In response to the posts concerning the “childhood roots of victimization” (the consequences faced by adults who grow up with parents who fail to respect the characteristics and needs of children), I've received several emails asking for advice about how to find a good counselor.
Given the very promising research and my own positive experience, and though I'm a big fan of Cognitive Behavioral Therapy, I really believe that when dealing with trauma and depression, I believe that Eye Movement Desensitization and Reprocessing offers the best alternative.
So what weird language am I speaking?
Types of Therapy
Cognitive Behavioral Therapy (CBT) is generally accepted as the best, standard therapy, and most people consider general talk therapy to be synonymous with CBT (though I no longer necessarily do). Cognitive means “thinking,” and CBT looks at how thought affects behavior (and emotion). It assumes that if your thoughts are healthy and realistic, your thoughts will guide your emotions, and your emotional state will become more positive. Essentially, this is the principle behind spiritual warfare. If you thoughts remain governed by a proper understanding of Scripture, good behavior and emotions will flow from those thoughts. I think that right thinking is essential. In the previous related post concerning resources for healing, I mentioned The Lies We Believe and the great companion workbook by Chris Thurman and a similar book by David Stoop called You Are What You Think. These Christian books can get you well on your way to doing much of your own CBT work yourself.
Another nice thing about these books? They can help give you structure for keeping a personal journal which for some marvelous reason helps to speed and aid emotional healing. I have an associate who once saw data from a study quoted by Marcia Means which showed that writing with pen and paper actually helped enhance healing of the mind and emotions. However, I have also heard people claim that the bilateral use of hands to type on a keyboard creates the same effect that EMDR achieves which helps reintegrate the brain. Either way, keeping a journal daily and expressing your feelings in some kind of written form does accelerate healing.
But on to the mysterious EMDR – Eye Movement Desensitization and Reprocessing. EMDR encompasses the same principles of CBT and adds to them the additional (very goal-oriented) focus on the body's felt sense to the healing process in a way that dramatically speeds therapy. (The most promising therapies for PTSD and depression, according to the newest research have been somatic therapies or those therapies which focus on body sensation, body movement, and felt sense. Some call this “mindfulness.”) A good place to start to learn more would be the EMDR website's general information and their FAQs page. (The drop down tabs at the top of the webpage will also provide you with lots of info.) This website also offers a description of the process.
In depression and in trauma in particular, it is as if the different parts of the brain loose their ability to work smoothly together. The right cerebral hemisphere focuses on feeling, and the left focuses on analytical thought and reason, and based on personality preference, the overwhelmed person will try to “live” in only one side. They will try to avoid feelings, or they will be incapacitated because they find that they are unable to avoid them. At the same time, other areas of the brain become overactive (such as those structures involved in survival), and some become underactive, producing a less than healthy state and practical level of function. Signs of this that we see translate as depression, an inability to concentrate, or unpleasant memories that become triggered and invade our focus, etc..
By stimulating the mind and the body to think about how the body feels while simultaneously stimulating several very different parts of the brain to work together at the same time through feeling and movement, basically, the technique of EMDR helps the brain realign itself and reintegrate so that it can smoothly work together again. While the separate areas of the brain come back into balance, the technique also realigns the person's thought and ability to feel physical sensation that the body experiences, so it teaches a new level of self awareness which ultimately improves a person's ability to respond to new difficult experiences in the future. In that sense, part of the healing involves a level of physical self-awareness which also helps align these areas of the brain.
In depression and non-complex PTSD, EMDR produces complete relief of symptoms without medication or other intervention in 75% of adults without a history of childhood PTSD/dysfunction during a limited 12 week comparison study with continued improvement upon six month follow up. Adults who experienced some type of depression or trauma as children experienced complete symptom relief at a rate of 33% in only 12 weeks. ([We] just need to work at it a little longer to develop the skill and coping ability that [we] failed to develop in childhood.) Explore additional research HERE.
At the level of neuroanatomy and physiology, as I understand the process and for those with interest in the technical aspect, the focus on the the way the body feels as it moves stimulates an area in the pre-frontal cortex (PFC, a part of that thinking area in the brain's higher cerebral cortex) which seems to have a natural and reflexive calming action on the survival system areas in the brain (the basal ganglia) which becomes very overactive in trauma and in depression. This is why mindful walking, yoga, tai chi, meditation, hypnosis, massage, acupuncture and any repetitive movement which requires the body to both move and focus on the sensations of the body helps in trauma – because they cause that medial PFC to become active, the area that appears to be our only “switch” which allows us to modulate and calm those structures of the brain that regulate the survival response. (In trauma or clinical depression, the idea of distraction or “Don't think about the negative” message that one tends to hear in nouthetic or typical types of “Biblical” counseling actually works against healing. Pastoral counseling can certainly be an adjunct to healing if it enhances the healing of the underlying physiology of trauma.) If you're struggling with overwhelming (irrational) emotion, EMDR presents a very targeted way of contending with those emotions and helps reunite thought and emotion.
