So you’re ready to go to therapy! You jump on the Internet to search for the perfect fit and…So. Many. Choices. Where do you even begin? If you haven't read part one of this series, check it out here. Otherwise, let’s start with who can actually provide therapy. Keeping in mind that this information may differ depending on where you are in the world, here in the US, there are only a handful of folks that can ethically and legally assess for, diagnose, and provide treatment for mental disorders:
LPC: The licensed professional counselor (my license) is a master’s level practitioner with a degree in counseling, counseling psychology, clinical mental health counseling, etc. In some states they may be called something slightly different, such as LPCC, or licensed professional clinical counselor.
LMSW: The licensed master social worker is also a master’s level practitioner but with a degree in social work. They may also be referred to in some areas as LCSW, or licensed clinical social worker.
LP or LLP: The former is a licensed psychologist with a doctoral degree; the latter is a limited licensed psychologist with a master’s degree who must practice under the supervision of an LP. Licensed psychologists can practice independently, and in some states may even prescribe medication with extra training.
LMFT: The licensed marriage and family therapist often treats more than just couples and families. In many areas, such as California, this master’s level therapist is also a generalist who sees individuals presenting with a variety of concerns.
Intern: While interns, who may go by other names depending on the state, have not yet earned their letters, they can still be great options for those seeking therapy, especially if you need a no- or low-cost option. Interns are second-year master’s students who are gaining hours toward a degree in counseling, social work, or marriage and family therapy and under strict supervision.
MD or DO: Physicians and psychiatrists are either medical doctors or doctors of osteopathy and may prescribe medication. These days, most primary care physicians are trained to look for and prescribe medication for common disorders such as depression, anxiety, and attention deficit and hyperactivity disorder or ADHD. This is fortunate due to the typically long wait list for psychiatrists, who are often referred to for more serious disorders like schizophrenia or psychosis.
PA or NP: Physician’s assistants and nurse practitioners, respectively, can also prescribe medication for more common disorders.
What is the Best Approach?
When it comes to gaining professional support for compassion fatigue, especially when it involves secondary traumatic stress, trauma-focused psychotherapy is still the gold standard. However, there are other professional therapeutic interventions that are worth mentioning, so let’s explore some of the most current, respected, and evidence-based treatments available for those who are suffering. Let’s explore some of the most common:
EMDR: Those who have experienced trauma often describe the memory as a movie scene that plays over and over in their head. EMDR, or Eye Movement Desensitization and Reprocessing therapy was designed to help alleviate the distress brought on by those memories. I used to tell my clients that the goal of treatment was not to eliminate the memories, but rather take the “emotional charge” out of them; instead of a looping movie, they would eventually be able to better able to control the film, much like taking a remote control and being able to pause, rewind, forward, or stop it.
EMDR is a structured, multi-step process that involves talking about the trauma with a trained therapist while incorporating specific eye movements, or other type of bilateral sensory input (stimulation), directed by the therapist. This could look like side-to-side eye movements as you follow the therapist’s finger, listening to a bilateral tone with earphones, or even tapping on one’s knees back and forth. As the brain integrates the memory in a different way, it “reprocesses” it, making it a more neutral memory instead of a scary or distressing one. In addition, EMDR helps to replace the negative narrative about themselves that so many trauma survivors struggle with.
In terms of secondary traumatic stress or PTSD associated with animal welfare work, EMDR can decrease the distress caused by secondary trauma by processing the trauma in a safe and supportive space. In addition, you may learn healthy coping skills, such as emotional regulation and stress management; build resilience; reduce cognitive distortions and negative beliefs; and decrease symptoms associated with compassion fatigue, trauma and PTSD.
Prolonged exposure therapy. PE therapy is primarily a treatment for PTSD. Similar to EMDR, PE therapy is a structured, evidence-based approach designed to help process trauma and reduce the distress associated with it. This approach is especially beneficial for those who are experiencing the avoidance symptoms so common in trauma. The problem with avoidance is that we can never truly heal until we face our demons. So PE therapy encourages the client to confront and process their traumatic experiences in a safe and supportive space – gradually expose the person to trauma-related memories, feelings, and situations that they have been avoiding due to the intense fear or anxiety these triggers cause. By doing so, the intervention aims to reduce the power these triggers have over the individual, helping them regain control over their lives.
