On receiving personal therapy

[Psych56]

I was curious as to when I should start the process of finding a personal therapist. My desire to receive therapy has been influenced by Dr. Yalom's teachings and I believe it would be of great value for me and my future patients. How many of you take the time to get therapy? Also, I don't have any specific complaints so how could I go about meeting with a therapist when I don't have any reason scheduling an appointment other than learning more about myself....is that enough of a reason?

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[Maeloryne]

Yes! I saw a therapist for my parent's divorce, and now that I'm doing better it is refreshing to just go and talk with my therapist. It is also a breath of fresh air for him, since he deals with many extreme patients each day. At the end of the day, you're paying for something and that's really all they care about. I've learned a lot!

 

[sunlioness]

I think it would be difficult to go to therapy without having identified an issue you want to work on. And without something like that, your insurance won't pay for it. An analyst would probably see you for the purpose of learning more about yourself, but again it would be rather pricey.

I go back and forth on the value of therapy. I do absolutely believe in the value of therapy when done correctly and competently. But it's harder than it needs to be to find someone competent and with whom you can develop a good rapport and that insurance will pay for. I sought therapy in residency to work on some social/performance anxiety that was limiting my ability to present effectively on rounds and make treatment decisions. It ended up doing more harm than good, though I did get an education on the importance of proper therapeutic boundaries (my therapist thought she was above such things).

 

[cookymonster]

I think it would be difficult to go to therapy without having identified an issue you want to work on. And without something like that, your insurance won't pay for it. An analyst would probably see you for the purpose of learning more about yourself, but again it would be rather pricey.

I go back and forth on the value of therapy. I do absolutely believe in the value of therapy when done correctly and competently. But it's harder than it needs to be to find someone competent and with whom you can develop a good rapport and that insurance will pay for. I sought therapy in residency to work on some social/performance anxiety that was limiting my ability to present effectively on rounds and make treatment decisions. It ended up doing more harm than good, though I did get an education on the importance of proper therapeutic boundaries (my therapist thought she was above such things).

Agree completely with this. I worked with a therapist in residency, when I was extremely stressed out from clinic. I was pretty conscious that I was paying a lot of money to get out of clinic for an hour a week, and it honestly may have been worth it (I really wasn't cut out for outpatient), but I may as well have been talking to my cat for how useful it was to me.

I would benefit greatly from therapy now, but I've moved to a new town after residency and don't know any therapists whose skills I think are exceptional enough for me to learn insights and strategies I won't derive from other means (friends, self-help books, and experience). I've come to the cynical conclusion that really helpful therapists aren't going to accept insurance, and if I'm paying $140 an hour, I'm pretty reluctant to shop around for the right fit. And even though we shouldn't be discouraged (let alone ashamed) for seeking help, no psychiatrist wants to schedule appointments with several therapists in town.

 

[notdeadyet]

Wait until intern year. You will likely have good insurance and can bill your therapy for Adjustment Disorder with Mixed Anxiety and Depression. I'm kidding (kind of).

If you end up in a residency with a strong psychotherapy bend, there will likely be a network of therapists that focus on providing therapy to psychiatry residents. These will (or definitely should) be therapists outside of the faculty of the program. Many will be out of network but have sliding scale for psychiatry residents. Some are cash only down to $50-100/hour and many are extremely good. Apparently some folks love providing therapy to psychiatrists. I'd personally sooner poke a fork in my eye, but that's editorializing....

 

[SmallBird]

I think it would be difficult to go to therapy without having identified an issue you want to work on. And without something like that, your insurance won't pay for it. An analyst would probably see you for the purpose of learning more about yourself, but again it would be rather pricey.

I go back and forth on the value of therapy. I do absolutely believe in the value of therapy when done correctly and competently. But it's harder than it needs to be to find someone competent and with whom you can develop a good rapport and that insurance will pay for. I sought therapy in residency to work on some social/performance anxiety that was limiting my ability to present effectively on rounds and make treatment decisions. It ended up doing more harm than good, though I did get an education on the importance of proper therapeutic boundaries (my therapist thought she was above such things).

This is quite contrasting to my experience and that of my co-residents... many of us pursue personal psychotherapy without any identified issues or symptoms at all (with no co-pays or any insurance problems) and I guess the theory is that if you are doing dynamic therapy, it helps to be in dynamic therapy, much like training analysts need to complete a personal analysis. I'm really interested to hear how people think about this at different programs or places...

 

[nitemagi]

Some residencies also have a group of faculty that get faculty hours for giving therapy to residents. Obviously has its pros and cons, but in that case it's free.

 

[splik]

Some residencies also have a group of faculty that get faculty hours for giving therapy to residents. Obviously has its pros and cons, but in that case it's free.

that is what they do at my program but many residents still elect to use their own insurance/find their own therapist than see clinical faculty. it is also a soft requirement to have at least 6 months of your own therapy. How many places still have this as a requirement? I am not sure how I feel about it.

