If you have had a Near-Death or Similar Experience: Experiencer's Guide to Psychotherapy

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THE HELPING PROFESSIONS

Extraordinary experiences are a relatively new area for the therapeutic and healing professions.  Some people find that, because of the nature of their experiences, they are most comfortable seeking assistance in the alternative healing communities.  Others feel that an open-minded psychotherapist with traditional training or even training in trauma is best equipped to handle the symptoms of post-traumatic stress that some people encounter after extraordinary experiences.  The initial interview and consultation guidelines discussed below, focus on choosing a psychotherapist; however, a careful interview is important before establishing any healing relationship, and the guidelines are easily adapted for interviewing any health professional.

The term "psychotherapist" is a generic title that anyone can use.  People who call themselves psychotherapists represent a wide range of backgrounds, training, and expertise, and they may or may not be trained members of any of the mental health professions.  The major categories of psychotherapists are described below.

Licensure

In general, there is no guarantee of proficiency in psychotherapy.  However, individuals who received training in mental health services in established training programs at accredited institutions such as universities and institutes, who are licensed by their state to practice mental health services, and who are members of one or more psychotherapy associations and, where possible, certified by such associations—these individuals are most likely to have acquired good therapeutic skills.  The following material will focus specifically on what it means for a mental health professional to be licensed.

First, it means that they have received a certain level of professional training and supervision in a major mental health discipline.  They have demonstrated an acceptable level of professional competence and have passed a state or national examination in their discipline.  Second, they are legally and ethically bound to specific standards of professional practice in their fields.  Professional training and licensing offer important protection to the consumer, although they are not a guarantee of competence in psychotherapy.

There are gifted therapists outside the licensed professions.  Some people practicing psychotherapy without a license may genuinely feel that licensure and training are inconsistent with their healing philosophies, or they may have moved to a location that has different licensure requirements from those of the state or country where they received their training.  Licensing also requires the commitment of considerable financial and personal resources that are not available for all therapists immediately after schooling.  The cause for concern is therapists who practice without licensure in order to dodge ethical requirements.  If you are considering unlicensed therapists, it is useful to learn their reasons for choosing to practice in this way.

Major Categories of Psychotherapists

Psychiatrists

are licensed physicians (M.D. or D.O.) who have completed specialty training in the practice of psychiatry.  A psychiatrist is licensed to diagnose and treat mental illness and may prescribe medications, if need be.  Some psychiatrists gear their practice toward medication therapy while others may specialize in psychotherapy, using special techniques of talk or dialogue to facilitate healing and growth.  Most psychiatrists are also able to help persons who are in a crisis situation that does not constitute "mental illness" per se.  Neither licensure, membership in the American Psychiatric Association, nor board certification assures proficiency as a "psychotherapist".

Nurse Practitioners (ARNP)

like psychiatrists come to the therapy arts through the field of medicine with advanced training in mental health.  Some focus on medication management, whereas others may be sensitive and skilled psychotherapists, depending on their training and work environment.

The remaining professionals receive academic rather than medical training.

Psychologists

are trained to diagnose and treat a wide range of psychological concerns through psychotherapy, but are not qualified to prescribe medication.  Psychology is a licensed profession, and the title of psychologist is controlled by state law.  Those psychologists with a Ph.D.  in clinical or counseling psychology, or the more clinically oriented Psy.D.  degree, are the most likely to have proficiency in psychotherapy.

Counselors

tend not to be trained to address serious psychological disorders such as psychosis but to address normal developmental challenges such as personal, interpersonal, and professional transitions and transformations.  The practice of counseling, and even the title of counselor, is controlled in most states, as in the case of the LPC (Licensed Professional Counselor).  Many competent counselors have a master's degree (M.A., M.Ed., or M.S.); those with a doctorate (Ph.D.  or Ed.D.) and those who are members of psychotherapy associations are more likely to have greater proficiency in psychotherapy.

Marriage and family therapists

address the problems of couples and families and usually see those clients together in the same therapy sessions.  The practice, and sometimes title, of the marriage and family therapist is controlled in many states, as in the case of the LMFT (Licensed Marriage and Family Therapist).  Many competent marriage and family therapists have a master's degree (M.A.  or M.S.); those with a doctorate (Ph.D.) and those who are members of the American Association of Marriage and Family Therapists are more likely to have greater proficiency in psychotherapy.

Social workers

may be certified or licensed by the state.  Training typically consists of a two-year graduate program leading to a master's in social work (MSW), which may or may not include training in psychotherapy.  Certification (CSW, ACSW) and licensure (LCSW, LICSW) are earned through supervised postgraduate experience in providing psychotherapy.  Membership in the National Association of Social Workers does not ensure psychotherapy skills, while affiliation with a psychotherapy institute or association indicates a greater likelihood of proficiency.

