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Finding the right therapist—Q&A with Dr. Esme Shaller

Published on May 15th, 2018

Asking for help is a sign of strength. In honor of Mental Health Awareness Month, we talked with Esme Shaller, Ph.D. (who works at Peer Health Exchange’s college partner UC Berkeley) about the benefits of seeking support, and how to find the right therapist for you. Our interview has been edited for brevity and clarity.

Q: Why should we care about mental health awareness month?

A: Pretty much everyone will have at least one loved one that’s struggling with mental illness, at one point or another. And it’s still, you know, one of our last major frontiers of stigma. So while everyone is dealing with it, not everyone is talking about it and that’s a huge problem. I think that’s why there’s an awareness month. These have the same serious health consequences as any other physical disease so the more we can talk about it and the more people can be aware and open with it because we all know somebody, the better help people can get and the more people can feel empowered to actually do something about it.

Q: When it comes to mental health…and looking back to when you were in college or even high school, what are some things that came to mind?

A: I think it’s a lot better than it was. I do see the teens and young adults now knowing more about it and knowing when to be concerned and so I do think we’re moving in a good direction for that. My main advice and this partly comes from the fact that I work exclusively with teens who have difficulty with suicide, people who have either made suicide attempts, engaged in self-harm, or have been hospitalized before. If you’re concerned about a friend with those things don’t take it on yourself. Get support for yourself, even if you’re just supporting a friend and encourage friends who might need more support to get it.

Q: What are some questions you think are important to ask when trying to find the right therapist?

A: So one of my big sort of life work things is to make sure that people are whenever possible getting evidence-based treatment. So getting some psychotherapy that has been studied by science in some way or another. A lot of times therapists call it a theoretical orientation. How do they approach their cases and what evidence backs that up? Just asking, how do you choose how you approach my problems? A good therapist will say, well, I start with evidence. I try to use things that are backed by science. I feel like some people reading your blog might say, well, but my therapist isn’t, and she saved my life. I wouldn’t argue with the world that people have not been comforted and been helped with those kinds of things, and with a bunch of different things. I think it’s important to start where we have the most data when dealing with serious issues.

Q: How many times would you recommend visiting a potential therapist before making that long-term commitment?

A: I think going through an evaluation, and a couple of sessions is a good idea. Of course, if there’s a really big problem in that session, I’m not saying that you should go back. If somebody says something disrespectful about your race or orientation, hopefully, that wouldn’t happen because therapists are supposed to be competent in those things. You should have an evaluation that goes across a session or two, and then you get some feedback. No therapist is going to be able to tell you for sure sixteen sessions and we’ll be done no matter what, but they should have a general idea. If anybody’s trying to sign you up for therapy for the rest of your life that’s not ethical, you should be there to solve specific problems and move forward with your life goals.

Q: Are there any warning signs to look for during these visits?

A: I think some of those might be different depending on the person, depending on sort of the presenting problem, and what you’re trying to work on. I think anybody that won’t answer questions that you have. How will I know if I’m better? How do you monitor progress? You should be doing some kind of objective measure and tracking some of your thoughts and emotions and behaviors in some way. You should be keeping track so that you can see if there’s improvement or not. If there’s no method of tracking improvement, if there’s no answer to how will I know when I’m finished, or how will I know if I’ve met my goals, it might be a little bit more open-ended and it might not help you solve a problem in the short term.

Q: How can someone evaluate a positive or negative visit?

A: Ideally, your therapist is asking every time. How was this today? This work for you? What’s your take-home message? They should also be giving you some homework.  They should be having you do something in between sessions to work on the things that you’re working on, and they should also be reflecting on what’s working for you and what’s not working with you. Therapists are trained to be relatively flexible people, to be able to work with people from lots of different backgrounds with lots of different emotions and different symptoms so if there are things that aren’t working for you in the session ideally, your therapist is also asking for feedback and you can give that feedback. If something isn’t working, you should feel empowered to tell your therapist, and if you’re getting any messages that you’re not allowed to tell them, then that might be a problem.

Q: Is there any other advice you can offer for someone searching for a therapist?

A: Yeah, I think the bottom line is that it is really hard. And so, I want to acknowledge that – to find somebody who’s evidence-based and trauma-informed and respectful to you and has good goals. There are mental health deserts in the same way that there are food deserts. If you’re in an urban area, sometimes it’s the opposite. It’s almost like as opposed to a food desert, it’s all gourmet restaurants, and there’s no cafeteria, and there’s no grocery store, and it’s not just people who are living in poverty that are waiting for a program, it’s anybody that maybe has a middle-class job and has insurance but can’t pay $300 a week. It may be that there’s hardly anybody and maybe that there are people but they only take cash, and there are programs, but with long wait lists. Depending on what you need and what you’re looking for, I think, persistence is really important. It’s frustrating, and mental health care in America has a long way to go. If you’re lucky enough to be in some system that offers things, like if you’re in college and there’s the university health center or in high school and they have a wellness center take advantage of those things while they’re there because it can be really hard.

Esme Shaller, Ph.D., is an Associate Clinical Professor in the Department of Child Psychiatry at UC San Francisco and in the Department of Psychology at UC Berkeley. She is the director of the Dialectical Behavior Therapy Program at UCSF and the Clinical Director of Outpatient Services for Child Psychiatry.

Dr. Shaller’s passion lies in the teaching and dissemination of empirically supported treatments for complex psychological problems, particularly in adolescence. As such, she devotes a large percentage of her time to teaching and training, both within UCSF’s residency and fellowship programs and in the larger Bay Area community. She has worked with other members of her team to implement comprehensive DBT for low-income teens in three California Counties.

Dr. Shaller received her B.A. in psychology from UC Berkeley and her Ph.D. in clinical psychology from the State University of New York, Stony Brook. Subsequently, she completed her psychology internship at the Zucker Hillside Hospital at Long Island Jewish Medical Center in Queens, followed by a postdoctoral fellowship at Kaiser Permanente in South San Francisco. She has been at UCSF since 2007.

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