What Is Good Trauma Therapy? Who Is a Good Trauma Therapist?
Good trauma therapy models recognize that individual distress is often caused or made worse by poor social, political, and economic environments as well as by harmful family dynamics. Trauma survivors are generally best served by therapists who work from an environmental framework, or trauma model, as they are also more likely to see their clients as experts in their own lives and as partners in healing.
Types of Mental Health Care Providers
The words “therapist” and “counselor” are unregulated, generic terms. They can be used to refer to anyone providing treatment and can be used as a title by anyone, with no requirement of special training. In some states, anyone can hang a shingle on their door and practice “therapy” with nothing more than a high school diploma; so beware of “therapists” with unfamiliar titles.
No ethical professional therapist should mind being asked about his or her educational or professional backgrounds. You should likely stay away from individuals who don’t have at least a master’s degree (e.g., M.S., M.S.W., C.S.W., M.A.).
In the United States, Doctors of Philosophy (Ph.D.), Psychology (Psy.D.), or Education (Ed.D.) must complete at least four years of post-graduate school, however, only those who have been licensed can call themselves psychologists. Clinical psychologists are specifically trained in assessing a client to determine the problem and to respond by providing treatment. In most states, if medication is needed in addition to therapy, a psychologist will refer the client to a psychiatrist for that aspect of treatment.
Social Workers/ Licensed Clinical Social Worker
Clinical Social Workers (LCSW) usually have earned at least a master’s degree (two years of graduate school) and some may have doctoral degrees. Clinical social workers credentials may vary by state, but these are the most common: B.S.W. (Bachelor’s of Social Work), M.S.W. (Master’s of Social Work), A.C.S.W. (Academy of Certified Social Workers), D.C.S.W. (Diplomat of Clinical Social Work). Although there are exceptions, most licensed clinical social workers generally have an “L” in front of their degree (e.g., L.C.S.W.).
Marriage and Family Therapists, Professional Counselors, mental health counselorS
Marriage and family therapists (LMFT), professional counselors (LPC), and mental health counselors (LMHC) may have two years of graduate school and have earned at least a master’s degree such as: M.A. (Master of Arts), M.S. (Master of Science), M.Ed. (Master of Education).
Requirements necessary to become licensed as a psychologist, clinical social worker, marriage and family therapist, professional counselor, or mental health counselor includes obtaining a graduate degree in the field, a period of supervised practice, and an examination process. In order to keep a license active, the individual must continue to meet the requirement of obtaining a minimum number of educational units ongoing.
Other Categories of Professionals
Many other categories of professionals also provide mental health care services in private practices or in agencies.
- Pastoral counselors are clergy who have the credentials M.Div. (Master of Divinity), Th.D. (Doctor of Theology), and have a degree from a seminary or rabbinical school with additional training in therapy.
- Psychiatric nurses and nurse practitioners comprise a growing segment of mental health treatment professionals. They display the credentials R.N. (Registered Nurse), R.N.P. (Registered Nurse Practitioner), or M.S.N. (Masters of Science in Nursing). A Psychiatric Nurse Clinical Specialist is a registered nurse with a master’s degree who has been trained in individual, group, and/or family psychotherapy.
- Psychiatrists are medical doctors (M.D.s), who after completing a medical degree like any other physician, follow up with a four-year psychiatry specialty. Psychiatrists’ fees are likely to be the highest of all mental health providers. In this day of managed care, psychiatrists rarely provide talk therapy. It is generally not necessary for a person with a trauma disorder to use a psychiatrist as a primary therapist. However, for those who have complex or co-occurring medical and mental health conditions, a psychiatrist has the advantage of being a trained M.D. Psychiatrists often work together with other non-medical psychotherapists to provide prescription and medication management services when needed.
In general, the most helpful therapists/counselors are:
- have respect and a high positive regard for their clients
- are warm and empathic
- are responsive and hopeful
- have firm boundaries but are not domineering
Helpful therapists also have:
- a variety of clinical skills to address the specific needs of the client
- an understanding of the power imbalance that exists in therapy and a willingness to work toward empowerment of the client
- a view of the client as the expert on his or her own life and as an active partner in therapy
- awareness of their own biases and the limits of their skill, and willingness to refer their clients to other professionals if necessary
Consumers of mental health services have contributed the following list of things to look for in a therapist:
- Find a therapist you feel comfortable with. Therapy is not an easy process and your therapist is not there to be your friend.
- Find a therapist who respects your individuality, opinions, and self.
- Find a therapist who will not get upset if you disagree with what he or she has said, but instead encourages you to express yourself when you do not agree.
- Find a therapist who never minimizes your experiences and always respects your feelings.
- Find a therapist who will not try to force you to talk about things that you might not be ready for.
- Find a therapist who does not spend time talking about his or her own problems. Your therapy sessions are for you, not your therapist.
