Consumers Guide To Therapist Shopping
by Ken Singer, LCSW
Note: For simplicity sake, all references to gender will be he or him but it is acknowledged that many therapists who work with male survivors are female, and are likely to be as competent (or incompetent) as male therapists.
Looking for a good therapist? Interested in changing your present therapist? It's not a simple thing like shopping for a car. At least you can pick up a copy of Consumer Reports and get objective information if you're looking for transportation. How do you get information about good therapists familiar with male survivor issues? Sometimes it can be recommendations from other survivors. But what if you are in recovery without the benefit of a male survivor support system from which to get referrals?
As a specialist working with male survivors for years, I've seen many men who had encountered misdirected, inadequate or harmful therapy. Sometimes it is a failure on the therapist's part to acknowledge he doesn't have sufficient experience with male survivor issues. The therapist's experience may be limited to having attended a workshop at a conference or read a book on the subject. While he may be sincerely interested in working with male survivors, the therapist, rather than the survivor, tends to learn on the job while you're paying.
Another therapist to avoid is the one with a theoretical bias. A clue to identifying (and avoiding) the biased therapist is his stressing a particular approach or technique (like advertising as a Jungian, analytic, Rational-Emotive-Therapy specialist, etc. Not that any of these schools of treatment is bad, but the emphasis on a particular specialty may indicate a bias which is not the most effective means of treating your victimization issues.) If it seems like the therapist is intent on fitting your issues and experience into his theoretical framework, you may want to look for someone who sees you more as an individual.
A big red flag should be the therapist's awareness and respect for your boundaries. Everyone who has been sexually victimized has had his boundaries ignored and violated. A therapist who gives hugs without an invitation to do so, is crossing boundaries. This can include less personal (and unwanted) contact such as shaking hands, sitting too closely or even intrusive eye contact. Your gut feeling is the best indicator of someone who does not respect your boundaries. If you feel uncomfortable when "interviewing" a potential therapist, trust your instincts.
What if you are already in treatment with a therapist you feel is incompetent, inexperienced, of a philosophical direction you don't see as helpful, not respectful of your boundaries, or just plain makes you feel uncomfortable?
FIRE THE THERAPIST! "Whoa! I can't do that," you might be thinking. Remember, you are the consumer of the therapist's services. Unless you are court ordered to be in therapy, you have the absolute right to enter and leave therapy when you want and with whom you want.
Being assertive, that is, saying what is on your mind, getting what is due you, and generally speaking up for your rights, is frequently a difficult area for survivors. I believe a survivor who tells a therapist he does not feel the relationship or therapy is working, is taking a positive step in being assertive. This is especially important if the therapist is not healthy. Sometimes, therapists are caught up in their own issues and project them on the client. The issues you are working on may trigger old unresolved areas in the therapist's life. Remember, you are paying the therapist. If he needs to work on personal issues, he should pay someone for his own therapy.
Some clues you might see, if this is the case, include the therapist's becoming too emotional about some aspect of your situation. This is not to say the therapist should be impassive and cold, however, if he seems uncharacteristically interested, avoiding or upset about something you've said, be alert. Also, if he strongly wants you to do something, like forgive a perpetrator, for example, this might indicate a personal issue for him.
If he begins to disclose personal information, more than you are interested in or comfortable hearing, it may be a sign of unresolved areas for him. I don't have a problem using personal anecdotes or experiences from time to time to illustrate a point or help normalize a behavior, however talking about personal sexual, drug or similar topics may be blurring the boundaries between you and him.
Whether or not a particular therapist's experience of personal victimization (that is, whether or not he is a survivor) makes him a more effective helper is questionable. His effectiveness is determined by his skills. Some survivor therapists however, have personal experiences with sexual victimization and that may help them better understand what you went through. Others may be handicapped by their experience and may be less than helpful for you. Non-survivor therapists may be more useful due to their distance and objectivity to the problem. There is no clear rule of thumb whether or not it is better to have therapist who is also a survivor.
Since sexual experiences play a big role in your abuse history, watch out for his showing too much interest in "gory" details. For example, describing what happened (as you are comfortable enough to disclose) is important. Knowing that a particular assault involved your having an erection and orgasm may be a valid question in the context of self-blame or guilt you might feel for "enjoying" part of the abuse. If the questioning gets into minute detail or feels like pornography, trust your feelings and let the therapist know you are feeling uncomfortable.
