What about when MOM is the abuser?

With the new year fast approaching I thought that a post that contains some information that would help people select and evaluate a therapist and therapy would be in order.

I am going to refer to and use some information from the book Navigating The MindField that is edited by Scott Lilienfeld, John Ruscio, and Steven Jay Lynn. It is a book I would recommend to everyone and was just released on December 10, 2008.


Selecting a Therapist

The American Counseling Association has these following questions they suggest you should ask a potential therapist:


Are you a licensed or certified counselor?
What is your educational background?
How long have you been practicing counseling?
What are your areas of specialization (such as family therapy, women's issues, substance abuse counseling, etc.)?
What are your fees?
Do you accept my insurance?
How is billing handled?
Do you offer a sliding fee scale or a payment plan if I do not have insurance for mental health services?
How can you help me with my problems?
What type of treatment do you use?
How long do you think counseling will last?

After you have had these questions answered by the counselor to your satisfaction, consider how comfortable you feel with the individual, since you will be working closely together during your counseling sessions. It is difficult to open up and share your problems with a stranger and you may feel awkward or anxious during your initial sessions. But it is also important that you have a "chemistry" or rapport with the counselor. Counselors have different styles, personalities, and approaches. Take time to evaluate how you feel interacting with the counselor and whether you believe that the two of you can work effectively together. If you do not feel at ease with a certain counselor, do not get discouraged. Instead, look for a different individual with whom you would feel more comfortable working with.

In Navigating the Mindfield they offer a few suggestions and a list as well:

The authors state that if you are treated with disdain for asking the questions it is probably a wise thing to think about how and why the person is doing so and how that person could help feel better and do better? If they begin with putting you down for being a wise consumer this is not a good start nor a good sign. There are thousands of therapists out there so keep searching.

1. How long is the therapy session?
2. How often should I see you?
3. How much do you charge? Do you have a sliding scale?
4. Do you accept insurance?
5. If I miss an appointment, will I be billed?
6. If I am late, or if you are late, what happens?
7. Tell me something about your educational background, your degrees. Are you licensed?
8. Tell me about your experience and your theoretical orientation. What types of clients have you seen? Are there areas you specialize in?
9. Do you use hypnosis or other types of trance-inducing techniques?
10. Do you have a strong belief in the supernatural? Do you believe in UFO's, past lives, or paranormal events? Do you have any kind of personal philosophy that guides your work with all your clients?
11. Do you value scientific research? How do you keep up with research and development in your field?
12. Do you believe it is okay to touch your clients or be intimate with them?
13. Do you usually set treatment goals with a client? How are these determined? How long do you think I will need therapy?
14. Will you see my partner, spouse, or child with me if necessary in the future?
15. Are you reachable in a crisis? How are such consultations billed?

After the interview ask yourself:

1. Overall, does this person appear to be a competent, ethical professional?
2. Do I feel comfortable with this person?
3. Am I satisfied with the answers I got to my questions?
4. Are there areas I'm still uncertain about that make me wonder whether this is the right therapist for me?

Remember, you are about to allow this person to meddle with your mind, your emotional well-being, and your life. You will be telling her very personal things and entrusting her with intimate information about yourself and other people in your life. Take seriously the decision to select a therapist, and if you feel you made a mistake, stop working with that one and try someone else.

Good advice and advice that the therapists themselves should inform clients of.

Sadly there is no guarantee that a particular therapist is ethical, responsible, educated, or proficient. For this reason it is important to check whether or not a therapist has a relevant academic degree and a license, but keep in mind that degrees and licensing do not guarantee that a person is keeping up with clinical and academic research or that they are basing their therapy on proper scientific research findings. If you find that your therapist has no degree and is not licensed, you should be very worried. What your therapist doesn't know can hurt you, and if an unlicensed therapist hurts you, there is no licensing board you can turn to for help or to report the therapist to. Therapists who base their therapy techniques on superstition, myth, and ignorance are more common than they should be. There are also therapists that use therapy to meet their own needs rather than the needs of the client.


How to Evaluate Your Current Therapy

Just as important as selecting a therapist is how to evaluate the therapy once you have begun or if you are already in therapy.

In Navigating the Mindfield they have the following list of Common Traits of Bad Therapy:


1. Inadequate history taken at the outset
2. No diagnosis or ill-formed, incorrect diagnosis
3. Lack of formulation or conceptualization of the problem and how to proceed
4. No goals, no treatment plan, or inappropriate treatment plan
5. Unclear roles or boundaries, including self-revelations and seductive or sexual remarks
6. No appreciation of discrepancy in power
7. Dependency and regression fostered
8. Therapeutic techniques mismanaged or inappropriate techniques used, including placing clients in group too soon, misuse or overuse of hypnosis and/or medications
9. Overriding adherence to paranormal theories or New Age philosophies that cannot be rationally or scientifically proven and that are covertly or overtly foisted on clients, requiring them to make tremendous leaps of faith in order to go along with the therapists interpretations and treatment
10. No rational theoretical connection between the practices and the goal of rehabilitation
11. Transference mismanaged, including failure to recognise, interpret, and understand its impact on the therapeutic relationship
12. Confidentiality violated, including telling client about others and/or telling others about client
13. Objectivity and professionalism lost, including becoming sexually or otherwise involved
14. Failure to monitor progress
15. Failure to treat or deal with presenting problems
16. Precipitous abandonment of client


The book also has a list of issues that are discussed in depth that can be very helpful. Anyone who is in, has been in, or is considering therapy should read this book. There is no one size fits all treatment or therapy yet if one looks to the late night television, self help section in the bookstore, or Internet you can easily find numerous pseudo scientific remedies that make promises to cure anything and everything.

Therapies should be science based, evidence based. They should have been tested and shown to be safe and effective BEFORE they are used on clients. Using therapies that haven't been tested for safety and effectiveness is just as dangerous as prescribing medicines that haven't been tested for safety and effectiveness, and just as unethical.

First do no harm should be the holy grail for all therapists. If you are a client that has begun or is considering starting therapy, you should protect yourself by asking therapists what therapies and techniques they use and if they have been tested for safety and effectiveness. Ask the therapist to provide references to controlled clinical studies demonstrating safety and effectiveness for the proposed therapy.

If a therapist is so irresponsible and unethical as to use therapies that have not been tested for safety and effectiveness, then you are probably better off searching for a therapist who cares enough about clients to test therapies before exposing vulnerable clients to possibly harmful treatments.

For therapists, it is their moral, professional, and ethical duty to investigate the scientific proof for safety and effectiveness for each and every therapy technique they use. It is also their moral, professional, and ethical duty to inform clients about the known risks, benefits, and alternatives to a proposed therapy before treatment begins and to get the client's informed consent.

And with the passage of the Mental Health Parity Act it is hoped that the junk science will be cleaned out more and payment will be made only for those treatments that are proven safe and effective.