Choosing a Psychotherapist

Do I Need a Therapist?

Occasionally journalists may seek out psychotherapy for personal or work-related problems. In particular psychotherapy may be useful:

• After covering a particularly difficult story or series of assignments about human suffering, violence or cruelty that is leaking into your day to day life and/or interfering with your life (sleep problems, personal life, feeling more reactive, concentration trouble, greater hypervigilance, lack of motivation, greater agitation or anxiety.)
• After job-related violent attacks, threats, captivity or torture
• When you want greater insight or self-awareness
• When some aspect of your work or personal life is particularly stressful or out of balance
• When there is an increase in your use of alcohol or other substances

Searching for a Psychotherapist

Before beginning your search for a psychotherapist, you should answer the following questions:

• Does your insurance plan (whether private insurance or, depending on your country, a national health plan) cover mental health? What portion of the cost is covered? Are there limits to the coverage? (Some plans will only cover a certain number of visits.) What types of providers are covered? (For example, some plans only pay for psychiatrists or psychologists.) How you can access them? Do you need a referral from a primary care physician?
• Does the gender of a therapist matter to you? Race? Ethnicity? Language spoken? Religion? Knowledge about your field? Naturally not all these things can be matched, but it might be helpful to know if you have any preferences that you believe would affect the way you interact with someone. Remember, however, that a therapist's skill should be your most important criterion.
• What can you afford to pay? Like all professionals, psychotherapists need to earn a living and cannot offer free services, although some do have sliding scales. Review your finances and consider what you could afford and for how long.
• Are you willing to complete lots of forms in exchange for free treatment? Several medical centers are running field trials to compare some of the best therapies or figure out what may enhance treatment. You may want to consider this option. Be sure to read the consent forms to make certain you won't end up getting a less effective treatment if other treatment will be provided after the short treatment. One good resource to learn about funded studies that have gone through rigorous scientific and ethical review is the National Institute of Mental Health.

Types of Trauma-Focused Treatment

No one treatment is effective for everyone, and it can take time to find the treatment that works for you. A skilled therapist will examine your specific needs, and match your treatment to those needs.

For symptoms of post-traumatic stress disorder, cognitive behavioral treatment (focusing on thoughts and beliefs), exposure-based treatments (confronting, remembering and/or reviewing painful memories and situations from a safe place) and certain antidepressant medications have the most research supporting their use. This does not mean that other techniques don't work; it simply means that the aforementioned techniques have been supported in rigorous testing. (Two good sources of information are the National Institute for Health and Clinical Excellence Guidelines and the International Society of Traumatic Stress Studies.)

For more longstanding trauma-related difficulties or interpersonal problems related to traumatic life events, therapies that focus on understanding the meanings of the events — and how these experiences affect relationships and expectations — can help individuals understand how current problems may be related to traumatic experiences. Also, treatments that focus on building relational capacities, the ability to tolerate emotional feelings without feeling overwhelmed and resiliency are believed to be helpful. Some clinicians use the treatment term "dialectical behavioral treatment" to refer to this latter set of skills.

Psychotherapy can be emotionally difficult and you should anticipate difficult periods over the course of treatment. This is especially true for trauma-focused treatment.

Finding a Therapist

• You can consult the directory in your insurance plan, an online directory of licensed professionals from the appropriate state board or referral programs from national associations representing each profession (e.g. American Psychological Association). In addition, ISTSS and SIDRAN have referral services on trauma-specific services. The Association for Behavioral and Cognitive Therapies also has a therapist referral system with the capacity to search for specialists in trauma treatment.
• If you are comfortable, ask colleagues or friends for recommendations for a therapist, or for whom to avoid as a therapist.
• If there is a local Veterans Affairs Hospital or Clinic in your area, determine if any of the therapists who know about post-traumatic stress disorder and deployment have a private practice where they might be able to see you
• If your agency has an Employee Assistance Plan (and you trust it), they may be able to make a referral.

Assessing a Therapist's Qualifications

Anyone can call him or herself a therapist or psychotherapist, so it is important to assess that person's qualifications. I suggest looking for professionals who have an academic or professional degree in a helping profession (such as Ph.D., M.D, L.P.C., Psy.D. or L.C.S.W.) and state licensure; or, in the case of psychiatry, board certification. Licensure and academic training assure that the person meets minimum standards for the field and is functioning in the field in which they were trained. Licensure or board certification typically means that the person has passed tests on local mental health law and ethics of the profession and has documented that they received training from a reputable training program. You can typically check a therapist's license status by contacting the appropriate state board (e.g. Oklahoma social workers).

