Tuesday, November 22, 2005

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

20 comments:

Gadfly said...

Excellent observation, especially on Type A alcoholics. IT's my opinion, following up on your post about 12-step groups and your screen name, that AA is best geared for them, but, beyond its "singleness of purpose" serves other types of alcoholics less well. Unfortunatley, it won't admit that.

Anonymous said...

Useful post. Fortunately here seeing a psychiatrist is free and I'm already finding a real difference between seeing him and a psychologist. I feel like I'm taken more seriously and the psychiatrist understands the biological implications of PTSD. I hope this will work! The downside of a free system is that you don't have a lot of choice, and changing doctors would involve re-entering the waiting list.

Redcat said...

I sure wish I had come across this post years ago.

Very useful info. Thanks.

GettingBetter said...

Redcat,
LOL, I could have used it a few years ago too! I had to learn most of it the hard way.

Gabriella3 said...

Awesome site/blog well done. My partner had a horrible upbringing yet when it all got too much after he met me - he had a one hour seizure in the ED. 18months later after being on epilepsy medication and finally got in for a week long EEG -viola - PTSD non - epeleptic seizures (NES) related to Dissociative Seizures (DS). The Docs were incredibly kind in how they explained what my partner (let's call him Bob) had. Because Bob was so tired of these seizures - he was not going to be impressed by someone who said "they are not real and they are all in your head". The Docs basically looked Bob in the eye and said "if you were a faker you would drop and have a seizure right now - and i know you don't fake it - we've seen it on the video monitoring. And we know that your seizures are REAL"

So Bob was happy, sad and dissappointed in his (not very nice) upbringing all at once.

Now that being said, i was helping to run a NLP training school - and yes you are right they are mostly con people - card sharks - where all they do is shift your attention to giving them money and you end up being a student referral machine "have you heard of NLP xyz school? oh they are brilliant" which is all you hear from the students of these schools, they are not cult schools they are just heavy and coniving brainwashers (DON"T LOOK AT THE hand gestures whatever you do - its all in the "anchoring" trust me).

Yep and Bob having seizures - did you think mightly NLP trainer person picked up that it was PTSD? DID ANY so called self claimed NLP expert? NO F**KING WAY. Total shit.

So looking at your blog especially the BOND: Betrayal book looks like it would be very helpful to break the "one sided loyalty bonds" that are created with other manipulative shits. Did the NLPers push the loyalty button?-many many many times.

I wish to thank you very much for putting your heart and soul on these pages - you are a Godsend for people like me - who just need answers - honest answers - from someone like you who has no other agenda then to tell the truth and who has been there and still is going through the journey.

God Bless

GettingBetter said...

Gabriella3, thanks for your comment and the insights re: NLP. I would love to go on a rant about it, but it would probably attract crazed acolytes and I would end up saying stuff specific enough to identify myself, plus it is emotionally taxing to dredge that horror show back up. Brainwashing? yep. Manipulative? You betcha. It destroyed families and lives in my experience, feeding off vulnerable, needy people by providing a "quick fix" -- if you pump in endless money anyway. All these things make it very cult-like IMHO. Anyway, thanks again for sharing, and sorry to take a few days to approve your comment.

Gabriella3 said...

considering your opinion and comments then yes... i agree that it is cult like. One negative comment against it and bam - you are out of the circle of friends. Quite sad really considering the course is supposed to open your mind (increase choices etc) instead of training it to be closed off "NLP only" discussions. Thanks again for blogging - i have no idea how many people view your site - i'm sure its many as i googled PTSD siezure your site was the first and second on the google lists and probably the best as well! Well done! P.S what books would you recommend on this subject "ptsd seizures" and nightmares.

GettingBetter said...

Thanks for more kind words Gabriela3. I can't think of any books on nightmares or PTSD seizures off hand. I think I learned whatever I have shared at the PTSD treatment center I was lucky enough to go to. ANybody else have suggestions?

Jen Stephens said...

Wow! I'm overwhelmed by the information you've included in your blog. I've visited the Sidran site - VERY helpful! And I've visited a few other sites dealing with PTSD, but for my situation, I really need to know what a counseling/therapy session is like. Would you please consider emailing me privately? jen@jenstephens.net

Blog Specialist said...

What I have done is the past is call a therapist and speak with them for a short while before seeing them regularly. This helped me determine how verbally expressive they are and how they react to different subjects.

Anonymous said...

LIve in Orange county, Calif my son went to prison for marijuana possession, a pd...He was raped and beaten there and cannot move into the future, his PTSD is bad...OH, also it was the officer who beat him that beat him in prison and raped. He is presently up for 1st degree murder and is locked up.. He also got Ulcerative Colitis in prison and almost died..They left him for dead and finally rushed him out via Paramedic to a private hospital for 6 days...I have no idea where we should send him..Any suggestions???

