Finding a therapist is really difficult (anxiety issue)
Discussion
I am currently having counselling for the first time in my life (50) after a GP referral. Like you all sorted that day through work via BUPA.
I didn’t ask for a list and they just assigned someone to me. I don’t know her surname, never met her (all done over the phone), have no idea if she’s a doctor, and it’s been brilliant.
My advice would be to just pick one and crack on. If you don’t get on with them you’ll be able to swap anyway and the longer you leave it the harder it becomes.
It really helps and the sooner you start to sooner you’ll start to feel better.
Hope it goes well.
I didn’t ask for a list and they just assigned someone to me. I don’t know her surname, never met her (all done over the phone), have no idea if she’s a doctor, and it’s been brilliant.
My advice would be to just pick one and crack on. If you don’t get on with them you’ll be able to swap anyway and the longer you leave it the harder it becomes.
It really helps and the sooner you start to sooner you’ll start to feel better.
Hope it goes well.
As above, distance isn’t an issue. My therapist is in the same town as me but usually 4500 miles away when we speak via teams.
CBT isn’t a switch. You should consider medication as a solution in the interim, 2-3days of a debilitating anxiety spiral isn’t something you should just deal with. You’ll need a prescribing psychiatrist for that.
Your first session should address how you want to be treated but it helps if who you are using has prescribing ability in house.
CBT isn’t a switch. You should consider medication as a solution in the interim, 2-3days of a debilitating anxiety spiral isn’t something you should just deal with. You’ll need a prescribing psychiatrist for that.
Your first session should address how you want to be treated but it helps if who you are using has prescribing ability in house.
Thank you both - but what do you mean "prescribing psychiatrist"? How do I determine which of the 30 that's listed (or however many), are able to do this? I don't see it clearly listed.
You've both helped me re-think my view of trying to get an in-person appointment. Will look at any of them across the UK and just go for a remote option
EDIT: I am wondering if I should be on the medication by default - even though about 70% of the time I am absolutely fine. I'll obviously address that whenever I see the therapist person
You've both helped me re-think my view of trying to get an in-person appointment. Will look at any of them across the UK and just go for a remote option
EDIT: I am wondering if I should be on the medication by default - even though about 70% of the time I am absolutely fine. I'll obviously address that whenever I see the therapist person
It’s probably not the correct term and I’m in a different country. Just when I started this years back there was only one person in the practice qualified to prescribe drugs.
I tried talking therapies but got to the point where I asked for the meds. No shame in it. Do what works for you.
I tried talking therapies but got to the point where I asked for the meds. No shame in it. Do what works for you.
redrabbit29 said:
Thank you both - but what do you mean "prescribing psychiatrist"? How do I determine which of the 30 that's listed (or however many), are able to do this? I don't see it clearly listed.
You've both helped me re-think my view of trying to get an in-person appointment. Will look at any of them across the UK and just go for a remote option
EDIT: I am wondering if I should be on the medication by default - even though about 70% of the time I am absolutely fine. I'll obviously address that whenever I see the therapist person
A therapist/counsellor/psychotherapist isn't a medical doctor and so cannot prescribe medication; you'd need a GP for that.You've both helped me re-think my view of trying to get an in-person appointment. Will look at any of them across the UK and just go for a remote option
EDIT: I am wondering if I should be on the medication by default - even though about 70% of the time I am absolutely fine. I'll obviously address that whenever I see the therapist person
A psychiatrist is a medically qualified doctor who has chosen to specialise in psychiatry and as such can prescribe medication.
The easiest way to tell from a list is that the ones with the prefix "Dr" are the psychiatrists (although I'd Google any individual you're interested in to see which areas they specialise in). They charge a lot more IME too!
Animal said:
A therapist/counsellor/psychotherapist isn't a medical doctor and so cannot prescribe medication; you'd need a GP for that.
A psychiatrist is a medically qualified doctor who has chosen to specialise in psychiatry and as such can prescribe medication.
The easiest way to tell from a list is that the ones with the prefix "Dr" are the psychiatrists (although I'd Google any individual you're interested in to see which areas they specialise in). They charge a lot more IME too!