Hypnotherapists

use hypnosis in a clinical context.  No organization or governmental body, such as the state, oversees training in and practice of hypnosis, and anyone can use the title of hypnotherapist.  However, reputable training programs do require that their students have degrees in professions such as psychology, psychiatry, counseling, or social work.  These hypnotherapists most often use hypnosis in conjunction with other methods.  One type of hypnotherapist treats behavioral problems, such as smoking or obesity, usually in only a few sessions of hypnotic work.  Hypnosis may also be used in the context of a longer-term therapeutic relationship to help people relax, gain insight, learn new behaviors, and access feelings and memories that have been unconscious.  There are two professional hypnosis societies: The American Society of Clinical Hypnosis and the Society for Clinical and Experimental Hypnosis.  Membership in either of these societies indicates the probability of greater skill as a hypnotherapist; certification as a hypnotherapist implies that the individual's credentials have been reviewed by the certifying organization and that certain standards of clinical training in hypnosis have been met.

Paraprofessionals

You may encounter paraprofessionals working under the supervision of licensed professionals.  Most have college degrees, though not necessarily in a mental health-related discipline.  Paraprofessionals receive on-the-job training and are usually closely supervised by professional staff who ensure the quality of services.  If a paraprofessional opens an independent therapy practice, there is no guarantee of supervision or quality of services.  On the other hand, some paraprofessionals are gifted, empathic healers, who lack only advanced academic psychotherapeutic training.

Alternative healers

Many experiencers have been helped by acupuncturists, massage therapists, breath workers, energy healers, and others who have chosen to pursue alternatives to traditional medicine or psychotherapy to express their healing abilities.  These healers are often trained at reputable institutes in their chosen professions and are sometimes able to provide sensitive consultation.  When dealing with unlicensed practitioners, it is important to ask about their training and experience.  Reputable professionals would welcome such inquiry.

Major Psychotherapeutic Approaches

All types of psychotherapy are practiced by members of all the professions, so it is generally not necessary to choose a therapist solely on the basis of profession.  However, it may be helpful to have an understanding of the psychotherapeutic approach of anyone you are considering to be your therapist.

A number of established psychotherapeutic approaches exist.  Many have names linked to their originators.  "Depth" approaches involve in-depth analysis of the patient/client and tend to be long-term; these include psychoanalysis (Freudian), analytical (Jungian), and various forms of psychodynamic psychotherapy.  "Brief" approaches address the resolution of specific problems and tend to be short-term; these include behavior therapy, cognitive therapy (Beck), multimodal therapy (Lazarus), rational-emotive-behavior therapy (Ellis), and reality therapy (Glasser), and systems-based approaches.  Some approaches may be used for either depth or brevity, or can include a combination; these include existential (May, Yalom), Individual (Adler), and person-centered (Rogers), as well as transactional analysis (Berne) and its close relative, redecision therapy (Goulding).  Many therapists identify themselves as "eclectic", meaning that they combine several theories or techniques; if asked, most will identify one established approach as the foundation of their work.

The approaches named above do not include an explicitly spiritual or transpersonal component, with the exception of analytical (Jungian) psychotherapy.  Less well established approaches, in which the spiritual or transpersonal dimension is core, include holotropic therapy (Grof), Integral Psychology (Wilber), and psychosynthesis (Assagioli).  Even if an NDEr seeking psychotherapy can not locate a therapist who subscribes to these more spiritually oriented approaches, one may still find a therapist who has integrated spiritual or transpersonal perspectives into their work with the more established approaches.

Therapists who affiliate with a specific religious denomination may or may not have received formal training in psychotherapy.  As was stated earlier, the goal of psychotherapy is a greater sense of well-being; and, like all beliefs, religious beliefs used in particular ways have the potential either to enhance or to reduce one's sense of well-being.  Therefore, the skillful integration of religious beliefs into psychotherapy requires specific training.  A therapist who is familiar with the phenomena of spiritual emergence and spiritual emergency might be particularly equipped to address the needs of NDErs.

It is a good idea to ask a prospective psychotherapist which approach they use and to describe it to you.  A psychotherapist should be able to describe their theory and techniques in terms you can understand.  Because NDErs very often find that the NDE and its aftermath involve spirituality, you might ask specifically how the psychotherapist addresses spirituality in their approach, and whether they are familiar with the phenomena of spiritual emergence and emergency.  Unfamiliarity with these latter phenomena need not be a deciding factor, but a psychotherapist's familiarity with them is probably an advantage.

Financial Considerations

If you have health insurance that covers psychotherapy, it will usually cover the services of only those mental health professionals who are licensed.  It is important to recognize that health insurance typically covers a very limited number of sessions, so even if you have insurance coverage, you may need to pay for part of your treatment on a fee-for-service (out of pocket) basis.  In case you may need to pay for part or all of your treatment out of pocket, you may want to ask your practitioner at the beginning of treatment their position on offering their services on a "sliding scale".  A sliding scale enables you to pay according to your ability.

It is also important to note that many insurance companies have other restrictions on their coverage, such as seeing professionals who have a contracted fee agreement with the insurance company.  Often called "preferred providers", it is important to recognize that "preferred" is a financial term and not an indication of quality or competence.  Many companies may also require that you obtain pre-authorization BEFORE scheduling your initial visit with a practitioner.  Some employers offer free or significantly reduced fee services through an independent and confidential "Employee Assistance Program" (EAP).  For all of these reasons, it is important that you check with the Human Resources Department at your work as well as read "the fine print" of your health insurance benefit policy before making your first appointment.

 

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