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Join host and trauma therapist, Lindsay Faas, as we talk through how to find a therapist who is a fit for you in all of your unique First Responder/Front Line Worker glory.
Created for First Responders and Front Line Workers to tackle the challenges of working on the front lines. Dig into topics on burnout, workplace dynamics, managing mental health, balancing family life...and so much more. Created and hosted by Lindsay Faas, clinical counsellor and trauma therapist. View the show notes, and access bonus resources at https://my.thrive-life.ca/behind-the-line.
Hey there and welcome back to Behind the Line.
I’m your host Lindsay Faas. If you are new to Behind the Line, what you should know about me is that I am a clinical counsellor specializing in trauma therapy, and after over a decade working with First Responders and Front Line Workers around issues like burnout, compassion fatigue, PTSD and related OSI’s, I have become a passionate wellness advocate and educator for those who sacrifice so much for our communities out on the front lines. Behind the Line is a place for us to talk about the real life behind the scenes challenges facing you on the front lines. I created this podcast with the hope of bringing easy access to skills for wellness – allowing you to find greater sustainability, both on the job and off.
Before we jump in today, I want to wish those of you in Canada a happy thanksgiving AND I’ll share that today is my birthday. Now, my birthday is usually a pretty low key event. I have a couple of traditions, like ordering in my favourite Chinese food for dinner and watching a movie in my jammies. I don’t tend to want for a lot…other than a clean house, wink, wink, nudge, nudge hubby! And, if you know me, you’ll know that I’m the kind of person who likes to give…shocking, I know… and that I thrive when those around me are thriving. So, for my birthday I decided…because I can…to do a blitz giveaway of my full resilience training program, Beating the Breaking Point, designed specifically for First Responders and Front Line Workers. If you don’t know about the program, check out our show notes from today’s episode, or google Beating the Breaking Point Lindsay Faas and you can get all the details of what’s included. From now until 11:59pm on Monday October 18th, you can snag the course for only $99. I promise you, it’s worth every penny – I put my heart and soul into developing it to support burnout prevention and reduction for those who sacrifice so much for our communities. If you go to register for the program this week, use coupon code BIRTHDAY and get to work investing in your wellness. Happy birthday to me!
Today we’re continuing our series on therapy 101 – focusing today on where to look for a counsellor; what to look for in a counsellor; what to ask a potential counsellor (and how to go about doing that); and what to expect from counselling (particularly early on). This episode is part 2 in a 4-part series, so if you haven’t listened to last week’s episode yet please make sure to do that. Look for Season 2, Episode 5.
Let’s start with where to look for a counsellor. Different people stumble into counselling through different routes, and it’s important to acknowledge that there are lot’s of ways to find a professional support person. Certainly there is google, how did we ever live without it?? The great thing about google is the ability to find someone conveniently located to you or to search for someone who specializes in a particular area of need. The downside to google and scanning clinicians’ websites is that it doesn’t disclose a lot about the persons personality and whether they’ll be a fit for you. I have seen my share of fantastic authors who sounds great on paper but aren’t the best in the therapy room; and others who are phenomenal clinicians who can’t talk up their skills in writing to get someone in the door. There are online counselling-specific directories that can help a bit – they tend to ask specific fill-in-the-blank questions that allow prospective clients to compare and contrast clinicians skills, interests and so on a bit more side-to-side. Some of these directories are offered by professional associations, which means that there is some amount of safety in knowing that the clinicians represented on the directory meet some minimum criteria for education, training and experience. I know I shared at length in last week’s episode about how counselling is not regulated in many areas, so this might seem confusing. Professional associations are not the same as regulatory colleges – professional associations are run by the group they represent. An example of this is the BC Association of Clinical Counsellors – I register with them, meeting their inclusion criteria, and I pay them annually to be allowed to represent myself as a Registered Clinical Counsellor. They have an ethical guideline that I am required to abide by to remain a member in good standing, but the guidelines are formed and enforced within the group, and the only ultimate outcome of failing to abide is to be barred from membership but can’t strip me of my ability to continue to practice since the profession overall is unregulated where I live and work. A regulatory body is intended for public safety to ensure that practitioners meet expectations and offers recourse if expectations are not met including being barred from continuing to practice altogether. Professional associations role is to support their members, but they do offer a layer of protection to the public in having some specific criteria for acceptance. You can also seek a referral from your GP or learn about someone through word of mouth from a previous client you’re friends with. Other professionals are often connected to counsellors they’ve worked in parallel with – like your lawyer, chiropractor, naturopath, or other para-medical professionals tend to know clinicians whom they trust to refer to. You can also connect with some non-profit or government funded agencies for referrals or direction including crime victim assistance, ministry of child and family development, community mental health, legal aid, and first nations health. These groups tend to be well-connected to their respective community organizations and privately operating mental health professionals and can suggest who might be a good fit for your needs. I will include links to some directories in the show notes if you need some help getting started.
