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#64520 - 09/02/06 07:03 AM Good Therapists and Not-So-Effective Ones
Brokenhearted Offline

Registered: 08/07/06
Posts: 644
Loc: TX
How common are bad therapists? How should one decide on one to see for csa? Should it be a psychiatrist more so than a psychologist? I think a psychiatrist would be smarter and could figure it out for sure, do you?

Have any of you been to a T and ended up with the T not even understanding the damage/dynamics of csa, and instead maybe they just offered you antidepressants or something? Isn't it sort of a specialized thing, understanding csa and its affects?


It were better for him that a millstone were hanged around his neck, and he cast into the sea, than that he should offend one of these little ones.
Luke 17:2

#64521 - 09/02/06 06:45 PM Re: Good Therapists and Not-So-Effective Ones
Ken Singer, LCSW Offline

Registered: 08/24/00
Posts: 5781
Loc: Lyons, CO USA
The degree is not important when talking about therapy. Psychiatrists, psychologists, clinical social workers, licensed professional counsellors, and nurse practitioners all are trained to do therapy.

The amount of education doesn't mean that the higher the degree, the smarter/better the therapist.

The differences in the professions have to do with the additional training in specific areas. Psychiatrists are MDs who specialize in brain function and can prescribe medications. So, if a person needs meds for depression, anxiety or other medically related problems, a psychiatrist can do the therapy (or have it done by someone else while s/he monitors the meds).

Psychologists are trained to administer psychological testing. If a person is in need of testing, perhaps for court, or a child needing a child study team eval, or other matters where the testing is requested, a psychologist can do the tests. Most psychologists (except for those who specialize in research) do therapy but it depends on their style, experience and other skills.

Clinical social workers and licensed professional counsellors (LPCs) do therapy. They can't do most testing nor prescribe meds. Nurse practitioners can prescribe some meds and do therapy.

Read "A Consumer's Guide to Therapist Shopping" elsewhere on this site. It will not only expand on the info above but it will help you shop for the right person.

Determining who is a bad therapist is tough to do before you see the person. You can go to Consumer Reports to get the lowdown on which washing machine would best meet your needs and help identify the bad ones, but there is no rating system to score therapists on ability.

Since few survivors know of other survivors (except maybe in groups), it is usually difficult to ask around for recommendations. If you feel comfortable with the therapist and consider the points raised in the "Consumer's Guide", you will have a better shot of finding the right one for you.

It generally is more helpful to find a therapist with experience in the area you are looking. Therapists tend to go where they are comfortable, so if you are a survivor and the therapist is not experienced with that, s/he may focus on your issues about being adopted, for example, because s/he is more comfortable with that.

Hope that is helpful.


Blissfully retired after 35 years treating sexual abuse

#64522 - 09/02/06 08:07 PM Re: Good Therapists and Not-So-Effective Ones
SAR Offline
Administrator Emeritus

Registered: 12/07/03
Posts: 3310
Loc: USA
Brokenhearted, I'm not sure that this is how you feel, but just because a T mentions medication doesn't mean that he isn't serious about helping. It's not an either/or kind of thing.

My experience with psychiatrists has been that they mostly handle the physical side-- they see you just once in a while to be sure that the meds are doing what they're supposed to do, and let someone else do most of the therapy.

My belief about most therapy is, I don't want someone who's going to "figure it out"-- or if he does, I don't want him to tell me about it. I would rather work with someone who can help me see things and learn things for myself. I've never worked well with any therapist who had a more heavy-handed approach.


#64523 - 09/03/06 04:22 AM Re: Good Therapists and Not-So-Effective Ones
roadrunner Offline
Administrator Emeritus

Registered: 05/02/05
Posts: 22045
Loc: Carlisle, PA

As Ken says, there are many varieties of therapy out there; the key is finding the one that suits you. It really does require shopping around, asking lots of questions and seeing what works for you. I read somewhere that you need to treat this as seriously as buying a house or a car, and I agree.

What has worked for me so far has been CBT, cognitive behavioral therapy. My T is interested in looking at me as a whole person, with a lot of positive talents and experiences as well as problems, and with a broad context of relationships - aside from abuse - that have all contributed to who I am today. She tries to help me see things for myself and faciliates my efforts to answer my own questions. If I ask her specifically, "So why is that?", she will tell me and I am usually fascinated, but she is watching me for signs she is losing me.

