December 13, 2008
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.
Kathy Broady, LCSW