I was approaching my third year back in my hometown of St. Louis, after having lived in Los Angeles for 10 years. My career was shifting, I’d started a family and I was thinking a little therapy would do some good. Having had a fantastic therapist in L.A., I knew the best way to find one is by personal referrals. In California, it was cocktail party conversation. You’d be asked if you knew a good therapist as casually as you’d be asked about a good car mechanic or plumber. There, it was normal.
Not here.
“Yes, I have a therapist, but I really can’t recommend her,” whispered one acquaintance, the only one willing to speak about the issue. “She’s not very good.”
“Um, if she isn’t very good, why are you seeing her?”
“I have no idea how to get another!”
An estimated 22 percent of Americans suffer from a diagnosable mental disorder in a given year, says the National Institute of Mental Health. And according to a charming publication called Divorce Magazine, new marriages have a 43 percent chance of ending in divorce.
St. Louis is no exception. How many people do you know who say they have a good relationship or are completely happy and satisfied with their careers? How many have experienced an unexpected loss of a loved one?
Now, how many of these people are getting professional help?
When I meet people in their 40s, like me, and they say they’ve never seen a therapist—never—it’s as if they’ve told me they’ve never been to the dentist. The amount of suffering I’ve seen go untreated because the mere idea of seeking professional help is incomprehensible to someone is stunning to me. Equally stunning is how quickly I’ve fallen in line, how quickly I’ve become part of the problem.
If a friend tells me he has been fired from a job he loved, is grieving the sudden death of a family member or is watching a parent slip into Alzheimer’s, I want to say, “You should talk to someone about that.”
But I don’t. Not here.
It has been a solid century since “the talking cure” began. Psychiatry has grown more sophisticated and more precise in recent decades, and schools of therapy have multiplied. Yet a 1999 report from the U.S. Surgeon General noted that “stigma in some ways intensified over the past 40 years even though understanding improved.”
Even a casual observer can see that stigma operating in St. Louis.
Marge Parrish, associate program director of the Mental Health Association of Greater St. Louis, told me that not nearly enough people seek therapy who need it, and men, especially, seem less open to the idea. “Men are in the mode to fix things,” she said. “They want to apply their normal fixing abilities and skills to mental health problems, and sometimes that just doesn’t work. And with these issues, it’s harder to be open. For instance, depression—men are less likely to seek help and then it ends up displaying itself through alcoholism.”
If you’re seriously seeking a therapist, a good place to start is with a trusted physician or member of the clergy. Physical, spiritual and psychological problems tangle easily, but professionals in all areas are growing more skilled at sorting out the best solutions. There also may be an employee assistance program where you work, but beware—your request may not be confidential. Even a simple question to an HR person on such a subject is going to be documented somewhere.
Googling “mental health professional St. Louis” led me to several good Web sites and eventually to Julien Worland, co-founder of Psychotherapy St. Louis. The organization’s Web site (www.psychotherapysaintlouis.org) offers background, qualifications and short bios for 70 therapists.
If you’re shopping for a therapist, Worland recommends asking the list of questions posted on the Psychotherapy St. Louis Web site, including:
- Is this therapist qualified? Make sure he is licensed and ask what other training, interests and specialties he has.
- Does this therapist fit your needs? Does she work with your age group? What types of therapy does she use? Ask the therapist how she would help you work on your problems, then see if the response makes sense to you.
- What does the therapist charge? Some work on a sliding scale, while insurance plans are more often structured to pay most of the cost for eight to 12 sessions.
- Does the therapist have openings at times that work for you?
- What is the projected length of treatment? How will you know when it’s time to end therapy?
Most therapists welcome the opportunity to meet initially for one session to answer questions or encourage an in-depth phone interview, so take advantage of that. “We encourage people to talk to a couple different therapists before committing to one,” says Worland.
Next, I got out the Yellow Pages. “Therapist” referred me to “Psychotherapist,” where I found less than a page of listings and only a handful of ads. (A little perspective: There are more than 40 pages for lawyers. How many people are calling them when what they really need is some couch time?) I called the number in the biggest ad, which offered “a warm, safe environment in which to explore personal issues for individuals, couples and seniors ….”
The ad belonged to Jeff Piper. When I told him I found him through his ad in the phone book, he was almost embarrassed. “I just put that there because I moved locations,” he told me several times.
Piper works extensively with families, married couples and individuals, but specializes in older adults. “Older adults experience grief and depression and become more frail, and often the children don’t know how to respond,” he explained. “Plus, there’s the stress of being a caregiver to a parent or a spouse who is aging.”
I guessed that if the current baby boomer generation was still hesitant, members of the “greatest generation” must be downright paranoid about the talking cure.
“They are initially resistant to the idea,” he conceded, “but they take to it really fast.”
