Twelve Guidelines to use when seeking counseling for MST

Prepared by Laurie Leitch, PhD Co-founder, Trauma Resource Institute

When phoning for an appointment:

1. You should feel comfortable asking questions about such things as:
• The therapist’s experience treating veterans/service members and, particularly his/her experience treating Military Sexual Trauma
• The fee charged and for what length of session
• What clinical license the therapist has (Social Work, Psychology, Psychiatry, Marriage and Family Therapy, Licensed Professional Counselor, Psychiatric Nurse Practitioner, etc). It is best to use a licensed therapist because they have had to meet standards of experience, supervision, and have a code of ethics they follow.
the main clinical orientation the therapist has…there are many orientations. We suggest that individuals who have experienced MST avoid Exposure Therapy.

2. If the therapist seems irritated on the phone by any of your questions just thank them and say you have some other therapists to contact. You need and deserve someone who treats you respectfully and is not annoyed by questions.

3. It can be useful to tell the therapist that you are looking for someone who is the right fit for you and you are scheduling initial interviews with several people. It can be good to do this (even though you may be eager to get started) so you can choose the person you believe can be the most helpful.

The First Session:

4. During the first session expect to give the therapist some background information. You should not need to give the details of what happened to you in the first session. It is important to set boundaries on what it feels safe to talk about when you have just met someone. Developing a relationship in which you feel safe and understood is essential and it begins during the first session. You can’t always tell if you are going to feel comfortable after just one session…but you should have the sense that your issues are known and you should have a sense of hope that things can get better for you.

5. Different people have different preferences for the personality and clinical style of their therapist. Some want a “listener” who is not very active. Others want an active therapist. Notice how it is to be with the therapist. Notice what body signals you get…are you relaxed, defensive, nervous? Does the therapist say and/or do things to help you feel safe and comfortable?

6. Be sure to ask the therapist how she is planning to work with the issue of MST. Does she do mind-body or integrative work that helps you tune in to your body in a safe way? Or, does she use EMDR (this is a type of trauma release that can be activating for some people and very helpful to others). Does she know how to work with flashbacks, dissociation (when you check out of your body) and other states of high arousal? Ask her what she would do if any of these things happen in the session.

7. You also need to know if you can call if you are in a lot of distress. Some therapists charge for this and others have already built it into their fee.

8. If you are taking an antidepressant, medication for anxiety, etc. be sure to ask how the therapist will work with the prescribing doctor. Ideally, they would touch base with each other every few months or if there is a need for a change of medication or dosage.

Subsequent Sessions:

9. Every therapist works differently…but what we recommend is that you not have the experience of going into so much detail about your traumatic experience all at once that you are extremely frightened, leave the office in a state of dysregulation, or have trouble functioning after a therapy session. If this is happening you need to tell the therapist and ask to work with small parts of the story alternated with talking about your strengths, resources in your life, etc. The therapist should know what to do if you go into a freeze or become amped up. This will help her create a container of safety for you. It should not be an ordeal to heal!

10. Finally, remember that you are the expert on yourself. If a therapist interprets something you say in a way that doesn’t fit for you, tell her. But, also cut her some slack as she begins learning who you are and how the two of you can best work together. No one is perfect. The best therapists will apologize if they inadvertently say or do something that doesn’t work for you.

A note about doing Group Therapy:

11. Many therapists believe in the benefits of group therapy…and it can be a great way to practice boundary setting, sharing details about yourself, etc. However, it is better for anyone who has experienced physical or sexual violence to have some time (ideally, a few months at a minimum) in individual therapy before starting group. This allows for time to understand the healing process, have one to one time with the therapist and not need to claim time for yourself as you do in a group, feel safe with the therapist and trust her style. It also means that s/he will know your issues by the time you start group and can help you find a place for yourself.

12. One thing that can characterize MST survivors is difficulty forming healthy relationships. Group can be overwhelming at first…so waiting until you are a bit stronger can be a way to make group therapy a good experience.

Other resources for healing:

• Meditation, yoga and other contemplative practices can be helpful…especially once you are feeling stable. Practices in which you get quiet and put your awareness into your body can cause flashbacks in some people…so take these practices slow and easy.

• The iChill app for smartphones and iPad is specifically designed for learning how to self-regulate. It has been used by active military and veterans as well as with family members. A version will be coming out for computers before too long. The app is sold for $1.99 in the App Store and Android’s Marketplace.