from The Therapist's Page in Eagles' Wings (an
organization for sexual abuse survivors) Newsletter:
Q: Do I need therapy and how long is it going to take?
A: It’s usually a big decision to enter therapy. Some survivors feel
like they have no choice in the matter because they are so desperately
unhappy and afraid. Even for them, it’s difficult to take the first
step because hopelessness gets in the way. People enter therapy for
many reasons, but here are some general guidelines for deciding if you“need” therapy and are ready for therapy. If you are so depressed that
you are having trouble leaving the house, getting out of bed, or
sleeping, you would probably be helped by talking to a therapist (and
possibly being evaluated for antidepressant medication). If you feel
like you are haunted by the past, in the form of flashbacks or an
inability to stop thinking about the past or a frequent inability to
discern past from present, therapy can help you to feel safer and
“more present in the present.” If you feel that you are bad, toxic,
unlovable or unworthy, therapy can help. The best way to decide if you
are ready for therapy is simply to know that you want to change. It’s
okay to feel scared and untrusting when you enter therapy. A therapist
who is used to working with survivors will understand and accept your
distrust, and will work with you to create a feeling of safety in the
Which leads to the second part of the question: how long will it take?
It may take a while to feel happier or to like yourself more, but you
should feel some relief from feeling terrified or out of control within
the first few months. The safer you begin to feel in relationship to
your therapist, the more other things will begin to change. For some,
of course, it takes a long time to learn to trust. Two things to
remember: first, change takes as long as it takes—you will learn to
trust your own process; second, life does not begin after therapy—your
therapy should support your life outside of therapy, not the other way
from The Therapist's Page in Eagles' Wings (an organization for sexual abuse survivors) Newsletter:
Q: How do I choose a therapist who’s right for me?
A: Much of what survivors need to work on in therapy is the same
stuff everyone works on. So, firstly, it is important to find a
reputable, ethical therapist who has good solid psychotherapy skills.
Secondly, in order to work with survivor issues—such as safety,
trust, flashbacks, dissociation, self-harm—a therapist should have
specialized training. (One of the most common mistakes an untrained
therapist makes is to focus too much on “memory work” rather than
containment and functioning in day-to-day life.)
To find a knowledgeable therapist, it’s usually helpful to ask for
recommendations. Ask other survivors you know or your doctor. You can
call Eagles’ Wings or the Georgia Council on Child Abuse for referrals.
When you have two or three names, try to talk directly on the phone
with each therapist. You can expect about ten or fifteen minutes of
the therapist’s time to answer some basic questions and set up the
first appointment. If you require a sliding scale or if you have
restrictive insurance, it is best to ask the therapist about her or
his fee policy right away.
Each therapist has her or his own style of conducting the first
session. Some therapists have a structured interview and some
therapists let the client take the lead. Either way, the therapist
should be willing to listen and should be open to discussing her fees,
policies, training and experience. She should try to understand what
you want from therapy and discuss with you whether those goals are
realistic. Sometimes this intake process happens in one session and
sometimes it takes several sessions.
It is most important that you pay attention to the level of comfort or
identification that you feel. Sometimes it’s hard to sort that out
when you’re feeling anxious about beginning therapy or changing
therapists. If you’re not sure, you can always take more than one
session to decide. You might want to take some quiet time after the
session to reflect or write in your journal. Try to be aware of how
you felt at different points in the session, how the physical space
felt to you, how the therapist responded to your questions, and whether
you asked all the questions you wanted to ask. Did the therapist seem
genuinely interested? Was she comfortable talking about her training
and experience? Did her style feel comfortable to you? If you got
scared or disoriented during the session, did you feel safe with how
the therapist handled it?
As with every new relationship you enter, there will be “unknowns” and
maybe some apprehension. Feel free to talk with the therapist about
your concerns. You are the only one who can know if a therapist is the
right one for you. Let your decision come from both your head and your
Making the Most of Supervision
Supervision and consultation are important aspects of maintaining ethically and clinically astute standards of care. On-going supervision gives you the advantage of a relationship in which the supervisor can get to know your style and your issues over time. Supervision or consultation groups have the benefit of providing colleaguial support for clinicians who often feel isolated in their work.
