June 25, 2015 at 8:52 AM
So you want to go for it, but you’re not sure how to go about it? Here’s the step by step.
One good source of referrals can be people whose opinion you respect, whether that be a friend, clergy, doctor, or someone else. But take the referral with a grain of salt, because:
- Not every good therapist is good at trauma therapy. And the person who makes the referral might not know how to tell which therapists are which.
- Not every good therapist is good for you.
Another source is listings. For example, you can find a listing of EMDR therapists at the EMDR International Association web site; it allows you to search by location, specialty areas, and level of credentialing (trained, certified, consultant). We also have a listing of therapists we’ve trained, whether in EMDR or PC, similarly searchable by location, specialty area, and level of credentialing.
While it’s no guarantee, you might as well start with those with higher credentials. Those who are certified in a treatment method have gone beyond the initial training to complete additional practice, consultation, and continuing education, so they are more likely to have gotten good at it. But don’t get too hung up on this, either – plenty of therapists who get good at something never bother to get the certification.
Similarly, the specialty areas the therapist lists are a beginning, but not the whole story. If the therapist says that they only work with adults and you want help for your five-year-old, this is probably not the right person. On the other hand, if the therapist says that they work with trauma but does not specify sexual assault (and that’s what you’re looking for help with), that doesn’t mean much. Pretty much all trauma therapists work with sexual assault, even if we don’t list every possible type of trauma as a specialty area. Similarly, many of us do work with couples and families even though we don’t list it as a specialty. Etc.
So if you’re lucky enough to be able to choose from a bunch of highly credentialed trauma therapists who declare expertise in your area of concern, that’s great. However, if it doesn’t line up that way, don’t despair. Just go ahead and check out the therapists who at least seem like they might work out. And you never know – they might.
If no one in your area is suitable, you might consider looking elsewhere. The short-term inconvenience can be worth it to get the help you need (as opposed to staying local and spinning your wheels with the wrong therapist). Perhaps there’s a good trauma therapist in a nearby city? Or you might prefer to travel for a one-time intensive multi-day treatment, to get the job done.
Interview the Therapists
When checking out therapists, it’s important to understand your position and to be empowered accordingly. You are the customer, trying to decide who to hire as your consultant and personal trainer. You have the right to shop around and ask questions – within reason – so you can make your best choice.
Interview the therapist on the phone. Explain your situation briefly (the 1-minute version) and ask: “ What is your training and experience in [trauma treatment, EMDR, PC, this type of problem...]?” And your next question, “How would you conduct treatment with someone like me?”
Hearing the therapist’s responses will give you quite a bit of information, not only in what they say, but in how you feel as you hear it. Trust your knowledge, and trust your gut. Ask yourself:
- Is this person trained, experienced, and competent with people in my situation?
- Does this person care about me? Respect me?
- Can I trust this person?
Is this person really a trauma therapist?
One challenge in evaluating prospective therapists is that virtually every therapist claims to work with trauma, but not all therapists (a) use a phase model approach, (b) including a proven-effective method of trauma healing. So how to discern this?
It’s easy enough to find out if they’re using a research-supported trauma treatment: ask. My favorites are PC, EMDR, and TIR – they’re effective, well tolerated, and efficient – and with rare exceptions I only refer (for trauma work) to a therapist who is using one of these. It’s not that a good therapist can’t get the job done with (for example) prolonged exposure or trauma-focused CBT – they can – but it’ll be slower, and more difficult for the client. Some therapists I respect are using promising trauma treatments like emotional freedom therapy or somatic experiencing, and these may indeed be good; but at present they’re not well researched, so I do not endorse them yet.
As to whether or not the therapist uses a phase model approach -- the current standard of care for trauma therapy -- here are the kinds of things to be listening for, in terms of what the therapist says they are trying to do/accomplish in treatment:
- Motivation (develop/identify the client’s goals)
- Psycho-education/understanding the impact of trauma
- Stabilization and safety
- Coping skills
- Trauma resolution
- Follow the client’s lead
- Focus on relationship
- Whatever the client is ready for
- Working intuitively
If your initial reaction is, “Why are all those good things listed in the Bad section?” you’re not alone; a lot of therapists do work that way. But being warm and fuzzy does not get the trauma healing done. For that, you need a therapist who will take you through the steps (listed in the Good section above) of the phase model, including the trauma healing. Don’t worry: a good trauma therapist is caring and supportive, too. They should also have the tough-love quality of a personal trainer, to guide and encourage you through the hard places so you can get through, and come out the other side.
So you found a therapist that you still think is promising, even after the phone call? Go ahead and make an appointment, and then show up for it. And this isn’t necessarily the final step. If you learn, through meeting, that this is the wrong person for you, you don’t have to go back (but do at least cancel the next appointment, if you’ve made one). If the therapist seems good enough, it’s generally best to stop shopping around at that point, so you can dig in and start getting your work done.
Note: This post is excerpted, in modified form, from my upcoming book, Slaying the Dragon: Overcoming Life’s Challenges and Getting To Your Goals.
Please add a comment
This idea of a personal trainer seems like an apt model, especially because with clients that avoid closeness might not know what they're ready for in terms of therapy. I think the trauma therapist works like a hand in the darkness, helping to guide the trauma survivor in a real and practical way to a brighter path, rather than sitting with them in the dark. I found a good resource from Dr. Rob Muller called "Trauma and the Avoidant Client". More info: http://psychotherapytoronto.ca/trauma-and-the-avoidant-client/ In my experience, Rob provides the psycho-education you refer to not only in his text, but in therapy sessions as well.