One area where I was especially impressed was how we handled flachbacks. I had some terrifying experiences with those and wanted help, but she asked if I could bear with her as we worked on the underlying causes of my flashbacks, though she was willing to give me specific guidance if I insisted. I went along with her and it was great. She didn't teach me to stir the burning stew faster, she showed me how to turn off the heat!

Ken speaks as a professional: I would like to add a word as a consumer. My T is a psychologist and has a Ph.D., and she is every bit as perceptive as a psychiatrist. She is a published author, and her book Managing Your Mind is highly regarded and a top-ranked book on Amazon. She works in the Department of Psychiatry at Oxford University, and she and her psychiatrist colleagues get along just fine. In fact, she has published jointly with several of them.

But what really matters isn't her Ph.D. - some of the greatest assholes and idiots I know have PhDs. What does it is her ability with people, or rather, with me. I have stayed with her because I feel safe and respected and because I have made such good progress with her. That's ultimately the key: what works for you.

I think every profession has its share of bad apples, and therapy is no exception. That's why you need to shop around. And if you find yourself with someone who makes you feel uncomfortable, or can't or won't answer your questions or deal with your concerns, I would just get up and walk. A T can't be perfect or right all the time, and results can't be hurried - that's for sure! One does have to be patient and trust in the T's abilities. But even when you feel confused and frustrated you should still feel safe and get the idea that the T is interested in helping you to understand where things are going. In fact, if a good T sees that things are falling apart he or she will immediately backtrack to get you on safer ground.

I personally have always had a "good feeling" for a good T. I know that's very subjective, but that's part of healing as well I suppose.

Much love,

Nobody living can ever stop me
As I go walking my freedom highway.
Nobody living can make me turn back:
This land was made for you and me.
(Woody Guthrie)

#64524 - 09/03/06 06:06 AM Re: Good Therapists and Not-So-Effective Ones
Brokenhearted Offline

Registered: 08/07/06
Posts: 644
Loc: TX
Thanks everyone for your guidelines on this. I have not yet read the "Shopping for a Therapist" on this website, but I will. It would just be a shame for a survivor to get stuck with a T that does not usually work with survivors or know how or want to. I think it's a good idea for one seeking a T to ask up front if they're familiar with csa issues, just in case, but that's just my opinion as the spouse of a survivor.


It were better for him that a millstone were hanged around his neck, and he cast into the sea, than that he should offend one of these little ones.
Luke 17:2

#64525 - 09/05/06 05:33 AM Re: Good Therapists and Not-So-Effective Ones
nursemanda25 Offline
Junior Member

Registered: 07/19/06
Posts: 18
Loc: KS
We see an LPC... and she is great for both us as a couple and for our individual issues.
When we first started seeing her as a couple, it was so we could get some relationship issues out of the way (I mean, lets face it, even without CSA in one's past, marriage is damned hard). After that we started going individually - my husband works on healing his childhood issues, including the sa; and I work on my self-esteem/assertiveness and weight issues.
One reason I think that our counselor is great for both of us is because she is the kind of person that we would keep around as a friend... I mean, she is like us and values many of the same things we do. Also, our counselor has BEEN THERE, DONE THAT.
She suffered from csa, abused drugs and alcohol for years (has been sober for 20+ years), reinvented her life as a successful counselor (with 2 Master's degrees at that), and has battled weight issues and self esteem issues - among other things. So that she has personal experience in the areas that we, each individually, need the most help with makes her a great match for both of us.

I think that is a good starting point for a GOOD counselor/therapist. Having personal experience with these things helps them understand you better and helps them be REALISTIC with their expections and in helping you develop goals. There aren't really many things that I would want someone helping me with if they didn't have personal experience.... its just different - you have a different perspective when you've worn those shoes.

OH, btw, our counselor does alot of work with Hypnotherapy; and each of us has tried it. It is difficult for my husband because he is so scared of what will be uncovered, but thus far has been very positive about his 2 hypotherapy sessions. They seem to have helped tremendously with his pent up resentment and anger (which is usually taken out on me). I have hope for future sessions being just as positive.


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