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PTSD Questions & Answers
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Joyce Boaz & Dr. Frank Ochberg, M.D.

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What should a PTSD client expect from their first couple of sessions.

Q: Dear Frank, What should a person with trauma issues and/or PTSD expect from their first couple of sessions. Also, are there some questions the client should definately ask? Is it a good idea to come up with a list of questions?

A: Dear Joyce, A good therapist will listen without judging and will leave you feeling respected and understood. She or he will show care and kindness as you describe your current concerns (we call that "The chief complaint" although it isn't a complaint in the usual sense of the word). A therapist needs to know what you are coming to therapy for -- what hurts right now - what you want to understand or overcome. Since we are talking about trauma and PTSD, there will be a trauma story to tell. But you may not be ready to recall and relate those details.

A good therapist will help you feel comfortable and then, with your consent, facilitate the telling of the trauma story. I often delay that part of therapy, but not if my patient or client wants to get there rather quickly. Later in therapy we will almost always get into the details, doing it in a way that reduces anxiety, shame, rage or confusion. Often I'll explain PTSD, as I've come to understand it, early in the therapy process. You should expect your therapist to be a good teacher, improving your knowledge of trauma, of traumatic stress, and of the reasons for symptoms such as emotional numbness, sleep disturbance, discomfort in crowds and physical disabilities.

Medications are not the only answer and often not the best answer, but your therapist should be well informed about standard medications and competent in discussing options, even if your therapist is not a doctor or nurse. When your therapist can't answer a question, she or he should know someone who can, and should be comfortable and considerate in referring you to other experts. If you need to change an appointment or bring a friend (or a pet) to an appointment, your therapist should be understanding. You have lost control when you were traumatized.

Your therapist should interact with you in a way that restores your sense of control. You own the therapy hour. Although you may be in need of someone who can lead the conversation, you should never feel that you are being patronized, bullied or ignored. At some point, you will need a treatment plan.

This means that you and your therapist are clear about your needs, your goals, and the way you are going to reach those goals. Some therapists are a bit too mechanical about this. They have a formula. They have printed protocols. They treat all clients in much the same way.

After a couple of sessions, you should feel that your therapist knows who you are and knows the general pathway to a good outcome for you -specifically for you. You can and should ask your therapist about her or his background, their approach to trauma work, their sense of how long therapy will last, and whether they have worked with anyone like you. Ask anything you'd like to ask. Ask about the therapist's personal life, if you think that will help you feel safe and well cared for.

I try to be professional as a therapist, and I don't want to mix the personal with the professional, but I believe a patient has a right to know my age, my education, the fact that I'm married with kids and grandkids, and what I've done as a clinician and as a teacher. If your therapist seems too aloof or too intimate, you might want to mention that and you might need a different person who senses accurately just how close or distant to be.

In sum, you should expect your therapist to be competent, kind and comfortable. You should have a reasonably clear idea of how your therapy will work. You should feel safe. You should make progress -- although progress may be gradual, with a few steps forward and a few steps back along the way. At some point you will face your fears and your shame. You want to do that with a person who deserves your trust.

Frank

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