TBF all the clinical psychologists I worked with in the NHS were PhD so entitled to call themselves Dr as will many counsellors who have PhDs in teaching, nursing all sorts. Most counsellors have a career in something else before training.A psychiatrist is a medically qualified doctor who has chosen to specialise in psychiatry and as such can prescribe medication.
The easiest way to tell from a list is that the ones with the prefix "Dr" are the psychiatrists (although I'd Google any individual you're interested in to see which areas they specialise in). They charge a lot more IME too!
Despite this, sensible counsellors or psychologists with a PhD either won't use the title Dr or make cllear they're not medics to avoid confusion and falling foul of the Medical Act - (impersonating a medical practitioner being a criminal act).
Psychiatrists will make it clear they are medically qualified as it's a USP and, as Animal correctly indicates, also distiguished by their consultation fees.
The common and effective medications for anxiety are prescribed in General Practice and most patients taking medication for anxiety will have been prescribed and (hopefully) supervised by GP and been nowhere near a psychiatrist.
I think clinical psychologist (ideally one who works in NHS) is a good choice as they will have the right skills; will know when to involve a doctor and will be happy to work alongside a medic prescribing medication.
More mild to moderate anxiety, there is a lot to be said for self management. Self help books. Mindfulness, breathwork, exercise outside. I found mindfulness a game changer almost like a brain reboot but it requires commitment and patience. Self management can sit alongside help from outside and I'd be wary of a practitioner who displays scepticism of your own efforts.
The best evidence for good going anxiety is medication (usually antidepressants in higher doses than used for depression) plus CBT. Whether you need or want to take medication, the attitude of a practitioner to its use is a pretty good indicator of their quality. If opposed to medication it's an indicator that they are a 'fringe' practitioner; inexperienced in people who really struggle and/or ideologically hidebound.
oddman said:
More mild to moderate anxiety, there is a lot to be said for self management. Self help books. Mindfulness, breathwork, exercise outside. I found mindfulness a game changer almost like a brain reboot but it requires commitment and patience. Self management can sit alongside help from outside and I'd be wary of a practitioner who displays scepticism of your own efforts.
The best evidence for good going anxiety is medication (usually antidepressants in higher doses than used for depression) plus CBT. Whether you need or want to take medication, the attitude of a practitioner to its use is a pretty good indicator of their quality. If opposed to medication it's an indicator that they are a 'fringe' practitioner; inexperienced in people who really struggle and/or ideologically hidebound.
Thanks that is really helpful. Expanding my search to the whole of the UK (for video appointments), I can see many different clinical consultants and medical psychiatrists. I'm really busy today, but my number one task is to make an appointment with one of them. The best evidence for good going anxiety is medication (usually antidepressants in higher doses than used for depression) plus CBT. Whether you need or want to take medication, the attitude of a practitioner to its use is a pretty good indicator of their quality. If opposed to medication it's an indicator that they are a 'fringe' practitioner; inexperienced in people who really struggle and/or ideologically hidebound.
I think I would like extra assistance. I am a deep thinker. I know about breath work, I exercise a ton, I do a journal (rarely but when I feel like updating it). I think I'd like framework, some "home work" and instructions. Something that I can use when I feel that anxiety episode starting.
EXAMPLE
I'll give you an example, and I feel pretty pathetic sharing this...
A while back a colleague on the East coast of the US asked me "Hey, would you mind doing a client presentation (online) as it really conflicts with my timezones. I am doing all the slides and prep work - you just have to deliver it""
Me: Yea sure, I can do that
I then join a client call as his prep work continued, with the purpose being that I can say hi and get to know them a bit ...
... a week later I get up and after he's logged off I see he's emailed me and a few others:
Him: Hey, the client keeps asking for calls. Do you feel comfortable taking over everything from this point on?
I didn't feel comfortable, as I'd only been on one call, I had no real idea of the status of the whole thing or what was required. I felt he was unfairly dumping it on me and he was not online to discuss it.
So that caused me all day to fret, become annoyed, frustrated, then panic, then worry about how to phrase my unhappiness back to him. Shaking, etc. really really stupid.
I am 40 years old, I was previously working in a role which is heavily based around confrontation and communication. Yet I fall to bits over that kind of thing.
Anyway, after about 5-6 hours of this, all day long, my day ruined, I email back:
Me: Hey, I'm really sorry but I don't feel that comfortable with this as I missed all previous calls and have no understanding of their requirements, deliverables or the status. I feel this could be a bad move as I'd be coming in half way through but with no knowledge..... blah blah
Him: Of course, that makes sense and you raise some good points.
