Why is it so hard to find a good therapist?!

[BigSue 1,320]

This got way longer than I expected, so let me start with the TL;DR: If you have gotten counseling that has helped with your WLS success, can you please give me some tips for how to find a good therapist? And what I should be discussing with that therapist? I'm looking at you, @Creekimp13 and @catwoman7 (since you've both mentioned the importance of therapy in your long-term success), but I would love to hear from anyone who has gotten this kind of counseling...

I've seen so many people say that therapy is really important for long-term success with WLS. I'm almost a year out and I've been struggling lately, and I've had a hard time finding a good therapist. I searched my insurance company's website for therapists who treat eating disorders. I reached out to a practice that had a few therapists who had eating disorders listed as one of their specialties, and they sent a very curt reply saying that they don't have anyone on staff who treats eating disorders.

I called another practice and explained that I'm a WLS patient looking for counseling on food and eating issues, and they assured me they could help, but the therapist they assigned to me knew nothing about WLS. I had a few sessions with him and it was useless. I had to keep explaining basics about WLS (like food restrictions, dumping syndrome, not eating and drinking at the same time, loose skin -- which he thought would go away on its own if I exercise enough and when I explained that the only way to get rid of it is plastic surgery, he suggested I ask my bariatric surgeon to do it at my next follow-up).

He didn't seem to understand my issues at all. In hindsight, I probably should have walked out of the first session. When I started telling him my WLS story and mentioned that my highest weight was 341 pounds, he interrupted me: "Sue?" I stopped and said, "Yes?" He replied, with a big smile on his face, "Sue, you were FAT!" and then busted out laughing, like it was cool to make fun of how fat I used to be just because I'm not that big anymore. When I told him I wanted to get counseling to address my food and eating issues to make sure I don't gain the weight back, he replied, "You won't gain the weight back. If I had a $100 bill right now, I would bet $100 that you won't gain the weight back," and then we never discussed regain again in the next 3 sessions. I think he was under the impression that regain was an irrational fear and he did his job by reassuring me that it's not going to happen.

Then I found another practice that has a whole paragraph on its web site about the support they offer for bariatric patients both before and after surgery. I called to make an appointment and said that I had bariatric surgery last year and I was interested in the post-surgery counseling they described on their web site. The receptionist told me she needed my surgeon's office notes from my most recent visit, and was oddly insistent that the notes come directly from the surgeon's office and not from me downloading them from my electronic chart and sending them. I had to sign release paperwork for the surgeon's office, and when the counseling practice got it, they called me and said they were confused because my surgeon's notes said I already had the surgery so there was no need for me to get a pre-surgery evaluation. I guess they thought I was asking for a psych eval for surgery approval and couldn't understand why I would need counseling after I already had the surgery.

I cited the paragraph on their web site and they sent me to a seemingly random therapist (probably the first one with an opening) who had no experience with WLS patients. She's better than the last guy, but the sessions have been pretty generic -- basically, she asks me how my week has been, I talk about things that happen (usually relating to WLS issues), and she asks me how I feel about it or how I handled it. Doesn't feel like I'm getting anywhere -- just feels like a WLS patient Q&A. I told her this and she suggested I think about what exactly I want to discuss and tell her next week. I'll give that a try, but to be honest, I don't really know -- she's the therapist, so I was counting on her to provide that kind of guidance!

[SunnyinSC 137]

My doctor's office had me do a psych evaluation prior to approval for surgery. I asked the therapist that did the evaluation for recommendations of a long term therapist I could use prior to and after surgery. She was able to give me one that accepted my insurance.

Therapy will be a lot of talk about feelings and that sort of stuff, because the goal is to get at the root of why we feel the need to overeat and address that, not just the eating itself. It's all about identifying triggers and then working to modify behaviors and such to either avoid the triggers or work through them in a healthier way. As some examples from my own therapy sessions, I know I'm an emotional eater. Through some questioning the therapist helped me realize that keeping a list of tasks/errands/chores in my head could cause me to feel overwhelmed and that stress would lead me to overeat. She gave a suggestion that I keep the tasks written down on our fridge, not in my head, and that way my husband can know what I want done without me having to ask, and it doesn't fall on me. That has been working for our household, but if it didn't then I would have gone back and discussed what about it worked, and what didn't, and other ways to address it.

