Questions for Parents When Interviewing a Trauma Therapist
Questions for Parents Interviewing a Trauma Therapist:
Being a parent and hearing that your child has been sexually assaulted is an incredibly helpless feeling. There are so many questions that come up and the answers can seem to be few and far between. But not least of those questions is “How do I help my child heal?”. Finding a good trauma therapist is often the first and most important step in that process, but how do you sort through all of the options to find the right one? This list of questions will help serve you in sorting through the available therapists to find someone with the right combination of experience, training, and personal qualities to help your child along their recovery journey.
1. What is your license?
In Florida, there are three separate licenses for therapy: Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), and Licensed Marriage & Family Therapist (LMFT). You likely won't actually have to ask this question as most practitioners have this listed on their webpage/your insurance listing. In general, I recommend going with a LMHC or LMFT over an LCSW. The training for LMHC's and LMFT's are essentially the same (a LMFT is a LMHC who takes four additional graduate electives in treating couples and families). However, the training requirement for LCSW's is much smaller and more generalized. Essentially, a LCSW is intended to be a Jack-of-all-Trades upon graduation whereas LMHC/LMFT is a specialist in counseling. (This is not to say that a LCSW cannot be a good counselor, but that generally requires additional training and specialization post-graduation.)
2. What is your specialty?
Private practice therapy is a business. Therapists are going to want to make sales. Whatever they list as their unprompted specialty is likely what they are best at. You want someone who is going to say, unprompted, that they specialize in treating trauma.
3. What is your experience with and training in treating trauma?
In order to be a licensed therapist in the State of Florida, an individual must have a Master's Degree from an accredited university. However, those degrees do not require training in trauma as a core class and many programs may not even have specialized training available as an elective course. That said, most therapists are exposed to trauma simply by the nature of the work we do and will likely tell you that they have "extensive experience" treating trauma. If you are looking for the best, however, asking whether they have worked in trauma-intensive populations (mental health hospitals, residential treatment programs, sexual violence or domestic violence programs) and what additional specialized training that they have received in understanding trauma can help to weed out a lot.
As a caveat, I will add that substance abuse treatment exposes practitioners to a great amount of trauma. However, addictions therapy has very different requirements than other forms of therapy. It is my professional opinion that someone who specializes in treating addictions is not the best provider for a trauma survivor without a comorbid addictions problem.
4. What is your experience (and do you have specialized training in) treating sexual violence?
While trauma has the same neurobiological impact on individuals whether its combat trauma, witnessing domestic violence, or experiencing sexual assault, there are unique considerations to treating sexual violence cases that may escape the uninformed. You want someone who has significant experience working with survivors of sexual violence. Asking how many hours of treatment someone has conducted in this field and what specialized trainings or certifications they have can be helpful in combing through therapists.
5. What is your experience (and do you have specialized training in) treating children or adolescents?
Again, treating adolescents is not the same thing as treating a pre-pubescent child or in treating an adult. You want someone who has worked significantly with your child’s age group and understands how to best interact with them in order to obtain a good outcome. Asking how many hours of treatment someone has conducted in this field and what specialized trainings or certifications they have can be helpful in combing through therapists.
6. What is your treatment modality/theoretical orientation?
This question is definitely technical and you may need to do some research in order to understand the response. But therapy comes in many different shades: this questions asks the therapist to tell you what their preferred shade is. This is a generalization, but you can imagine that there are two separate sliders to define any form of therapy:
Directive ----------------------------------------------- Nondirective
Intrapsychic ------------------------------------------------Systemic
The form of therapy that is going to best suit your child is going to depend on what their specific goals are. However, in general, when treating sexual trauma a nondirective approach is important because it empowers survivors to make their own choices in treatment for a trauma in which their choices were taken away. I also believe a balance between intrapsychic (within the individual) and systemic approaches is necessary as treatment is incomplete without acknowledging the wider context within which this trauma took place, whether that is a family system, a school or workplace environment, or the general society/culture that we live in today.
7. Are you getting your own therapy? Do you have access to case consultation or supervision?
No therapist knows everything. Having access to other experienced counselors who are not involved in the case (obviously HIPAA considerations still apply) can be a vital resource in ensuring a good therapeutic outcome. Talking about the case with peers or a more experienced supervisor can allow others to speak into it and maybe point out a pattern that the therapist has been missing or offer treatment suggestions that may not have been considered.
And for trauma-focused treatment providers, receiving their own treatment is crucial. To highlight this, the criteria for a diagnosis of PTSD includes: "Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse)." There is a very high burn out rate among helping professionals; a trauma therapist not addressing their own well-being is taking a dangerous risk - both with themselves and with their clients.
8. Self-pay versus Insurance
So most therapy is provided through an insurance company nowadays. There are a couple considerations to keep in mind with this, however. First, as the insurance company is the payor, they get to dictate both the duration and the type of treatment. This can mean, because insurance companies want to reduce costs, utilizing short-term, directive forms of treatment which may not allow sufficient time to develop the safety and rapport necessary to fully address the trauma. They may also only authorize treatment for certain diagnoses, often requiring that those diagnoses be more "severe" in order to justify these pay outs. You should look into exactly what your insurance plan will cover in this regard.
Second, because the insurance company is the payor, they are entitled to access both the diagnosis (which is necessary to authorize treatment) as well as the progress notes themselves, which may or may not get audited to ensure that treatment is being provided per their requirements. While this does provide an additional layer of oversight for clients, it does also mean that individuals beyond your child and their therapist could be privy to the details of her sessions. Insurance companies remain bound by HIPAA as well and it remains illegal for them to disclose those details, but it does become and remain part of her medical record.
Self-pay does not have those same requirements. Florida does require that a treatment plan be on file for any client in therapy, but the diagnosis for that treatment plan can be (just for example) V62.89 - Victim of Crime rather than something more severe such as 309.81 - Posttraumatic Stress Disorder. Because you would be the payor, the only limit on duration and type of treatment utilized would be the limits that you set.
Obviously, the draw back with self-pay is a higher cost to you. Oftentimes, however, practitioners will discuss payments on a sliding scale based on what you can afford.
9. (For your child) Do you have a preference in the faith, age, culture, ethnicity, gender, or sexuality of the therapist?
(For the therapist) How do you address differences in faith, age, culture, ethnicity, gender, or sexuality between you and your clients?
In setting up initial consultations, it's worth asking the question to your child about their preferences (again, giving them choices). Frankly, a good therapist will be proactive in addressing any differences between themselves and the client, opening up the door to conversations about how those differences are impacting treatment and allowing for comfort and safety within the therapeutic relationship despite them. You can also screen out some therapists based on how they answer this question. If they don't report proactive acknowledgement of these differences and demonstrate a willingness to address them, move on.
It is worth adding, differences can be very beneficial to the treatment process if handled well. For example, as a male therapist, the weight my words carry in condemning a male perpetrator is different than when condemned by a female practitioner. However, there is certainly an added difficulty there that must be addressed for therapy to be effective if my gender matches that of the perpetrator’s.
10. How do you handle situations in which you and the client are not a good fit?
No matter how good a therapist is, sometimes the fit between them and the client just isn't right. That may be a matter of training and specialization, or it could simply be a personality mismatch. Regardless, it is important that therapists both recognize this possibility and have a good procedure for what we call "aftercare". A good therapist will be willing to make recommendations to clinicians they feel like might be a better fit and will work with the client to provide a warm hand-off, supporting them through the transition and following up with them afterwards to make sure they're satisfied.
If you have any questions about any of the content here or would like to ask about any of my answers to these questions, please reach out to me either by phone at (407) 986-1137 or through the Contact Us page on the website.