 

[nitemagi]

I'm not aware what residencies require this. It's a mixed bag using faculty, especially since many are analysts and that might not be your cup of tea.

I did once a week for a year of residency, along with "training analysis" four days a week during a year of psychoanalytic training. Beneficial, but I really believe as a trainee you max out on your learning after less than a year. IMO.

 

[Psych56]

Thank you for the responses. I will wait until residency and go from there. Not too much longer until July 1

 

[sunlioness]

And even though we shouldn't be discouraged (let alone ashamed) for seeking help, no psychiatrist wants to schedule appointments with several therapists in town.

This is true. Thankfully, I'm doing okay now. But if I weren't, it would be difficult. I have insurance through work that mandates that I see providers who are employed by the same organization. Now for my PCP, I don't really care. It's a big organization and I found a doc in another building in a nearby town. We share some patients in common, but we don't really talk. If I needed counseling? Oh dear. I'd be required to see people with whom I work closely, attend departmental meetings with, see socially from time to time, etc. I could probably go to my insurance and get an exception, but in order to do that I'd have to talk to another colleague who works with the insurance co.

Now if I really felt I needed counseling, I'd either jump through those hoops to try to get an exception (the guy at the insurance co is a good guy and not the judgmental sort) or do self pay with someone private. But it definitely gives one pause for thought. There are also 6 EAP sessions per year and they do have a few contracted therapists outside the organization for just this reason. So there is always that.

My residency program didn't require or specifically encourage counseling. And I think that's appropriate. I mean interventional cardiology programs don't cath all their fellows. I don't think you necessarily need to have experienced therapy yourself to either provide it or know when to refer to it, though it can be helpful. My only concern in programs that use their own faculty would be that I think it would be inappropriate for your therapist to be your supervisor or evaluator. If it's just someone who might give you a lecture or two, that would be okay.

 

[Doctor Bagel]

I'm not aware what residencies require this. It's a mixed bag using faculty, especially since many are analysts and that might not be your cup of tea.

I did once a week for a year of residency, along with "training analysis" four days a week during a year of psychoanalytic training. Beneficial, but I really believe as a trainee you max out on your learning after less than a year. IMO.

My understanding is that residency programs cannot require residents to do their own therapy. Maybe they could in the past, but it's no longer allowed -- at least that's what my program's PD claimed.

I've got to say I'm really jealous of people who have access to low cost psychoanalysis or psychodynamic psychotherapy. Our insurance is decent about paying for things (including historically psychoanalysis, although we recently changed companies so who knows), but I'm not aware of analysts in the community offering treating to trainees for low cost, which we would be preferable than using insurance for reasons mentioned above. We do have access to a pretty extensive resident wellness center, but I think the MH care there is more problem focused and generally short term in nature. Good, but maybe not what a lot of psychiatry residents are looking for.

The other downside of my community is it's small even though we're in a fairly big city. If you see a training analyst, you're guaranteed that they will have some contact with people you interact with professionally. They might also be teaching that class you really want to take at the psychoanalytic institute. I'm guessing this is the reality for most trainees who aren't in SF, LA, NYC, etc.

About doing your own therapy, I think it's beneficial even from just a training perspective. The process of being in therapy feels fairly different from how I imagined it would feel.

 

[Doctor Bagel]

This is true. Thankfully, I'm doing okay now. But if I weren't, it would be difficult. I have insurance through work that mandates that I see providers who are employed by the same organization. Now for my PCP, I don't really care. It's a big organization and I found a doc in another building in a nearby town. We share some patients in common, but we don't really talk. If I needed counseling? Oh dear. I'd be required to see people with whom I work closely, attend departmental meetings with, see socially from time to time, etc. I could probably go to my insurance and get an exception, but in order to do that I'd have to talk to another colleague who works with the insurance co.

Now if I really felt I needed counseling, I'd either jump through those hoops to try to get an exception (the guy at the insurance co is a good guy and not the judgmental sort) or do self pay with someone private. But it definitely gives one pause for thought. There are also 6 EAP sessions per year and they do have a few contracted therapists outside the organization for just this reason. So there is always that.

My residency program didn't require or specifically encourage counseling. And I think that's appropriate. I mean interventional cardiology programs don't cath all their fellows. I don't think you necessarily need to have experienced therapy yourself to either provide it or know when to refer to it, though it can be helpful. My only concern in programs that use their own faculty would be that I think it would be inappropriate for your therapist to be your supervisor or evaluator. If it's just someone who might give you a lecture or two, that would be okay.

That's why lots of people self pay in these situations. There's also a feeling that things are less likely to be discovered (don't know how true that is or not). Imagine working for Kaiser and using their MH benefits. I think the reality with us is if your insurance mandates you to use the small network you work in, you essentially don't have outpatient MH benefits.