All absolutely fine. however I'd worked myself up into a massive state over it.
I previously had therapy and the woman there spoke a lot about the "Adult-Parent-Child" relationships. In that situation, I was acting as a child, feeling vulnerable and looking for validation, worrying about what the parent would say - a completely wrong relationship.
Look up a local to you client-centred therapist on the BACP website and go and see them. They will listen. Nothing you've written leads me to think you'd benefit from medication and your reaction to the work scene you've described is well within the bounds of normal behaviour, though to you I understand it may well feel different.
I'm a qualified counsellor/psychotherapist in the NHS.
I'm a qualified counsellor/psychotherapist in the NHS.
popeyewhite said:
Look up a local to you client-centred therapist on the BACP website and go and see them. They will listen. Nothing you've written leads me to think you'd benefit from medication and your reaction to the work scene you've described is well within the bounds of normal behaviour, though to you I understand it may well feel different.
I'm a qualified counsellor/psychotherapist in the NHS.
Thanks popeye, that's very helpfulI'm a qualified counsellor/psychotherapist in the NHS.
popeyewhite said:
Look up a local to you client-centred therapist on the BACP website and go and see them. They will listen. Nothing you've written leads me to think you'd benefit from medication and your reaction to the work scene you've described is well within the bounds of normal behaviour, though to you I understand it may well feel different.
I'm a qualified counsellor/psychotherapist in the NHS.
Agree. I'm a retired psychiatrist and trained in CBT. Point I was making about medication isI'm a qualified counsellor/psychotherapist in the NHS.
a) Most prescribing is done by GPs so seeing psychiatrist for medication is unecessary
b) A dogmatic anti medication stance in any therapist is a red flag for me.
BACP is a good call.
Having experience of CBT and mindfulness, I think they are trying to get to the same issue by different routes ie. identify and tackle unhelpful thoughts.
In some rare situations eg. severe OCD, medication seems to directly interrupt the abnormal thought process but in general it just seems to have generic antianxiety effect. I wouldn't recommend for mild to moderate anxiety. Too risky. Other options better. Philosophically it is appealing for a patient to overcome their difficulties by themselves, albeit with some help.
CBT looks at the antecedents and thinking associated with anxiety symptoms. Likely to involve diary keeping, thought records - 'homework' if you like. In my experience some people find it very difficult to 'catch' their thinking in the heat of the moment so it can sometimes take a bit of practice and time to bring useful information to the therapist. Probably appeals to the more analytical. Definitely for those who want to participate rather than be 'fixed'.
Mindfulness/Meditation provides a laboratory or space for thoughts to happen. Involves daily routine meditation practice of IMO minimum 20 minutes. As thoughts intrude into meditation (which they always do), in time, they take on a more distant/objective quality which may reduce their power. My experience of mindfulness practice (everyone has a unique experience) was that thoughts that intruded were mostly banal but when something upsetting popped up during meditation, it was isolated from an emotional reaction and as banal as the other 'what shall I have for tea?' type thoughts that intruded. This had the effect of defusing their power and recognising them as thoughts like any other, transient, neither 'true' or 'real', was very helpful. Some people find the experience of meditation very upsetting (typically people who have experienced trauma) and others really struggle to stop intrusive thoughts buzzing and it gets very frustrating. Others aren't persuaded by the rather nebulous nature/offer of meditation. There are some specific guided meditations called 'body scan' meditations (usually 20 to 40 minutes lying down) which I, and others find very calming and helpful and could probably be dipped into outside of regular practice to good effect.
In my experience patients with anxiety are constantly making predictions. Usually of a 'What if....' nature. The irony is despite making loads of predications, they are really s
t at it and don't get better despite all their experience doing it! CBT and Mindfulness both are ways of making those affected aware of their patterns of thinking. In the case of CBT recognising, for instance, predictions; naming them; asking not necessarily 'is it true?' but 'is it useful? and getting some udenrstanding and control of them. Most people seeking CBT will encounter barriers to progress and dealing with these personal idiosyncasies that get in the way is the business of therapists way more skilled and experienced than me.oddman said:
Agree. I'm a retired psychiatrist and trained in CBT. Point I was making about medication is
a) Most prescribing is done by GPs so seeing psychiatrist for medication is unecessary
b) A dogmatic anti medication stance in any therapist is a red flag for me.
