Choosing A Trauma Psychotherapist

Choosing a psychotherapist is a difficult, sensitive task.  Unlike choosing a dentist, for example, the person looking for psychotherapy may not feel comfortable asking a few friends and co-workers for recommendations!  The internet or yellow pages don’t offer much in the way of personalized recommendation, although if a therapist has a website it can offer a few hints about the way they work.  For survivors of traumatic experiences, finding a therapist that specializes in trauma can be even more daunting.

Qualifications

In choosing any health professional, one should be aware of qualifications, but psychotherapists vary widely in their length and philosophy of training and experience.  Licensure is a minimum qualification, at least guaranteeing that the therapist has fulfilled a graduate training program and a certain number of hours, probably taken an exam, and met requirements set by the state.  Most states license psychologists, social workers, marriage and family therapists, and professional counselors.  These websites describe differences among the various mental health professions:

•    http://www.behavioral-care.com/SocialWorker-Counselor-Marriage-Family-Therapist-Psychologist.html

•    http://therapists.psychologytoday.com/rms/content/therapy_professionals.html

Insurance

If you cannot pay for psychotherapy in cash, you will probably expect to use your health insurance.  Your insurance company might limit which therapists you can see, and even how many sessions it will cover in a year.  Recent changes in the law require parity between physical and mental illness, but disparities will remain until plans in effect now expire and renew for the next year.  

Trauma-Informed Care

Not every psychotherapist is trained and experienced in treatment of psychological trauma.  If your problems or symptoms result largely from a traumatic event or events, you should try to locate a therapist with this specialty.

Trauma symptoms might include flashbacks, nightmares, sleep disturbance, irritability, anxiety, and avoidance of things that are reminders of the traumatic event.  Trauma-informed treatment is an approach that differs from the medical model, and the traditional model of psychotherapy.  In traditional models, the therapist is considered the expert, and the client the recipient of the expert’s help. In some psychotherapy models, the therapist’s task may be to identify faulty beliefs, persuade the client to accept another perspective, and instruct the client to complete various tasks.

In contrast, trauma-informed treatment assumes that the client is the expert on the client’s strengths, problems, needs, and goals.  The therapist is an expert on the effects of trauma, information about symptoms and coping skills.  Trauma-informed care is care that respects the client’s expertise, assists the client to be in charge of the direction of treatment, and supports the client in making changes.  It is essential that the treatment be collaborative, and that the client retains the power for making decisions in the therapy.

Why the emphasis on power for the client?  Because loss of power is one of the hallmarks of a traumatic event.  The person who is a victim of a crime, accident, or abuse has experienced powerlessness; it’s part of what makes the event traumatic.  Traditional approaches to treatment that assume the expert has all the answers, and that the client is the passive recipient of care, can be less than helpful, or even triggering or re-traumatizing.  How can we expect a person who has been robbed of their power and left helpless in the face of overwhelming circumstances to respond well to a treatment in which the therapist holds the power?

Trauma-informed care seeks to create an atmosphere of safety.  The therapist educates the individual about symptoms that are often frightening, explains how they come about, and normalizes responses to trauma.  For example, individuals might be afraid of returning to the place where the event happened, even though there is no present danger.  Or might be having terrifying nightmares or flashbacks, reliving the traumatic event.  They might feel they are going crazy.  The therapist can explain the origins of these symptoms, and make recommendations to reduce the symptoms and help clients to reclaim a sense of control over their thoughts and emotions.

Making Your Choice

When you find some therapists to call, either through your insurance company, referrals, or yellow pages/internet search, make a short list of questions to help you get an idea of whether this therapist might be a good fit for you.  Be sure to ask about fees, payment policies, and insurance acceptance.  Find out if the therapist has open hours at a time when you will be able to come.  Here are some other questions to consider, but you’ll probably have some yourself!  In addition to finding out what license the therapist holds (which can easily be verified on the internet in most states), you might want to ask:

•    How long have you been in practice?
•    Do you have an area of specialization?
•    What kind of approach do you take in the treatment of trauma?
•    Have you seen many clients with issues related to trauma?
•    When was the last time you saw a client with problems similar to mine?

There are a number of newer approaches designed for treatment of trauma. Somatic Experiencing (SE) and Sensorimotor Psychotherapy are two new and very promising approaches, with some research support. Eye Movement Desensitization and Reprocessing (EMDR) also has some research support.  Some innovative approaches should be considered experimental.  Thought Field Therapy (TFT) and Emotional Freedom Techniques (EFT) are being studied now.  Anecdotes about effectiveness surround any new treatment method, but that is not the same as solid research support.  As compelling as those anecdotes can be, it is this author’s opinion is that experimental approaches may be appropriate if other trauma treatment approaches aren’t working.  Ask lots of questions about the approaches taken by the therapists you call!

If your past experiences involved feeling helpless or powerless, do ask about trauma-informed care.  Listen not only to the words of the answer, but notice how your questions are received.  Is the therapist genuinely interested in your concerns, and listening carefully to what you want?  Or the opposite – interrupting to tell you about her or his expertise?  Pay attention to your gut feeling:  you will be talking about some very personal issues with this person, so you want to feel comfortable.

Choosing a psychotherapist is a challenge for most people.  Individuals with a history of psychological trauma may have more concerns to address in the process of choosing someone.  

copyright 2010 Anne C. Pratt, Ph.D.

Dr. Anne Pratt is a licensed psychologist in Springfield, Massachusetts, specializing in the treatment of psychological trauma.  Her practice is located in the Family Care Medical Center, 1515 Allen Street in Springfield.  The phone number is 413-783-9114.http://www.drannepratt.com
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