Of course the other reality is that self-pay isn't that expensive. I find it curious that we have the idea that we can't do certain things if insurance doesn't cover it. Not to say we shouldn't be annoyed by insurance not meeting our needs.

Honestly, I kind of like the thought of my personal psychotherapy, which is by nature not problem focused in a way an insurance company would like separate from all of that.

 

[member2721]

Talk to your PD or psychotherapy training director to get a referral to a network of therapists that they know. Finding a good fit therapist may be one of the most beneficial types of clinical/therapy/meta training for psychiatry residents. Insurance will typically cover mixed adjustment disorder, with some amount of co-pay.

 

[PikminOC]

As a doc or future doc, just pay for it yourself and keep it off your insurance. The less of a record, the better.
And medical education is highly standardized by the acgme. These other fields, not so much. That's also why the variability is higher.
If you are already a doc, do not see therapists in the area. No matter what.

 

[smalltownpsych]

As a doc or future doc, just pay for it yourself and keep it off your insurance. The less of a record, the better.
And medical education is highly standardized by the acgme. These other fields, not so much. That's also why the variability is higher.
If you are already a doc, do not see therapists in the area. No matter what.

I am curious about why never seek treatment in your area. To avoid multiple relationships or concerns about confidentiality and reputation? In my practice it is unavoidable since we have such a small pool to choose from. To be honest, I am more uncomfortable getting a physical from the docs I work with than baring my soul to a therapist I work with.

 

[PikminOC]

Confidentiality and reputation. .
Loose lips...

 

[Psych56]

Reputation? I feel like I would be playing into the stigma of mental illness if I made an effort to be so secretive in seeking help for my mental health by choosing a therapist far from where my future residency is located so as not to be tracked. Perhaps that is my naïveté speaking. I would like to think that psychiatrists practicing what they preach is the best policy and would look favored upon. I would also like to believe that my therapist would maintain confidentiality regardless if they are somewhat affiliated with whatever program I match into.

 

[microshar88]

I'm glad I read this thread. I am going through the roughest challenges of my life (going to interviews, parent's divorce, ranking programs, dealing with my sister's downfall). I just really need to talk to someone and I am glad that I don't have to be afraid that I can still be a competent psychiatrist at the same time.

 

[smalltownpsych]

Reputation? I feel like I would be playing into the stigma of mental illness if I made an effort to be so secretive in seeking help for my mental health by choosing a therapist far from where my future residency is located so as not to be tracked. Perhaps that is my naïveté speaking. I would like to think that psychiatrists practicing what they preach is the best policy and would look favored upon. I would also like to believe that my therapist would maintain confidentiality regardless if they are somewhat affiliated with whatever program I match into.

I agree about your perspective about not wanting to contribute to stigma but unfortunately many in this field stigmatize the most and you don't want to be on the negative end of that. The dynamic I often see that can develop with mental health providers is that mental health problems are what our poor pathetic patients have and health is defined as the way I am. It's a corollary of the fundamental attribution error.

 

[Psych56]

I'm trying to find articles that discuss prevalence of mental illness and/or history of childhood abuse, neglect, etc. in mental health professionals and to my dismay have not found any. I've been told before that a good majority of psychiatrists choose the field because of experiences with mental illness (whether it be second-hand), etc. I don't feel like this is discussed enough. I found one article on a psychiatrist with bipolar disorder. If anyone knows of any research done in this realm let me know please.

http://www.bphope.com/Item.aspx/102/conspiracy-of-silence-when-the-psychiatrist-has-bp

 

[smalltownpsych]

I'm trying to find articles that discuss prevalence of mental illness and/or history of childhood abuse, neglect, etc. in mental health professionals and to my dismay have not found any. I've been told before that a good majority of psychiatrists choose the field because of experiences with mental illness (whether it be second-hand), etc. I don't feel like this is discussed enough. I found one article on a psychiatrist with bipolar disorder. If anyone knows of any research done in this realm let me know please.

http://www.bphope.com/Item.aspx/102/conspiracy-of-silence-when-the-psychiatrist-has-bp

My understanding is that it is sort of an urban legend that we have more problems than the average person. When you consider prevalence of mental illness in the general population, I think that having a high degree of connection or personal exposure is the norm rather than the exception.

 

[Psych56]

My understanding is that it is sort of an urban legend that we have more problems than the average person. When you consider prevalence of mental illness in the general population, I think that having a high degree of connection or personal exposure is the norm rather than the exception.

Those are good points. Thank you

 

[Doctor Bagel]

I think the stigma issue is psychiatry is present, which is both surprising and not. We see ourselves as being different from out patients. I'm not sure about the data about prevalence of mental illness, but I do think as a group psychiatrists one of the specialties that's more likely to have board disciplinary issues, which might suggest something.

