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Counseling & Therapy
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Principles of Counseling and Therapy
There are several important principles of treatment that anyone seeking good professional help in dealing with the effects of unwanted or abusive experiences should know about.
I cannot list them all or spell them out in great detail. But I can introduce some crucial ones, to help with interviewing potential therapists and reflecting on one’s experiences in treatment.
Reflecting on these principles can be particularly helpful at the beginning of therapy, while establishing trust, as well as later on when challenging things come up in the process.
Not all professional therapists are competent to provide treatment to people who have had unwanted or abusive experiences as children or adults, or with particular problems related to such experiences. Competence requires, but is not guaranteed by (1) extensive experience and training in work with people suffering from negative effects of such experience, or (2) ongoing supervision with a more senior and qualified therapist. (See Finding and Evaluating Therapists for resources on interviewing therapists to gather information about their likely level of competence.)
A core experience of unwanted or abusive experiences is disempowerment: one’s needs, choices and wishes (including not to be used) are ignored and trampled upon. Because such experiences involve betrayal of trust by a more powerful person, it is essential that the therapy not repeat this pattern by disempowering the client.
Thus good treatment is not something that a professional requires the client to accept and ‘comply’ with, as tends to be assumed by what’s been called the ‘medical model’ of therapy. Therapists with this approach or attitude are much less likely to be helpful, and could cause harm.
Rather, the client must be educated about the treatment process and informed of options. Basically, he or she should be involved as a partner in setting treatment goals and decisions about how to go about achieving them. (There are exceptions, of course, in cases where clients are at immediate risk to harm themselves or others and unable to make safe choices on their own; however, even then, the client should be given as many options and choices as possible.)
Two other principles related to the therapist working to empower the client are worth noting here
- Neutrality. This means that the therapist does not take sides in clients’ inner conflicts (e.g., Should I leave or should stay? Do I trust her or not?), but helps clients identify and work through their mixed feelings and come to their own decisions and solutions. Often people expect therapists to give them advice or tell them what to do (which is consistent with the ‘medical model’ of therapy). But when therapists do so, it can take power away from clients, and prevent new learning and growth. Furthermore, if the client reacts negatively to being ‘told what to do’ – not an unusual response for someone who’s been dominated and manipulated by others in their life – this approach can even increase their attachment to unhealthy choices and behaviors.
- Disinterestedness. This means that the therapist does not use the client to meet his or her needs. This principle not only covers more extreme examples, like sexual exploitation of the client, but more subtle things like the therapist using the client to gratify needs to be admired, respected, etc. This also refers to the therapist not using the client to promote a personal agenda, for example, about how someone who has been abused ‘should’ relate to family members or the perpetrator. Of course, as Judith Herman points out, this is ‘an ideal to be striven for, never perfectly attained’ – since therapists are, after all, human beings with their own needs and motives for doing therapy, with personal biases and limitations, etc.
Disconnection is another core component of experience of unwanted or abusive experiences. Thus a therapist must be capable of connecting with her or his client, that is, capable of being present as a fellow human being with genuine relatedness and empathy.
However, anyone in therapy, especially people who’ve been deeply hurt and betrayed in their lives, are sometimes unable to accurately perceive the therapist, and may ‘project’ onto the therapist their own difficulties connecting (or those of a person who used or abused them, or a parent who did not protect them).
Also, connection does not mean ‘closeness’ or ‘intimacy’ in the traditional sense of non-therapy relationships. Boundaries between the therapist and client are absolutely essential. Therapists who share too much of their own experience, become over-involved or engaged in ‘rescue missions’ are not helping their clients; they’re violating the principle of disinterestedness by trying to use the client and the relationship to meet their own needs. This can do tremendous damage to the therapy relationship, disempower the client, prevent healing, and even retraumatize the client.
The Therapeutic Frame
Because the therapy relationship can be an intense experience at times, and involves addressing vulnerable areas of one’s life, it is absolutely essential that the relationship is bounded by a ‘frame.’ This can be understood as the collection of ‘ground rules’ that create consistency and stability in several dimensions of the relationship. In this way, the frame ensures that the therapy relationship can be safe and healing.
