Aphrodite Matsakis, Ph.D.
Licensed Counseling Psychologist







Appendix:  Seeking Help: Groups and Therapy Programs

Anyone who has been traumatized or who suffers from emotional pain (whether or not it is accompanied by physical injury )  can benefit from the right kind of help. Notice, however, that I said  “the right kind.” Even if your circumstances have damaged your self-esteem, you need to convince yourself that you deserve a therapy program –  whether individual or group– which offers quality counseling and which is suited to your individual needs. Finding and evaluating therapists, treatment programs, and survivor groups is the subject of this appendix.

Minimum Criteria for Effective Counseling
Unfortunately, there are many therapists and programs that should be avoided. For example, in recent years, certain forms of trauma (such as sexual assault and incest) and certain psychiatric problems (such as depression, bulimia, and panic disorder) have received considerable media attention. As a result, some therapists and programs have simply jumped on the bandwagon. Although they claim to be qualified to treat these or other conditions, the only training they may have is a few workshops and, perhaps, some extremely limited experience. In addition, you can not assume that even a licensed social worker, psychologist or psychiatrist has had adequate training in your particular area of concern, especially in the area of trauma.. To date,  training in trauma recovery (or in recovery from anorexia, bulimia or other eating disorder) is not required in order to obtain a degree in any mental health profession.


There is a minimum set of criteria for effective trauma-related counseling. The only therapists or recovery programs you should consider must do the following:

Regard the trauma as real and important in itself, apart from your other concerns view you as capable of being healed, not as a willing participant in the trauma,  someone who is genetically or biochemically addicted to suffering (or being abused), or as a hopeless psychiatric case or addict

Be familiar with and be able to educate you about the facts of your particular trauma (whether it be war, sexual assault, medical disability); the grieving process; the various kinds of post-traumatic reactions, such as depression, post-traumatic stress disorder, and dissociation; the physical, emotional, sexual and interpersonal aftereffects of trauma; the nature of the recovery process; and the faulty thinking patterns that can lead to an irrational sense of unworthiness,  guilt, shame, powerlessness and hopelessness

Be aware of the effects of racism, sex-role stereotyping and blame-the-victim attitudes on the recovery process and not evidence such biases themselves

Provide you with information about your particular trauma’s related health and legal issues or be willing to either get this information for you or direct you to sources where you can obtain it for yourself

Be willing to listen to details of your traumatic experiences yet not pressure you to share aspects of the assault you do not wish to disclose

Not push you to discuss your trauma (or any other aspect of your past)if you are coping with a current life crisis; if you have an untreated addiction psychiatric or medical problem; or if you develop any of the warning signs listed in the section below entitled “Emergencies.”

Either teach you coping skills, such as relaxation techniques or anger management, or make appropriate referrals for you to receive such help

Use or recommend medication and behavior-management techniques when appropriate, but not to the exclusion of examining the trauma or any past and present events important to you.

Where to Begin

The organizations and materials listed here are by no means all the resources available.  You are encouraged to seek additional help by spending some time on the Internet or at your local library or by talking to helping professionals.

Addictions: Alcohol and Drug Abuse/Eating Disorders

Names of treatment centers specific to a particular addiction or eating disorder  can be obtained from the phone book, hospitals, city or county mental health or social service agencies, your or your partner’s employee and family support programs or twelve step programs such as  Alcoholics Anonymous  (www.alcoholics-anonymous.org); Narcotics Anonymous www.na.org,

Overeater’s Anonymous (www.overeatersanonymous.org);  Al-Anon and Ala-Teen ( www.al-anon-alateen.org); Adult Children of Alcoholics (www.adultchildren.org); and Nar-Anon (http://www.soberrecovery.com/links/nar-anon.html) (http://alcoholism.about.com/od/naranonresources/); Information about twelve step programs can also be obtained from your telephone directory or local library.

