September. Kiddies off to the school bus, a crisp autumnal tang in the air, those tight, white pants folded up neatly and put away for next summer with that lovely lavender sachet Aunt Caroline, bless her heart, gave you last Christmas. Oh, and time to stop being a crazy nightmare and driving everyone else insane.
Time to shop for a new shrink.
Most people have two concerns when shopping around for a new counselor. The first is cost and how to minimize the out-of-pocket expenses and somehow make that crappy insurance your company graces you with pull its weight.
To that end, trying to find an in-network therapist who is accepting new clients, lives reasonably close by and has figured out that Liberace and Eleanor Roosevelt were gay can be a challenge. Check out the magazine Psychology Today's webpage for their nifty "Find a Therapist" search engine. Once you do an initial search by zip code, you can customize by your insurance carrier and by sexuality, or what they call "Gay Issues," which most of us have our fair share of. Yuk, yuk.
Counselors and therapists must pay to be included in this listing, so it's not comprehensive -- I'm not in there, for instance -- but you are likely to find that plenty of options come up in your search with a dashing picture of the therapist, a little blurb they've included about their approach to counseling and other useful information.
While nothing beats a face-to-face consultation for assessing "goodness of fit" (as they say, and which always sounded a little dirty to me, frankly; more on this in two paragraphs), most therapists charge for that, so just getting a bead on them from information online and even listening to their voice on their voicemail can help weed out those chakra-balancing, urine-therapy-practicing, come-to-me-to-find-your-Patronus-just-like-that-cute-Harry-Potter-did kooks.
Many seasoned therapists have stopped participating in insurances networks, as their reimbursements are usually about 50 percent of the going market rate for a 45-minute counseling session. Insurance companies may also require that therapists report on clients' progress in order to assess granting more sessions, which raises issues that concern me, for one, about them being big buttinskis. And there are still great therapists who are on these "panels" or who keep a few slots in their practice for in-network or lower-income patients. While I have stopped working with insurance companies directly, as a licensed clinician, my clients with insurance can still submit paid invoices for reimbursement at the out-of-network rate or to chop down that pesky deductible.
In New York City, where I practice, most therapists charge somewhere between $125 and $225 per 45- to 50-minute session, a pretty penny. Some will "slide" lower. (Don't you love learning all this insider shrinky-dink lingo?) In my practice I will see four or five patients in my case load of around 30, give or take, for $75 if they are just out of school, or up to their ears in debt, or waiting on tables before joining their rightful place in the cast of Pretty Little Liars. I tell them, "When you hit the lotto or your financial fortunes improve, you should consider giving me a raise if I've been worth it."
The second concern, and vastly the sexier one, of course, is this goodness-of-fit business. If you're like me, you still walk into the Gap hoping to fit into the 32-inch waist jeans you wore during your senior year. I have a dear gal pal who worked for a few years fitting women for bras at Sears who can vouch for the truism that three out of four women are wearing the wrong bra size. She tells tales that will curl your toenails. So just knowing what we are actually looking for can be a challenge, especially if we've never even been in therapy before. What the hell does that sexy mechanic in that greasy jumpsuit do underneath the hood of my car? Who knows, baby, and who cares?
Well, not just the gays but most everybody basically wants someone smart and kind. Usually, just like at gay speed dating down at the LGBT community center, within about two seconds most people have plunked the counselor in question into one of three categories:
- Not in a million trillion years if he was the last shrink on Earth and I was Justin Bieber's vastly confused boyfriend.
- Hell, yes! She's smart and funny, and she listens, and I like the little, fuzzy pillow on her couch, and she smells good, and she clearly knows what she's talking about.
- I'm not quite sure.
The first two are clear and easy. The third one is a little more problematic, and this is where the gay thing can get tricky. You know you are gay, perhaps, but do you know they are? Some shrinks are out, loud and proud and market aggressively to the gay community. Others play it a little closer to the vest, following that old, Freudian "tabula rasa" model where the psychoanalyst shares next to nothing about his or her life with clients.
There are strong rationales for both positions, but most people today are more comfortable with therapists who are a little more forthcoming. Not that anyone needs or necessarily wants to know one's sexual role or, God forbid, one's hangups with their mother's boyfriends. The general rule for counselors is that disclosure should be well-considered and cautious, and its intent should be to benefit the client, not to get the shrink's own ya-yas out. Generally, one can tell the difference. Of course, one wants and deserves a therapist who is nonjudgmental, culturally competent and curious, and if they are not exactly familiar with the Radical Faeries or the Lesbian Herstory Archives, then they should be respectfully honest about that and willing to learn up.
But here's a tip: See if they've read Sarah Schulman's Ties That Bind: Familial Homophobia and Its Consequences or Alan Down's The Velvet Rage: Overcoming the Pain of Growing Up Gay in a Straight Man's World. Both are uniquely powerful and insightful recent books on the gay experience that any therapist who works with gay men and women should be familiar with. For extra credit, see if they know the following:
- Taking Sides: Clashing Views on Gender by Jaquelyn White
- Beyond Betrayal: Taking Charge of Your Life After Boyhood Sexual Abuse by Richard B. Gartner
- Cruise Control: Understanding Sexual Addiction in Gay Men by Robert Weiss and Patrick Carnes
- Lesbian Couples: A Guide to Creating Healthy Relationships by Marilee Clunis and G. Dorsey Green
That should give you a pretty good sense of whether they are au courant on the littrachur of the homosexual experience. They are good books for you to read as well!
Finally, whether you think you are looking for a male or female shrink, a gay one or a straight-but-not-narrow one, just follow your gut. It's the best guide. It's a very subjective thing, but this is certain: The healing you are looking for is a destination that is arrived at through the vehicle of the therapeutic relationship. Can you tell they like you and are interested and sympathetic? Do you feel that they "get" you? Do you know they care? Do they model good boundaries and discourage unannounced visits after midnight and offer you gin-and-tonics as a warmup to the session?
Most therapists are good and hard-working crazy people, just like you and me, and a fair proportion of them are gay or enormously gay-friendly without being weird about it. If you're in New York and are trans or gender-exploring and you feel that they might be iffy on the subject or, God forbid, the reality of transgender folk, call up NYC's LGBT Community Center at 212-620-7310. Their groundbreaking Gender Identity Project keeps a nationwide list of trans-experienced and trans-positive therapists.
One of the best gay therapists I've ever known, Bertram Schaffner, who died in 2010 at 97, and whom Alfred Kinsey doffed his hat to as a pioneer in understanding sexuality and gender, and who also founded the Gay and Lesbian Psychiatrists, once told me that being gay is, at its essence, about how we love, and that therapy tries to help us love better. Pretty smart. And he was a little pixie-dust fairy of a queen.
To read an interview with Bertram Schaffner, click here.
Christopher Murray, LCSW-R, is a psychotherapist in private practice in Manhattan. To reach him, go to christophermurray.org.