CPTSD Foundation Presents Our Introduction Article on Psychotherapy.

One of the most important treatments for the effects of complex trauma for adults is psychotherapy. Sitting with another adult who has received training in the listening profession, is a powerful method to exchange the old tapes that were installed by our traumatic experiences.

In this first article, we are going to explore together the types of psychotherapy and Therapists, as well as the different methods they use to help their clients overcome the side-effects of complex trauma.

What is Psychotherapy?

An article, written by Michael Herkov, Ph.D. from the website Psych Central offers the following very good definition of psychotherapy:

“Psychotherapy — also called “talk therapy” or just plain therapy — is a process whereby psychological problems are processed, via communication and relationship factors, between an individual and a trained mental health professional. Modern psychotherapy is time-limited, focused, and usually occurs once a week for 45-50 minutes per session.”

For some of you who have never experienced psychotherapy, the term may conjure in your mind images of someone lying on a couch, while their therapist sits, with pen and paper jotting, down their thoughts on what you are saying.

However, while it is true that therapists pay close attention to your words, they are normally facing you and you are both sitting in comfortable chairs. They may have a pen and some paper handy, but usually, they take mental notes of what they feel the important aspects of your session.

The therapist will not only be aware of your words, but they will also be actively watching your body language because we often say more with our bodies than with our mouths.

Different Types of Therapists

Therapists, like many professions, have different types of training and thus there are different types of therapists. Awareness of this is important because what you need in a therapist may vary widely and you will need to make an informed choice when looking for a counselor.

The National Alliance on Mental Health (NAMI) offers this breakdown of the different types of therapists.

Psychologists. Psychologists hold a doctoral degree in clinical psychology or another specialty such as counseling or education.

Psychologists’ training enables them to evaluate a person’s mental health using clinical interviews, psychological evaluations, and testing. They can make diagnoses and provide individual, as well as group therapies. Some may have training in specific forms of therapy like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), or other behavioral therapy interventions (we’ll discuss these different types of therapy treatments in another post).

A Psychologist has earned an advanced college degree of either a Doctor of Philosophy (Ph.D.) or in a field of psychology, such as research or forensics (Phys. D.).

Counselors, Clinicians, and Therapists. These masters-level health care professionals receive training to evaluate a person’s mental health and use therapeutic techniques based on specific training programs. They operate under a variety of job titles—including counselor, clinician, therapist or something else—based on the treatment setting. Working with one of these mental health professionals can lead not only to symptom reduction, but better ways of thinking, feeling, and living.

Counselors, Clinicians, and Therapists have earned a master’s degree (M.S. or M.A.) in a mental health-related field such as psychology or family therapy.

Clinical Social Workers. Clinical social workers receive training to evaluate a person’s mental health and also use therapeutic techniques based on specific training programs. They are trained in case management and advocacy services.

A clinical social worker has earned a master’s degree in social work (MSW), licensed independent social worker (LICSW), or licensed clinical social worker (LICSW).

A Trauma-Informed Therapist, A trauma-informed therapist is aware of the complex impact of trauma (any perceived trauma) on a person’s suffering and how it shapes a person’s efforts to cope.

It also means that any person or organization that claims trauma-informed credentials makes emotional and psychological safety a priority for the people they serve.

Trauma-informed therapists can be any of the above-licensed professionals and may also include Psychiatrists and medical professionals.

Reasons to Seek a Psychotherapist

The reasons people seek a psychotherapist are many and varied. Some look for help in the efforts to stop smoking or lose weight. However, in the case of people who are experiencing the lasting effects of complex trauma, utilizing the skills a psychotherapist provides is a must.

The reason I say that one needs to seek a therapist to overcome the effects of complex trauma is that complex trauma can cause an enormous number of cognitive (thinking) and emotional problems, and in the safe setting of therapy we can begin to sift through such problems. We know this because of a study conducted in the years 1995-1997 by Dr. Vincent Felitti, chief of Kaiser Permanente’s Department of Preventative Medicine.

(We have an extensive discussion of the ACE’s study here.)

