Contents:
Introduction
Finding a Therapist is Hard
What Therapy Should I Go To?
Reenactment of Trauma in Therapeutic Relationship and its Healing
Good vs Good-enough
My Therapist Failed Me. Should I Fire Them?
Extra: What if I donât have the Money
Introduction
In this short text I will offer some advice on the not-so-often discussed topic of how to find a good therapist to guide us along the process of healing childhood trauma, be it a personality disorder, or CPTSD. One quick glance at the support forums proves that this is the main problem that people face in the beginning of their recovery. There is a certain art to finding a good therapist, but we are often left to our own devices. Partly because of systemic problems that there is very little psychological help in the intermediary stage after we reach out for help, but before we actually get assigned a therapist.
Finding a Therapist is Hard
As stated above, a therapist is often our only source of any mental health help. It is true â sometimes psychiatrists or GPs who refer us to therapy are very empathetic, but when it comes to an ongoing, week-by-week process, a therapist is all we have.
So how can we actively choose one, if thereâs really no choice; if a therapist is synonymous with getting help itself? Either you are in therapy, or youâre not. If only there was a âtherapy-therapistâ, whom we could contact when we want to part ways with our current therapist, or who could help us find one in the first place. This problem sits on top of practical concerns - such as access to qualified therapists, financial problems, stigma, etc.
I think this is where the general community is where that help should be. And this is proven by the fact that so many CPTSD forum posts are about the choice of a therapist or discussing problems relating to ongoing therapy. But letâs be honest with ourselves, CPTSD or emotional neglect often result in social isolation â we simply have no access to good people who could help us with that choice.
Therefore, I think there is a pressing need for ourselves to organise in such a way, where people who healed from CPTSD or personality disorders would share their stories, and offer guidance on what helped and what didnât. And this article is just that.
Practical Concerns
The most important and yet hardest to get aspect of choosing a therapist is: which one to choose. We have so many competing schools of therapy. Every country has its own governing bodies for therapists, and whatâs worse: often a lack of regulation on who can call themselves a therapist, a social worker, a counsellor, a psycho-traumatologist, a psychoanalystâŠ
But you need to learn these things.
In âTrauma and Recoveryâ Judith Herman, the person who came up with the name CPTSD, says that the first and most important step to recovery is the decision made by the sufferer. No intervention can help. Only an honest, internal decision, often against all odds, saying: I want to be healthy.
And the best way to cement that decision is to make that first step on the path to recovery and MAKE AN EFFORT to learn as much as possible (within reason) about what can help you. Much in the same way that people going to chemotherapy learn about how it works, and what causes cancer.
That is not to say that you need to be an expert in psychology. You need to put in an effort to obtain that knowledge, but it can be second-hand â but it needs to go through the filter of your own true self. If it sounds true to your soul in the context of the growing hope for your future recovery â that should be your truth. Therefore get rid of all catastrophising, inertia, and narcissistic âI know betterâ. And arm yourself with hope, self-love and a resolution to look for help and knowledge.
What Therapy Should I Go To?
Obviously that question is best left for professionals, but I will try to sum up what I learnt, in case someone resonates with that.
It goes without saying that you should avoid coaches, or people who donât have any training in evidence-based therapy modalities. Not all therapists are psychologists (people who studied psychology), but itâs definitely a big plus if they did.
First of all, itâs worth pointing out that at least here in Europe, CBT is king in terms of availability of practitioners offering therapeutic services. CBT stands for cognitive behavioural therapy, and as the name suggests, it focuses on cognition. Itâs a proven modality of treatment for many things, such as anxiety disorders, phobias, etc.
However, in my experience, CBT, as amazing as it was in overcoming symptoms, was surface deep in terms of addressing actual trauma.
So in my opinion, CBT is amazing in addressing distress right here and now, but itâs not a healing modality for childhood trauma or emotional neglect â it might be a modality that will help you for example set up boundaries or silence the inner critic, and in that itâs invaluable, but it wonât name these things at this deep level, and wonât, at least from my experience having attended CBT for many, many years, offer you complete healing.
Itâs worth mentioning DBT in this context. Itâs an offshoot of CBT thatâs targeted for people who have problems with emotional regulation, such as people with BPD. Itâs super effective in teaching people how to control their emotions. However, I found from personal experience, people who donât have a big problem with that, or who were wrongly diagnosed with BPD instead of CPTSD - will find this modality a bit patronising.
But donât disregard it â if CBT or DBT is all you can find, choose that modality: why? Iâll answer that in the Good vs Good-enough section of this text.
So, in my experience, that takes care of the majority of whatâs on the market. I believe the reason for that is that CBT is relatively straight forward when it comes to teaching therapists how to use it. It doesnât require any enigmatic knowledge about the psyche to be able to offer help in this evidence-based school of therapy.