A licensed social worker who has been in private practice for three years, Piper agreed that it’s challenging to “market” oneself as a therapist in St. Louis. Clients come via personal recommendations, clergy members and the like, but “for the most part there is a reluctance to talk about therapy.” For him that’s the benefit of a group like Psychotherapy St. Louis, to which he belongs.
“There is a phobia of advertising,” he said. “It’s a discreet profession, and that makes marketing hard. How do I market and not seem crass?”
Recently I met Susan Benigas, who, like me, grew up here, lived on the West Coast and ended up back here. Turns out her husband is a therapist (lucky break).
Jon Benigas grew up in Wichita, Kan., and was a marriage and family therapist in Fresno, Calif., for 15 years before moving to St. Louis. Most recently, he co-founded Solutions Counseling. “There’s not the same acceptance for therapy here as there is on the coast,” he said, adding that in California, therapy is “part of being somebody, it’s part of the culture.”
But, Benigas noted, that’s not necessarily healthy either. There’s potential for having too much therapy and winding up paralyzed, using the sessions as an end in themselves, not a way to make the necessary changes. “There are people in therapy for years who aren’t becoming better people,” he said. “There is a therapist on every corner in California, and some aren’t good. And there’s an emphasis on self-awareness as a goal. Well, that’s not necessarily the greatest goal. One can be aware, but that transition from awareness to action doesn’t always happen.”
Benigas believes St. Louis is a good place for mental health, mostly because he believes in the power of the family. Here, “multiple generations are likely to live in proximity to each other, and that increases the potential for help from family members,” he said. “I tell this story that my business would be cut in half if family members lived within 15 miles or less of each other.”
He acknowledged that refusing to seek help is a common scenario here. We’ve all met the married couple, for example, in which one wants to go to couples counseling and the other refuses. Maybe it has to come to a threat of divorce before the skeptical party agrees to go.
“In this case, the likelihood of changing him [or her] is fairly low,” conceded Benigas. “But at least it opens the opportunity. [The situation] certainly wasn’t going away without therapy.”
Marital stress is particularly challenging for those who grow up in traditional religions that insist that marriage is forever, that it’s a spiritual love, the kind of love God has for humankind, said Benigas. “The truth is, none of us is God.” He suggests periodic checkups: Are we happy? How’s our communication? How are we handling conflict?
By now, I’m asking myself a larger question: What is it about the Midwest, and St. Louis in particular, that makes us loath to seek therapy? The distrust seems unfounded, yet the outdated idea of the “rugged individualist” who never needs this kind of help still prevails here—as if it’s a character flaw to seek help.
“Some people do believe it’s a sign of weakness,” Benigas reminded me. “In all areas of our life we have mental barriers. I have an uncle who refuses to see a doctor for diabetes, and now his feet are numb. But for therapy it’s harder—facing our own weaknesses is not easy, and some refuse to do it.”
Piper pointed out that, although mental illness and physical illness continue to be thought of as separate, the barrier between the two is softening.
“The old theory that depression was mental weakness has given way to medical evidence that it’s a chemical imbalance in the brain,” he said, “much like iron deficiency in the body. We also know that people under a lot of stress will come down with depression after a certain amount of time.
“You say ‘depression’ and there’s still a stigma,” he continued. “I think it just stems from that attitude, which is truly American: ‘You pull yourself up by your bootstraps.’”
Some might say that having the courage to go to therapy amounts to pulling yourself up by your bootstraps.
I’ve noticed that in St. Louis, if we talk to someone about a problem, it’s often a friend. But that’s not always a good replacement for professional help.
“The therapist can provide you with a lot more objectivity,” Piper said. “Friends have an agenda—they have their own feelings about you, your relationships. Often they aren’t going to be brutally honest and say what they are really thinking.”
No matter. Finally, I know how to find a professional therapist.
You’ll never hear me talking about it at a cocktail party, though.
Some of the many types of therapy (via www.4therapy.com):
Behavioral Therapy. Strives to eliminate or reduce unwanted reactions to external situations. The therapist teaches clients to replace undesirable responses (groundless fear, for example) in their day-to-day lives. Learning-based techniques include exposure therapy (volunteering to expose oneself to the undesirable experience in a relaxed state), contingency management (having desirable actions selectively reinforced and undesirable actions ignored whenever possible) and modeling (clients observe another person performing desired behavior).
Cognitive Therapy. Relies on other, largely verbal, learning principles—namely those that involve perception, thinking, reasoning, attention and judgment. Strives to change the thoughts, beliefs, assumptions and attitudes that are contributing to the client’s emotional or behavioral challenges.
Eye Movement Desensitization and Re-processing (EMDR). A new psychotherapy tech-nique used for those who suffer from trauma, anxiety, panic, disturbing memories and other emotional problems. It uses a natural function of the body, rapid eye movement (REM), reasoning that the brain’s normal emotional processing breaks down with trauma, and REM sleep doesn’t bring the usual relief from stress.