These problems include:

• Substance Abuse
• Depression
• Suicidality
• Borderline Personality Disorder
• Dissociative Disorders
• Anxiety disorders
• Depression
• Feelings of worthlessness and hopelessness
• Memory difficulties
• Troubles regulating emotion
• Problems concentrating
• Avoidance symptoms (subconscious fear that causes avoidance of places or people)
• Flashbacks
• Insomnia

It is obvious that, when we experience the problems caused by repeated traumatic experiences over a period of time, our lives are difficult and chaotic.

When our lives have become too overwhelming and we feel lost, psychotherapy can help us regain our sense of control.

Why Does Therapy Work?

To be honest, although there are many theories about why therapy works, no one really knows.

However the best theory I found, when researching for this article, was by a psychoanalyst Wilfred Bion who wrote: “When two personalities meet, an emotional storm is created.”

What did Dr. Bion mean by an emotional storm?

I think there are two explanations. The first theory proposed by Vanessa Bright, a Psychoanalyst in private practice. She states in her blog post Painfully Human that she believes what Dr. Bion meant by the term “emotional storm.”

Being human is difficult almost by definition and is why we find so many ways to avoid each other’s emotional reality.

And I don’t think I am alone in the recognition that, despite the vulnerability, it requires, being human together is much more healing than life in isolation through superficiality.

It takes practice, it takes work getting used to our “storms” (which could encompass a nanosecond or years), it takes work releasing that demand for perfection, and it takes work to just recognize that all of this is utterly, and most painfully human.”

However, having experienced extensive psychotherapy for many years to heal from my own adverse childhood and highly traumatic experiences, I believe I have a better answer and it includes why therapy works.

As Vanessa Bright suggests, we are all painfully human and sharing our experiences in life has a powerful impact on the healing from complex trauma for ourselves and those around us.

It is my belief that the “emotional storm” that happens when a client and a therapist meet on a two-way street. By sharing some of the most intimate moments anyone can share with another human being,  the client brings their experiences and hurts to the therapist, who in turn brings into the alliance their training but also their own life events.

The emotional storm is the tornadic activity that goes on when the two very different experiences and expectations of the therapist and client, alliance come together.

The Importance of the Therapeutic Alliance  

In war or peacetime, an alliance between two or more countries secures a balance of power and aids in the defense from hostile countries. They form an understanding and often sign treaties established on common goals.
The therapeutic alliance is not much different.

In therapy, the vital process, where a client and a therapist work together to defeat a common enemy (specifically the lasting effects of complex trauma) begins and continues the process of healing. Psychotherapy is a turbulent and dynamic relationship between the two parties, it is not a sterile non-caring environment for either the client or the therapist.

Research has found that a good therapeutic alliance can result in healing that lasts far beyond the original therapeutic experience.

Just like the rest of us, therapists are human beings, and as such they bring to the table not only their training but also their home lives and past experiences. Therapists are not superheroes, mind-readers, or magicians.
Psychotherapy requires an enormous amount of courage, vulnerability, and trust for it to work well and the therapeutic alliance allows all these things to develop over the course of treatment.

So, the therapeutic alliance is more than just learned knowledge on the part of the therapist from their training, it is a bond formed between client and therapist.

With that having been said, it is important to note that the therapeutic relationship is much different from any other type of relationship.

Your therapist is not your friend. That means that unlike other relationships in your life, your therapist will not share intimate details of his or her life with you, and will not give you advice or tell you what to do. Neither will a therapist share the information you have shared with them with anyone else without your permission.

(Important Note: If you are a danger to yourself or others, this rule does not apply.)

Your therapist isn’t being coy in not divulging personal information. Instead, the reason therapists do not divulge their personal information is simple. Your therapy should be centered around you, your goals, and your needs. By not divulging their personal information you are free to explore your own journey without being affected by obsessions with the life of your therapist.

A therapist will not give you advice nor tell you what to do. This means that he or she is not directly responsible for your choices, nor living with the consequences of them; You are, and always will be.

During your therapy, they may make suggestions for you to consider, but it is totally up to you to decide if you want to pursue those suggestions.

Your therapist will use questions to help guide you through the maze of emotions and memories to help you decide what you will do and how you will heal from them.

He or she will use reflective listening to “reflect” to you what you say to them.

They do this for three reasons:

• to make certain they heard you correctly.
• to validate to you that they are listening.
• to allow you to hear your own words so you can examine them better.