But we want more if possible, right?
So whatâs left? What is left are all the psychoanalytic schools of therapy. These are really good in my experience assuming the therapist offering them isnât old-fashioned. I know it sounds funny, but I attended a lot of therapy sessions with psychoanalysts who simply liked being a psychoanalyst, if that makes sense. They have this overreaching theory of the psyche, and often fail to reach outside and want that theory to define the patient. Itâs not necessarily bad, but more open-minded psychoanalysts who arenât afraid to reach out to other systems or learn about trauma - are really effective, since most of these schools, for example psychodynamic therapy, reach out to childhood a lot, or rather what childhood has done to us.
But modalities that offered the most help to me were: IPFS, internal family systems therapy, and trauma focused therapy. The former is a very abstract and modern way of approaching your internal world, and the world of voices that were installed or âbody-snatchedâ in you during abuse. This school of therapy makes you interact with those voices as if they were a bit separate from your ego. You learn to have a relationship with them, to control the problematic ones, and accept love that emanates from all of them at the end.
The latter, trauma-focused therapy, is all therapy that recognises trauma as central in personality disorders, anxiety, depression and addictions. This is a growing trend. To find out if your therapist is trauma-focused ask him about what he things is the root cause of for example BPD. A trauma based therapist will focus on trauma, and will recognise CPTSD as the spectrum of psychological dysfunction as opposed to brain stuff â but you need to ask them about this. Itâs on you. Often therapists who practice this either advertise as CPTSD therapists, or as psycho-traumatologists, etc. Do your research on that, and donât be afraid to do a formal interview with your therapist to figure out what his/her credentials are and their outlook on the role of trauma in psychological distress.
But as I said earlier in this section â if you canât find the perfect match when it comes to credentials or official, letter-soup acronyms, work with whoever is available and is a good-enough person (more on that in the next 2 sections).
Reenactment of Trauma in Therapeutic Relationship and its Healing
So we sorted out the problem of credentials, but even with that, there will be an ongoing problem and struggle. Namely, that of reenactment of trauma in the therapeutic relationship.
Judith Herman says that what is broken in relationships can only be healed in a relationship. And our childhood trauma was all broken in very early childhood. Often so early, that we didnât even form our memories then.
What caused that break was the evil or not good-enough nature of our parents. Thereâs no two ways about it.
We havenât experienced the magic sauce so to speak that makes psychological development proceed without delay: unconditional love. Our mothers and fathers didnât give it to us for one reason or another.
Therefore in relationships this is what we crave. This is the source of all our problems when it comes to romantic relationships: we crave it so much, we often attracted people similar to our parents so we could recreate those abusive conditions because we want to relive the past and attempt it once more time: maybe this time my mum or dad, whoâs now just hidden in our partner symbolically, will bestow on me that holy grail, the cup of unconditional love.
And yet, we learn time and time again, that unconditional love has no place in adult relationships. It has its place between a mum and her child, but not in the world of fully formed people. It would be deeply disturbing to actually have this kind of love come from our partner â despite how much romantic comedies entertain the idea.
And the same dynamic and problem is true of a therapeutic relationship. On one hand there shouldnât be an unconditional love or regard between adults, never. And yet we go to therapy seeking exactly that. And thatâs where the maturity of the therapist should kick in.
The role of the therapist is not to give unconditional love in itself, but rather to show you love by virtue of being good enough. In this context Otto Kernberg says that this therapeutic relationship is very similar emotionally with that of a good-enough mother.
Good vs Good-enough
Often our inability to get that unconditional love causes our anger. We put impossible demands on our partners â and that goes even more so for our therapists! We often expect them to be exactly on time, never to be late, always to pick up the phone. At the beginning of my therapy, I wanted my therapist that they would still see me even if I became a monster⊠I reiterated hypothetical scenarios, fishing for her to say that she would still stand by me.
This dynamic is called transference. When these wishes and fantasies are believed to be available then we idealise the therapist. Often falling in love with them if they are of our preferred sex. Or when these wishes arenât met, we rage. We think of all the flaws in their character. We remember that one time he asked us about the payment: could it be that theyâre doing it only the money? Or that one time they were running late â he clearly disrespects me. Or that one time when I saw their other client and felt very jealousâŠ
This dynamic is healthy. This is the dynamic that a child has towards their mother. Itâs called splitting. Itâs a oscillating attitude of hate and love. In our childhood this process was interrupted, because our parents were too weak to withstand it. They felt threatened by our overt aggression (because that is what it is), or were immature not to take it personally (we were a couple of years old).
