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Brief Therapies Usually Not Suitable For Combat PTSD

All Posts Information April 10 2009
 — By Scott Lee
I had a comment on a recent post on the merits of whether or not going to therapy had benefits or would be damaging. I think it safe to say that some practitioners can and do delve to soon into the deep fissures of the mind before proper preparation and can cause great harm to the client.
Peter Christopher, I feel that your comment has some merit. In a way that therapist should have specialized training in trauma therapy, especially in combat trauma therapy. You are correct to assume that many practitioners go into deep psychological therapy to soon.
The private practice model concentrates on brief therapies that usually only work with the less complicated end of the pathology spectrum. They do this not because the evidence expresses itself so, but dictated by insurance policy. In other words, although brief therapy can and usually does work for less comprehensive classifications. The more elaborated diagnoses should compel the practitioner to begin with psychoeducation and cognitive restructuring therapies. First concentrating on educating the client about their particular pathology. Identifying emotions and values, coping strategies, self depreciating statements and their impact and a host of other foundational psychological restructuring.
All of this developmental preparation should be construed in a systematic and fluid interpretation designed especially for the client. Much of this work for the combat variety of PTSD should take many months. I went through similar therapies for approximately 14 to 16 months before I started to address combat issues. During this time I was in an inpatient facility for 20 months, receiving around 10 hours of therapy a week. After the 20 months I still only touched briefly on my combat experiences and then decided to take a break from therapy due to the intensity and starting college.
I am now back in therapy and seeing my psychiatrist regularly. I was recently hospitalized for suicidal ideation and started a new regimen of antidepressants; Prozac, Trazadone and an increase in Prazosin for PTSD. So my point is that combat PTSD in all probability will require many months if not years of therapy to get to the point that a “normal” life can be experienced.

(5) Readers Comments

  1. 04/11/2009 at 8:47 am

    “They do this not because the evidence expresses itself so, but dictated by insurance policy. In other words, although brief therapy can and usually does work for less comprehensive classifications.”

    Absolutely! It is that driving force that has caused a lot of malpractice issues to crop up for practitioners. Instead of using research and case study to guide practice, many are being guided by insurance policy — and there is the ethical rub. Do you practice to the best of your ability or to the best of the insurance company’s policy. Fortunately I left that particular field of social work practice before I had to make that decision.

    Reply
    • 04/11/2009 at 1:45 pm

      I do not think that I will have to face that dilemma because I will be working at the Veterans Administration. But, I will experience other ethical concerns I am sure due to the VA’s bureaucracy.

      It is a shame that practice is guided by the insurance company’s policy instead of the patient’s best interest.

      Reply

  2. Army Wife

    04/12/2009 at 5:19 am

    I have a neighbor here on post that got back from Iraq a year ago with Injuries and PTSD. I talk to his wife quite often, she needs some cheer! Her husband is not doing well, he is a different person, and will never be the person he use to be! He had to investigate all deaths that happened in Iraq, and he read a saw too many horrible things, that will never leave his mind. Are we prepared to take care of soldiers like this for life? I do not think a year of therapy will cure his PTSD! It has already been a year, and he still freaks out! Last week he was at a meeting he was required to go to, and he started screaming and hit the floor. He saw things that no one should, over and over again for a year! I also think everyone has different circumstance, and there is no way to say in two years with this therapy and these medications, you will be fine!

    Reply
    • 04/13/2009 at 7:31 pm

      This was the entire gist of my summary and argument. That, as you say, no one has similar circumstance and reactions to combat especially for those of us chronically traumatized. In all probability two years will not be enough time mend a broken mind.

      A brief therapy is considered to be 6 to 10 sessions. For some people this will be appropriate, for others not at all and can actually do more harm than good.

      Medications are not the end of treatment, but a means to an end. Many people may only require medications to abate the symptoms enough to begin therapy. And others will require all of these therapies combined in a specifically designed treatment program for an individual who is chronically limited by their extreme stress reactions. Some may require medications for the rest of their life.

      Reply
  3. 04/17/2009 at 10:58 am

    What about therapy combined in a protocol with other formats like EFT, craniosacral and healing touch? There is a vast network of Americans who have been busy learning and practicing various soothing modalities who would be *honored to help with the healing process…I have not seen any research on this but I have seen a bit on how well EFT and Craniosacral can work on combat PTSD….it’s time to pool the resources we have to and put together a *protocol* instead of relying so heavily on therapy – especially brief therapy.

    Chris

    Reply

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