Part of it has been discussing exercise, and how I schedule it into my day. Or that I don't cook often, but really need to be better about that long term so I'll have "homework" to cook x times per week. My homework for my next appointment is to pick out some clothes I feel good in (I've been living in PJs or athletic clothes for months). Which sounds simple and maybe silly, but I find therapy can just give me that extra little push sometimes to set goals I wouldn't have otherwise set for myself, and reporting to the therapist adds a level of accountability that makes me more likely to stick to it.

It is a long process, and changes to behaviors and attitudes won't happen overnight. I started seeing my therapist about 4 months ago now, and I still have a lot to work on.

[lizonaplane 1,604]

I had a therapist for 15 years who was great, but knew nothing about weight loss. He would always suggest I saw someone else about that, and it really frustrated me, because I was really attached to him (he's mostly retired, but I still call him sometimes). I tried to see someone else, but she was really into OA, and that's just not my jam. I'm not a religious or spiritual person and I don't believe in a "higher power". I saw a therapist for binge eating for a while but insurance decided binge eating isn't covered. I tried Better Help, but the person didn't have any weight loss related experience either. I think it's really hard. I'm sorry you had such a crap experience with that one therapist who thought it was fun to make a fat joke and didn't think regain is a thing.

I asked the therapist from the surgery center and she said she could find someone to see me if I needed it after surgery. Did you try your surgery center?

I hope you find someone. I don't personally like homework from therapy; I just like the supportive place to work out how I feel about things and test what I'm thinking.

[Creekimp13 5,837]

Sue, I wish I knew who to call in Tennessee, but I don't. I'm sorry. My group is affiliated with a research university and they do their homework. They have a few therapists that they have vetted and recommend to follow up with surgery patients. In addition to doing counseling appointments, our therapists also provide leadership for our support group meetings. It's kinda cool to see your therapist in the framework of working with several people you know going through the process. I know mine has heard a hundred bariatric surgery horror stories, success stories, has heard people just like me struggling through the process of making lifelong peace with food.

If you're trying to find a therapist on your own, I'd suggest looking for someone with experience treating disordered eating, cross over addiction and food addiction. Find someone who can help you identify eating triggers associated with unmet needs. (they're usually linked). Those needs need to be addressed to ensure the habits don't backslide.

Looks like the University of Tennessee has a bariatric center. It might be worth calling them and seeing if they have someone vetted who they work with....who is good....maybe you could do video visits?

You are dead right that it's hard to find the RIGHT therapist for this niche. But I can't recommend it enough.

Best wishes.

[BigSue 1,320]

22 hours ago, SunnyinSC said:

My doctor's office had me do a psych evaluation prior to approval for surgery. I asked the therapist that did the evaluation for recommendations of a long term therapist I could use prior to and after surgery. She was able to give me one that accepted my insurance.

Therapy will be a lot of talk about feelings and that sort of stuff, because the goal is to get at the root of why we feel the need to overeat and address that, not just the eating itself. It's all about identifying triggers and then working to modify behaviors and such to either avoid the triggers or work through them in a healthier way. As some examples from my own therapy sessions, I know I'm an emotional eater. Through some questioning the therapist helped me realize that keeping a list of tasks/errands/chores in my head could cause me to feel overwhelmed and that stress would lead me to overeat. She gave a suggestion that I keep the tasks written down on our fridge, not in my head, and that way my husband can know what I want done without me having to ask, and it doesn't fall on me. That has been working for our household, but if it didn't then I would have gone back and discussed what about it worked, and what didn't, and other ways to address it.

