Welp, I’m back! I got avoidant for a minute. Life got busy and I didn’t practice what I preach. I stared at the computer screen, I paced, I yowled “I don’t wanna” and I avoided. See. I get it. But now, I’m back. Those of you who know me know my writing works because I only write about things I’m passionate about. Well, this one’s gonna get a little ugly. So, ladies, hold on to your pearls, and I’m probably gonna cuss cause I’m pissed- so fair warning.
Ready? Here we go!
I’m noticing something in my practice lately: I get patients in severe pain and they’ve been in that place for at least a year. Many of them saw at least one therapist who “specializes in trauma” (more on that one in a minute) and didn’t get better. Several of them are misdiagnosed as Bipolar (the two look similar) or were NEVER screened for a trauma issue, even with a severe trauma history. In fact, several of them are worse: they’re convinced they’re incurable (as if they’re “sick” in the first place!), that this is just life now, and that they’re just destined to be one walking activated nerve ending for the rest of their lives.
The worst part? THIS ONE ISN’T ON THEM. This one is on the therapists. I’m calling us out and I’m talking to you about how to defend yourself against this bullshit. Because that’s what this is- complete and total, amoral, unthinking, bullshit.
Want to hear something scary? I belong to some therapist Facebook groups. (That’s not the scary part.) They’re great for placing referrals, networking, and general information. Here’s the scary part: there are entirely too many therapists who don’t know their own limitations. They post questions like “I’ve got someone with complex trauma. How should I help them?” Therapists, I’m talking to you: If this is your question, the only answer is REFER OUT. The one exception is if you’re training and under supervision, in which case you should be talking to your supervisor, not searching the internet. I’ve also seen “I had someone with trauma dissociate/have a bad reaction/freak out in session today and I didn’t know how to bring them down. How do I help them next time?” Again, refer out. KNOW YOUR LIMITS. This is not something to play with. You can get in deep and fast. You have a responsibility to know your lane and refer out. It’s not a personal failing. We can’t all specialize in everything. Just work on what you know, learn what you don’t under supervision, and refer out what you can’t or don’t want to handle.
To the clients: I’m writing this to empower you in defending yourself from this. It’s bullshit. It’s disrespectful. And it’s terrifying. How many people were harmed by inept therapists and then just gave up? I shudder at this thought. I get it. I’ve looked at the directories. MY eyes cross and I know what I’m looking for. And I’m not in crisis. So- how do you protect yourself? Ultimately, it’s on us- because a lot of the ways that you protect yourself are hard for people who have been traumatized for a lot of reasons. However, I still want to reiterate the ways you can protect yourself.
So, what's a person to do when they just want the pain to stop and they want good help?
Realize that a license does not ensure a good therapist.
Sad but true.In all honesty, I don’t like a lot of therapists. They annoy me for a lot of reasons. (I have some I know, adore, and trust. I refer to them a lot!) I think the thing that horrifies the most is how often I’m thinking “where in the hell did you get your license?” They’ll ask questions that I feel are basic or self explanatory.
This is coming off a bit holier-than-thou, but give me the benefit of the doubt. I’m pissed here. It’s bullshit that I’m having to unfuck what some inept therapist fucked up in the first place. We’re better than this. At least we should be. What we do is sacred, serious, demanding work. We don’t need MORE people making it that much harder for clients to trust us. We also don’t need clients who have to be in therapy longer because of extra foundation work. It’s terrifying walking through that door. It’s worse when you’ve done it before and gotten screwed.
This one is so important I’m going to say it a lot. Ask questions. Realize that you are interviewing us too. Don’t fall into the power dynamic of “they’re the expert. They must know what they’re doing.” Don’t be worried about being annoying, hurting someone’s feelings, etc. And this is a hard one for you- because people with trauma have been browbeaten into submission and not making waves. So, really, this one’s on us. However, I still want to encourage you to ask questions.
Ask about the “treatment plan.” A good therapist will have goals for therapy and a road map- and you should be involved in what those are. Ask HOW they treat trauma- there are specific ways to do it. They should be able to put it in language you understand. Ask what their average “treatment time” is and ask what the average number of sessions before a client shows relief. Many of us track this data and can tell you. I can tell you these things and so can my badass friends. Oh, and if they get defensive- LEAVE. There is zero reason that a therapist should get annoyed at you wanting to be informed about your own care.
EVERYONE “specializes in trauma.”
I hear practically every therapist say this. Except for my friends, because my friends are badasses who know their lane. We all SEE trauma. We don’t all SPECIALIZE. Have I seen depressed clients? Yes, but I don’t specialize in depression. Have I seen eating disorder clients? NO, BECAUSE ITS NOT MY LANE. < see what I did there? I refer out. Specialization is a term for hours of training in a specific area. So, if they say they “specialize in trauma.“ ASK THEM HOW. What certifications do they have? What kind of training did that take? What would you do if I had a bad reaction? How are you going to help me get control of this? NEVER BE AFRAID TO ASK QUESTIONS. YOU are in charge of your healthcare. (see? I’m gonna harp on this.)