BACP is a good call.
Thank you, I have the BACP website open now, and I am very open minded about treatment options. I agree with point two, I wouldn't feel comfortable having medication thrown at me as a primary solution. a) Most prescribing is done by GPs so seeing psychiatrist for medication is unecessary
b) A dogmatic anti medication stance in any therapist is a red flag for me.
BACP is a good call.
oddman said:
Having experience of CBT and mindfulness, I think they are trying to get to the same issue by different routes ie. identify and tackle unhelpful thoughts.
Makes complete sense, it is unhelpful thoughts. They serve no purpose and often are just catastrophising a particular situation. oddman said:
Philosophically it is appealing for a patient to overcome their difficulties by themselves, albeit with some help.
CBT looks at the antecedents and thinking associated with anxiety symptoms. Likely to involve diary keeping, thought records - 'homework' if you like.
That sounds good, I like the idea of home work. I keep a journal now - more like a life log where I update on all manner of things. Sometimes just once a month but sometimes 3-4 times in a week depending on my mood. I am a very deep thinker which is good and bad for obvious reasons!CBT looks at the antecedents and thinking associated with anxiety symptoms. Likely to involve diary keeping, thought records - 'homework' if you like.
oddman said:
Mindfulness/Meditation... <snip>
Thankfully I have no trauma and I am not emotional in the pure sense of the word. I have in the past flirted with the idea of meditation but not properly tried it. I have read some guides too on breathin patterns, also on the 5 things you can see, 4 things you can hear thing. Would happily try it but I do have some doubts over whether meditation is "my thing" or not. oddman said:
In my experience patients with anxiety are constantly making predictions. Usually of a 'What if....' nature. The irony is despite making loads of predications, they are really st at it
That is me pretty much and why I think it's less about meditation and more about changing my mindset and brain's reaction. I know it's ridiculous but I often just spiral downwards quickly and then sometime later (4-5 hours or the next day) it's all absolutely fine again. t at it My knowledge about this is non-existent compare to you, but it's like I need to readjust my mind's reaction and thought process. A bit like changing someone's reaction from "OMG, the weather is absolutely s
t today" .. to "I am so glad I am off work today and have the whole day free" - that kind of thing. Thanks for the great response and detailed thoughts!
You're welcome
It does sound like you are a CBT kind of guy. These are a couple of body scan medititations to try.
This is Mark Williams Body Scan. He's part of the Oxford group who have published a lot of the research and popular guide to mindfulness - cover on the YT link
Jon Kabat Zinn's Body scan medication It's a bit American in language but this is my 'go to'.
I found them very helpful right from the first time I tried but they probably need a few repeats before writing off.
It does sound like you are a CBT kind of guy. These are a couple of body scan medititations to try.
This is Mark Williams Body Scan. He's part of the Oxford group who have published a lot of the research and popular guide to mindfulness - cover on the YT link
Jon Kabat Zinn's Body scan medication It's a bit American in language but this is my 'go to'.
I found them very helpful right from the first time I tried but they probably need a few repeats before writing off.
I have been dealing with anxiety for around 18 months. I have been using an app called DARE and I have also read a book by Claire Weeks called 'hope and help for your nerves'. I would recommend both to you. I have also had counselling and done a CBT course. I refused medication.
I have found the app the most helpful. It aims for a full recovery, using acceptance as the key. Stop fighting yourself.
It's not easy, and you have my sympathy. You are not alone. Anxiety is very common, and so are all the symptoms, as weird or unique as they may feel.
Believe in yourself. You CAN and you WILL recover. It just takes time.
I have found the app the most helpful. It aims for a full recovery, using acceptance as the key. Stop fighting yourself.
It's not easy, and you have my sympathy. You are not alone. Anxiety is very common, and so are all the symptoms, as weird or unique as they may feel.
Believe in yourself. You CAN and you WILL recover. It just takes time.
oddman said:
You're welcome
It does sound like you are a CBT kind of guy. These are a couple of body scan medititations to try.