These standards are only the first step in proficient practice, however. A good psychotherapist must be able to apply knowledge to an individual situation, display compassion and communicate well.

When you first consult with a therapist — on the phone or in person — you should ask some initial questions:

• What are your credentials and training?
• How long have you been in practice?
• What are your areas of expertise and specialization? Do you belong to a supervision group? What types of details will be shared about my case when you consult with others?
• Do you conduct individual or group therapy?

If you are a journalist who is often on assignment or have a rotating schedule, find out if your therapist can set up appointments that meet your schedule without penalties for missing a session. This is an area that journalists sometimes struggle with, and it is important to discuss these issues early with potential providers.

If you are uncertain about what you are looking for in a therapist, try comparison shopping. Interview two psychotherapists in person and then reflect on your reactions to each. Did you feel more comfortable or compatible with one therapist? Trust your reactions and use them to inform your decision.

A therapist's style should be suited to the client's style. These are qualities that individuals need to evaluate, because it is important for clients to find someone they feel confident in and with whom they can undertake this work.

Most therapists are trained to deal with multicultural issues and to recognize if they need to learn more about a specific group to enhance therapy. If you have concerns about whether a therapist is familiar enough with any culture-specific or occupation-specific issues, raise these concerns with the therapist. A skilled therapist should be able to address your concerns in a way that makes you comfortable.

You should ask some specific questions to help you find out more about a therapist's training and views about trauma:

• When was the last time you attended training about treating trauma-related problems? What types of training have you received in treating trauma? Any supervision? What is your general approach to treating survivors of traumatic stress?
• What typically works for your clients? What do you think will work for me? What scientific evidence supports your approach?
• Is there one technique that you tend to use with most of your clients? (If this therapist only uses one technique to treat all clients, it may require further investigation.) My bias is that therapists who use one technique for all client problems (e.g. sand-tray therapy) may not be as well trained as those who use broad theoretical approaches (e.g. cognitive behavioral treatment, interpersonal approaches) where they adapt techniques to the particular client.
• What professional organizations do you belong to? (You might want someone who belongs to a trauma-specific group, such as International Society of Traumatic Stress Studies or the American Professional Society on the Abuse of Children.)
• What professional journals do you read? (Are they trauma-specific, such as Journal of Traumatic Stress, Journal of Interpersonal Violence, Journal of Trauma Practice, etc.?)

Once you've selected a therapist

• Although some professionals may need a few appointments to get to know you and make a detailed treatment plan, during the initial session, you should be informed about general approach, fees, cancellation policy and confidentiality policy.
• You should learn what conditions or diagnoses the provider feels they are treating and the recommended treatment plan or assessment phase to determine the treatment plan.
• You should get a general idea about the length of treatment, or, at least, the indications for when it is time to stop treatment should be discussed.
• Good providers typically address the benefits and risks associated with the treatment and discuss alternative treatments for you to pursue.
• Most good professionals give you this information in writing, so you can review the policies in detail and ask questions.
• Getting the most from therapy: What do you want to address in psychotherapy? What specific problems or situations do you need help with? Are there issues that you might want to address but feel ambivalent about? If you could imagine your life "better," what do you envision? Be prepared to discuss such questions with your therapist during your first visit so that you can work together to identify goals for your treatment.
• Be prepared to do "homework" — to practice or consider issues outside the therapy hour.
• Be honest with yourself and your therapist. Ask as many questions as you need to ask. It is important to let your therapist know your reactions to the treatment.

Other issues to keep in mind

• Sexual relations of any kind between patient and therapist are inappropriate and unethical.
• It is not a good idea to see a therapist who is a good friend of yours or of your closest friends. (In fact, this is considered unethical in many fields.) However, if you live in a small community, it may be impossible to avoid a therapist who is connected to your social network. If this is the case, discuss with your therapist any concerns you may have.
• Although you will want your therapist to be responsive to your questions and give you information, be wary if your therapist tells you too much information about their personal life.
• If you feel horrible after all your sessions and have not seen any progress in your goals at all (sometimes you might feel worse but still experience growth) discuss this with your therapist, and seek a second opinion if needed. Unfortunately, dealing with trauma is usually hard work and does involve painful feelings.
• Not all treatments work for everyone, and matching the right treatment to the person may take some time. Don't give up if one approach doesn't seem to be working.