Before you decide to work with a T, there is usually a first interview, where T and patient can get to know each other.
You will get the most out of your interview if you prepare for it. The following questions should help you to get a good measure of the T, how they work and what therapy would be like. Some general information might be found on the Ts website. Make sure to read that before the interview to avoid wasting time on unnecessary questions.
Approach therapy as a consumer. You are not looking for a friend, you are looking for quality service. You are interviewing a T to find out if you want to hire them. This is their job, they get paid for it. You, as a mental health customer, have a choice.
Through many interviews we learned not to care too much if the T feels uncomfortable during an interview. We want someone who can help us, not someone who will like us. A tough interview will create clarity, for you and the T, if they are up for the task.
No therapy is better than bad therapy. While no therapist will ever be perfect, you can expect them to know what they are doing.
We recommend taking notes during an interview and shortly after. The T will probably do the same.
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Here are the questions we consider useful, in no particular order:
What kind of training do they have? Ts can be doctors, psychologists, social workers etc (there are advantages of having a medically trained T, our best experiences are with psychologists.)
What kind of therapy do they offer? That includes things like hypnosis, DBT, EMDR, IFS, systemic approaches, body work etc (what you need depends on your problems)
Treatment of co-morbid disorders? Not every T knows how to treat every problem. Ts generally know about depression and anxiety. If you have an eating disorder, OCD, ASD or other specific co-morbid disorders you should ask about the Ts experience with them.
What is the focus of therapy? Past or present? Working on behavior today or dynamics in the past? (We prefer a strong emphasis on behavior and today for phase 1 work, with the option to touch on the past.)
How structured will therapy be? Some go with the flow, some (like DBT) have a very clear structure with specific topics for every session. Some use books, worksheets etc (this will depend on your personality type and the kind of therapy you are looking for)
Does the T offer trauma work? If yes, which tools? (This is especially important when you dissociate. Not every kind of trauma work is ideal for highly dissociative people)
What kind of experience does the T have? Some Ts usually treat people with a single traumatic incident, others have specialized on child-abuse patients and developmental trauma. „Trauma T“ does not automatically indicate experience with dissociation. It is worth asking about that separately.
Do they have supervision? The more dissociation you have, the more important it gets for the T to have supervision. If they brush this off, it is a very bad sign. Supervision is similar to quality control. It keeps you and your T safe and on track.
Insurance/costs? Do they take insurance, do you have to pay yourself? How much? You should also find out about their policy for missed sessions (it is common to charge you for sessions you missed or had to cancel last minute) and whether they charge you for contact between sessions like emails or phone-calls.
General information about sessions? How often do they think you should meet? How long would these sessions be? (We believe that less than a session per week is not enough, more than 2 are probably too much. We consider 45-60 min a time when focussed work is possible, more if it is a session where you process trauma (phase 2), less will not get you anywhere.)
Contact between session? Is it possible, if not, why? If yes, how? (Phone? Email? Other?) When is it ok to do that? Where is the limit? (We prefer to have no more contact between sessions than necessary. Make sure there is a way to make contact you can use. If you are like us and sometimes can’t speak, depending on phone calls alone is problematic)
Emergency policy? Some Ts are ready to help out when you have an emergency situation, others ask you to rely on other helpers or call an emergency hotline. (We believe that a network of helpers will spread responsibility more evenly and that in some situations the T is the wrong person to turn to, we need a doctor instead. Crisis will happen. A good plan will catch you. A T who holds crisis against you (as a sign that you are „not commited to therapy“) is not familiar enough with trauma and dissociation to treat you)
Time limit? In some countries insurance limits the time of therapy, sometimes therapy programs have a time limit, sometimes the T has personal plans, like retirement, that put a limit to your therapy together. You need to know that in advance.
Openness to additional therapies? Sometimes you get the chance to have DBT, art therapy, trauma-sensitive yoga or something similar with someone who is not your main T. (We believe that this is a tremendous help and that Ts who demand to be your only source of healing have a problem)
Confidentiality? This should be a given, but it will make you feel safer to address it. In some countries Ts have to report back to the insurance, who will report to your employer. You probably don’t want that.
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Testing the waters
These are things you might not need to know, but they might give you a good measure of the Ts understanding of your problems.
Will they diagnose you (again)? If yes, using which tool? Some Ts refuse to talk about diagnosis at the beginning because they want to focus on your experience before narrowing it down. Some want to avoid the stigma of a dx. If they can never make a dx you should ask why. If they treat you based on a wrong dx it can be very harmful.
Physical contact policy? Would they touch you and how? (They should ask you back what you are comfortable with and express personal boundaries.)
Recording sessions? Some Ts demand at least audio recording from dissociative patients due to memory problems. With a certain trauma background we think it is irresponsible to demand video recording. If a T is absolutely against recorded sessions you should find out why. (We personally don’t record, but we take notes during and after session. Your T should do the same)
Response to self-harm? If that is a problem, you should ask how they will respond when you harm yourself and how they would respond if you did it in session. If they don’t have an answer for that, it means they don’t have an established policy, which means that they lack experience.
Response to dissociation? If that is a problem, you should ask how they will respond when you dissociate in session, for mild dissociation as well as a full shutdown. The answer could be found here or here or here. If the T has no plan how to help you when you dissociate, that is a clear sign to walk away from them. They lack the experience you need to be safe.
Religion/Spirituality/Philosophy? For some people it is important to know where the T is positioning themself. (We find that openness is a more important characteristic than their world-view. A good T supports you in whatever you choose for yourself as long as it is not causing you mental health problems.)
Plans for further education? It is ok to ask them about their plans to educate themselves in the future. Especially if you are willing to work with a T who is not as experienced as you need them to be, it is important that the T has a plan to catch up. You should not be their test object, they need to go to workshops and seminars and conferences to get better.
Who leads? Before we knew we could influence the session the T led and situations turned abusive. Since then we demanded to lead sessions. That caused a lot of trouble with Ts who didn’t like to be controlled. We believe that shared leadership is best. You want to work as partners, not with a power imbalance.
Ask about anything that is important to you. These are just examples.
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You will not be the only one asking questions in a first interview. Ts usually have a few standard questions and it helps to prepare for them and think about answers before you go there. If your memory is poor or you struggle to speak when stressed, write things down.
Why do you want/need therapy?
Why did you call them specifically?
What is your history? What are your problems? The history of your symptoms? Your diagnosis, if there is one? etc
What is your current life situation?
What are your goals in therapy? What are you hoping for?
Why do you think they could help you?
We don’t believe that a first interview is the right time for a T to do their first assessment. It takes some courage, but you need to speak up and ask your own questions. There is time for more of your story later in therapy, if you choose them.
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After the interview, take time to review it:
Did the room feel safe?
What is your first impression of the T? (If you have DID, what are your Others first impressions?)
Do they seem like a person you can work with?
How did you feel emotionally/ in your body when you left the session?
Do you have a good picture of the T and the therapy they would do?
Does it align with your needs/wishes?
Do you have enough information to make a choice? (We have made second appointments for more clarity.)
Chances are that your options are limited and there is no perfectly qualified T in your area. Then you need to decide if you want to choose them anyway. If you work with someone who isn’t qualified or experienced the key characteristic you are looking for is their willingness to learn.
The Ts age is not a good indicator for good therapy. Age could come with experience, but young Ts usually got the best training available today. Our experience with young Ts is extremely positive.
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We can’t take the decision from you, but we hope that these questions will help you make your own.
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