type? what is the cycle of negative thinking?
> 
> A therapist should leave you with the thinking that somebody *gets* you but is also a mentor. Also, you want a therapist that works for you - not one that works for just your wife. If one works for your wife and not you, then you should go elsewhere. It's nice if one works for both of you but more important if you are seeking a therapist for you that that therapist clicks with YOU.


CPAP no good. I did better without it. Simply can not sleep with apparatus on my face. Dental guard that holds jaw in position during sleep works better. I can actually sleep with that. And my wife says far less snoring, which I took to be a sign apnea was taken care of. But since my fatigue has gotten far worse in recent years, doc still thinks apnea is a problem. He has proposed a couple alternative approaches that I have to study.

Yeah, I'm a Tricare guy. 

As for this doc working with me, MC is not his specialty.


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## john117

IMHO, PhD and 20+ years experience, and experience in specifics. Larger group practice 3 or 4 but not assembly line therapy. PhD also would be more likely to have published, and one can read those and get a better idea. 

Specifics as in, say, experience with international couples (multicultural). Specific subjects like anorexia or anxiety or what not. 

There's a gray area between family counseling and marriage counseling. We did family for 6 months before calling it quits. It was all covered but then again it was not "he leaves the toilet seat up" type of issues.

Marital issues often have their root cause in underlaying mental health issues. Not merely personal choices and such. 

I would also like someone well versed in both cognitive and dialectic methods, as suggested. 

Finally, someone who would start off with a few sessions worth of individual counseling and assessment, rather than "why do you hate her or him". 

+1 for Psychology Today.


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## happiness27

Rocky Mountain Yeti said:


> CPAP no good. I did better without it. Simply can not sleep with apparatus on my face. Dental guard that holds jaw in position during sleep works better. I can actually sleep with that. And my wife says far less snoring, which I took to be a sign apnea was taken care of. But since my fatigue has gotten far worse in recent years, doc still thinks apnea is a problem. He has proposed a couple alternative approaches that I have to study.
> 
> Yeah, I'm a Tricare guy.
> 
> As for this doc working with me, MC is not his specialty.


You know, IC isn't such a bad thing, really - even insomuch as it actually helps the couple without the couple being in there together. If you both dig this guy, I don't see why that wouldn't be just as much help as getting an MC. My husband and I used the same therapist and it was actually kind of cool in that he knew what was going on with both of us and...it worked. So, ya know, maybe give that a try for awhile if the therapist is amenable and your wife is amenable to it. 

What was going on with us as individuals really was the crux of the matter when it came down to it. Each of us working on ourselves did move both of us towards each other when we could each see what our own issues were. It helped us start a conversation with each other and, over time, we have worked a lot of things out. 

I don't blame you for the attitude on the CPAP. My husband has been diddling with the CPAPs the past couple of months - and is seeing finally seeing a pulmonologist in person to see if he can get a third option - the nasal cannula. It's for side-sleepers - but also, my hubs has a beard and mustache. He says he sleeps far better with a CPAP after having time to compare with and without it.


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## Rocky Mountain Yeti

happiness27 said:


> You know, IC isn't such a bad thing, really - even insomuch as it actually helps the couple without the couple being in there together. If you both dig this guy, I don't see why that wouldn't be just as much help as getting an MC. My husband and I used the same therapist and it was actually kind of cool in that he knew what was going on with both of us and...it worked. So, ya know, maybe give that a try for awhile if the therapist is amenable and your wife is amenable to it.
> 
> What was going on with us as individuals really was the crux of the matter when it came down to it. Each of us working on ourselves did move both of us towards each other when we could each see what our own issues were. It helped us start a conversation with each other and, over time, we have worked a lot of things out.
> 
> I don't blame you for the attitude on the CPAP. My husband has been diddling with the CPAPs the past couple of months - and is seeing finally seeing a pulmonologist in person to see if he can get a third option - the nasal cannula. It's for side-sleepers - but also, my hubs has a beard and mustache. He says he sleeps far better with a CPAP after having time to compare with and without it.


My wife loves him, and I was highly impressed myself. But when I say MC isn't his specialty, the same goes for IC as well. His charter per his support of the clinic where he works is strictly tying behavior modification as opposed to drugs to specific diagnosed medical issues. So any kind of long term counseling or psychotherapy is outside what he's there for. He's more than fully employed with his primary purpose, so even if he was capable of IC/MC, he's still going to refer out for that.


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