Since narcissistic abuse is not yet a recognized therapeutic specialty, it can be especially difficult finding a good therapist. Adding to the challenge can be trying to sort through the jumble of degrees, MDs, PhDs, PsyDs, MSWs, MAs, MSs, not to mention the variety of professional designations, psychiatrists, psychologists, social workers, marriage and family therapists, and licensed and professional counselors, which only make the task of finding a therapist even more daunting. Then just when you think you have it all figured out, you realize the words: therapist, psychotherapist, counselor, psychologist and clinician are often used interchangeably but can be vastly different in terms of the level of education and professional training.
So let’s take a look at the professional designations first:
Psychiatrist (MD): Psychiatrists hold a medical degree and are physicians who specialize in the diagnosis, treatment and prevention of mental, emotional and behavioral disorders. Psychiatrists can prescribe medicine.
Psychologist (PH.D): Psychologists hold a doctorate degree and are professionals who conduct research, perform testing and evaluate and treat a wide range of emotional and psychological disorders and challenges.
Psychologist (Psy D): This is a newer degree for psychologists that have a doctorate degree but the focus is more on clinical practice (psychotherapy) and less research focused.
Social Worker (MSW): Social Workers hold a master’s degree and are professionals that provide mental health related services with an emphasis on diagnosis, assessment, treatment and advocacy following a traditional psychological approach to patients in schools, health settings, and other settings where clinical work takes place to enhance and maintain a person’s psychological and social functioning.
Marriage and Family Therapist (MFT): Marriage and Family Therapists hold a master’s degree and are professionals who have undergone training in psychotherapy and family systems and administer therapeutic treatment by focusing on the mechanics of a relationship as they pertain to marriage, the family unit, and/or other groups.
Licensed Professional Counselor (LPC): Licensed Professional Counselors hold a master’s degree and are professionals trained to work with individuals, families and groups in treating mental, behavioral, emotional problems and disorders.
1.Do you have a graduate degree?
This is an important question when you are choosing a therapist to work with since someone can call themselves a “counselor” after taking a 6 hour online course in coaching or a specific therapeutic approach. You’ll want to confirm that they have a graduate degree in psychology, social work, marriage and family therapy or a related field of study.
2. Are you licensed?
This question is a good successor to the last question. Licensure indicates that the individual has jumped a few more hurdles than non-licensed therapist. Typically, depending in which state you live in, licensure means that the therapist has completed at least 3000 hours of supervised clinical experience and has passed their state’s professional licensing exam. In addition, in order to apply to take the state exam, a therapist must not have any felonies and pass a background check.
3. What is your therapeutic approach/framework?
This question can give you an idea of how the therapist conceptualizes their client’s issues and human nature and what type of framework and interventions they will use to help you solve your issues. Most therapists learn about and receive education and training about many different approaches. Some therapists may exclusively use one approach, but the majority of therapists tend to favor one approach while incorporating elements from a variety of approaches, and tailor them to their client’s specific needs, symptoms and goals. There are a number of acknowledged approaches with new ones developed all the time. Most new approaches tend to expand on the concepts of existing approaches or combine elements of several approaches.
How Do You Know Which Approach Is Right For You? Well, that all depends upon your beliefs about the root of your problem. There are too many approaches to list, so I will just focus on and briefly describe 5 common approaches.
Psychodynamic: If you believe that all problems can be traced back to childhood and behavior and personality stems from unconscious psychological processes (wishes, fears and conflicts) resulting from childhood then this approach originating in the work of Sigmund Freud, which is one of the oldest psychological theories, would be more suited for you. Psychodynamic theory views mental disorders as the result of getting fixated (through frustration or over gratification) in one of the psychosexual childhood development (e.g.- stuck in the “phallic” stage), which in turn, results in problems with the balance of your personality structure (the ego, superego,and id). Psychodynamic therapists tend to emphasize the significance of interpretations to bring about insight. However, increased insight doesn’t necessarily equal changed behavior.
Cognitive-Behavioral: If you believe that thoughts influence your behavior then Cognitive- Behavioral approaches which emphasizes identifying and modifying dysfunctional and faulty thought patterns and learned behaviors to break the cycle of maladaptive, repeated behaviors, is more geared for you. Cognitive-behaviorists generally believe in the role of social learning in childhood development, and the concepts of modeling and reinforcement. This means that your behavior is shaped by the behavior your parent’s reinforced and modeled. This perspective helps people see the link between how they think, what they tell themselves, and the feelings and actions that follow.
Family Systems: If you believe that behavior is influenced by family dynamics and growth and change can be gained through modifying family relationships, then a Family Systems approach may be beneficial. Traditional individual therapy frequently addresses the individual’s inner psyche in order to generate changes in relationships and other aspects of life. Family Systems theory introduced by Dr. Murray Bowen suggests it is beneficial to address the structure and behavior of the broader relationship system, which he believed to play a part in the formation of character. Family Systems theory uses the concepts of structural, strategic, or intergenerational to examine family processes and functions, such as communication or problem-solving patterns, by evaluating family behavior inside and outside the therapy session. Therapeutic techniques may include reframing or redefining a problem scenario or using paradoxical interventions. This perspective believes that changes in the internal system will affect changes in the external system and vice versa.