Elements of the therapeutic frame include the length of sessions, starting and ending on time, cancellation and payment procedures, confidentiality and its limits, etc.
The frame helps ensure that the relationship will be a healing one, in which expectations can be established and clarified, boundaries can be maintained, and intense emotions, memories and other experiences can be contained and managed.
Much more could be said about principles of therapy or counseling. The point here has been to spell out a few really important ones. Please know it is your right to ask potential therapists to describe the principles that guide their work with people who have had experiences and problems like yours.
Finding and Evaluating Therapists
There are ways to find therapists where you live who have the right experience, training and knowledge.
But first, you should know about good web resources on how to choose and evaluate potential therapists once you’ve gotten some names and numbers.
I strongly suggest reading these articles before seeking or contacting potential therapists in your area. For example, as these articles suggest, it is important to “interview” at least two or three potential therapists, rather than committing to the first one who seems to know what he or she is doing.
- Therapy for Post-Traumatic Stress and Dissociative Conditions: What to Look for and How to Choose a Therapist, by the Sidran foundation, has great information about the nature of helpful therapy, how to find potential therapists, and how to determine if one is right for you.
- Dr. Richard Gartner’s website has Helping Yourself Heal: Why Therapy? (chapter 12 of his book, Beyond Betrayal), which includes sections on locating, interviewing, and evaluating therapists.
- Click on “How to Choose a Therapist” at the website of Dr. Patti Levin
The Sidran Foundation has an extensive list of therapists and clinics around the country that specialize in treating people with histories of mild to severe childhood adversities or abuse. See their page About the Help Desk. Again, neither I nor the Sidran Foundation can vouch for every therapist on the list, but they can usually, at a minimum, provide some good leads.
As described elsewhere (on a page I wrote for 1in6), EMDR is a therapy proven to help people transform traumatic memories into nontraumatic ones, and particularly suited to men who do not want to talk about what actually happened. It is also practiced by thousands of therapists around the world, many of whom are very experienced at working with men and women with histories of unwanted or abusive sexual experiences in childhood, or sexual assault as adults. You can find EMDR therapists through the Find a Therapist service of the EMDR International Association. EMDRIA’s primary objective is to “establish, maintain and promote the highest standards of excellence and integrity in Eye Movement Desensitization and Reprocessing (EMDR) practice, research and education.”
RAINN’s phone hotline at 800–656-HOPE (4673) can connect you with people who, in many cases, can recommend therapists or clinics qualified to help you in your community – but please keep reading before you use this service. The phone hotline automatically links callers to local counseling centers in their area with trained staff members who know about (a) the effects of unwanted or abusive childhood sexual experiences and (b) available local services. However, someone answering the phone at a local center may not understand issues and concerns specific to men, and may not know any local therapists or clinics qualified to help you.
The Therapist Resource Directory of The Association of Black Psychologists — Lists African American psychologists around the country and their areas of specialty, including “sexual abuse.” Those without that specialized focus may know African American or other therapists of color (or White therapists) in their area who are skilled at working with people of color who’ve had unwanted or abusive sexual experiences in childhood.
The Consumer’s Guide to Psychotherapy, by Drs. Jack Engler and Dan Goleman (author of the best-selling Emotional Intelligence), is an excellent book available in paperback from Amazon, both new and used (some really cheap), and may be in your local library. Though it was published in 1992, and is not up to date on the latest treatment innovations, this book has a great deal of timeless wisdom about choosing a therapist, the nature of therapy, different schools of therapy, etc.
For men with histories of unwanted or abusive sexual experiences in childhood, MaleSurvivor has an online Resource Directory for finding therapists. Neither I nor MaleSurvivor can evaluate or vouch for the competence of the therapists who list themselves with this resource, but this may be a good sources of leads. If you do contact someone from this directory, I recommend asking them if there’s anyone else (aside from themselves) that they’d recommend as experienced and competent at helping men with your concerns and needs. Depending on where they are, there may not be, but it’s important for you to have multiple options whenever possible.