Children

Imagination Press: Self-Help Books for Kids .. And the Adults in Their Lives sponsored by the American Psychological Association offers books on helping children understand their emotions, cope with separation from a parent and other issues. www.maginationpress.com

The following web site can direct you to organizations and materials on parenting and helping children: American Psychological Association – Helping Children

Mental Health Treatment Books

Fanning, Pat and Mc Kay, Matthew, Eds.  Family Guide to Emotional Wellness   2002, Oakland, A: New Harbinger Publications, Inc.   

Organizations: Finding a Therapist or Treatment Program

In choosing a therapist or treatment program, you have the right to shop around and ask questions. Get recommendations from friends, doctors, and people who report having had positive therapeutic experiences; from hospitals with specialized treatment programs for the area of concern;  the police; university health or counseling centers (if you are a student); and local mental health and social services agencies, which are usually run by either the city or county.

Local addiction and eating disorders treatment programs; local hotlines, local health centers, and local or state chapters of the Anxiety Disorders Association of America, the International Society for Traumatic Stress Studies, the American Psychiatric Association, the American Psychological Association and the National Association of Social Workers may also have lists of qualified professionals.  If you or a family member is or was in the military, contact any of the military organizations listed below to inquire about mental health services.

Your telephone directory, local library, or social service agency can provide you with the phone numbers of the organizations listed here. If you contact any of these organizations, be sure to inquire if the therapist and programs are identified by speciality, such as depression or trauma recovery. For example, if you call your local or state chapter of the American Psychiatric Association, the American Psychological Association, or the National Association of Social Workers, ask for a specialist in the area of your concern. The Sidran Institute provides suggestions for finding trauma specialists and other resources. (The Sidran Institute 200 East Joppa Road, Suite 207 Baltimore, MD 21280-3107 phone(410) 825-8889 toll free phone (888) 825-8249 fax (410) 3370747 email sidran@sidran.org web site www.sidran.org

Military Organizations Helping Active Duty Military and Their Families

Army: Army Family Team Building (AFTB) http://Www.goacs.org www.armyfamilyteambulding.org  Army Community Service and Family Advocacy Programs, www.goasc.org.

Navy: www.navy,mil then click on OTHER INFORMATION and go to LIFELINES or go directly to www.lifelines.navy.mil; Fleet and Family Support Division.

Marines: www.usmc.mil (Then go to Family); Marine Corps Community Service www.usmc-mccs.org

Air force: www.af.mil (Then click on Questions and go to Tricare or go directly to www.tricare.osd.mil;   USAF Combat Support and Family Service

Organizations Helping Veterans and their Families

Veterans and their families can seek assistance at their closest Department of Veterans Affairs Medical Center (VAMC) or Vet Center. Consult your local phone directory, library or hospital to locate the nearest VAMC or Vet Center nearest you. Vet Centers may be listed in your telephone directory under “Vet Centers” or as “Veterans Outreach Centers.”

Organizations such as American Legion, Veterans of Foreign Wars, Paralyzed Veterans of America, Disabled American Veterans, and Blinded Veteran’s Association  help veterans and their families. Consult you local telephone directory or library, military service organization or VAMC or Vet Center for a complete listing of these organizations and their location.

Emergencies       
            If you are experiencing any of the following symptoms, seek professional help immediately: memory problems; feeling disoriented or out of touch with reality, even temporarily; suicidal or homicidal thoughts; self-destructive behavior, such as substance abuse or self-mutilation; hyperventilation, extreme nausea; hemorrhaging,  uncontrollable shaking; irregular heartbeat; hallucinations (visual or auditory), increased symptoms of a preexisting medical or psychiatric problem; fear of being or becoming out-of-control, or any intense, new or unexplained pain. If you can not contact a licensed mental health professional immediately, call a local crisis center or go to the emergency room of the nearest hospital. Consult your local phone directory or library or the Internet for contact information on local crisis hotlines, local crises centers, and local hospitals.