Ok, let’s move into what to look for when looking for a counsellor. I have mentioned that the counselling profession is having a bit of an identity crisis at this point in history and is composed of a wide variety of individuals calling themselves counsellors. Now this is not to say that individuals using the term counsellor who do not have Masters Degrees and years of experience are without their merit. For clients seeking more “simplified” supports or life coaching kinds of support, this can be an alternative that is sometimes more fiscally manageable and may meet the need. Meanwhile, for those seeking support for issues that involve mental health concerns (like anxiety, depression, PTSD, and so on) or issues that have been chronic or pervasive, it is likely more appropriate to find a counsellor who has been trained in assessment and treatment protocols for these issues. So what should you be looking for?
Well tip number one is education. The main professional associations across Canada require that their counsellors have a Masters Degree in psychology. Individuals who have completed this level of education will have done a four year undergraduate Degree as well as a Masters program typically between two and three years in length. These programs include training in assessment, treating psychological disorders, working with individuals/couples/families/children, and working with a variety of wellness concerns including relationship issues, work issues, addictions concerns, grief and loss, etc. These programs also include intensive practicum/internship experiences where students complete a given number of hours directly counselling clients under the supervision of a professional.
Tip number two…you may have guessed it… look for registration. You want to see letters after their name. In areas that are regulated, this is taken care of for you. But for those in unregulated areas, look for registration with a professional association which helps to protect the client. Finding a registered counsellor acts as a bit of a safeguard – you know they had to pass specific criteria to get registered which means that they have the fundamental things they need to effectively help you. Belonging to a professional association requires your counsellor to abide by specific ethical guidelines and it gives clients a place to voice any concerns/complaints. In addition, belonging to an association means that your counsellor is getting regular information about training, resources, and other information that allows them to be even better at their job.
Tip number three is be specific about what you want. This is two-fold. First, be clear about what kind of clinician you are looking for. Check with your extended medical coverage to see what credentials they cover, and look specifically for someone who meets that. It stinks to go see someone and connect with them only to discover that you can’t get reimbursed for those sessions after the fact. Clinicians do not know which medical programs cover which credentials, so you have to do this piece of diligence to ensure that you are finding someone who will be covered. Second, be clear about what you are needing counselling for and find someone who specializes in that area. Just like there are GP’s who are generalist medical practitioners, and then there are specialists who focus on a specialized area of medical practice, therapists similarly have generalists who work with a range of needs but aren’t necessarily deeply versed or trained in any given one, as well as highly specialized clinicians who invest in dedicating themselves to a specific area of treatment. So if you’re looking for relationship counselling, don’t go to someone who tends to focus on depression. If you’re looking for counselling around a recent or past trauma, don’t go to someone who prefers to do career counselling. If your work factors in as a significant aspect of what you hope to work on in therapy, I would really encourage you to seek out someone who has a specialization in working with trauma, as well as experience working with other First Responders and Front Line Workers, as you are a somewhat unique demographic and tend to benefit from someone who gets your unique challenges.
Alright, you’ve narrowed your search down and found a few counsellors who you feel pretty good about. What comes next? Well, next I want you to anchor to WHO YOU ARE in this process. As you navigate into contacting counsellors and setting up initial sessions, I want you to remember that in this process you are the consumer of a service. This service is personal and intimate and you have a right to be choosy, to be informed and to make choices that are right for YOU. I find that all too often clients come in nervous to ask questions or in some way question my expertise. When we enter into scenarios like this we tend to see the clinician as an authority figure – which is fair to an extent, they are an authority on the subject matter they’ve studied rigorously. Meanwhile, you are the expert on YOU. You know what feels like a fit and what doesn’t; you know what you need to feel safe a supported; and you have every right to bring your expertise on you into the therapeutic process. In fact, it’s the only way it will be effective. Think of it like hiring someone to clean your home, or visiting a hair stylist for the first time, or taking your precious car to a new mechanic…these are all service providers who are skilled in what they do. They are the expert, all things relative, in their respective professions likely as compared to your own skill, ability or knowledge in these same areas. When we utilize these kinds of service providers we tend to have expectations, and we evaluate the service providers capacity to meet or exceed these expectations. If our expectations are disappointed, we’ll tend not to continue bringing our business to that service provider. Counsellors are service providers too, and you are allowed to ask questions the same way you would with other service providers – we’ll talk about what kinds of questions to ask in just a minute. You are also allowed to decide that someone isn’t a good fit for you after the first session, or the first few sessions. Often when we’re seeking this kind of support we need to be advocates for ourselves – don’t be afraid to advocate with your counsellor. If they are good at what they do, they will want to partner with you in advocating for you, and they won’t be at all insulted or bothered by all of your questions, they’ll want you to express these to help facilitate you feeling safe.