On the other hand, a therapist who avoids any discussion of details and talks in generalities is probably not comfortable with sexual abuse. You need someone who can address questions you have about your experiences and feelings. There are plenty of other people in your life who are uncomfortable with sexual victimization whom you can talk to for free. Your therapist should not be one of them.
Another type of therapist to avoid is the one with a mission. This can include a therapist who wants to fit you into a group that is not appropriate for you or that you are not ready to join. (For example, when I was running a male survivor group I often heard men complain of previous experiences of having been the only man in a survivors' group dominated by women.) Also watch out for the dogmatically religious counselor or one who maintains that you need to forgive your perpetrator to be truly healed. Beware of the one who wants to get a confrontation going with your perpetrator before you are willing or ready. Confrontation is a serious undertaking that needs careful preparation and safety.
So, these are some of the kinds of therapists to avoid. How do you find someone who you think will be good for you? If you have a support group available to youãsuch as one for survivors or sexual addictionsãyou can ask who has a therapist to recommend. You can also call a rape crisis hotline or mental health agencies in your area and get a referral specifically for sexual abuse issues. Many competent sex abuse counselors can be inexperienced with male issues and you may need to ask lots of questions before you go.
Agencies can be helpful for a sliding scale fee structure. Be aware that many agencies are field placements for graduate students or interns. While there is nothing inherently wrong with having a therapist who is a grad student (they often tend to be well supervised), you want to be sure the intern or his/her supervisor knows what he is doing.
Therapists may be psychiatrists, psychologists, clinical social workers, or "counselors." In therapy, there is no general rule that the higher the degree (MD vs MSW), the better the treatment. Psychiatrists are physicians and usually do mental status exams and prescribe medication. If you have depression, anxiety or other problems that may require medication, a psychiatrist can provide a prescription to alleviate the symptoms. Psychiatrists' time is expensive and if you want or need to see one for therapy (beyond medication or maintenance), it will cost you or your insurance plan quite a bit of money.
Psychologists (Ph.D. or Psy.D.) do psychological testing in addition to therapy. Unless you need testing done for some reason, you are simply looking for competent therapy from a qualified therapist. This may be a psychologist or clinical social worker (MSW, LCSW or ACSW)ãboth disciplines trained in providing therapy. Those who advertise themselves as "counselor" may lack training in clinical treatment and/or have inadequate supervision. Be careful of the background of a "counselor" who may be a lay person working through his own issues, or a pastoral counselor with a religious agenda. In the past, there were no regulations in many states and individuals could call themselves "counselor" without meeting the training and education criteria for other licensed professionals. Many states now license clinicians who may use the letters "LPC" or something similar after their names. This usually indicates that the person has met standards for that state and has been licensed. The bottom line is that you have the right to know the person's qualifications and that s/he meets the standards of your state or province to practice psychotherapy.
When you interview a therapist, you should be able to get answers to the following questions. (Courtesy of Carlos Loredo, Ph.D., Austin, TX.)
What is your academic degree?
Are you licensed by a board? Which one?
How many years have you been providing therapy?
What internships or special training in sexual abuse have you had? Where and when?
Have you attended or conducted any sexual abuse workshops? If so, where and when?
How many sexual abuse cases do you treat each year? How many do you currently have? What percentage is male survivors?
Do you specialize in any area of sexual abuse (working with offenders, clergy abuse, ritual abuse, etc.)?
How much experience do you have working with gay men (if this is a consideration for you)?
Do you have supervision/consultation available to you?
Has a complaint ever been filed against you?
What is your fee? Billing or payment policy?
What is your policy on cancellation or "no show"?
Do you charge for telephone consultation or calls between sessions?
What is your policy on confidentiality?
If the therapist seems annoyed or puts you off for asking, consider that person someone you don't want to see.
You can always ask for professional references, but don't expect the therapist to give you names of "satisfied customers" the way a painter might.
After you have been in therapy with a particular individual, ask yourself:
Am I intimidated by this therapist?
Does he listen to me?
Do I feel I can disagree with him/her?
How does he handle crisis and conflict?
Is this therapist comfortable with the feelings and content I bring out?
When you were being abused, you were in a situation you could not get away from (for whatever reasons). If the therapy or the therapist does not feel right, get out. In your recovery work, you need help from the right person. Your therapist should be a trusted partner in your healing. Remember, above all else, you are the consumer.