The exception to this rule is, the therapeutic alliance if your therapist is concerned for you or someone else’s safety. In this case, your therapist will make direct and overt directives with you.

The Boundaries of Your Therapist

There are rules of engagement in any alliance, and a therapeutic alliance is no different. These rules are known as boundaries, and they set the structure for the relationship to both the client and therapist in a consistent, reliable, and predictable path.

Your therapist has boundaries that they expect you to honor and remember. These rules ensure that both of you remain physically and emotionally safe during the therapeutic alliance.

One very important boundary is that there will be no unwanted physical contact. Your therapist is bound by ethical rules not to hug, kiss, or otherwise have physical contact with you.

This does not mean that if, by mutual consent, you hug one another at the end of a session you are breaking any boundaries. However, it does mean it is unethical for them to have any overt or other sexual contact with you.

There is a vital reason for strict ethical boundaries.

The power that a therapist can have over a client is considerable, and using that power to exploit or use a client is horrendously wrong. For this reason, a therapist will express to you the limits of their contact with you.

There are other more benign boundaries, such as your therapist telling you what form of communications they will accept between you. Some therapists allow their clients to email them and others don’t. Some will allow you to call their homes if you are in crisis, others will not.

Therapy shouldn’t take place in other venues other than the therapist’s office. The reason for this boundary is to protect the therapist and you. Holding a therapy session in a coffee shop threatens your right to privacy, and going to your home for a session exposes a therapist to possible lawsuits involving unwanted sexual contact.

Your therapist will not allow themselves to become involved with you in secondary relationships. They are not your friend, they are your therapist. So, do not expect your therapist to attend a wedding, party, or even to acknowledge you in public at all (unless you instigate the greeting) because of their concern to keep up the therapeutic alliance even outside the office.

Establishing and maintaining healthy boundaries between themselves and you, their client, helps them not experience emotional burnout. You can only imagine what a day in the life of a therapist is like, as they sit for hours listening to the problems and traumas of their clients.

Remember, always remember, they are human beings with emotions and feelings just like you. For this reason, they may take an unexpected day off. When they cancel your appointment or take a week or two off for a vacation, it is to maintain their own balance and quality of work. They need time to decompress and take care of themselves and their family’s needs. By establishing ground rules with you, they are making sure they continue in a position where they can help you on your healing journey.

Concluding Our Time Together

Every therapist is different in their personality, approach, and how they interact with their clients. They should, from the beginning, start the foundation of their therapeutic alliance with you. While they are doing this, they will show the ground rules, of what to expect from both of you, during the healing journey you will be on together.
Getting to know each other and what to expect and not to expect from psychotherapy takes time. For some of us, it takes more time than average.

I will give you a brief rundown of my experience in psychotherapy.

I entered therapy in 1989 with a wonderful therapist named Paula. From the beginning, I believe Paula knew our journey would be very long, dangerous, and complicated.

For one, I had severe trust issues. I couldn’t trust her at first, and even after several years, I hid things from her. That’s how damaging my childhood trauma had been.

Eventually, Paula became a motherly figure to me. This made things difficult for her because while it was important to build my trust in her to stay effective as a therapist, she had to keep her distance.

We worked on my issues for 14 years in total, and in all that time I never encroached upon or crossed the boundaries she had set for our alliance.

She had told me she would accept phone calls at her home if I was in crisis, but she would return my calls from her office.
She made it clear from the beginning that unless I asked for a hug, one would not be forthcoming.

She also explained to me that our therapy sessions together were my hour. If I wished to waste that hour discussing the weather or dissociating out of the room, she would chit chat and or wait for me to return. There would be no extra time allotted for such things.

Paula retired in 2016, and at the conclusion of our time together, we left each other feeling as though we had accomplished the goals we had set on the first day I came to her office.

I had my dignity and personal power intact, and she felt a deep sense of accomplishment in helping me heal.
Although I may never see Paula again, she will forever remain in my heart as the mother I never had. I can’t help but believe that I have made an indelible mark on her heart as well.

In our next piece, we’ll look at the different types of psychotherapy. Until then, take good care of yourself because you are tremendously valued, and mean a lot to us here at the CPTSD Foundation.