So what kinds of questions should you be asking a therapist, and when and how should you bring these up? Well, let’s start with the when and how. Some clinicians offer a free brief over-the-phone consultation in advance of booking an appointment, but not everyone does this. If you have found someone who offers this, you can use this time to ask some of these questions, enough to satisfy your hunch that this is likely a person you’ll connect with. If the clinician you’re interested in seeing doesn’t offer this, then you may be able to ask some preliminary questions via email or while setting up the first appointment, but then save the remainder of your questions for the first session. I will say that often prospective clients feel that clinicians should offer a free first session or time for them to feel clear about whether it’s a right fit before they pay for ongoing services and I find this a bit concerning. While I appreciate that it can be hard to pay for services that don’t end up feeling like the right fit, the clinicians time is still valuable. You likely wouldn’t ask any other service provider for something like this, recognizing the value of their time even if you don’t return to use them again. To some extend those in mental health will tend to be taken advantage of because they care and genuinely want to help. Please value their hearts and effort and lengthy education and be respectful of these pieces when asking for any concessions in setting up a consult or first session.
When it comes to key questions you should be asking your therapist, there are two main groups of questions. I’m going to group these into practical, and professional.
On the practical side of things, there are several fairly straightforward questions you will likely want to ask. These might include questions regarding their qualifications (what level of education do you have, where did you go to school, how many years of experience have you had, are you registered, with which association are you registered). Additional practical questions like how much do you charge, how long are sessions, do you bill to insurance companies, how do you expect payment, where are you located, do you offer telehealth session, and so on can also be helpful to ask in advance of meeting for the first time. Also, if you are seeking a counsellor who uses a specific kind of therapeutic approach (e.g. EMDR, OEI, body therapies, play therapy, etc.) you will want to ask about their specific training in the approach as many of these require additional training to a Masters degree.
When it comes to more professional questions, some of my favourites are: ask about their counselling style (for instance, are they really directive or do they collaborate with you; do they do a lot of teaching skills or do they focus on processing feelings, etc.). Also ask about their theoretical orientation…now the answer to this question may feel a bit over the heads of some people who aren’t into psycho-babble, but you can say something like “can you tell me a bit about how you shape your treatment, in a user-friendly kind of way?” The answer to this question will tell you a lot about what you can expect from the counsellor in your work together. Another way to approach this is to tell the counsellor about what problems you are experiencing and ask for an idea of how they would approach these issues. It’s ok to ask the therapist whether they have background working with first responders or with the specific type of concern you’re coming with, like PTSD for example. You can ask about what additional training they have to support your specific concerns, and ask about what kinds of successes and challenges they’ve had with other clients with similar concerns.
If there are any other questions you would find helpful to feel clear about expectations or would promote your sense of safety with this person on an ongoing basis as you work together, don’t hesitate to ask. They work for you, you get to have a voice in that space, and actually need to for the process to really work for you. Did you know that research has shown that “therapeutic alliance” is THE strongest determinant of the successful outcome of therapy? Therapeutic alliance is the connection between client and counsellor and is defined by 3 main pieces: agreement on therapeutic goals (ie, why you are coming for therapy); agreement on the tasks that make up therapy (ie. the steps toward the goals); and the quality of bond between therapist and client. When these 3 pieces work together, the likelihood of success is far greater and is the strongest predictor of success in therapy.
Ok – so we’ve found a counsellor, refined our options to those we think are the best fit and started connecting to make sure it’s all the goldilocks things…JUST right! But for many who are new to therapy and believe it involves laying back on a chaise lounge while some stuffy old dude scribbles notes about how your mom failed you – let’s take a moment to talk about what to ACTUALLY expect when you start going to counselling.
Now, every counsellor approaches things a little differently, but on the whole you should be able to expect a few key things. If these things are not present, ask questions. In your first session, you should expect the counsellor to present you with some kind of contract or agreement that outlines the counsellors expectations (i.e. payment, what will happen if you no show or cancel at the last minute, etc.) as well as the rights you have to confidentiality and the limits to confidentiality. Your rights are to have your information kept confidential except when there is a risk (or suspected risk) of harm to a child, when there is a threat of harm to yourself or to someone else (e.g. threatening to commit suicide or homicide, but not restricted to these alone), and where required by law which becomes a factor if you are involved in an active court case (or will be) as counsellor notes are able to be subpoenaed. Besides the confidentiality agreement, many counsellors will also use the first session to discuss any other stakeholders in your care (e.g. physician, psychiatrist, mental health, social worker, etc.) and may discuss with you the possibility of filling out a form that will allow your counsellor to have contact with these other professionals in order to provide the most effective care possible.
