How to find a mental health provider who’s right for you

Simon Floss (host):

Hello and welcome to the latest edition of the “Health and Wellness” podcast series, brought to you by Sanford Health. I’m your host, Simon Floss, with Sanford Health News.

Mental health challenges are on the rise. Statistics show one in five U.S. adults experience mental illness each year, and one in six U.S. youths between six and 17 years old experience a mental health disorder each year. This according to the National Alliance on Mental Illness.

If you or a loved one are experiencing these concerns, you may wonder when it’s time to seek care or what kind of mental health provider best fits your needs. Here to offer guidance and support is Kayla Nalan-Sheffield and Kate Andal. Both are psychologists at Sanford Health in Sioux Falls, South Dakota. Thanks so much for being here today, both of you.

Kate Andal, PhD (guest):

Happy to join you.

Simon Floss:

So, we’ve got a lot of ground to cover in a short amount of time to get there. So, we’re going to hit the ground running here. First, when it comes to the types of mental health providers, can you explain the differences between them?

Kate Andal, PhD:

I think the first biggest distinction is the difference between psychiatry and psychology.

So, psychiatry (providers) are providers that have gone to medical school or PA school, or nurse practitioner school, and they have a prescription pad, and they help you. They prescribe medications to help you manage your mental health difficulties.

Psychology providers, which would be therapists, counselors, or psychologists, they have a graduate level education, either a master’s degree or a doctorate degree in psychology or social work or counseling, something like that. And they provide therapy services to help you develop skills to help manage your mental health difficulties.

Simon Floss:

And Kayla, all of this is so important to keep in mind when choosing the right mental health provider for you. Say someone’s noticing some things about themselves and they just don’t know where to begin. How do you get matched with the right provider?

Kayla Nalan-Sheffield, PhD, LP (guest):

Here at Sanford, we do have mental health providers, primarily counselors, embedded in all of our family med clinics. And so asking your primary care physician for a referral to there is a good place to start. Otherwise, you can reach out to the psychiatry and psychology clinic yourself and get referred to somebody.

We do have provider bios on the website as well. And so you can peruse that, see who you might think be a good fit. And the reality of our profession is that sometimes it does take a while to find somebody that you gel with. And that’s okay. So it’s not uncommon for me to see people who have seen several providers before just because they haven’t felt like they’ve found the right fit, either in personality fit, or fit in terms of type of therapy that you want to do.

Enlarge

Simon Floss:

How do you decide what the right fit is?

Kate Andal, PhD:

That’s a really good question. Some of it starts with thinking about what it is you can commit to in therapy. Does that particular therapist require you to come weekly? Sometimes that doesn’t work for people. Or can they only get you in monthly? Which sometimes feels like not enough to help you. Also, personality fit really is probably the biggest, biggest predictor. You should sit in that room with them and really feel like they understand what’s going on with you and they have a good plan. And you feel like they have your back.

That is the biggest predictor of success in therapy. Beyond all of the techniques that we learn and all of the other things there are, that fit is the biggest, and it’s a very qualitative thing. It’s hard to describe, but when you feel like you have it, that’s the person who’s probably going to help you.

Enlarge

Simon Floss:

And Kayla, piggybacking off of that, is there anything else you would add as far as anything specific that one should look for in a mental health provider?

Kayla Nalan-Sheffield, PhD, LP:

I think whatever condition you are struggling with or symptoms you’re struggling with, if you’re looking for a specific therapy modality, trauma treatment for example, there are pretty well-known treatments for addressing those concerns. And so if you’re looking for cognitive processing therapy or prolonged exposure, another kind of trauma treatment, making sure that the providers that you are potentially going to connect with have training in providing those treatments.

Simon Floss:

So, if someone has never seen any type of mental health provider, what would you say to them if they’re feeling overwhelmed and concerned, and when you’re experiencing some of these things, mental health concerns, that’s scary in and of itself. And then starting this whole journey of, “oh, I want to feel better,” and you don’t know where to begin, that’s a lot too. What would you say to people who are listening to this and might find themselves in that situation?

