12.13.08
Are Specialized Trauma Therapists Necessary?
Posted in DID Education, DID/MPD, Dissociative Identity Disorder, Therapy and Counseling, Trauma, mental health, therapy tagged Abuse, Adjunct, Boundaries, Communication, Compassion, Consultation, DID / MPD, Dissociative Disorder, dissociative disorders, Dissociative Identity Disorder, Distance Therapy, Dynamic, Effects of Trauma, Expert, Family Dynamic, Healing, Honest, Listening, Memory Work, Mental Health Professional, Online Therapy, Painful, Post Traumatic Stress Disorder, PTSD, Safety, Self Harm, Support Group, Therapeutic Gain, Therapeutic Process, Therapist, therapy, Trauma, Trauma Bond, Trauma Disorder, Trauma Specialist, Trauma Survivor, trauma therapist, Traumatized, treatment, treatment for DID, Trust at 9:04 pm by Kathy Broady
I am writing this post in response to a question asked by BehindtheCouch.
BTC wrote, “do you think that a “trauma client” (ie one with PTSD or a dissociative disorder) should necessarily be treated by a specialised “trauma therapist” or, in your opinion, could any therapist who has the skills that you mention in your post do just as good a job with the client?”
This is a good question.
My first thought is yes, a client that has experienced a significant amount of abuse should (hopefully!) receive better therapeutic care from a trauma specialist. If you have the option to work with an experienced therapist who specializes in trauma disorders, snap up that opportunity as quickly as you can.
Trauma therapy is very much its own area of study, the same as with any other medical issue. In trauma work, the therapist must understand dynamics of traumatic relationships, trauma bonds, wide-ranging effects of trauma, layered complications of dissociative disorders, issues of external safety, self harm, system work, memory work, etc. There are dozens of issues specific to trauma disorders, with dissociative disorders being the most highly complex and requiring the greatest clinical skill. (Please see my article listing 50 Treatment Issues for Dissociative Identity Disorder.) The terms “trauma specialists” or “trauma therapists” imply these clinicians have invested significant chunks of time learning about trauma disorders. They should be more comfortable than the average therapist in terms of recognizing, understanding, and addressing the details of trauma work.
Please remember there are many areas of clinical expertise for mental health professionals. For example, I am licensed to provide clinical therapy for any area of my choosing, but in my 20+ years as a therapist, I have not worked with autistic children. However, I have worked with families with traumatized children who also have some very definite and particular needs. Sure, I could apply my basic, fundamental clinical skills with autistic children and their families, but once it became necessary to understand specifics related to autism, I would fail miserably. I would be scrambling for information, and fast! Even though I am a good trauma therapist, would these autistic children receive the same quality of clinical treatment with me as they would with a clinician that specialized with autism? I am quite sure they would not.
Who is a trauma therapist? For most clinicians, there are no regulatory boards that specify exact qualifications. Trauma therapists are self-proclaimed experts in the field, and clients are left hoping the professionals they are trusting are actually qualified to be specialists. Unfortunately, I have seen far too many problems caused by well-meaning professionals who simply did not know as much about trauma issues as they claimed. Their lack of understanding of trauma-related complexities, timing, processes, etc. caused significant harm, damage, and confusion.
On the other hand, finding a trauma specialist is difficult, and you simply might not have many therapists in your area that work with severe abuse issues. It is imperative that people suffering from Post Traumatic Stress Disorder (PTSD) or any of the Dissociative Disorders receive treatment in order to heal from their traumatic experiences. If your only option is to work with a “general practitioner” instead of a specialist, then that is what you do. Good basic therapy is certainly better than no therapy at all.
Select therapists who are open-minded to the effects of trauma, honest about their limitations, and willing to learn more. As long as their clinical skills include active listening, deep understanding, gentle compassion, effective communication, recognition of family dynamics, emotional tolerance, clear boundaries, etc., you will be able to progress in your healing.
However, it will be highly important to augment your treatment with additional information. Read books, search online, get regular and ongoing consultations with trauma specialists, join trauma / DID support groups, attend conferences, consider online or distance therapy with a trauma therapist as an adjunct (secondary) therapist, etc.
Don’t assume that general therapists will learn enough on their own to get you through the most difficult and complex places in your healing. You will have to take charge of your own work. Make sure to do extra homework!
Your greatest therapeutic gains will be with a therapist you trust. Therapy is about you. It is your looking at your life, your history, your feelings, your reactions, your truths, your beliefs. When you feel safe enough to be totally and completely honest with yourself, you will be able to look at your painful wounds and all the resulting affects of the trauma. You will be able to bring down those dissociative walls that you built for safety and separation from “all the hard stuff”.
Pick a therapist you can connect with, build a solid foundation, and keep going from there. You’ll feel better for it.
__________
by:
Kathy Broady, LCSW
davidrochester said,
December 14, 2008 at 11:59 am
What an excellent and well-considered answer.