Family/Marital Therapy. Engages the participating family members, individually and as a group, to reinforce constructive aspects while working to eliminate destructive and counterproductive interaction styles. Typical issues are inability to compromise, sexual difficulties, financial disputes, child-rearing conflicts and extended family (and in-law) issues.
Gestalt Therapy. Clients are challenged with questions so that they increase their awareness of feelings and develop a stronger ability to face daily living situations and problems.
Humanistic Therapy. This approach works with present, rather than past, occurrences and attitudes with a goal of client growth and fulfillment. It acknowledges that individuals’ minds are strongly influenced by on-going determining forces in both their unconscious and in the world around them, specifically the society inwhich we live.
Stress in the City
For those of you out there keeping score, turn your browser to Sperling’s BestPlaces (www.bestplaces.net). Sperlings’ 2004 studies determined that, among St. Louis’ other problems, we’re stressed out and don’t sleep well.
St. Louis is the 10th worst city for sleep. Detroit is the No. 1 tossing and turning town, followed by Cleveland, Nashville, Cincinnati, New Orleans and New York. Due west on I-70, Kansas City is the 10th best place for catching zzz’s, with Minneapolis as No. 1, followed by Anaheim, Calif. (but Disneyland is there!); San Diego; Raleigh-Durham, N.C.; and Washington, D.C. (glad our politicians have nothing to lose sleep over).
Of the top 100 most stressful cities, we landed in the 16th spot, just ahead of Denver. Not surprisingly, Miami, New York and Detroit are in the top 10—but Tacoma, Wash., is No. 1. Must be the rain.
Credentials Don’t Determine Your Therapy’s Success
Hard work and mutual trust are more important. Still, it’s good to know the basic differences among the therapists:
Psychiatrist. A physician who can prescribe medication. Treats the more serious chronic mental illnesses, such as schizophrenia and bipolar disorder, and looks for physical causes to a person’s mental health problems, such as imbalances in brain chemistry.
Psychologist. A professional who is not a physician, a psychologist deals more with emotional and cognitive issues. Has a post-graduate degree, has completed a supervised training program in the field of clinical psychology and has passed a state board exam.
Psychotherapist. A catch-all title that includes physicians specializing in the practice of psychiatry, psychologists, clinical social workers or marriage and family therapists. People who call themselves psychotherapists have master’s degrees and additional training.
Licensed Clinical Social Worker. An LCSW is qualified to employ psycho-therapeutic techniques, including counseling and applied psychotherapy, with individuals, families or groups. Has a master’s degree, has completed a training program and has passed a state licensing examination.
Marriage and Family Therapist. An MFT has a master’s degree in marriage and family therapy and has completed training and passed a state-approved examination.
Counselor. A generic title that in some states is unlicensed. Here, the Missouri State Committee for Professional Counselors administers examinations and licenses and regulates counselors. Ask questions and verify this person’s credentials (check online at pr.mo.gov/counselors.asp).
Psychoanalyst. Once, nearly all analysts were psychiatrists and the approach was exclusively Freudian; today, the category spans all the therapists listed above, and they use various methods to gain a deeper understanding of ways the past influences the present.
When Money’s Part of the Problem
In a stately former home on South Grand is the Mental Health Association of Greater St. Louis (MHA), a not-for-profit organization founded in 1945. The organization promotes mental health and works to shape public policy. According to Marge Parrish, associate program director, whether or not St. Louis is mentally healthy depends less on stigma than on status.
“If you’re a client with no health insurance, it’s not a good place to be,” Parrish says of St. Louis. Those with major diagnoses, such as bipolar disorder or schizophrenia, are usually on disability and have Medicare or Medicaid coverage. But others face chronic depression or anxiety, or are suffering from the loss of a spouse or parent or a high-stress job change or divorce, and their symptoms are interrupting normal life.
“I don’t know where to send them,” admits Parrish. Every day, she takes calls from people who think they might be suffering from depression or anxiety. If a professional therapist isn’t an option, even at one of the sliding-scale clinics below, she refers them to the scores of self-help groups available. The MHA also has a referral list of professionals, although it’s not comprehensive.
- Sliding-Scale Counseling Agencies
- Care and Counseling (main office) 314-878-4340
- Christian Psychological & Family Services 314-567-4994
- Community Psychological Services (UM-St. Louis) 314-516-5824
- Family Resource Center 314-534-9350
- Jewish Family & Children’s Services 314-993-1000
- Lutheran Family & Children’s Services 314-787-5100
- Provident Counseling (main office) 314-533-8200
- Psychological Services Center (Saint Louis University) 314-977-2278
- Psychological Service Center (Washington University) 314-935-6555
- The Schiele Clinic (St. Louis Psychoanalytic Institute) 314-361-7075