Kate Andal, PhD:

I think, and this is coming from my own ideas of how I would feel about it. I think the most important thing is to just start somewhere. If you go to psychiatry and you really meant therapy, no one’s going to judge you. It happens all the time. We’ll get you to the right person so you don’t have to have it all figured out or know exactly what you want before you step into the office. Just be open to having a conversation about it and we can help guide you from there.

Kayla Nalan-Sheffield, PhD, LP:

I would also add to that, I think a lot of people feel that they are alone in whatever experience they are going through. And just recognizing that that’s not reflective of reality. Lots of people struggle in very similar ways. So, just taking that first step, I do think in and of itself is helpful for people in healing, for people just kind of admitting that they do need help and kind of breathe that out, so to speak. And of course, as Dr. Andal said too we can help you connect with whatever you need, just connect with somebody.

Simon Floss:

Some people might say asking for help is a sign of weakness, but it’s actually the complete contrast – when you notice you’re going through some challenges and you might need a little bit of help, asking for help is actually one of the most courageous things that you could possibly do. Is there anything that either of you two would piggyback off of that?

Kate Andal, PhD:

There’s actually a whole bunch of research particularly about Midwestern and rural Midwestern values of self-sufficiency and the ideas that seeking help and helping and those kinds of behaviors somehow represent your inability to be self-sufficient, which Midwesterners will agree is not a thing any of us want to be. And I think the mental health community has worked really hard over the last couple of decades really trying to combat that idea because none of us are truly self-sufficient.

And I would argue that humans are not meant to be self-sufficient. We are meant to have connections and relationships and depend on each other and have a sense of community, that all of those things are really important. And seeking mental health services, I think, falls neatly into that package as opposed to just trying to do the whole “I can handle it” thing.

Simon Floss:

And we’ve talked a lot about if you’re noticing some challenges within yourself, and I think we should identify some of those so we’re not speaking so broadly. So, at what point should an individual take steps to get help, or maybe what are some signs that someone isn’t doing well?

Kayla Nalan-Sheffield, PhD, LP:

Sure. I think biggest thing that I would encourage people to look for is whether they’ve noticed a change in their functioning, whether that’s at school, work, relationships. If you’re not sleeping well, if your appetite changes, if you just notice any difficulty with coping like you normally would or you’re used to coping with, that would be a sign that you might need to ask for some help.

Simon Floss:

Sleeping is a big one. When I have experienced challenges myself, I could not fall asleep at all – and then it took every single possible thing (I had) to get out of bed in the morning. And at that point I was like, OK, something’s going on (laugh) and I’ve got to do something about it. How should someone prepare for their initial appointment?

Kate Andal, PhD:

Well, it’s not a test. (laugh) You don’t have to study for it like it’s homework. But just have a general idea and be ready to talk about what’s going on with you. Sometimes I see patients who try to control the narrative by having certain topics be off limits because they’ve decided that it’s not important. And sometimes that can hinder our progress because sometimes things you think aren’t important are in fact important.

Simon Floss:

So similar to any sort of provider, you two can only help someone if they’re honest, you know what I mean? If you go to your primary care provider and let’s say you’re having some digestive issues, they don’t know that unless you tell them. And so how important is it to – it takes a lot of courage and it’s really hard – but how important is it to be completely honest in therapy and talking with providers?

Kayla Nalan-Sheffield, PhD, LP:

Yeah, you’re exactly right. We don’t know what we don’t know. We can’t treat what we don’t know is a concern. And at the same time, that first visit in and of itself does take a lot of gumption to get up and do. So we also recognize that we might not always know the full picture in that first visit. And there are certainly things people might not feel comfortable disclosing until later on, but we obviously would hope that you get to a point with your provider where you trust them and feel comfortable with them enough to be able to talk to them about that at some point.

Kate Andal, PhD:

I think it was your patient and you’d been doing depression treatment with them for a long time, and they just weren’t getting better. They weren’t getting better and we couldn’t figure out why because they were doing all this stuff, but it just, it wasn’t getting better. And then they disclosed they had trauma. And we were like, oh yeah. So that would’ve been useful to know a while ago.