Overall, I think it would be odd to be a therapist and not have some experience of your own in therapy, but I might be a little old school in that thought.

 

[SmallBird]

This may very by region, but based on the environment where I am (the Northeast) it is very normal for psychiatrists to be in their own therapy, and the idea of keeping it off insurance and avoiding local practitioners seems totally paranoid. Obviously one should avoid having a therapist that could in the future act as a supervisor but these problems, when they have come, have been very easily resolved.

 

[hamstergang]

Overall, I think it would be odd to be a therapist and not have some experience of your own in therapy, but I might be a little old school in that thought.

Why? I have no experience with mental illness of my own, or of taking the medications we prescribe. Why is therapy different in that it would be odd for that alone to be something I should experience personally in order to provide it competently to others?

 

[smalltownpsych]

Why? I have no experience with mental illness of my own, or of taking the medications we prescribe. Why is therapy different in that it would be odd for that alone to be something I should experience personally in order to provide it competently to others?

I think this comes from the perspective that a significant part of what we do depends on the interpersonal factors. The more awareness we have of what is going on with ourselves, then the clearer we can be about understanding the projections and perceptions of our patients. I actually believe that the few practice sessions that I have had throughout my training were sufficient experience of what therapy is like and I use several means of increasing my own self-awareness. Or you could pretend that the interpersonal is not relevant and just do med management.

 

[Doctor Bagel]

I think this comes from the perspective that a significant part of what we do depends on the interpersonal factors. The more awareness we have of what is going on with ourselves, then the clearer we can be about understanding the projections and perceptions of our patients. I actually believe that the few practice sessions that I have had throughout my training were sufficient experience of what therapy is like and I use several means of increasing my own self-awareness. Or you could pretend that the interpersonal is not relevant and just do med management.

Mainly this. It probably depends on the type of work you're doing, too. If you're sticking with medication management or even more strictly behavioral type of psychotherapy, maybe it's less important, but if you're delving into deeper territory with your patients, it's probably good that you've done some of your own delving. Even without a clear diagnosis of a "mental illness," I think we call carry around a lot of issues that could be problematic in doing more intensive work with others.

Of course the other question is how do you view psychotherapy -- is it just to fix some clearly defined issue, or can be it be about improved understanding and overall functioning even if your baseline functioning is OK. The latter might not be easily covered by insurance, but I'd argue that it still has value.

 

[Armadillos]

To play devil's advocate here.
Seems kind of strange to get therapy if you weren't suffering from mental illness. Raises questions of if therapy is truly a treatment for illness, or rather a general self help experience that everyone could benefit from? If its just something that everyone could benefit from, why do providers try to make it so "clinical" in nature?
(This concern doesn't really apply to analysis, because it seems to have expressly different goals than other types of therapy)

 

[SmallBird]

To play devil's advocate here.
Seems kind of strange to get therapy if you weren't suffering from mental illness. Raises questions of if therapy is truly a treatment for illness, or rather a general self help experience that everyone could benefit from? If its just something that everyone could benefit from, why do providers try to make it so "clinical" in nature?
(This concern doesn't really apply to analysis, because it seems to have expressly different goals than other types of therapy)

I would say that in many cases the goals of ongoing, dynamic therapy (Which is what I would imagine most residents are doing) are similar to analysis.

 

[smalltownpsych]

To play devil's advocate here.
Seems kind of strange to get therapy if you weren't suffering from mental illness. Raises questions of if therapy is truly a treatment for illness, or rather a general self help experience that everyone could benefit from? If its just something that everyone could benefit from, why do providers try to make it so "clinical" in nature?
(This concern doesn't really apply to analysis, because it seems to have expressly different goals than other types of therapy)

I would say that psychotherapy can be both. I have seen patients that see me for help with more typical difficulties that we all face and would be fine without therapy, but find it a useful option to help navigate a problem and discover more about themselves and their relationships. However, most of my patients struggle with more severe symptoms that are undeniably "clinical". Even from more of a CBT standpoint, people can benefit from more awareness of their maladaptive vs adaptive coping strategies and rational vs. irrational beliefs. It doesn't have to be a "deep" experience to uncover the unknown layers of a person's psyche. That is an unfortunate holdover of Freudian thinking. Therapy can be as simple as getting to know a persons strengths and weaknesses and helping them to maximize their strengths and minimize the weaknesses. It gets a little more complex when you start to explore the relationship patterns, but it is far from being mystical.

 

[smalltownpsych]

As I read the above post, it sounds a bit too reductionistic. Having expertise with treatment of some specific disorders and understanding the mechanisms of that treatment is vital, too. For example, Exposure Response Prevention for OCD, Exposure Therapies for PTSD, Motivational Interviewing for substance use, DBT for Borderline, etc.
Don't want to throw my own skill set under the bus!