Once these formalities are complete, the remainder of the first session is often an information gathering time. The counsellor may take notes while you talk, or may have an intake form with specific questions they require to have answered. These questions may include information regarding past counselling, other stakeholders (it can be helpful to bring a list of names and contact information for these people), medications (it’s a great idea to bring a list of medications you are on and the dosage), family (i.e. kids, spouse, etc.), and questions regarding the presenting concerns that brought you to counselling. If you are receiving counselling through an insurance company or other funding, you will likely have a specific number of sessions being paid for which you will also want to discuss with your counsellor so they can tailor treatment to your timeline. This may also be the time when the counsellor will tell you a bit more about themselves and their approach, and is a great time to ask any other questions you may have.
After the first session, subsequent sessions will typically follow a basic pattern of checking in regarding how things have been going, and then moving into the specific work/goals you have outlined. You can expect that you counsellor will continually check in with you regarding how your goals are being met. You can also expect your counsellor to refer you to other resources/supports as they see fit in order to provide you with optimal care. You can expect that your counsellor will act respectfully but will challenge you to make changes that may not always be comfortable. Above all else, you should expect yourself to assess your own progress and be aware of whether you are making the gains you are wanting to make. If it seems like you are not making progress or have stalled, try discussing this with your counsellor, or consider finding another counsellor. If your therapist is trained in specific treatment interventions like EMDR (eye movement desensitization and reprocessing), Neurofeedback, OEI (observed experiential integration), and so on, you can expect them to discuss this treatment with you and walk you through how they would apply it in their work with you before they begin applying these skills. Do ask for additional information and ask questions about any treatment intervention – they should be able to clearly identify why they think this would be helpful for you, how it will look, what to expect and should be able to point you to additional resources where you can learn more. You are allowed to decline interventions that don’t feel like a fit for you, or to try an intervention and then ask to stop if you are finding it is not helpful to you. Your clinician is skilled at lots of things, but we’re not mind-readers and your feedback is really important to help guide the process and ensure that we’re tailoring your treatment to meet your needs. Don’t hesitate to speak up.
I hope that this sets you up with a roadmap for how to proceed forward in connecting with professional support. I know it can feel like a lot, and on the front end, it can be, but it’s worth it. You are worth investing in, and it can be hard to do it alone, so even if you hit some stumbling blocks in getting connected, don’t give up. I hope you’ll come back and join me next week when I’ll be chatting with ER nurse and author of the View from the Wrong Side of the Day, TC Randall; as well as with retired RCMP staff sergeant with the integrated homicide investigation team, and creator of the blog fuelforfirstresponders.com, Jenn Pound. Our interviews with each of these two earlier this year were some of our MOST listened to episodes, so I have invited them both to chat and I can hardly wait for you to hear their insights on the hard and the hopeful of therapy as survivors of occupational stress injuries.
Also, please check out our one week Birthday special of Beating the Breaking Point – check out the show notes or visit our page to register before end of day on Monday October 18th to get the 7-part online resilience training program that I developed specifically for First Responders and Front Line Workers for only $99 using coupon code BIRTHDAY.
Oh, and before I forget, consider this your reminder that the Self-Care Dare 5 Day Challenge for First Responders and Front Line Workers is re-opening for registration in ONE WEEK! Registration opens October 19th and will close November 1st at 11:59PM. The dare kicks off on November 2nd. Registration is only $10 and includes 5 days of video lessons around 5 key domains for self-care; bonus resources and worksheets to develop a bombproof and sustainable self-care plan; access to our private facebook group to connect, problem solve and hone our skills; and fun prizes along the way to keep you pushing forward. If you are needing to up your self-care game, join us and take the dare. Watch for posts on our social media and website next week when registration opens, or go onto our podcast page now by googling Behind the Line Lindsay and click to join our waitlist where you’ll get notified the minute that registration opens.
As always, please reach out and connect if you have any questions or feedback. I love hearing from you and shaping this podcast to echo your needs and interests. You can find me on facebook and Instagram, @lindsayafaas, or you can email me at support@thrive-life.ca.
Do check out our show notes for this series and share with those you know.
Until next time, stay safe.