Object Relations: Object Relations is an off shoot of psychoanalytic theory which suggests that humans are primarily motivated by the need to form relationships with others rather than motivated by drives and urges. The aim of an object relations therapist is to help an individual in therapy uncover early mental images that may contribute to any present difficulties in one’s relationships with others and adjust them in ways that may improve interpersonal functioning. A therapist can help people in therapy understand how childhood object relations (attachments) impact current emotions, motivations, relationships, and contribute to any problems being faced. By bringing awareness in therapy of aspects of the self that were split and repressed, individuals can address these aspects of themselves in order to experience a more authentic existence. A therapist can also help a person explore ways to integrate the “good” and “bad” aspects of internal objects so that the person becomes able to see others more realistically. Therapy can often help a person to experience less internal conflict and become able to relate to others more fully.
Gestalt Therapy: Gestalt Therapy focuses on the here and now but does factor in past events or future possibilities; in fact, this approach believes the past is intricately linked to one’s present experience. The idea is to avoid dwelling on the past or anxiously anticipating the future. Experiences of the past may be addressed in therapy sessions, but the therapist and client will focus on exploring which factors in the moment brought up the present experience. Gestalt therapy places emphasis on gaining awareness of the present moment within the present context. Through therapy, people learn to discover feelings that may have been suppressed or covered up with other feelings. Through this process, a person’s insight increases and a new sense of self develops.
4. Do you have experience working with people with the same issue as me?
You should approach choosing a therapist the same way you approach choosing any health practitioner. Fancy credentials are great but you don’t want to be the first open heart surgery your surgeon performs, and you don’t want to be the first narcissistic abuse survivor a therapist treats. Obviously the more experience a therapist has had with a particular issue, mental disorder or area of concern, the more knowledge and expertise they have developed along the way. I want to add that searching for a therapist who advertises they specialize in your concern rather than choosing a Jack of all trades, who lists every problem known to humankind, is far more likely to be more skilled in the area(s) of specialty.
5. Can you tell me how you plan to help me?
This question is a good follow-up question to the last one. A therapist with experience in your presenting problem will be able to give you a pretty detailed answer of what to expect and their plan of how they will approach treating your presenting issue(s). Here is where you will be able to really decipher how much experience they have with treating narcissistic abuse survivors. A therapist with experience in narcissistic abuse most likely will provide you with a blueprint of the symptoms/concerns that will be assessed, the techniques they use to treat those symptoms/concerns, other focus areas of treatment, and referrals that they may consider and so on.
6. Have you been in your own therapy?
This is not an inappropriate or rude question to ask a therapist. Not all graduate programs require students to attend their own therapy. And even if all graduate programs did mandate every student attend their own therapy, it would not guarantee YOU that the therapist has insight and is free and clear of all problems or issues. Although this is not the reason why this question is important.
A therapist who has never had a problem or has never tried therapy to help resolve their own problems is probably not a therapist that will be able to understand or relate to you as well as one who has. People who have been successful in healing their own wounds, facing their own fears and overcoming their own challenges and have experienced the healing aspects of the therapeutic process are typically the best qualified healers.
7. Do you engage in regular peer consultation?
This question assumes you have chosen a licensed therapist. Once a therapist becomes licensed, they are no longer required by their governing license board to receive supervision from a licensed therapist. However, it’s just good practice to engage in peer consultation with colleagues. This is also beneficial to you as the client because you receive the benefit of the input of a treatment team.
Remember, therapy is a collaborative process and doesn’t work unless you feel comfortable and safe with your therapist. These questions can help you narrow down your choices, but the only way to know if the therapist is truly a good fit for you and can provide you with a safe space where you are open to experience the healing benefits of the therapeutic process is to approach the first few sessions like you would approach test driving a car. Unfortunately, so many people decide that therapy is “for the birds” after having a disappointing experience with a therapist or sticking it out with a therapist that they really didn’t care for and didn’t receive any benefit from.
Research on the effectiveness of therapy supports that one of the most important factors that influences the success and effectiveness of therapy is the therapeutic alliance between the patient and therapist. So it’s worth taking your time, test driving a few therapists if need be, and finding the right fit for you.
Lastly, you’ll want to check your therapist’s license to find out if they are under investigation or have had any actions taken against them and what the result was. You can look up the therapist’s license on the Internet on your state’s licensing board, usually under the state department of health or occupational licensing.
Bree Bonchay is a Los Angeles based Licensed psychotherapist (LCSW) who believes “relationships are the currency of life”. She’s dedicated to helping people heal from break-ups, recover from toxic relationships with narcissists and sociopaths and to never settle for a life less than the one they dreamed of. She is a Blogger, Advocate, Facebook Toxic Relationship Recovery Forum Administrator, Radio Guest Expert, and is the Author of the book, I Am Free. Click Here To Order
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