Kayla Nalan-Sheffield, PhD, LP:

And they did trauma treatment.

Kate Andal, PhD:

And then they got better.

Kayla Nalan-Sheffield, PhD, LP:

Yeah. Yep.

Simon Floss:

So, what are some of the differences, or if there’s even similarities too, between things like depression, anxiety, bipolar disorder, a lot of the mental health challenges that you see people facing?

Kate Andal, PhD:

Sure. So, one of the things I always think about with things like depression, anxiety is those are also emotions. They’re emotions and then they can also be a disorder. So if you’re feeling depressed, that doesn’t necessarily mean you have depression because we all get depressed sometimes.

But if you are feeling sad or depressed or down, or if you’re just feeling kind of blah and nothing sounds good or fun or interesting anymore and that persists for a couple of weeks, then you’re looking at more of a depression. Like a clinical level of depression.

Anxiety on the other hand tends to be more worry-based or future fear-based kinds of, you know, thinking something bad’s going to happen or you have to be in control of everything and it’s a little more agitated, I would say.

And then bipolar disorder specifically is episodic. So you have episodes of depression that last a few weeks and then periods of stability and then you have manic episodes. And those manic episodes involve, you know, feeling amazing. Doesn’t usually work out well, but you feel pretty good for a while with impulsive behavior and risk taking and really poor sleep.

Kayla Nalan-Sheffield, PhD, LP:

Yes. Sleeping very little, but not being tired. Starting a lot of projects, not finishing them.

Kate Andal, PhD:

Things like that. And the sleep thing is important because it’s not “can’t sleep,” it’s “don’t need to sleep.” Most disorders have sleep disturbance as a criteria for them, but it’s usually either feeling tired all the time and trying to sleep all the time or being unable to fall asleep either because you can’t quiet your mind or you’re just restless or you’re ruminating or whatever. But with manic episodes, you don’t feel the need for sleep. You’re not tired.

Kayla Nalan-Sheffield, PhD, LP:

I think there’s a lot of misconception about bipolar disorder in particular because a lot of people will experience mood swings that are fairly rapid.

But in bipolar disorder, the highs and lows do tend to last longer. Four or more days, two or more weeks, kind of depending on whether you’re talking about the depression side or the mania or hypomania side.

So, I just wanted to kind of clarify that because I do think that is one thing that I see often is people say, “well, my mood changes a lot and very quickly I think I have bipolar disorder.” It’s a little bit different than that.

Simon Floss:

So, it might be a little bit longer timeframe, what you’re saying, than people might expect?

Kate Andal, PhD:

Right. The highs. And when people tell us that they’re experiencing mood swings lasting a couple of hours or even a day or so, that’s not likely to be a manic episode. That is more likely to just be having trouble regulating your emotions, or being emotionally labile is the term for it.

Simon Floss:

Hmm. What are some tips to regulate your emotions?

Kayla Nalan-Sheffield, PhD, LP:

One of my favorite skills to teach is the tips skill from dialectical behavior therapy, specifically the temperature change. So, if really dysregulated, changing your temperature and this time of year in the winter is kind of nice because you can just walk outside and you’ll be cold, right? In the summertime and really cold shower or splashing cold water on your face, something like that.

Intense exercise. So, doing some squats pretty rapidly or running in place, just trying to get your heart rate elevated. Paced breathing, muscle relaxation. That’s kind of my go-to. I feel like a lot of patients respond pretty well to that.

Kate Andal, PhD:

And you can teach kids that.

Kayla Nalan-Sheffield, PhD, LP:

Yes. Yeah. My daughter responds well to ice packs (laugh) on the face.

Simon Floss:

Yeah. Yep. I take cold showers, so yeah. Not during the winter, obviously, because it’s like, I just, I don’t need that much cold in my life.

Kayla Nalan-Sheffield, PhD, LP:

(Laugh)

Simon Floss:

What would maybe be like, what are some of the biggest misconceptions that you see in your line of work?

