What makes a good trauma therapist?
Monday I got an email from someone I respect very much asking me for some referrals. One of his questions was, “What makes a good trauma therapist?”
Good, good, good question. An important one.
Here’s the list I came up with. I’m wondering what you think and if I’ve covered it all.
What would you add? What has your experience been as you’ve walked the path of healing?
- The most basic question is whether the therapist has the fundamental skills to deal with trauma. What kind of post-graduate training has the therapist had, especially in trauma treatment. And who did they train with? Is it all cognitive-behavioral or is the therapist versed in some of the body-oriented therapies? I don’t think it’s possible to heal trauma without knowing the body or knowing how someone’s internal world is disorganized so that it can be reorganized.
- We now know that trauma doesn’t resolve without reorganizing relational patterns of neglect, rejection, humiliation, shame, abandonment. Knowing that I’d also be curious about whether the therapist understands the underlying attachment and intersubjective issues that complicate trauma processing.
- Does the therapist listen — not just to the story you tell but to the multiple layers of the communication. As the therapist listens do you feel heard and understood?
- Is there a connection, a resonance between you? Or do you feel like a “patient” – someone who has problems and that the therapist has never had a personal problem, or encountered anything like this? Personally, I prefer the “wounded healer” therapist – someone who has walked in similar kinds of shoes, encountering issues like I have.
- Is there a foundation for respect between therapist and person seeking support?
- Do you get the sense that the therapist can help you? Does the therapist have the training to do so?
- Healing trauma and attachment wounding is a long and windy road. Do you get the sense that the therapist has the internal steadiness and solidity to stay in it with you as you explore what one of my favorite theorists, Daniel Stern, calls the “sloppy” path of therapy?
- And perhaps more than anything, does the therapist impart a sense of hope that you can find the healing that you want? Are they confident that there is a way through? Can they communicate the markers on the healing journey so you don’t feel like you’re flailing aimlessly? Richard Schwartz, the founder of the Internal Family Systems model says he’s a “hope merchant” selling people on the possibility of change/transformation. I’m all for that as well.
I’m really curious what you think? How has your experience with therapists been? In the inquiry above have I covered what works? Is there more you would add? What am I missing? Leave a comment below — let’s think this out so we can help others on the path who are just finding their way.
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Part 2: How to Find a Real Trauma Therapist and What You Should Look For
This post is part two of a three-part post that covers why it is important to work with a real trauma therapist, what a real trauma therapist is, what you should look for when finding a therapist, and what you can expect when in treatment with a real trauma therapist.
“Real” Trauma Therapists
This subheading may sound somewhat confusing, as to some patients, and perhaps therapists, a “real” trauma therapist is “anyone who works with trauma.” Well, that is … extremely inaccurate. I cannot put it any other way other than that this notion is entirely false. Unfortunately, there are many, many therapists who advertise that they work with trauma. Many times this comes from an interest in trauma or perhaps the thought “I wouldn’t mind working with trauma, plus this opens up my clientele, so let’s see what happens.” Unfortunately, that is not what it takes to actually effectively help someone who has experienced trauma.
Working with trauma is a highly specialized area of psychological practice, which is why it is important you seek treatment from a trained and experienced trauma psychologist or therapist.
Yes, it is simple for a therapist to state they work with trauma if they have even once sat with a patient and listened while the patient shared a traumatic experience. But, that is not trauma treatment. Listening to a patient share a life experience does not even cross the threshold of what is involved in understanding trauma, knowing how it impacts the individual, knowing how to effectively treat trauma, and how to problem-solve nuanced aspects of the treatment process.
Take this brief metaphorical example that may help to make more sense of this: If a patient goes to their general practitioner (GP) and has a conversation with the GP about complications from recent heart surgery, does that now make the GP a cardiologist? Absolutely not. In fact, in such cases, the ethical and competent GP would refer the patient back to the specialist (the cardiologist); in the case of psychology and trauma, it is important you see a trauma specialist in order to obtain treatment with a knowledgeable and skilled therapist that can actually help you.
So What is a Real Trauma Therapist?
Put simply, a real trauma therapist is a licensed mental health professional who has had explicit training, supervision, and clinical experience working directly, and perhaps almost exclusively, with trauma. The therapist is likely to be a psychologist, licensed mental health counselor, or sometimes a social worker. A real trauma therapist is not someone who has had passive experience working with trauma; this means that working with one or two patients, even if the primary focus was trauma, does not qualify someone as a trauma therapist. More specifically, the next section outlines what to look for when searching for a trauma therapist.