- Find a therapist who wants neither a friendship nor a sexual relationship with you outside of your counseling sessions.
- Find a therapist who is more than willing to discuss problems that might arise between the two of you within the therapist/client relationship.
- Find a therapist who will help teach you new and healthier ways to cope.
- Find a therapist who will never make you feel like a failure or cause you to believe they are disappointed in you if you have a slip or a relapse.
- Find a therapist who is dependable, reliable, and consistent.
- Find a therapist who supports your recovery and resilience and is not just focused on your symptoms.
Types of Therapy
There are many approaches to therapy, and most effective therapists are trained in several and tailor their approach to the person with whom they are working. Therapy may be long or short-term and may be focused primarily on the past or on the present, but all should aim to alleviate distress and help clients learn how to acquire more effective coping strategies and identify steps toward wellness and recovery.
Psychodynamic approaches attempt to help the client discover the origins of the problem in the past as well as how it affects life today. A behavioral approach tends to focus on changing current behavior with little emphasis on past events. The cognitive approach focuses on changing the client’s way of thinking, and a family systems approach aims to change unhelpful patterns in relationships/families.
Formats for therapy include individual (or one-on-one) therapy, couples’ therapy, family therapy, and group therapy. Some therapists use a combination of these formats.
Today, many therapists describe their work as eclectic, meaning that they draw from a wide variety of approaches in order to best meet the needs of each individual client. Research indicates that the quality of the therapeutic relationship is often more important than the particular methods employed. In therapy for traumatic stress, the relationship is particularly important, as rebuilding interpersonal trust is often a key objective of treatment. The most important thing to remember is that your needs are paramount; choose a therapist whose approach seems most appropriate for you.
Interviewing Potential Therapist
When interviewing a potential therapist, keep in mind your needs and goals for therapy, as well as the particular qualities you feel are important in a therapist. We often hear about the need for a good match when selecting a therapist and there is a lot to be said for feeling comfortable with the person you choose. Although your objective is not to build a friendship with the therapist, you will be spending a lot of time together, and you will need to feel comfortable enough to discuss sensitive, confidential thoughts and feelings.
Below you will find a list of questions that may help you determine who suits your needs the best. You may find it helpful to take this list with you on interviews (in person or over the phone) along with a pad of paper to record your information. *Please note that these questions can help guide you in evaluating all kinds of service providers, not just therapists.
Questions to ask potential therapists
- What are your credentials?
- What are your specialties?
- How long have you been conducting therapy?
- What experience have you had in treating traumatic stress conditions?
- How do you approach treatment of traumatic stress conditions?
- What do you charge?
- Do you accept MY health insurance?
- Do you have a sliding fee scale? If so, how is payment determined?
- Do you bill people, or is payment expected at the time of the session?
- How do you protect client confidentiality? Who (besides you) will have access to my files?
- How long is each session? Are there exceptions to this?
- Has anyone ever lodged a formal complaint against you?
- If I were in crisis, would I be able to reach you? How do you handle crises?
- What is your policy about missed sessions?
- What is your policy about physical contact with clients?
- What is your policy about contact outside of the session?
- Do you arrange vacation coverage?
- What happens if one of us decides to terminate without the other’s agreement?
- Do you think you can help me?
- Is there anything I should know about your services that I didn’t think to ask about?
Keep track of all that apply:
- I felt safe and reasonably comfortable
- I felt understood and taken seriously
- I was treated respectfully
- We agreed about the nature of the problem
- This feels like it could be a good “match”
- My questions were answered adequately
- My treatment goals were addressed
- This individual is clinically qualified
- I can afford it
- I can get there with reasonable ease
After the first meeting you should ask yourself some questions:
- Did you feel comfortable and able to begin discussing your problems?
- Did the therapist seem to understand what you were talking about?
- Did you feel your concerns were taken seriously and that you were treated with respect?
- Were the two of you in general agreement about the problem and your expectations for therapy?
- Were you satisfied with the therapist’s answers to your questions?
- Did you feel that you could grow to trust and work with this person?
- Pay attention to your intuition; choosing a helpful therapist will require trusting your own thoughts and feelings. Remember that you are a consumer of a service and that it is your right to choose a therapist who best meets your needs.
If you don’t feel respected, valued, or understood, or if your experience is being minimized or distorted, it may be a sign that your therapy is not working. If you feel there is something wrong in your therapy, or if you get upset or angry with your therapist, discuss it in your session. If your therapist discounts your feelings or responds in a defensive manner, you can choose to switch to a different, more respectful therapist.
If you are working with a helpful therapist, you will begin to be able to better recognize and understand your feelings, thoughts, and behaviors. You will also begin to develop new, more effective coping strategies, and you should have a sense of change and increased satisfaction in your life. Over time, you should begin to feel more and more independent and able to use the skill and insights you are learning in therapy to solve your own problems.