Personally, I strongly believe that matching the client’s needs with the therapist’s area of expertise is a crucial component to healing, although given the choice between an excellent trauma therapist with whom I did not have a particular rapport, and an open-minded Jungian analyst whom I did trust, I’d go for the Jungian. But even there, the philosophy and ethos of therapy would have enough crossover to certain aspects of trauma therapy that I think significant benefit could occur.
I went through eight therapists before finding a trauma therapist, and she has been the only one who was able to help me at all. The others often blamed me for being uncooperative when I didn’t show results, even though I was following their recommendations exactly. None of them even realized I had dissociative trauma, despite my describing my DID to them extremely clearly. I can’t believe what a difference it’s made to actually be with a therapist who understands exactly what is broken, and has a compassionate, intelligent, and time-tested approach to fixing it.
moreheads said,
December 14, 2008 at 4:42 pm
KB
Have you worked with clients that have ‘extreme torture’ trauma history in cult-RA and/or mind-control (governmental experiments)? If so, what has worked?
Ravin
Kathy Broady said,
December 14, 2008 at 5:24 pm
Hi David,
Thanks for coming back!
I very much agree with your comments — couldn’t have said it better myself. I have met DID clients who were so blatantly DID that it was really and truly hard to fathom how none of their previous therapists recognized their dissociative issues. But, that was simply because those therapists were not trained in how to recognize dissociation, and so they didn’t.
And, the flip side is also true. Once you know how to recognize DID, it’s really not that hard to see it at all.
Thanks for your input — I appreciate that.
I hope you are having a good day –
Kathy
Kathy Broady said,
December 14, 2008 at 5:38 pm
Oh boy, now there’s a big question!
I’ll put that one on my “make a blog post about this” list.
Thanks, Ravin. I hope you’re having a good day –
Kathy
wynne270 said,
December 15, 2008 at 9:39 pm
Kathy,
I was wondering about the specialization you’re talking about here being a two-edged sword: specifically, that to someone with a trauma specialization, everything looks like trauma.
This question probably sounds a bit more prickly-pear than I want it to; I’m just not sure how to say it.
Thanks!
Wynne
Kathy Broady said,
December 16, 2008 at 1:11 am
Hi Wynne,
Good point. Of course, the more familiar a person is with something, the easier they recognize it.
At the same time… becoming really familiar with something also means you can be more comfortable in recognizing fraudulent things. I’ll be the first to admit I’ve seen people faking it, and trying to pretend they were more dissociative than they were… or trying to over-dramatize their trauma history for manipulative gain… or lying about their trauma for extra attention etc. etc.
I’ve seen enough of that through the years that I don’t automatically believe everything I hear. Sometimes things just don’t smell right. And when the pieces don’t fit, I’m willing to consider other options.
Kathy
behindthecouch said,
December 16, 2008 at 6:28 am
Kathy, thanks for taking the time to respond to my question. Right now, it’s incredibly important to me.
BTC.x
Kathy Broady said,
December 16, 2008 at 10:38 am
Hey BTC,
Well, you were kind enough to give me a wonderful shout out to help get this new blog rolling. I have had 4-5 x’s as many site viewers since you posted your very supportive link to this blog from your blog. You have been an amazing help in getting this blog off the ground, and your comments meant a whole lot to me. The least I could do to thank you was to answer a question!!! (or two, or three… keep ‘em coming!)
I’m glad my response meant something to you as well.
Kathy
behindthecouch said,
December 16, 2008 at 3:30 pm
Hey Kathy,
You’re more than welcome. I get very excited when I find a great well-written blog that is of use to me and as I **am** my audience I feel it my duty to tell people where to find such resources!
The question you answered here is very important as I am about to lose a non-trauma therapist and attempt to find more trauma-focused practitioner… with any luck!
Thanks again for such a great blog.
BTC
behindthecouch said,
December 18, 2008 at 5:53 am
Hi Kathy,
Another question for you if you’re up for it – what should a trauma client/patient ask a potential new therapist to assess whether they are up to the task? I ask because I have recently terminated an unsuccessful therapy with a non-specialist, and am now looking for someone who can take the work forward with the right kind of processes and knowledge and feel confident in their abilities not to make the splitting and trauma a whole lot worse!
Many thanks as always,
BTC.
Kathy Broady said,
December 18, 2008 at 12:51 pm
Hi btc,
That is an excellent question, and I’ll be glad to make a post about that. Let me think on it for a bit, and I’ll get a post up here as soon as I can.
I hope you’re having a good day –
Warmly,
Kathy
gobbies said,
December 28, 2008 at 7:48 am
I have worked with 3 T’s: One who claimed to be an expert but, was really just obsessed with religion and integration, one who had almost no experience with anything, and you, Kathy, who actually IS an expert. And it definitely makes a difference. Having a T who really gets it makes you feel so much safer, and it makes the hard work easier to do because you feel confident that the T has a good reason for “making” you to do it.
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August 30, 2009 at 2:45 pm
[...] few who will have the kind of knowledge and experience that you are looking for when you need a specialist in the areas of trauma and [...]