GettingBetter said...
This comment has been removed by the author.
GettingBetter said...


Hi, Sorry to hear about your son's travails. That sounds truly horrible and I hope he can get help. PTSD can be managed, but it won't heal with time unless directly addressed, and its manifestations are usually tragic, so I hope he can get help. I am not a professional, only sharing my experience and hope, but take a look at the Comprehensive list of US treatment centers. Especially follow up with Sidhran, they can help you. Good luck, and I am sure anyone who reads your post will be wishing you the same.

Wyeth Bailey said...


I have complex PTSD from chronic childhood abuse. I was 40 before I became aware that I was dissociating and experiencing trauma triggers. I was also diagnosed with two autoimmune disorders, including fibromyalgia, which is linked to PTSD. All the while, I led a "normal" life, no substance abuse, but severe bouts of depression.

I want to share with you two big things that have helped me very much. One- all the books written by the late Alice Miller, specifically "The Drama of the Gifted Child." I read that one, then read them all. She is controversial because she has spoken out against the Catholic Church and other institutions for systematizing and normalizing violence against children. She also took a string stance against 12-step and other self-blaming bullshit "solutions." Alice Miller says in order to heal, we need a therapist to stand beside us as witness, and share our outrage at what happened to us, in order to move on. (All the new-age claptrap about forgiveness and letting go is just another form of the denial of abuse forced upon us by abusers (with threats or pretending it never happened) --- all of which, over time causes as much harm as the abuse itself.)

The other thing that has saved my life -- without drugs -- is a treatment called EMDR. It's a real thing approved by the medical authorities and actually developed by the military. Google it. I could explain more but there's alot of good info on it. Therapists require special training. It has literally saved my life, and calmed down my reactions to severe triggers.

I too am dubious about most therapists. I was in regular old talk therapy with an LCSW for 10 years with a woman who never saw what was happening to me, even when, as an adult with a high stress, high profile career, I would regress to cutting behavior as I did in adolescence. (It's really malpractice, or at least benign regret. But of course, she was a mother figure to me, and I was just trying to please her by keeping it upbeat.)

Anonymous said...

EMDR is indeed a great treatment as it has helped me tremendously. I suffer from PTSD as a result from a massive gasoline explosion which burned me severly at the age of 9 and then the subsequent medical care that is associated with burn trauma at the age of 9.. it happened in 1984... what I have found to be SO difficult is to find a good pych that has a backround in child/adolsecent traumatic stress and can help to translate the PTSD symptoms of suffering into an adult. its a scarce mix to be able to find.... can anyone else relate?

Anonymous said...

One of the problems I find for treatment now is how few Psychiatrist and even fewer Psychologists take Medicare. The problem that created PTSD for me happened when I was 15. I am now 69 and the symptoms have suddenly arisen again. Having to depend on Medicare and a supplement, and being limited in financial resources, prevents me from freely choosing my therapist. Is there a service anywhere that helps in finding a psychiatrist or psychologist who accepts Medicare?

Anonymous said...

Great article, very helpful. I have layers and layers of PTSD and am on a great deal of medication for physical issues. I'm certain that the PTSD has caused many of these issues. I've tried hypnosis and anti anxiety meds to recall parts of my past and traumas that are still hidden from me so that I can finally resolve them rather than wrestle with them in my sleep, but I cannot get through them. What do you think of drug guided interviews and how would I find the right doc for that? This would take a great deal of trust needless to say. Is it something I should even attempt? I've been through all the same sh*t you've been through already, but I finally want to be done with this 20 year burden. Anyone???

GettingBetter said...

Personally I would not do a guided drug therapy although I do take medications. That is because of my history of addiction though. your mileage may vary and I know nothing about this subject.

Anonymous said...

I appreciate your blog very much. I have been dx with ptsd AND I work in the mental health field. I refused to go on medication for a long time. However, I espoused it for my clients who were struggling with their ptsd sx. I know, I am a hypocrite. I finally decided to call my eap...that was a disaster. ..won't go into details, but I will tell you I will never recommend a eap program in the Northwest. I tried a couple of psychiatrists and they were the worst in regards to prescribing habits. One would type and ask questions, but never changed his notes. The pharmacy would try to give me medications I was no longer on. I finally changed providers. I went to a psychiatric mental health nurse practitioner. She has been incredible in regards to medication management. She also listens to me. Let me say Prazosin in high dosage has been remarkable in helping with augmenting dbt,cbt to decrease nightmares.

Anonymous said...

Thanks to your blog, and the feedbacks left by others I found something useful and hopeful.