The Screening Process

When you have obtained the names of at least four or five therapists who seem to meet the minimum criteria for effective trauma related  counseling listed above or whose specialties seem to fit your needs, call and interview each of them by phone. (If you are considering a program, you will interview a program representative or staff member.) Before inquiring about qualifications, ask about available openings and fees, including the possibility of a sliding scale. Eliminate therapists and programs that are geographically inaccessible, whose fees are prohibitive and whose available time slots are not workable for you.

If the therapist or program meets your needs in these areas, then inquire about their training, experience and focus. It is essential that you inquire about these matters to verify that any potential therapist or program does, in fact, meet the criteria listed above for effective trauma related counseling (or counseling for your particular concern.)   Do not be afraid to ask how many workshops the therapist or staff members have attended;  how many books they have read about trauma or related topics, especially health issues, depression, PTSD or addiction; how they keep up with the latest developments in area of trauma and related areas; and whether they have colleagues available for consultation who are experts in areas relevant to your recovery.

You needn’t sound hostile, but don’t avoid asking the hard questions for fear of offending either. Remember, your mental and physical health are at stake. You can preface your questions by stating that you are faced with a bewildering array of alternatives and want to make the best choice for you.

Consider asking questions such as the following (if you are considering a program, you would ask these questions in terms of the program’s staff): How long have you been in practice? Are you a member of any professional organizations? How many trauma survivors (or persons suffering from depression, severe anxiety, or whatever is your particular concern) have seen you in therapy? What is your formal training in the areas of (a) your particular trauma and (b) related or other concerns? What, in your view, constitutes the trauma recovery process?

What approaches would you take towards helping with some of the secondary problems arising from trauma,, such as substance abuse, eating disorders, dissociation, or depression? What would you do if I became suicidal or felt out-of-control?

What is your view on self-help groups or other group therapies? (If you want couples or family counseling as well,) Do you conduct couples or family therapy? If not, do you work colleagues who do? What limits do you impose on contact with clients? Is there a charge for phone calls outside of scheduled sessions or for time spent writing letters on your behalf?

After you have narrowed your list down to two or three therapists or programs, go visit them. Most therapists charge full fee for an initial visit. Despite the cost, it’s is critical that you meet with the therapist face to face before making your selection. (Programs usually provide for a similar type of interview, usually at no charge.)

After this initial interview, think about these questions: Does the therapist or program counselor seems supportive and respectful towards you? Do you feel you could disclose to this person your inner feelings about the trauma (or other important concern)? Most importantly, what is your gut feeling about the therapist? Qualification are important and you should be considering only qualified therapists at this point but the final decision may be a matter of finding the best emotional match for you. If you have strong negative feelings towards a particular therapist after an initial interview, even if the therapist is well qualified, it probably isn’t a good match. If you are ambivalent, consider meeting with the therapist an additional time before making your decision.

While many psychologists – both men and women - call themselves “feminist” or “nonsexist,” you need to decide for yourself if they actually are. Remember that just because a therapist is a woman does not automatically make her a nonsexist. Furthermore, today many male therapists are committed to nonsexist treatment and provide excellent counseling. In general, however, it takes considerably more effort for a man to truly understand the impact of sexual assault and sex role stereotyping on women than it does for a woman.

Evaluating the Course of Therapy and Other Forms of Counseling

Note: The suggestions provided below for evaluating the course of therapy apply to other forms of counseling, such as working with a member of the clergy, a spiritual advisor, or others.

Once you’ve selected a therapist, you can begin your therapy on a trial basis. Make a commitment to work with the therapist for a month, six weeks or some other limited time period; then reassess your choice. How do you seem to be faring? How effective has the therapist been in addressing the problems you’ve had due to the trauma, including secondary problems such as addiction or depression? Discuss these issues with the therapist. What is his or her assessment of your progress and prognosis for healing?

