Choosing a therapist for people with ptsd

[n.b.: links fixed, 12/8/08]

When the symptoms of my ptsd exploded on me a few years ago, I had no idea what it was, what was going on or how to deal with it. I thought I had gone crazy and was headed for a trip to the loony bin again. Fortunately, with a lot of help from friends, especially my partner, I was able to get help. I wish I had a guide like the one I found today from the Sidran Institute back then. If you need emergency help, if you think you will harm yourself or others, get help from 911 or a hotline immediately. If you are well enough to look for a therapist check out the guide now. What follows is my experience in finding both really bad therapists and finally figuring out how to find some good ones (I also needed to go to a treatment center, which helped a lot, giving me an understanding of ptsd and some tools to deal with it in a safe supportive environment).

I had no idea of what to look for in a therapist when my life fell apart on me. Part of my ptsd involves earlier abuse by therapists, and I was turned off by the whole thing but really needed help. I chose a real loser at first, another abusive therapeutic relationship. There are so many bad shrinks out there. This one blamed everything on me and said I had caused all my own problems because of my shortcomings. I think he was trying to goad me into getting angry at him, some kind of manipulative move to get a reaction from me for the sake of "therapy." I went with my partner to one visit and she was like "this guy is nuts, let's get out of here," so we walked. She has good sense. I seem to have a broken "picker," something that is pretty common to people with complex ptsd.

Things were too crazy and unmanageable for me to give up the search, so with my partner's help, I kept looking. We asked around about what to look for and interviewed several people before settling on one who turned out to be good. We came up with a set of questions to ask, but I forget what they were. Today, while reading the post on treatment centers, I followed a link at the bottom of the page that turned out to be an excellent guide to choosing a therapist for people who have ptsd and trauma-related issues. It would have been great to have it back then.

The guide gives a few important criteria for choosing. First, the therapist should be your partner in healing, not the director of it. She has to respect you and your experience and draw on it to help you. This doesn't mean you need to be pals inside or outside therapy. That can turn into more trauma and cause major trust issues later when trying to start with another therapist. But you need to collaborate in your recovery, so look for a good rapport. This was pretty hard for me, as trauma and abuse taught me not to trust my intuitions. That is why I was lucky to have friends to bounce things off of while I was choosing a therapist -- once I was willing to, anyway. Like I said, I stumbled on my own at first. That is slowly getting better though, and I am reclaiming trust in my intuitions, which are actually pretty sharp, like those of most survivors.

Second was to find someone qualified. Anyone can call themselves a therapist, so ask about training. Look for people with at least a masters degree in an appropriate field. Psychologists have to be licensed and have at least a Master's. I have looked for ones with Ph. D.s. This is not a guarantee, as the one we walked out on was a Ph.D. Losers come in all flavors. I had consistent problems with a group of people called "certified addictions counselors" (CACs). All you need for this is a Bachelor's degree and some additional experience and training. The people found tended to go for new-agey solutions or be didactic about twelve step programs, and were in hindsight consistently bad. I also had lots of problems with boundaries with these peole. They did a lot of overzealous intrusions into my life. Part of the problem is that many of them are egotistical "type A" alcoholics. Unfortunately for the dually diagnosed ptsd suffering addict, most rehabs refer clients to CACs. I am sure there are good ones but my experience has been uniformly awful, not matter how well-intentioned they were. A thorny problem is that bad therapists tend to be more affordable than good ones, which is really an important factor for people who don't have insurance and are in early recovery from addictions. If you are on a budget and don't have insurance, be extra careful!

There are many types of therapy, and various camps will tell you that one or the other is the only or most effective treatment for ptsd. I have found that rapport and qualifications and a willingness to collaborate are much more important than the particular approach, whether it is cognitive behavioral, Jungian psycoanalytic, Psycho-dynamic or whatever.

HOWEVER, that said, avoid at all costs quick wonder cures or anyone that tries to sell you a one-size-fits-all treatment regime. Recovery from complex ptsd takes time, flexibility, and sensitivity. I don't know, maybe simple ptsd, where there is no chronic or multiple abuse, responds to some of the more legitimate brief therapies, but not mine. Run as far away as quickly as possible from any cultish or new-agey spiritual methods like "neuro-linguistic programming" (NLP) or any of its myriad offshoots like "time-line therapy," "advanced neuro-dynamics," "humanistic neuro-linguistic psychology," the fake Hawaiian spiritual practice "Huna," or whatever other label they are using this week. These promises of quick cures are tempting to people who are literally dying for a solution, but they play on vulnerability, slowly, even imperceptibly, seeking to separate the client from his wallet through ever-more expensive treatments and "trainings." They are manipulative, and if the "cure" fails, they blame the client rather than trying something else, further compounding the trauma. They often play on people's spiritual longings or cloak themselves in quack versions of legitimate sciences like linguistics or quantum physics.

Unfortunately, these treatments, with their promises of quick solutions, often present themselves as the most affordable and financially accommodating, making them doubly attractive to the doubly vulnerable, those without insurance or a lot of financial resources. Look for someone you can trust. If you are not sure of your own instincts, get someone whose judgment you respect who has no connection to the proposed therapist to help you pick and choose. Its vitally important that you be able to develop rapport and a partnership with your therapist. It will take some time.

Having said all that, here is a brief excerpt from the guide to choosing a therapist if you have ptsd. If you like it they have a version that you can print out and take with you (pdf) too.

Questions:

• What are your credentials?
  
• What are your specialties?
  
• What professional organizations to you belong to?
  
• 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 insurance? If so, what kinds?
  
• 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?
  
• Have you ever been censured by a professional organization?
  
• 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?

My impressions: check 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
  

Overall impression:

• Good
  
• Fair
  
• Poor