Trust your gut.
Again, this is a hard one, because with trauma everyone tells you that your interpretation is wrong and you’re overreacting. Trust it. If you don’t like that therapist, you don’t have to have a reason, don’t schedule.
My one warning here is this: this mostly applies to when you’re meeting a potential therapist or in the first few sessions. Once you’ve built a relationship, feeling icky may be about something else. We can often trigger things- so if you’re already established, speak up about this before ghosting us. But if it’s a new therapist- you don’t have to have a reason. If you’re uncomfortable and your gut says no, then listen.
A tough one for traumatized individuals who constantly have boundary violations and have been ignored at outcries. (Are you seeing a pattern here?) if something feels off- speak up. If it’s been six months and you feel no change, speak up. Hell, if it’s been six weeks, speak up! Our relationship is based on information- WE WANT TO KNOW. If I’m pushing a client too far too fast, if I missed something, if they forgot to tell me something, if my clients don’t understand something, or if they’re feeling any kind of way, I need and want to know that
Remember that ultimately your care is in your hands.
If you want to do research and then talk to us about it, that’s okay. I’ve had clients come to me asking about PTSD and stating that other therapists never screened them for it. They came upon the diagnosis on their own. I’ve had clients who knew they weren’t getting better but felt like maybe they should wait just a little bit longer… I’ve had clients who stayed with a therapist because they “didn’t’ want to hurt their feelings.” I’ve had clients who went with the first therapist they met, not really realizing that a good fit is critical to good therapy work.
Okay, so we’ve covered you end, what about ours. How do you know a good trauma therapist from a not so good one?
There are a few things to watch out for:
What are they like in the pre-screen?
What I mean by pre-screen is the first phone call, where you call to schedule. YOU ARE SCREENING THE THERAPIST AS MUCH AS THEY ARE SCREENING YOU. Do they ask you what’s going on? Do they seem to get it? Do they empathize and make you feel like they really understand your pain? Do they rush you off of the phone, interrupt you, or go straight to price talk? Pay attention.
The initial visit is STILL screening.
Now that you’ve met them in person, do you “click?” If you’re flooded (really, really needing to talk) are they all business or do they let you speak? I work with severe trauma. Often, the first visit is nerve wracking and I need to make the client comfortable and let them be heard. It’s not that unusual, and I’m in no hurry- we can get to the history the next session. If , for ANY reason, you don't like or feel comfortable with your therapist, move on.
Do they pick up on your cues?
Do they seem to pick up on when things are too hard to talk about or do they push you too hard too fast? Are you sitting there feeling understood, or are you struggling to explain yourself?
Do they go into the trauma too fast?
This is a telltale sign that I've heard about more than once. When working with trauma, it is RARE to go straight into it. More often than not, the client needs some work before we go there. If they don't try to teach you techniques to handle the big emotions BEFORE going into the big stuff that's a hard NO. Get out and find someone who understands that this is tough, that you need help knowing how to handle what comes up bfore digging, and notices your behavioral/emotional cues.
*Again, the one exception to this is when taking a history. We need to know what has happened, but a good trauma therapist will walk you through how to summarize and speak about it briefly and not trigger yourself.
What trauma-specific training do they have?
You aren’t expected to know the ins and outs of trauma therapy, but ask if they have TRAUMA SPECIFIC training. That’s a simple yes or no. We all see trauma, but that doesn’t mean that we’re all highly trained. Trauma is a special topic and isn’t hobby-work. All I mean is that the reactions that can come from trauma work are specific, messy, and can get hairy fast. If you don’t know how to deal with that, it can do more harm than good.
You can also ask “If I had a bad reaction, how would you help me out of that?” They should have an answer. In fact, they should have several answers.
This post isn’t meant to scare you. It’s meant to inform and empower you. YOU are always in charge of your care and it’s important that you remember that. It’s easy to fall into a dynamic where you feel that the therapist is the expert and if you just hold on long enough maybe you’ll feel some change.
I will say this: we can only help you if you talk to us. We have big shoulders- at least if we’re good we do! If you tell us you don’t feel a change we will/should discuss it with you. Sometimes it’s as easy as managing expectations. Other times, it means we need a different approach. It may even mean a referral to a specialist- and a good therapist won’t have a problem with that and will even offer names of people they trust! Whatever you’re going through, you shouldn’t be “suffering through” therapy too! Therapy is hard enough without being lost about what you’re doing. Again, speak up. Be your own advocate. We’re here when you’re ready.