Volume 3: It's OK To Not Be OK
Q: What would you say to a civilian who may be struggling with a trauma? Are there certain types of therapy you recommend for people who have PTSD, or questions they should ask potential therapists before getting started?
A: Do not suffer alone or in silence. Trauma has a way of shutting down your ability to reach out to others.
The strategy of avoiding thinking about an event is typically partially successful for a limited period of time. The traumatic event needs to be discussed in order to make sense of it and move on. There are some individual therapies that have evidence to support their use.
Those include ‘exposure-based’ therapies and Eye Movement Desensitization and Reprocessing (EMDR). There are a number of other therapies that have some evidence for working, but it’s not as much evidence as exposure or EMDR.
However, these therapies, while helpful to many, are not helpful to everyone. If you don’t “respond” to a particular therapy, don’t blame yourself or give up trying to find help that works for you.
Two characteristics to look for in a therapist are (1) relatability and (2) expertise in effective interventions. Feeling safe with your therapist, and feeling like your therapist can truly understand your experience (whether they have a similar background of experience or not), will make a difference in whether the therapy is successful. Successful therapy may mean a decrease in symptoms, but it can also mean coping better with the symptoms that don’t entirely go away. Living a good and meaningful life in spite of some symptoms may be what success looks like. There are specific questions you can ask your potential therapist which I’ll mention here (excerpted from our book Courage After Fire), but what is as important is the “feel” of the response you are getting from a therapist. You’ll need to ask yourself, “Is this someone I feel I can work with and possibly trust with sharing my experience?”
Some questions for a potential therapist may include:
• What is your experience with treating someone with this particular problem?
• How long have you been in practice and where are you licensed?
• What training have you had in the area of trauma?
• What does your approach look like? Are you someone who teaches skills, is more directive, listens quietly, uses homework assignments, or wants to primarily focus about the past, including my childhood?
• Do you typically involve family members in your approach?
• How long is each session and how often will we meet?
• What results do you typically see?
• If you cannot provide a service (like a prescription for medication), can you refer me to someone who does provide that service?
Typically, you’ll be able to figure out if the “fit” is right within the first few sessions. If you are feeling uncomfortable with some aspect of therapy, speak up about it!
Keith Armstrong LCSW is a recently-retired Clinical Professor of Psychiatry at the University of California, San Francisco (UCSF), who worked with veterans for 38 years, and served as a mentor and contributor to the Heart and Armor team since 2013. He is the co-author of the acclaimed book “Courage After Fire: Coping Strategies for Troops Returning from Iraq and Afghanistan and Their Families.”