Part of it has been discussing exercise, and how I schedule it into my day. Or that I don't cook often, but really need to be better about that long term so I'll have "homework" to cook x times per week. My homework for my next appointment is to pick out some clothes I feel good in (I've been living in PJs or athletic clothes for months). Which sounds simple and maybe silly, but I find therapy can just give me that extra little push sometimes to set goals I wouldn't have otherwise set for myself, and reporting to the therapist adds a level of accountability that makes me more likely to stick to it.

It is a long process, and changes to behaviors and attitudes won't happen overnight. I started seeing my therapist about 4 months ago now, and I still have a lot to work on.

Thank you so much for your helpful reply! I also had a psych eval for surgery approval and I actually really liked the therapist. I could tell he knew a lot about weight loss surgery. I think he said that he offers post-surgery counseling, but it seems like it would be awkward and maybe a conflict of interest. But I've been thinking about going to him if I give up on the current one.

I realize that there will be a lot of talking about feelings and stuff with any therapist, but what's frustrating to me is that neither of these therapists seems to make any effort to relate any of my feelings to food/eating, even though I explicitly said these are the issues I want to address. But maybe if I can articulate this better to the therapist, she will understand what I'm looking for.

[BigSue 1,320]

20 hours ago, lizonaplane said:

I had a therapist for 15 years who was great, but knew nothing about weight loss. He would always suggest I saw someone else about that, and it really frustrated me, because I was really attached to him (he's mostly retired, but I still call him sometimes). I tried to see someone else, but she was really into OA, and that's just not my jam. I'm not a religious or spiritual person and I don't believe in a "higher power". I saw a therapist for binge eating for a while but insurance decided binge eating isn't covered. I tried Better Help, but the person didn't have any weight loss related experience either. I think it's really hard. I'm sorry you had such a crap experience with that one therapist who thought it was fun to make a fat joke and didn't think regain is a thing.

I asked the therapist from the surgery center and she said she could find someone to see me if I needed it after surgery. Did you try your surgery center?

I hope you find someone. I don't personally like homework from therapy; I just like the supportive place to work out how I feel about things and test what I'm thinking.

There's a WLS YouTuber (My Level 10 Life) who swears by Better Help (she's actually paid to promote them, but she swears that she gets asked to promote a lot of things and only promotes things she really believes in), but I'm skeptical of it and I'm almost certain my insurance wouldn't cover any of that.

I can try asking my surgery center for a recommendation. I didn't ask them because I wanted to get someone in-network for my insurance, but at this point, I think I'd rather pay out of pocket for something that actually helps. I have a high deductible that I haven't met yet, so I'm paying out of pocket right now, anyway. Maybe I could ask the therapist who did my pre-surgery eval for a recommendation. I've actually thought about going to him because I liked him and I could tell he knows a lot about WLS, but it seems weird (and maybe a conflict of interest) to see the person who did my eval.

I agree about not liking homework! That's another thing that annoyed me about the first one -- he was big on homework, and it was all really generic, nothing that he came up with specifically to help me. I had told him that my biggest struggle was that I felt like my surgery and weight loss is taking over my life and I have no time or energy left for anything else, and then he comes up with some busy work for me to do.

[SunnyinSC 137]

1 hour ago, BigSue said:

Thank you so much for your helpful reply! I also had a psych eval for surgery approval and I actually really liked the therapist. I could tell he knew a lot about weight loss surgery. I think he said that he offers post-surgery counseling, but it seems like it would be awkward and maybe a conflict of interest. But I've been thinking about going to him if I give up on the current one.

I realize that there will be a lot of talking about feelings and stuff with any therapist, but what's frustrating to me is that neither of these therapists seems to make any effort to relate any of my feelings to food/eating, even though I explicitly said these are the issues I want to address. But maybe if I can articulate this better to the therapist, she will understand what I'm looking for.

Yup, finding one that deals with disordered eating and all is extremely tough. One of the things I found super surprising was that I've actually been in therapy for a good 15 or so years now off and on, with different therapists as I've moved around. Not once was disordered eating ever brought up in regards to my weight. My weight was addressed as something I wanted to change, but nothing really beyond that. The general understanding from my therapists was that if we just fix the depression, then the weight will magically float away. Which didn't happen. So I was super surprised come psych eval time when they mentioned it. I definitely recommend talking to the therapist that evaluated you if that's an option. Even if you don't decide to go with him, he may be able to offer suggestions for other people/places.