A session of EMDR involves the identification of an underlying negative thought and establishes the desired healthy thought objectively and as a measure of intensity of discomfort of the idea which gauges progress. Then, while the therapist guides the client to focus intently on how they feel in body and mind in response to the underlying negative thought that fuels the experience of depression or trauma, the therapist uses rapid bilateral stimulation of the body of some type (eye movement back and forth via tracking an object or light, alternately “tapping” the right and left sides of the body, or through sound alternating from right to left through a device) as the client focuses on their overwhelming and painful emotion. The therapist watches the client for cues and varies the speed of the stimulation to achieve either liberation of the negative emotion (from the vantage of safety) so that the person can “think through it” and make sense of it, or they can use the speed and pattern of the movement or stimulation to reinforce pleasant emotion (accompanied by the client's spontaneous ideas or epiphanies that they experience once they've pushed through the negative emotion).
The aptly named process thus guides the client into a desensitization to their experience of painful memory (so that it no longer feels overwhelming, ongoing, or part of that relived type of re-experienced memory that is typical of trauma). The memories of events remain, but the desensitized client can access the memory without that deep and threatening sense of overwhelming and invading emotion that tend to trigger the perception of threat. It becomes like any other memory instead. The reprocessing aspect concerns the CBT element of drawing on rational thought which allows the client to put the experience into perspective.
Shadowspring, a blogger who discusses her recovery after spiritual abuse speaks highly of her experience using EMDR as a powerful help in her journey to find healing and wholeness. HERE is the link to many posts on her blog discussing her experience with the therapy. I have also been a very pleased recipient of the benefits of EMDR myself, after years of CBT alone which did nothing to alleviate the PTSD component of my symptoms. Particularly when dealing with issues of childhood trauma, I believe that EMDR presents the current ideal type of therapy. It will certainly save you time, money, and perhaps the necessity of medication (which I believe can be helpful in the early stages of treatment, especially when accompanied by physical pain and illness).
Develop a Working List of Affordable Practitioners
So stated reasons, I would recommend finding an EMDR therapist first, then I would narrow down possibilities by asking certain questions related to your particular therapy need. And word of mouth and the recommendation of friends is also a most valuable resource, too. The next consideration for most people likely concerns finding a provider that participates with their insurance plan if they have one. Visit the referral engine at www.emdr.com on their site HERE (and take note of their “Hints” on how to best use the search engine which is quite important).
Narrow Down Your Working List
The National Association for Christian Recovery site features a nice and general list of questions to ask a potential therapist as well as a list of Christian counseling organizations. It offers good advice and is well worth reading through.
For stated reasons, I'm less inclined to start my search with the list of organizations they offer, as Nouthetic counselors can be members of some of the groups listed (my general, negative thoughts concerning nouthetic counseling can be found HERE). You may choose to try to cross-reference referrals from the EMDR site and from these Christian organizations, or you may choose to navigate directly from one of these groups:
Here is my own tailored list of suggestions that one might ask a therapist, once you've created a working list of possible providers:
- Qualifications and Credentials. Once you've narrowed down some possible candidates in your local area that ideally work with your insurance provider, ask questions about credentials. I highly recommend finding a therapist with a more clinically oriented background and would avoid some of the study from home counseling programs that do not include instruction in real mental health disorders. You can also check with your state to see who they consider to be legitimate licensed or certified practitioners. In my own state, a practitioner with under a full year of full time experience in counseling can work independently, and their credentials can give you some indication of their level of experience.
- Focused Care for Dealing with Problems Arising from Dysfunctional Families. If you've responded to the material in this series of blog posts, before deciding to schedule a session with a therapist, find out whether your therapist appreciates the addictions and recovery approach or a Twelve Steps approach to therapy (I've used a codependency and recovery model to address child development in these posts, so if you responded to them, it would likely be wise to find a practitioner who also approaches matters from the same perspective.) Some counselors do not take this approach or specialize in different types of therapy.
- Ask about their favorite authors, books and researchers. I also prefer the brain based approach to therapy because of the objective nature of the new findings concerning mental health. Ask the therapist if they are familiar with “three camera SPECT” studies or the writings of Daniel Amen who specializes in these types of brain imaging. Ask who their favorite researchers are concerning trauma, and if Bessel Van der Kolk, Peter Levine, or anyone associated with The Meadows facility in Wickensburg, AZ or The Trauma Center in Boston, MA, you've very likely found a fairly good practitioner who takes an approach to these topics that is similar to my own (if the material on this blog speaks to you.)
- What does the therapist require of the client? Ask whether the therapist assigns homework or requires clients to do certain reading related to the therapy. Do they also encourage or require you to journal? What does the therapist expect of a client?
- How do they evaluate progress? I tend to prefer to seek care from a practitioner who writes a plan of care and evaluates that plan on a regular basis. Ideally, the client (you) should initially work with the therapist to establish very clear and easily evaluated goals for your work together. (A good therapist will show skill at setting goals and working with you to establish measurable and meaningful goals to guide your work with them.)
April 2014 Update: Visit Alice Miller's FAQ's about finding a good therapist.
… And these ideas should give you a place to start!