If the therapist you’ve selected turns out to have been a poor choice, use the knowledge you’ve gained to find a better one. The wrong therapist can do more harm than good. However, as you make your decision about whether to continue with a specific therapist, bear in mind that the course of therapy is not always smooth: backsliding, regression and hostility on your part may all be a part of the healing. Just because you don’t feel better every time you leave the office doesn’t necessarily mean the therapist isn’t helping you.

Definitely stop seeing the therapist if you believe that he or she is actually doing you harm: for example, if the therapist directly or indirectly blames you for the trauma or for other forms of emotional or physical pain in your life; doubts your truthfulness; shows excessive interest in the sexual or violent details of your trauma or life situation; can not seem to tolerate your emotional pain or your anger; is unwilling to discuss your questions about or discontent with the therapy without becoming hostile towards you or blaming you for your dissatisfaction with your progress; is constantly or frequently  pointing out how the problems you had before the trauma (or other stressful situation) contribute greatly to your symptoms; or urges you to continue examining your trauma (or your childhood or other aspects of your life) when you can barely make it through the day, for example, when you relapse into addiction, sink into a deep depression, or begin having any of the warning signs listed in the Emergencies section of this Appendix.

You should also be skeptical about a therapist who believes that the negative effects of the trauma (or your particular stressful situation) would go away if only you tried harder, forgave the whomever or whatever wronged you, really wanted to heal, gave up your anger, or had a more positive attitude towards life. You should also be concerned a therapist who only seems to offer you platitudes or overly simplistic answers to your complex problems or who answers “yes,” to any of the following questions: Would you ever socialize, flirt or have sex with a client or someone who used to be your client? Would you ever trade services with a client, for example, accept house repairs in exchange for therapy?

If You Are Referred to a Psychiatrist

If your psychological symptoms are sufficiently severe, a psychiatric evaluation may be suggested. You have nothing to lose by taking a few hours out of your life for a complete psychiatric work-up. Be prepared to list your current and past medical problems and medications and your symptoms, their duration and frequency and any other observations you have about them. At the conclusion of evaluation, medication may or may not be recommended. It is your choice whether or not to take it. You don’t have to decide on the spot. It is your right to have the psychiatrist explain your diagnosis and the medication in detail. You may want to look up additional information about your diagnosis and the recommended medication on the Internet or at the library before you decide.

If you chose to take medication, be aware that medication needs constant monitoring. You may need to telephone the psychiatrist several times before the right dosage is established. You will also need to call if the negative side effects are problematic or seem to outweigh any positive effects of the medication. Call the psychiatrist if you feel numb or tired much of the time; can not concentrate; have physical symptoms such as bleeding, muscle tremors, seizures, dizzy spells, hyperventilation, dark or discolored urine, rashes, inability to urinate, constipation, loss of menstrual period or sex drive, severe headaches, nausea; suicidal thoughts; or have any of the symptoms listed in the Emergencies section of this Apendix.

If your call is not returned promptly, call again. Do not let these side effects go unattended! Finally, be wary of any psychiatrist who does not sem familiar with the medication, who seems to discount your concerns or who does not return your phone calls regarding questions or problems with the medication. If contacting the psychiatrist is always a problem, consider changing doctors. However, it is recommended that you discuss this decision with your therapist or support group first, as well as with the psychiatrist.

Finding a Survivors Group

Many assault survivors have benefitted greatly from participation in a support group. However, being exposed to the emotional pain of other survivors can be overwhelming. If attending group results in your developing symptoms such as those listed in the Cautions section of the Introduction to this book, consult with a mental health professional before returning to group. You may need some individual therapy before participating in a group.

Some support groups are led by professionals, other by survivors only. Some are identified with a certain faith or denomination. Church-affiliated and survivor-led groups may be free or charge little. Professional led groups vary price. Some offer a sliding scale; others do not.

To search for a group appropriate to you, consult the resources for finding a therapist or a sexual assault treatment program listed above. Take the same steps to find and a select a survivor’s group and, later, to assess your progress in group, as have been described above for finding, screening, and evaluating an individual therapist or treatment program.