Qualities of a Real Trauma Therapist
1. The therapist has trained in a dedicated trauma setting. This typically means the therapist has completed an extended-length practicum, internship, or residency in a trauma facility or center, with a focus on trauma psychology. To confirm this, read the therapist’s bio or “about” page. It should mention receiving training and supervised clinical experience in a DoD (Department of Defense), VA (Veteran’s Administration), hospital, or community trauma center. If still unsure, look up the facilities where the therapist has gained experience and see whether they exclusively work with trauma. Also, ask the therapist about their experience with treating trauma.
2. The therapist has treated multiple trauma cases. Again, working with a few trauma cases does not make a therapist a trauma clinician. Going back to the cardiologist example, does a resident doctor who examines a few cardiology patients instantly become a cardiologist? No. Trauma psychology is a very specialized area of psychological practice, which requires that the therapist has significant experience working with a variety of trauma cases from start to finish in order to be considered competent and proficient in providing trauma treatment.
3. The therapist must possess sound and applied knowledge of the development of acute stress and post-traumatic stress. Knowing how post-trauma responses form and develop over time is an incredibly important aspect of knowing how to treat trauma. A therapist must know what to look for and how to best treat the symptoms you are experiencing (and even the ones you are unable to report because they happen so automatically that you don’t realize they are happening). A real trauma therapist will be very knowledgeable about these aspects of diagnosis and treatment.
4. The therapist must possess a thorough understanding of the impact of trauma on one’s life. This is only gained by being extremely familiar with trauma and trauma treatment, which is a function of significant training and experience with trauma. The reality is that if you work with a pseudo-trauma therapist, they just won’t know what trauma responses actually “look like.” This means they won’t pick up on the struggles you are experiencing, won’t know the right questions to ask, and the subtle behaviors and statements to pick up on. Only genuine trauma therapists have the breadth and depth of training to be able to thoroughly and accurately provide treatment.
5. The therapist should be trained in at least one, but hopefully more evidence-based trauma treatments (EBTs). EBTs are therapies that have empirical evidence supporting their effectiveness. Fortunately, trauma treatment includes three EBTs that are highly effective in reducing trauma symptoms and helping the individual to regain their quality of life: these are CPT (Cognitive Processing Therapy), PE (Prolonged Exposure), and EMDR (Eye Movement Desensitization and Reprocessing). A real trauma therapist should be trained in at least one of the three, but ideally is trained in all three since they are not exactly interchangeable.
6. The therapist should be certified in trauma treatments. The definition of training can be vague. Some clinicians will unethically state they are trained in a particular treatment based on having minimal exposure to the therapy. For example, perhaps the treatment was discussed during one lecture in a graduate course, or they observed a supervisor administer the treatment a few times. This does not equate to being trained. “Trained,” in the most ethical use of the term, means that the clinician has been taught, practiced, refined, tested, and frequently uses the treatment. For this reason, it is better to work with a therapist who is certified in one or more of the aforementioned treatments (CPT, PE, and EMDR). This is the only sure way of knowing that the therapist truly knows what they are doing and can provide the treatment according to protocol, which means it is more likely to be effective for you.
7. The therapist focuses their clinical practice on trauma. This means that they identify themselves as a trauma clinician and markets their practice specifically as providing trauma treatment. If the therapist advertises themselves as primarily treating another problem area (for example, as an ADHD therapist), and then lists multiple other clinical problem areas “on the side” that includes trauma, trauma is not their focus. Likewise, if their primary area of practice is on children and they are offering treatment for combat veterans who have PTSD, then trauma and adults (i.e., combat veterans) are not their focus. If trauma is not their focus, it often means they are not as experienced in treating trauma (which may be why it is not their area of focus), they are not as passionate about treating trauma, or they acknowledge their proficiency in treating trauma is reduced as most of their training and clinical work has likely been in the area which they primarily market themself and their practice (e.g., ADHD, autism, couples, eating disorders).
8. The therapist does not generally apply CBT (cognitive behavioral therapy). Yes, CBT forms the basis of some of the trauma treatments (e.g., CPT), but a therapist who is generally teaching patients CBT skills for the treatment of trauma is not a trauma therapist; that is a therapist who is reaching for methods to help you, but is not actually trained in the treatments that are specific to healing from trauma.
While generally speaking it is important to find a specialist for most mental health problem areas, this is especially true with trauma due to its highly nuanced and specialized nature. Again, the biggest concern on the patient’s part is usually results. You are far more likely to obtain positive results if you are working with a therapist who knows what they are doing and how to help you. Part 3 will review what you can expect when in treatment with a real trauma therapist.
To find a therapist, please visit the Psychology Today Therapy Directory.