Itâs a job of our therapist to withstand that, and offer unwavering âconditionalâ regard and love. Not unconditional, because that is in the realm of splitting. But conditional â like in a normal human relationship. If they do it, and we push through that process, and also go through it with enough hope and resolve, we come out of it with a sense of: âoh my god, what did I expect from that woman? That she would be my mom, and she would love me unconditionally. I was so aggressive to her and she didnât leave me, and yet she kept her own boundaries, for example telling me Iâm out of order when I got angry. She didnât shame me for that anger, and yet I learnt about how to express it better.â
Repeat that process in many contexts, with the periods of discovery about the source of your trauma, add a cognitive aspect of recovery to that, and that is what recovery is.
Trauma therapists call it reparenting. But that reparenting happens in every good-enough relationship. Itâs just that therapists are trained to withstand our narcissistically inclined self-centredness, if it occurs, and it often did in my case, but whatâs more important, they can withstand our defensive structures without being offended, and our unbelievably potent way of projecting the need for unconditional love. Because of that a trained therapist is a secure, yet-not-perfect, base to which we can return and return, in the course of a couple of years â which is how much the recovery can take â to test that good-enough relationship.
If the hope and love of that good-enough relationship sinks in, and with it, like dominoes, all the other good-enough relationships that you form by virtue of knowing what it is outside of therapy, then you internalise it. That type of relating in hope and love becomes your internal schema, your blueprint for navigating the world and human connections. And whatâs most important, that becomes the way in which you relate to yourself.
So with that itâs worth pointing out that a therapist needs to guide you through this process. This can happen explicitly, as in the case of trained CPTSD therapists who are aware of this process, but it can also happen in the case of CBT therapist, or a priest, or a good friend even, although the last two are less likely to withstand your projections and to re-align them for you, and in fact I think itâs not very practical to expect that from friends - but thatâs a different topic.
All I want to say here is that all that a therapist needs to be is, the same as it was with your mum, good-enough. And being good-enough is hard. But itâs not impossible. Itâs their duty to manage your projections, but itâs also our duty to observe your own aggression, because for sure you will project that onto them.
My Therapist Failed Me. Should I Fire Them?
So what to do if a therapist fails me? Is he/she not good enough? We can see how often people are advised to fire their therapist in recovery forums. In truth it is a tricky question. Because on one hand we are almost programmed by our abuse to repeat conditions of abuse, to be re-traumatised, but on the other, we have so many defensive structures (such as splitting described above) that a realistic appraisal of whether the therapist is good enough is extremely difficult.
What is worse, our attitude towards authority (and a therapist in a position of power towards their client) is often extremely shaky because of abuse, which tainted any power in our eyes as a tool for oppression:
Their emotional responses to any person in position of authority have been deformed by the experience of terror. - Trauma and Recovery, p. 196
While this quote is about a specific type of post-traumatic patients, such as those with BPD, we all share that vulnerability, but to a lesser extent.
So my advice is to always look both ways, and try to answer these questions:
Is my therapist a good-enough person? Not perfect, but good-enough.
Is he withstanding my projections, and in turn doesnât project stuff onto me (for example falling in love with you, or hating you)
Am I not projecting my anger at him? (For example, being super angry about him being late, about being insensitive, etc.)
A word of caution, point number 3 is insanely hard to manage at first. Because you donât really know if heâs being insensitive or whether we have a hair-trigger. Because letâs face it we often do, just as often we come across an insensitive therapist.
As your true self grows, you will get better at trusting that secure, hopeful, pro-social part of yourself without the input of the narcissistically-overtaken internal critic. But it will take time. If you arenât sure â remember, true judgement comes in calm. Also, you can always refer that question back to the therapist, and see if they can empathetically relate to that. But be warned, donât expect unconditional love out of them and for them to simply change their mind because youâre sad for example.
This is all an ongoing process, and you will get better at it. Donât be afraid of experimenting with it. Just like in romantic relationships, there will be ones that you regret letting go. Itâs part of the process.
A final word here is that while you should expect good-enough and not perfect â donât ever accept abuse, such as any romantic inclinations, financial manipulations, cult-like behaviours, etc. But do give people a chance, and be aware of your own projections of anger and fantasies of unconditional love. Reach out to people, what you donât know, make the best effort to learn. And remember the most important aspect of the whole process: your relationship with a good-enough therapist is meant for you to model a realistic relationship you will have with yourself and your internal world. It should be reality-based, and yet filled with hope, love, meaning, and camaraderie.
Extra: What if I donât have the money
Literally your soul and life is at stake â as much as humanly possible try to earn or save for it. If that doesnât work, beg, steal or borrow. And if that for some reason doesnât work â in the case of severe problems, depression, etc. â do self work via books, for example IFS introspections, reach out to groups, forums, and most of all try to do a therapy in your mind so to speak in the meantime, that your inner self doesnât feel abandoned.