<snip>
Thank you, I did look at these and have added to my Favourites on YouTube. I have a few days off from work (Friday-Monday) so going to try these out. It does sound like you are a CBT kind of guy. These are a couple of body scan medititations to try.
<snip>
unclemark123 said:
I have been dealing with anxiety for around 18 months. I have been using an app called DARE and I have also read a book by Claire Weeks called 'hope and help for your nerves'.
Stop fighting yourself.
Anxiety is very common, and so are all the symptoms, as weird or unique as they may feel.
Believe in yourself. You CAN and you WILL recover. It just takes time.
Great reply - thank you for sharing your experiences and that app (which I'd not heard of). I will look at the book too. I've heard similar advice about "stop fighting", and people saying about recognising the feelings but the technique of kind of absorbing it, reframing it and putting it to the side. Quite tough mentally but I think I could do that with some practice.Stop fighting yourself.
Anxiety is very common, and so are all the symptoms, as weird or unique as they may feel.
Believe in yourself. You CAN and you WILL recover. It just takes time.
No update regarding Counselling. I have now emailed 8 different counsellors and all have replied saying they do not have capacity for any new patients. Pretty frustrating.
I'm going to try to contact another 3 today in the hope that one does have space.
I started out carefully reading their bios, viewing their site, considering if I'd click with them. But now I'm just getting less picky which I'm not sure is a good thing, as I think it does matter to an extent that you get on with them and they're someone you can engage properly with.
I'm going to try to contact another 3 today in the hope that one does have space.
I started out carefully reading their bios, viewing their site, considering if I'd click with them. But now I'm just getting less picky which I'm not sure is a good thing, as I think it does matter to an extent that you get on with them and they're someone you can engage properly with.
redrabbit29 said:
No update regarding Counselling. I have now emailed 8 different counsellors and all have replied saying they do not have capacity for any new patients. Pretty frustrating.
I'm going to try to contact another 3 today in the hope that one does have space.
I started out carefully reading their bios, viewing their site, considering if I'd click with them. But now I'm just getting less picky which I'm not sure is a good thing, as I think it does matter to an extent that you get on with them and they're someone you can engage properly with.
Sorry to hear your woes. There's many many people using the services of counsellors at the moment. Keep trying would be my advice, and bear in mind it's the process of building trust during the counselling itself, rather than having anything in common with the practitioner that is the driving factor in a fruitful therapeutic relationship. Good luck!I'm going to try to contact another 3 today in the hope that one does have space.
I started out carefully reading their bios, viewing their site, considering if I'd click with them. But now I'm just getting less picky which I'm not sure is a good thing, as I think it does matter to an extent that you get on with them and they're someone you can engage properly with.
In my experience of anxiety all my life, I have not got to where I want to but I do understand way more about my chemistry and trauma underlying stuff now.
I saw some counsellors over the years who were like a good friend at best. You could consider a psychologist instead. Even then you need to be careful to find a decent one who you feel gets and understands what you are saying and helps you get to the bottom of it.
Tv makes out that these guys have answers for us, it's not how it works. They help you to figure it out and support you with the right tools. There are some good ones out there and a lot of crap ones, just because they are qualified does not mean they are any good (think like tradesmen).
There are tons of self help stuff out there but you cannot beat the feeling of support and understanding! Good luck! There has never been a better time to have these issues with all that is available to us.
I saw some counsellors over the years who were like a good friend at best. You could consider a psychologist instead. Even then you need to be careful to find a decent one who you feel gets and understands what you are saying and helps you get to the bottom of it.
Tv makes out that these guys have answers for us, it's not how it works. They help you to figure it out and support you with the right tools. There are some good ones out there and a lot of crap ones, just because they are qualified does not mean they are any good (think like tradesmen).
There are tons of self help stuff out there but you cannot beat the feeling of support and understanding! Good luck! There has never been a better time to have these issues with all that is available to us.
I just started counselling again as things came to a head over NY - new and recent constant back pain was triggering for some reason.
I was recommended a psychotherapist. She had a full schedule and couldn’t see me for a while but a regular slot then became available. But thankfully I immediately trusted and really liked her - and I think that is key - to opening up.
As you’ll probably know, they won’t provide answers to your questions or issues, the idea is they provide very good signposts and tools for you to work around any issues you have. And it will take time and a fair bit homework.