For all clinicians-- even the most experienced, there are times that we need to seek guidance. Here are some times to make that call:
1. When you feel like you’re losing perspective on whether or not you are being helpful to a client;
2. When you are doubting your competency (over a period of time or with several clients);
3. When you’re feeling “stuck” and can’t figure out whether it’s you or the client;
4. When you’ve identified your counter-transference but nothing is shifting for you;
5. When you realize you have lost your ability to hold your boundaries;
6. When you realize, in the course of working with someone, that you are moving into an area in which you are inexperienced, and you are unclear whether to refer or to seek expertise;
7. When you find yourself blaming or shaming a client; and
8. When your friends or co-workers keep telling you that you seem burned out.
It’s helpful to choose a supervisor whose assumptive world, theoretical orientation, and supervisory style complement or support yours. It may also help to take the time to reflect upon a past supervisory experience. (Was it a positive or negative experience for you—and why? What did you like or not like about your relationship with your supervisor?) Do you know what you want now in terms of style? Do you want someone who is facilitative? Directive? Task-oriented? Do you need someone who is familiar with your particular work setting? Or with the ethnic or cultural concerns of your clients or yourself? Would it be more helpful to bring a consultant into your agency or practice to address organizational issues?
The more you can know about what you need ahead of time, the easier it will be to focus on the problem at hand, and to explore the yet unknown region.
Mindful Presence in Psychotherapy
We usually know when someone is really present with us. We can feel their attention, their focus, their positive regard, their presence in the moment. If, as therapists, we believe that relationship is at the core of psychotherapy—and I do, then we must learn ways to bring ourselves to the present moment, with genuineness and without distraction. As our awareness of our own inner world, our subjective experience, is heightened, so, too, is our sensitivity to and ability to be present with our clients.
One of the paths to an increased self-awareness is the practice of mindfulness. Mindfulness, a Buddhist meditation practice that is applied to daily life, is a state of consciousness in which the body is relaxed, the senses are alert, and the mind is clear andfocused on the task at hand. Pema Chödrön says mindfulness is “a sense of clear seeing with respect and compassion for what it is we see…. It’s a life-time’s journey to relate honestly to the immediacy of our experience and to respect ourselves enough not to judge it.”
The practice of mindfulness teaches us to keep gently bringing our attention back to our in-breath and our out-breath, observing our body, our thoughts and feelings, without judgment, having an awareness of what is in the present moment, with each breath. “To be mindful,” says Thich Nhat Hanh, “means to be fully present in the moment—not one part of you washing the dishes while another part is wondering when the work will be finished.”
How can we apply this to psychotherapy?
Being mindful helps us trust the client’s integrity—by that, I mean her own inner wisdom and truth. It sets the pace. It provides the answers and discoveries and solutions and meanings. We can trust that issues and feelings will arise, out of the therapeutic relationship, at the appropriate time.
We are more genuine when we are mindful. If we know our own vulnerability, we are more present and more willing to be present with a client’s vulnerability. We are more willing to be with them when they are on the edge of the unknown—not leading them there but making room for that to happen and not backing away from that edge too soon.
Being mindful, we are more willing to meet the client where he is. We seek to understand the client’s experience, from the client’s perspective, within the client’s structure and meaning. As the client begins to tolerate, and then understand and accept, the present moment, his meanings begin to change. This can happen with few power struggles because the practice of mindfulness steers us away from preconceived ideas of who a person is or what she thinks or what needs to happen next. We become more willing to accept the place of conflict or resistance as the client’s fear moving him away from the present moment, the edge of the unknown.
For beginning therapists, mindfulness can relieve the pressure to perform, to make something happen, to impress the client. It can help the therapist notice and then let go of inner critical voices.
And, finally, mindfulness helps us to process our work with peers or mentors. With the clarity of mindful observation, we have our subjective experience as a reference point, from which we can process how we are facilitating or prohibiting our client’s discovery of self.