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Getting the Most Out of Therapy - Chat Transcript

The Pandora's Aquarium chat room welcomed Dr. Patti Levin on September 18, 2008.  Dr. Levin is a clinical psychologist with more than 30 years experience in the field. She sees clients in a private practice in Boston, and has significant experience working with trauma survivors. She is also an EMDR expert. You can learn more about Dr. Levin on her website: drpattilevin.com

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Shannon: Hi everyone! I just want to extend a big welcome to you and our guest speaker. Thank you for coming! Dr. Levin is a clinical psychologist with more than 30 years experience in the field. She sees clients in a private practice in Boston, and has significant experience working with trauma survivors. She is also an EMDR expert. You can learn more about her at her website, http://www.drpattilevin.com/.

We'll be asking pre-submitted questions during the first half of chat. During the second half, Dr. Levin will answer your follow up and additional questions. Feel free to ask them throughout the chat, though they will not show up until later.

QUESTION: I am going to college next year and am thinking of finding a therapist. How do I know if it's the right choice for me?

DrPattiLevin: This one has a long answer... if you have emotional/psychological issues and negative beliefs that seem to get in the way with the way you'd like to live your life, seeing a therapist is a great start. Ask people you know whom you believe are in a good therapy for referrals for you from their therapist. Ask other health care providers for referrals. Check out state or local associations. Ask lots of questions. You are "hiring" a consultant to help you! You are entitled to know about their education, training, areas of expertise, methods used, cancellation policies, etc. If the therapist seems annoyed or put off, that's a red flag. Then there's the "fit" - the chemistry. That may take time. Trust your gut.

QUESTION: What would you suggest to someone who is hesitant to seek therapy?

Ask other people about their experiences in therapy, if they were hesitant, too. Watch the TV show "In Treatment" ;-) But tell yourself you'll just give it a try, no long commitment and see what happens.

What can you expect in your first session with a new therapist? Is there anything in particular that I should do to prepare for it?

Generally, the therapist will ask lots of questions such as why you want to be in therapy, what you hope to get out of it, and lots of stuff about your life history. If you would like to ask questions, too, say so! There is nothing to prepare.

QUESTION: How can you tell the difference between a healthy trust and need for support from your therapist, versus being too dependent on her?

DrPattiLevin: This is a tricky distinction. If you find yourself unable or uncomfortable making any decision without running it by your therapist, that's a red flag. If your therapist allows unlimited telephone calls (for free) that's another red flag. If you're not sure after discussing it with your therapist, ask to have a consultation to the therapy.

I just started therapy not too long ago and I don't see any progress so far. Is that normal? I might be jumping the gun but shouldn't I feel some change?

DrPattiLevin: If you are in regular talk therapy, then progress takes time, just like trust does. EMDR or other similar therapies show progress more quickly. Either way, discuss your expectations of change with your therapist and together come to some agreement about checking in regularly to ascertain progress. Be patient! But curious...

QUESTION: I've heard that a lot of people actually get worse when they start therapy. Is that true? If so, why is that? Wouldn't I be better off to just muddle through on my own instead of feeling worse?

It's true sometimes. The reason is that one starts opening up distressing areas perhaps never discussed before or even thought of before. Bringing it to the surface can be disturbing. Talk with your therapist about coping strategies if this happens to you. Relaxation exercises, exercise, helpful books/websites. The first phase of therapy is about stabilization and safety before you jump into the deeper work. You need a floor, a platform on which to do the hard work together. It does get easier!

QUESTION: Do you have any suggestions for coping with panic attacks and flashbacks?

DrPattiLevin: On my website there's a terrific section for such suggestions and since I am unable to cut and paste as I had thought, I will direct you there. Also www.anxietyandstress.com and Nancy Napier's book "Getting Through the Day." With panic, the main motto is "what you resist, persists" so try to ride it out, accept it, know it WILL pass.

QUESTION: Sometimes my therapist says things that make me angry and I don't know how to tell her because I don't want to offend her. What's the best way to give a therapist feedback?

DrPattiLevin: Of course you don't want to offend but remember, you are paying her/him for help so you are entitled to say how you feel, which usually is extremely helpful in the therapy. Any therapist who won't take feedback... another red flag. If a real problem persists and you like the therapist except for one or two issues, get a consultation to the treatment, together or separately (I think together is great).

QUESTION: A lot of trauma survivors have other issues like self-injury, addictions and eating disorders. How do you know what to address first? Do you need a specialist for the addiction and another specialist for the trauma work?

DrPattiLevin: You need a therapist with specialized training in trauma treatment. This therapist may refer you for adjunctive treatment, for medication eval, for AA or other self-help grps. The therapist will know how to pace the work so that you don't feel you're dealing with everything all at once.

QUESTION: What is EMDR? Do you recommend EMDR for all sexual violence survivors? Who can benefit from it most?

DrPattiLevin: check out www.emdrnetwork.org - it's a wonderful method that takes your thoughts, feelings, beliefs, body sensations, memories, and works them all together to come to an adaptive resolution. It uses bilateral stimulation - like watching the therapist's hand move back and forth in front of your eyes, which theorists believe is akin to REM sleep where your eyes move back and forth as you process the day's events. I recommend it for almost everyone, especially survivors of sexual assault. Anyone can benefit. The good news is that you know within the first 1-3 sessions if it will be helpful to you.

How do you feel about online therapy?

DrPattiLevin: Huh? I don't know anything about online therapy but if it's like telephone therapy with a licensed therapist, hmmmm. Maybe.

QUESTION: I've seen people talk about body memories. I think I might have them but I'm not sure. Do you know what they are? How do you deal with them?

