Therapy With a Real Trauma Therapist: Part One

Why it is important to work with a real trauma therapist.

Posted Jan 30, 2019

I’ve said it before, and I will say it again (because it is applicable in so many ways): Not all therapists are created equal. Beyond the basic differences (type of degree, master’s versus doctorate, education, location, years of clinical experience, type of clinical or non-clinical work setting, past supervision, and breadth and depth of clinical experience), a therapist’s area of expertise— meaning, what they really know how to treat—is what matters.

Have You Had Ineffective "Trauma Therapy" Before?

As a trauma psychologist, I have had many patients come to me who previously were in therapy with another clinician. This often is a result of the patient taking a break from therapy, they or their therapist relocating, or, based on what I later find out, the patient wanting to try a different therapist because not much was changing in their life. Many times these patients will tell me that they saw the previous clinician for trauma or PTSD treatment. Naturally, my follow-up question to this is “what did you do in therapy?” and “how effective was your treatment?” I am often disappointed to learn that the answer is “they [the therapist] taught me how to do deep breathing” or the patient shares a description of grounding strategies. In some cases, the patient’s answer is that they “just talked” with the therapist. At this point, I have a much greater understanding of why the patient looked for a new therapist (although the patient typically does not exactly understand why—many of these patients really liked their previous therapist, but are confused as to why therapy was not that helpful).

Let me be clear, there are a lot of therapists out there that literally check the box on their Psychology Today profile saying that they work with/treat trauma (do a brief search and you will see the number of therapists making this claim). However, quite frankly, this means nothing. If you are really wanting help, it is important to distinguish between the catch-all profiles claiming to work with trauma and those clinicians who, putting it bluntly, actually know what they are doing. This three-part post is written to educate readers about why it is important to work with a real trauma therapist, what a real trauma therapist is and what you should look for when finding a therapist, and what you can expect in treatment with a real trauma therapist.

Simply having an interest in working with trauma does not make a therapist a trauma specialist. Sure, any therapist can listen while you share the details of a traumatic event that you experienced, but knowing what to do with those experiences and how to help a person heal from the things that has happened requires specific training, supervision, and in many cases, certification.

Why Is It Important to See a Real Trauma Therapist?

The short and simple answer is results. Most people make the decision to seek therapy because they are experiencing significant enough difficulties in their life. That being said, most of the time the patient’s goal is to lessen their distress by seeking the help of a mental health professional. And most patients do not want to be in therapy forever. They have finally made the courageous decision to seek help, and expectedly they would like treatment to be as effective as possible and as short as possible (both which are subjective and not always practical due to a number of reasons). However, your chances of effectively reducing your distress and in as short of a period as possible are significantly higher when you work with a therapist who specializes in your particular problem area. Let me be clear again, we are talking about truly specializing (not just checking the box).

So while the short and simple answer to the question above is results, the path to obtaining results is not short and simple, at least in the sense of simply picking any therapist who states they treat trauma. Trauma and PTSD are very specialized areas of psychology. Unless the therapist was specifically trained in working with this population, it is highly likely that they do not actually know what to do with trauma. Treating trauma is NOT just about listening—there is a whole lot more that goes into it, including knowledge, strategies, and skills that the clinician must possess.

Working with a true trauma therapist is important in order to ascertain that you are being accurately diagnosed and that the therapist knows how to help you.

PTSD Diagnosis

As a patient, you may be able to objectively identify your experience(s) as trauma (this is not always the case—in fact, many people are unaware that their experience is considered trauma). However, only clinicians who are actually trained in trauma treatment are aware of the various components and nuances that constitute a PTSD diagnosis. Making a PTSD diagnosis in and of itself requires thorough training and experience. In many cases, PTSD diagnoses are often overlooked for depression and anxiety diagnoses, while in other situations, clinicians without the proper training tend to over-diagnose PTSD without having true expertise in making such an assessment. Research statistics have shown that many community-based mental health practitioners do not properly identify those who have PTSD.

The purpose of diagnosis is to inform treatment. This means that if a clinician is making an inaccurate diagnosis, it is likely that the patient is not receiving the correct (i.e., the most appropriate and effective) treatment. This is a huge barrier to positive results.

Trauma and PTSD Treatment

It is one thing to make a PTSD diagnosis (which we have established is not as straight forward as it seems), but it is entirely different to actually know how to treat trauma. Again, trauma treatment is not just talking. In order to help someone heal from what has happened, there are specific strategies that must be incorporated into treatment, and which usually are the entire focus of therapy sessions. More precisely, there three specific trauma treatments (CPT, PE, and EMDR) that are highly effective for treating trauma (based on clinical trials demonstrating strong evidence of effectiveness), but if a therapist is not actually trained (and certified) in these treatments, then they would not be able to effectively provide them. If the therapist is not actually providing you with what you need, and what truly works, then therapy is not going to be as effective as you would like and perhaps, as you need.  Low effectiveness means you are still experiencing distress and are probably wasting a lot of time and money in therapy.

Realistically, the aforementioned treatments are not widely practiced in many settings, which means there are not many true trauma therapists. Outside of clinicians who have worked for the VA (where working with trauma and PTSD is common), it is uncommon for clinicians to be trained in CPT or PE, though you will find more therapists trained in EMDR. In many cases though, the EMDR-trained therapists are not specialized in trauma but completed EMDR training and from time-to-time, use it with some patients; this is not a trauma specialist.

The aforementioned treatments are not equal, either—they each work differently and the effectiveness varies based on the patient’s actual experiences and symptoms. For that reason, just because a therapist is trained in EMDR, this does not mean they are a trauma specialist or that treatment will be effective! It is incredibly important that you seek a therapist who specializes in and primarily treats trauma, which means they know what to look for, how to diagnose it, and multiple methods of treating it. Next week’s post will explore the topic of what a real trauma therapist is and what to look for when finding a trauma therapist.