Also wanted to clarify my "homework" comment a bit. That was probably the wrong word for it. I have behaviors that I need to change for this to stick long term. So each session we'll kind of pick a behavior to focus on given my current progress and feelings. I will report how it went, but I don't get graded on how I've done, and the therapist doesn't degrade/insult/demean me or anything negative if I do badly. We always tend to focus on what went well, and what we can do better. It's strictly a trial and error thing and finding what works for me while making slow, sustainable changes.

I have actually used BetterHelp around 4 years ago (maybe more?) and, it wasn't for me. Now, they may have improved since I used it because if I remember correct they didn't use to require people to be certified and all that, and now they do. But the old experience was just not something I found helpful. Was fine for just venting, but pretty useless beyond that.

[BigSue 1,320]

21 hours ago, Creekimp13 said:

Sue, I wish I knew who to call in Tennessee, but I don't. I'm sorry. My group is affiliated with a research university and they do their homework. They have a few therapists that they have vetted and recommend to follow up with surgery patients. In addition to doing counseling appointments, our therapists also provide leadership for our support group meetings. It's kinda cool to see your therapist in the framework of working with several people you know going through the process. I know mine has heard a hundred bariatric surgery horror stories, success stories, has heard people just like me struggling through the process of making lifelong peace with food.

If you're trying to find a therapist on your own, I'd suggest looking for someone with experience treating disordered eating, cross over addiction and food addiction. Find someone who can help you identify eating triggers associated with unmet needs. (they're usually linked). Those needs need to be addressed to ensure the habits don't backslide.

Looks like the University of Tennessee has a bariatric center. It might be worth calling them and seeing if they have someone vetted who they work with....who is good....maybe you could do video visits?

You are dead right that it's hard to find the RIGHT therapist for this niche. But I can't recommend it enough.

Best wishes.

Thank you so much for replying! I was especially interested in your thoughts because you have posted a lot about this subject. It's too bad not all bariatric centers provide this kind of resources.

So, if I'm understanding what you're saying, it seems like you think I should try to find another therapist -- one who has experience treating WLS patients or at least disordered eating? I actually really liked the guy who did my pre-surgery psych eval and I've been thinking about going to him. It seems like it might be awkward, but I got the sense that he knew a lot about WLS and the issues relating to it.

I had a session with my current therapist today and I wrote up a list of issues that I wanted to address, and I think that helped... But I don't want to keep wasting time and money with someone who is not going to be able to help me with what I need to work on.

[lizonaplane 1,604]

18 hours ago, BigSue said:

There's a WLS YouTuber (My Level 10 Life) who swears by Better Help (she's actually paid to promote them, but she swears that she gets asked to promote a lot of things and only promotes things she really believes in), but I'm skeptical of it and I'm almost certain my insurance wouldn't cover any of that.

I can try asking my surgery center for a recommendation. I didn't ask them because I wanted to get someone in-network for my insurance, but at this point, I think I'd rather pay out of pocket for something that actually helps. I have a high deductible that I haven't met yet, so I'm paying out of pocket right now, anyway. Maybe I could ask the therapist who did my pre-surgery eval for a recommendation. I've actually thought about going to him because I liked him and I could tell he knows a lot about WLS, but it seems weird (and maybe a conflict of interest) to see the person who did my eval.

I agree about not liking homework! That's another thing that annoyed me about the first one -- he was big on homework, and it was all really generic, nothing that he came up with specifically to help me. I had told him that my biggest struggle was that I felt like my surgery and weight loss is taking over my life and I have no time or energy left for anything else, and then he comes up with some busy work for me to do.