Kate Andal, PhD:

The fact that we don’t have a magic wand. You’re not going to come to therapy for one session and you’re not going to walk out with a cure. That’s not how it works. Therapy is really an investment and in developing a skill to manage your symptoms, I would say the other one just left my brain. I had it in my head and then I left it. So (laugh), I got nothing.

Kayla Nalan-Sheffield, PhD, LP:

No, I would agree. I do think people sometimes do expect us to be able to solve whatever their struggle is. But honestly, most of the change in therapy happens outside of our office. And it’s what changes they make, how often they practice the skills that we talk about. And it’s really, really a patient driven process.

Kate Andal, PhD:

I remembered it. We are not advice givers. A lot of people, they get kind of really mad when they sit in your office and they’re telling you about things, but you’re not telling me what to do. Nope. I sure am not. And that is not actually part of what we do. We help you figure out what’s important to you and strategies that you can use to make your decisions. We don’t make them for you.

Simon Floss:

Wrapping up here, I always like to ask this question: what’s a take home message that you want people to know?

Kate Andal, PhD:

I would say the biggest take home in general is we are not scary people. I mean, we are, but – (laugh)

Simon Floss:

No, I’ve hung out with you guys a couple times. You’re pretty fun.

Kate Andal, PhD:

(Laugh) I understand that it can be scary and intimidating, but really, mental health providers are just here to help. You can tell us anything and we will help you figure out where the place you need to go is next. So, if you’re afraid that you just can’t quite make that step yet because you don’t know if it’s the right step, that’s something you can talk about with a therapist or a psychiatrist or your doctor as well. We will help you help figure that out.

Kayla Nalan-Sheffield, PhD, LP:

One thing I talk about often with a lot of my patients, just to kind of demonstrate shared humility, right? Like we all struggle with very similar things. I remember one of my first semester of grad school is when we have one of our hardest class, this big book of diagnoses, right? I’m never going to remember this stuff. How am I going to make it in this profession?

And then you get into it. And the more experience you get, you realize that people with similar experiences do really have internal worlds that are quite similar. People with trauma history have very similar thought process, yet also feel like nobody understands them or that they’re alone, right?

And so, I think just recognizing that you really are similar to your peers. We just don’t talk about it enough. If we talked about it more, we’d probably be in a better spot as a society in general. So, I think that’s my biggest takeaway is just really understanding that we truly are much more similar to those people around us than we think we are.

Simon Floss:

What resources are there at Sanford and what makes mental health care at Sanford so great?

Kayla Nalan-Sheffield, PhD, LP:

One thing that I think is nice about getting services in a health care system is that your providers are able to communicate with one another more effectively. I like it when my patients are seeing psychiatry here versus psychiatry outside of here because I can very easily secure-chat their psychiatry provider or talk with their psychiatry provider rather than having to play phone tag or faxing. So I think it, from that perspective, can create a more well-rounded care, I don’t know if that makes sense. More comprehensive.

Same thing is true, especially depending on the condition we’re treating because our brains and bodies are so connected, right? And so being able to touch base with their primary care provider, Kate talks with neurology all the time. And so having those shared records and just ease of access to other providers, I do think benefits patient care in ways that they might not see.

Kate Andal, PhD:

And I would add that I think we have amazing providers here. I know all of them personally because I work here, but I’ve known most of them for a long time, which is not to say that providers elsewhere aren’t also good. And there is enough mental health need in the community right now that I would certainly never discourage you from seeking help anywhere, even if it isn’t Sanford. But we do have a really strong focus on evidence-based treatments with really skilled providers. And I think add that to all of the things Kayla already said.

Simon Floss:

Well, thank you both so much for being here today.

Kate Andal, PhD:

Yeah, thank you.

Kayla Nalan-Sheffield, PhD, LP:

You’re welcome. Thanks for having us.

Simon Floss:

A reminder, you can find this podcast, and many more, on your favorite podcast listening apps like Apple, Spotify, or YouTube, or by going to our website, news.sanfordhealth.org.

Thanks again for listening. I’m Simon Floss with Sanford Health News.