I’ll freely admit I have a bit of ‘trauma’ mainly due to a lengthy period where my wife was very ill and I thought she was going to die. Coupled with a perfectionist personality trait, I flirt with anxiety a little too much now.
I figured I’m going to have to deal with this….. then the floodgates opened! Turns out there quite a lot of things I need to work on! I can clearly see links between lots of little negative experiences that led to the pot boiling over at NY.
Not necessarily to the OP, but don’t ever be too sure that you’ve never had any trauma in your life. I think most people will experience events that require some complex mental gymnastics and don’t seem then as trauma. And we think we’ve dealt with them.
That is until we find we haven’t.
As above posters have said, I think the self help path with mindfulness etc is really beneficial, BUT bouncing thoughts around with a counsellor / therapist means that it’s harder to skip or miss the important things.
Good luck with finding someone who you can work with. Just getting the first appointment was a huge relief for me.
I was recommended a psychotherapist. She had a full schedule and couldn’t see me for a while but a regular slot then became available. But thankfully I immediately trusted and really liked her - and I think that is key - to opening up.
As you’ll probably know, they won’t provide answers to your questions or issues, the idea is they provide very good signposts and tools for you to work around any issues you have. And it will take time and a fair bit homework.
I’ll freely admit I have a bit of ‘trauma’ mainly due to a lengthy period where my wife was very ill and I thought she was going to die. Coupled with a perfectionist personality trait, I flirt with anxiety a little too much now.
I figured I’m going to have to deal with this….. then the floodgates opened! Turns out there quite a lot of things I need to work on! I can clearly see links between lots of little negative experiences that led to the pot boiling over at NY.
Not necessarily to the OP, but don’t ever be too sure that you’ve never had any trauma in your life. I think most people will experience events that require some complex mental gymnastics and don’t seem then as trauma. And we think we’ve dealt with them.
That is until we find we haven’t.
As above posters have said, I think the self help path with mindfulness etc is really beneficial, BUT bouncing thoughts around with a counsellor / therapist means that it’s harder to skip or miss the important things.
Good luck with finding someone who you can work with. Just getting the first appointment was a huge relief for me.
popeyewhite said:
Sorry to hear your woes. There's many many people using the services of counsellors at the moment. Keep trying would be my advice, and bear in mind it's the process of building trust during the counselling itself, rather than having anything in common with the practitioner that is the driving factor in a fruitful therapeutic relationship. Good luck!
Thank you - really good advice, makes complete sense. Unbelievably, I've now had 11 responses from separate therapists with no availability. I'll send out another 2-3 requests today.
White-Noise said:
They help you to figure it out and support you with the right tools. There are some good ones out there and a lot of crap ones, just because they are qualified does not mean they are any good (think like tradesmen).
There are tons of self help stuff out there but you cannot beat the feeling of support and understanding! Good luck! .
Thanks - yep agree with all you said. I've had conselling a couple of times before, and like you said, it's not about them advising or giving you answers, it's self-discovery. There's been some really good occasions where they've clearly led me down some path based on something I said, and then I've realised something at the end of it.There are tons of self help stuff out there but you cannot beat the feeling of support and understanding! Good luck! .
thepritch said:
But thankfully I immediately trusted and really liked her - and I think that is key - to opening up.
...
As you’ll probably know, they won’t provide answers to your questions or issues, the idea is they provide very good signposts and tools for you to work around any issues you have. And it will take time and a fair bit homework.
....
Just getting the first appointment was a huge relief for me.
Thanks for the really useful responses. I'm someone who will speak to anyone, so I'd happily bear my sole to a random in a pub as quickly as I would to a counsellor. As a result, I think I'm quite confident in finding someone who I can connect and have a relationship with....
As you’ll probably know, they won’t provide answers to your questions or issues, the idea is they provide very good signposts and tools for you to work around any issues you have. And it will take time and a fair bit homework.
....
Just getting the first appointment was a huge relief for me.
Glad you found some really good support with it all. When I've had counselling in the past, it's really helped release some pressure from me, just having that hour slot of someone listening and not judging was good.
I'm still looking unfortunately - as stated above, 11 therapists replied saying they don't have any availability. I think I've been blacklisted
... but I'll send out another few emails today.Gassing Station | Health Matters | Top of Page | What's New | My Stuff