BetterHelp is not covered by insurance, but it's generally cheaper than paying for weekly therapy without insurance. I also suggest joining the My Level 10 Life Facebook group if you're on Facebook. It's $10 a month but the group is super supportive and they have 1-2 weekly zoom calls that are wonderfully supportive. They have been wonderful as I've struggled to wait for surgery. I also joined a free facebook support group and it was terrible. ML10L is so good, and I'm not really a support group person.

I don't think that having the person who did your eval do therapy is a conflict of interest at all - the eval is over and done with, and now he's just a competent therapist with the right expertise! It's not like he still has to evaluate you - you can't go back and undo the surgery!

Some people really like homework, and I don't think it's busy work; I just don't find it helpful.

[BigSue 1,320]

On 7/8/2021 at 1:51 PM, SunnyinSC said:

Also wanted to clarify my "homework" comment a bit. That was probably the wrong word for it. I have behaviors that I need to change for this to stick long term. So each session we'll kind of pick a behavior to focus on given my current progress and feelings. I will report how it went, but I don't get graded on how I've done, and the therapist doesn't degrade/insult/demean me or anything negative if I do badly. We always tend to focus on what went well, and what we can do better. It's strictly a trial and error thing and finding what works for me while making slow, sustainable changes.

I don't have a problem with therapy "homework" per se, but the first therapist gave me this generic feelings journal that he wanted me to fill out every day, and it felt kind of pointless and condescending. I suspect he gives this to every patient. I actually think it would be great to have a therapist give me some actionable advice to try between sessions, and it looks like that's what yours is doing!

[BigSue 1,320]

On 7/9/2021 at 7:10 AM, lizonaplane said:

BetterHelp is not covered by insurance, but it's generally cheaper than paying for weekly therapy without insurance. I also suggest joining the My Level 10 Life Facebook group if you're on Facebook. It's $10 a month but the group is super supportive and they have 1-2 weekly zoom calls that are wonderfully supportive. They have been wonderful as I've struggled to wait for surgery. I also joined a free facebook support group and it was terrible. ML10L is so good, and I'm not really a support group person.

I've like to join the ML10 group, except for the fact that it's on Facebook and therefore not anonymous. I chose not to tell anyone other than medical professionals about my surgery, so I don't want to join a WLS group with my real name.

On 7/9/2021 at 7:10 AM, lizonaplane said:

Some people really like homework, and I don't think it's busy work; I just don't find it helpful.

For me, it depends on what the homework is. The first therapist gave me a generic feelings journal that felt really pointless, and I suspect he gives the same thing to everyone. I wouldn't mind doing "homework" that felt like there was a purpose to it -- some kind of actionable advice.

[Stella S 612]

Search addiction and look for ACT - Acceptance Commitmemt Therapy. It focuses on healthy choices and such. If you have normalish levels of trauma this may work I have worked in mental health for years Best t you

[TinDE 83]

On 7/11/2021 at 1:34 PM, BigSue said:

I've like to join the ML10 group, except for the fact that it's on Facebook and therefore not anonymous. I chose not to tell anyone other than medical professionals about my surgery, so I don't want to join a WLS group with my real name.

For me, it depends on what the homework is. The first therapist gave me a generic feelings journal that felt really pointless, and I suspect he gives the same thing to everyone. I wouldn't mind doing "homework" that felt like there was a purpose to it -- some kind of actionable advice.

Just saw this post. I have a separate FB account that I use for bariatric groups and information only.

[sureshots 5]

Late post. psychologytoday.com has listed therapists (all across the US) that shows their specialities or interest areas.

[GradyCat 3,692]

I didn't see a lot of use in the counselor at my surgeon's office, even though visits with her are lifetime free visits, but I just happen to also have Major Depressive Disorder and Anxiety, so I talk regularly (monthly) with a counselor/therapist and she also coaches me on WLS issues. My psychiatrist who prescribes my antidepressants just happens to be a WLS pre-admission doctor who counsels people before their surgeries and evaluates their success potential. So both of my mental health professionals are very WLS friendly and knowledgeable. If you shop a new counselor you could ask if they have any experience dealing with bariatric patients.