FINDING A THERAPIST
Marlene Steinberg, M.D., 2003
I. Getting Started: Some Relevant Issues
Since the publication of THE STRANGER IN THE MIRROR, many people have asked me how to find a therapist experienced in the treatment of dissociation. Because there are a limited number of specialists in the field of dissociative disorders, and managed care insurances have restricted access to out-of network professionals, locating a provider who is experienced in the treatment of dissociation may require considerable effort. In fact, the majority of e-mails that I receive are from people who are having difficulty locating a treatment provider. Finding a qualified therapist is one of the most important decisions you will make with respect to your or a loved one's recovery. I hope that the information provided in this section will allow you to approach this process with greater ease.
An educated consumer is the best advocate for finding treatment for either you or your loved ones. Familiarity with recent advances in the field of dissociation, including the existence of specialized diagnostic tests and treatment will allow you to search for a therapist whose training is based on the highest standards of psychological/medical care. For example, if you needed heart surgery, you would never think of going to a general surgeon . Similarly, people with dissociative disorders are wise to seek help from a mental health professional who specialize in the treatment of dissociation.
Though Dissociative Identity Disorder (DID) has been recognized as a genuine psychiatric disorder (that is included in the American Psychiatric Association's Diagnostic Manual of Mental Disorders since 1980), there are some professionals who believe that a person who experiences symptoms of DID is not suffering from a real illness. If the therapist you consult does not recognize DID, the type of treatment that you receive may differ from accepted treatment standards . Due to misconceptions related to dissociative disorders, it would be useful to understand whether the professional you consult harbors such opinions which may affect your treatment.
What kind of events or experiences are likely to cause symptoms of dissociation? People who develop dissociative disorders are likely to have experienced and/or witnessed various types of traumas. There are traumas within one's home, either emotional, physical or sexual abuse. Other types of traumas include natural disasters, such as earthquakes, political traumas such as holocausts, hostage situations, wars, random acts of violence (such as the Oklahoma city bombing and the Columbine shootings), or the grief we feel after the death of a family member or loved one. Some mental health professionals specialize in the treatment of trauma survivors and post traumatic stress disorder. It is important to note that these therapists may or may not also specialize in the treatment of dissociative disorders . One way to find out what their experience is with dissociative disorders is to ask them about their experience directly (see questions listed in Section III. The Initial Consultation below.)
II. Recent Advances in Detecting Dissociation
Until the 1980's, there were no objective tests that reliably diagnosed the severity of dissociative symptoms and disorders. Fortunately, we now have various screening tools and diagnostic interviews that allow for early detection of dissociation, so that appropriate treatment can begin. The Structured Clinical Interview for DSM-IV Dissociative Disorders, (or SCID-D) (American Psychiatric Press, 1994) is considered the most comprehensive and rigorously evaluated diagnostic test for the identification of specific dissociative symptoms and the dissociative disorders. It is a series of standardized questions designed to help identify whether you are experiencing symptoms of dissociation and the dissociative disorders. Trained mental health professionals with a variety of backgrounds (including psychiatrists, psychologists and social worker) can administer the SCID-D. Depending on how you answer these questions, your therapist will tell you whether your symptoms are nothing to worry about or serious enough to merit professional help.
The five dissociative symptoms evaluated by the SCID-D include amnesia, depersonalization, derealization, identity confusion, and identity alteration. THE STRANGER IN THE MIRROR provides you with practical information about the five dissociative symptoms, and allows you to screen for their presence. Briefly, there are five main symptoms of dissociation evaluated by the SCID-D, and they occur along a spectrum (from mild or normal to severe):
With the help of the SCID-D interview, therapists can now identify the five core dissociative symptoms (amnesia, depersonalization, derealization, identity confusion, and identity alteration) at the earliest stage so that effective treatment can begin. Mental health professionals throughout the United States and abroad have used the SCID-D and there are many scientific investigations describing its reliability and validity.
(For further information about these studies, see Resources for Professionals. For further information about the five dissociative disorders that can be assessed with the SCID-D, see Understanding the Dissociative Disorders. )
III. Finding a Qualified Provider
There are several options for locating a qualified provider. These include contacting family physicians, therapists, relatives or friends for possible referrals to professionals specializing in dissociative disorders. The Psychiatry and/or Psychology Department s of local hospitals and universities may have listings of professionals and their specialties, as well as mental health clinics. If you call a therapist who informs you that they do not specialize in the treatment of dissociation, ask them if they can recommend a colleague who does specialize in this area. Another resource is the International Society for the Study of Dissociation (ISSD), a nonprofit professional association that provides no-cost referrals. These mental health providers are listed geographically so you can obtain the name of those nearest you. The ISSD's telephone number is 847-480-0899 and their e-mail is: firstname.lastname@example.org. As the providers on their list are not screened by the ISSD, you might wish to consult more than one professional before choosing a therapist .
It is important to recognize that if you live in a large city, you may find numerous professionals who are experienced in DID treatment. On the other hand, if you live in an area that is remote, and lacks a professional who specializes in dissociation, you should not rule out commuting to someone who is qualified. Many people with dissociative disorders commute an average of one hour or more in order to obtain appropriate treatment , as I have seen with my own patients. I recommend that you select the therapist you feel is most qualified to help, rather than the one who is located closest to your home.
IV. The Initial Consultation: Questions to Ask
Once you have obtained the names of one or more therapists, you are ready to call for information about setting up an appointment for a consultation. Prior to your first visit, you will need to find out whether the therapist accepts your insurance and what the fee is for the session. Consulting with a provider can allow you to learn about the provider's experience and approach to treatment. While an initial consultation may include only one session, a more complete diagnostic evaluation and treatment plan may require several sessions, particularly if specialized testing, such as the SCID-D is conducted.
It is important that you find a therapist that you not only feel reasonably comfortable with, but one who is trained in working with people with dissociation. During your consultation session, don't be afraid to ask some of the following questions , as they can help you select an experienced therapist :
------------------Disclaimer: This information is for educational purposes only. Dr. Steinberg is not responsible for the quality of the referrals given by any of the resources. Dr. Steinberg advises that you carefully evaluate the appropriateness of any referral and consult your doctor if you have questions about a medication or are experiencing side effects from your medication.