DrPattiLevin: Body memories are often pre-verbal, before you learn to talk, that don't have words attached. Also can come from later life trauma. If you have disturbing, distressing, even painful feelings in your body (anywhere), these might be body memories. An experienced trauma therapist will help you, first with safety and stabilization and containment, sometimes meds. EMDR is great at neutralizing this kind of thing.

QUESTION: How do you know if you should be on medication for depression or if it's something you can handle without meds?

Another tricky question. I tend to be pro-meds in general so I'd suggest an eval with a good psychopharm who will give you lots of options, including non-traditional, non-medication ones. Exercise can be helpful. But meds don't have to be forever. With depression, meds can give you the energy and space to get some great work done in therapy and then later you can wean off the meds.

Shannon: Next up Jennifer will moderate....

Jennifer: Hi everyone, and thank you again Dr. Levin for being with us. Now I will be submitting questions that people have come up with during the first half. If you have questions, continue to submit them, but please know that not all questions may be asked due to time constraints.

QUESTION: Could you explain what you mean by asking to have a "consultation to the therapy"?

DrPattiLevin: Yes. This means getting the name(s) of another good therapist. Then you and your therapist have a session with the consultant, either together, or separately, and discuss what's happening, or not happening, in your therapy.

QUESTION: I recently turned 18 and I'm going to college in Boston, I'd like to see a therapist, but I don't want to have to explain to my parents why it would turn up on the medical insurance. Do you have any suggestions?

DrPattiLevin: Some colleges will not charge your family insurance. But if they do, you can discuss with the therapist how to talk with yout parents, different kinds of less "loaded" reasons.

My therapist isn't trained in EMDR, but I would still like to see her while i am seeing someone else for EMDR. Will that interfere with the treatment in anyway?

Not at all. I often work adjunctively with someone who has a primary therapist. It might speed the main therapy along, however!

What are the signs to see in the first sessions of EMDR that let you know it will be helpful to you?

DrPattiLevin: Whatever memory you are targeting starts to change, gets more distant, less intense. You might feel calmer, that the memory is over. Or just some inklings of what I've said.

QUESTION: I have been in therapy for two years and felt like I was making progress and I feel myself back sliding, is this normal and what can I do to keep from back sliding anymore?

DrPattiLevin: Talk with your therapist aboyt your back sliding. It is not unusual for therapy to go thru ups and downs, and talking about it can help. If not, here's that suggestion for a consultation to the therapy again!

QUESTION: Do you think being physically disabled adds to the emotional pain/distress and lonelyness of being a survivor?

Of course! But if you ask someone who isn't physically disabled about their level of pain etc., they might say it's just as bad. Everyone's pain is the only real pain they know, and pain simply feels awful.

What specific credentials should I look for in a therapist to find the right treatment for PTSD associated with prolonged CSA? How do I know someone has them?

DrPattiLevin: First, a license as a mental health counselor, a social worker, a psychologist, or a psychiatrist. Then, where/how did they get specialized trauma training. A workshop isn't enough. Get recommendations from Trauma centers, from websites, from people who are in therapy with good trauma therapists.

QUESTION: What are some ways to get through feeling "stuck" in therapy, where you feel as though you're not moving forward or backward, just in limbo with your healing process?

First, discuss these feelings with your therapist in a DIALOG. Try something adjunctive to move it along like EMDR, Internal Family Systems (IFS) sensorimotor therapy, or a consultation to the therapy ;-)

QUESTION: I have heard that EMDR is only for people with single traumas instead of multiple traumas - is that true?

DrPattiLevin: Absolutely not true at all.

QUESTION: Can EMDR work with clients who are extremely dissociative?

Yes. But make sure the EMDR therapist is also highly experienced with dissociative disorders. There are special protocols for DID and DDNOS. It might be more slow-going, but it can be terrific.

QUESTION: Could talking about a perp in therapy get them in trouble with law enforcement?

DrPattiLevin: No. Everything you say in therapy is confidential. Completely confidential. Unless you threaten and have a plan to harm someone (or yourself).

QUESTION: How do you handle the pain and confusion when your Therapist changes boundaries due to stuff in her life?

PattiLevin: Sigh. It's really, really hard, especially if you like the therapist. Ask the therapist to get into their own therapy and to get lots of supervision/consultation for the therapy with you. Maybe get another, adjunctive therapist for a while, or change therapists if things don't smooth out. It's YOUR therapy, not your therapist's therapy.

QUESTION: "Trauma" is a very broad term. Would you recommend someone who has been physically abused throughout their life to try EMDR therapy even if the abuse wasn't sexual per se?

DrPattiLevin: Yes! Trauma can be physical, emotional, sexual, big T and little t - for instance, rape and war are considered big T trauma while a car accident or a critical parent might be a small t. EMDR can be used for phobias, panic disorders, depression, eating disorders, addictions, any kind of trauma (chronic, single incident, multiple incident), negative beliefs about yourself like low self-esteem... and more.

QUESTION: What books do you recommend to trauma survivors? Which is your favorite and why?

DrPattiLevin: My favorite is Judith Herman's "Trauma and Recovery" - it has lots of great info on trauma, a great chapter on the therapeutic relationship, and stages of recovery. Also love "Getting Through the Day" by Nancy Napier because it really helps (even dissociative people) get thru the day!

DrPattiLevin: Thank you all! Take good care!

Shannon: That's all the time we have, despite the great questions you've all asked. Dr Levin, thank you SO much for coming and sharing your wisdom and expertise with us.

To the attendees, I hope you all found this chat as helpful as I did - thank you for coming, and for your insightful questions.


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