Dear Dr. Dan: My adult daughter is in desperate need of psychological counseling. She has been unhappy for a long, long time but rarely talked about her feelings and, for the most part, has been putting on a brave front that has broken down due to a recent personal rejection. She has been home since this happened, crying uncontrollably and missing work.
She finally said she was depressed and accepted my offer to find professional help. How can I help?
Dear Concerned: Depression can be debilitating but it is also quite treatable with a combination of medication and psychotherapy. In today’s mental-health world, that usually means two different people: one for medication and another for psychotherapy.
Medical doctors such as psychiatrists, internists and family physicians have the authority to prescribe antidepressant and other drugs. But most psychotherapy these days is done by various kinds of licensed mental-health professionals (psychologists, social workers and family therapists). Psychotherapists who treat depression generally are used to working in conjunction with a prescribing physician.
Finding a good therapist may take some research, which is especially difficult for someone who is depressed. So I’m happy that your daughter is open to your offer of help. The best way to find a good therapist is through word-of-mouth. Ask friends or relatives if they have ever seen or know of a psychotherapist they have been happy with. A family doctor might know a name but is less likely to have specific knowledge of the person’s clinical skills.
If you can’t get a personal recommendation, find out from your insurance carrier who in your area it reimburses. Then have your daughter begin to make calls. Most therapists should be willing to spend a couple of minutes on the phone. (If not, call another therapist.)
Some issues to cover:
Make sure the therapist is a licensed mental-health professional with experience treating depression.
Find out how much a session costs and how long the therapy takes, on average.
Perhaps most important, your daughter – or anyone seeking therapy – should get a sense of whether she would be comfortable with that clinician.
If all is good, make an initial appointment. This first session is really a two-way evaluation, as both will be deciding if they can work together. Your daughter probably won’t feel completely safe with a new person but she should get a sense of competency and a feeling that she is understood.
Hopefully, she will leave with an idea of how that therapist works and how long treatment typically lasts. I wouldn’t be comfortable with a therapist who says it will be X number of sessions because I wouldn’t want a “one-size-fits-all” treatment (although health-insurance companies may push in that direction). On the other hand, therapy should not take years.
Finding a physician for medication is easier. Psychotherapists often can recommend a medical doctor they have worked with. I also sometimes encourage new patients to start with their family doctor. Family physicians and internists are pretty knowledgeable about depression and medication, and this is generally the easiest and least expensive way to begin.
If the first drug prescribed is not effective, or if there are too many side effects, don’t worry; it’s sometimes difficult to find the right medication on the first try. Even if you do, it could take four to six weeks to see results. If one or two tries with the family doctor don’t work, I think it is important to see a psychiatrist who can do a more thorough evaluation and who may have more knowledge about which medication, or combinations of medication, would be helpful.
If your daughter doesn’t feel at least some improvement after a few months, it might be time to review the direction of therapy, medication or both.