The treatment typically involves four main stages – providing psychoeducation on how trauma affects the brain and behavior, which can help clients feel empowered to engage fully with the therapy process, leaning breathing techniques to help manage the anxiety symptoms that typically accompany trauma, imaginal exposure, which involves the repeated telling of the trauma experience(s) to the therapist while practicing the self-regulation skills taught previously, which can help to reduce the intensity and distress caused by the memories, and finally, real world, or in-vivo exposure, which involves gradually confront situations, places, or objects they have been avoiding because they are reminders of the trauma. The goal during this stage is to help the client understand that these cues, or triggers, are not inherently dangerous and that avoidance only maintains fear.
Cognitive Behavioral Therapy. A popular intervention for a wide range of mental health struggles, cognitive behavioral therapy (CBT) is also beneficial for compassion fatigue, trauma, and PTSD. The aim of CBT is twofold: to help identify and replace negative thoughts and beliefs that contribute to distress. So for example, after working in animal welfare, we might start to believe that the world is a dangerous place, all people are cruel, or that you’re not making a difference. The therapist helps you to realize how those thoughts impact your emotions, and in turn, impact your behaviors.
So, let’s take the first example, the world is a dangerous place. When you think that, what emotions come to mind? Anxiety or fear perhaps? So if you’re feeling anxious and afraid of the world, how will this impact your behavior? Well, you might start to avoid going out into the world. This behavior might now lead to even more negative feelings, such as loneliness. So you can see how the dominos can fall from just one thought! But what if we took a negative thought, let’s use the “I’m not making a difference” example, and turned it around? Your therapist, using the CBT approach, would help you to reframe the thought into a more realistic one. Given that you all help more animals in one day than most people do in a lifetime would definitely be contradictory evidence to the thought that you are not making a difference. So what if that more realistic thought was, “I do make a difference.” What emotions come up for you now?
The second pillar, or the “B” in CBT stands for behavior. One of my absolute favorite techniques, behavioral activation, is a technique I’ve used with nearly all of my clients and incorporate into my own life on a daily basis. The gist of this technique is that by engaging in meaningful and productive activities, we can increase well-being, motivation, and fulfillment while helping to restore a sense of normalcy – all of which we can be robbed of by trauma. In addition, CBT therapists can help you develop healthy coping skills, which are needed to handle the stress of animal welfare work, as well as help you let go of the self-blame and guilt that so many of us who try to save and protect animals really struggle with.
Somatic Therapy. Sometimes when we experience physical symptoms such as exhaustion, chronic headaches, stomach issues, muscle tension, or illnesses that seem to have no underlying medical cause, it could be that these “mystery” aches and ailments are rooted in suppressed emotions. Somatic therapy recognizes, and is built on the foundational principle that the body stores trauma. I’m a huge fan of many of the techniques of this mind-body approach and think it can be beneficial for those in high-stress, emotionally charged fields such as animal welfare.
This holistic approach combines traditional talk therapy with techniques such as grounding skills, breath work, guided imagery and meditations, relaxation exercises, mindfulness, affirmations, creative expression, and movement. A crucial component of somatic therapy is helping clients release pent-up emotions that are manifesting as physical discomfort. Doing so allows them to better navigate and recover from trauma, reconnect to their bodies, gain a sense of empowerment, improve interpersonal relationships, and build emotional resilience.
Other Therapy Paradigms. I think there are some other types of therapy approaches that are worth mentioning, especially because many therapists these days consider themselves to be eclectic, meaning utilize a holistic approach, pulling the best elements from several different theoretical orientations in order to best treat their clients’ needs. You may find that you benefit from a therapist who incorporates any of the following:
o Narrative Therapy
o Art Therapy
o Music Therapy
o Dance/Movement Therapy
o Walk and Talk Therapy
o DBT (Dialectical Behavioral Therapy)
o Psychodynamic
o Equine-Assisted Therapy
o Animal-Assisted Therapy
o Eco Therapy
o Mindfulness-Based Stress Reduction
o Trauma-Informed Yoga Therapy
o Somatic Experiencing
o Grief counseling
Finding the right therapist and therapeutic approach might feel overwhelming at first, but with a little guidance, you’ll soon discover a world of support tailored to your unique needs. Whether you’re drawn to evidence-based methods like CBT and EMDR or intrigued by the holistic benefits of somatic and mindfulness-based therapies, remember that therapy is a collaborative journey. The key is finding someone you feel comfortable with—someone who can hold space for your healing and growth.
-By Jen Blough
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