May 21, 2013

Preparing for Therapy

So you are ready for therapy but don't know what to expect. What's the difference between all the mental health professionals?

A psychologist has a PhD, they use a variety of therapies but do not prescribe medications. They usually run programs, in rank they compare to captains. A psychiatrist is a medical doctor who specializes in mental health, they use a variety of therapies and prescribe medication. They often run departments, they would be considered a colonel or appropriate rank.

Therapists would be the high-ranking Non-commissioned officers the military could not run without. They are usually clinical social workers with a master's degree and often have specialties. My therapist is a nurse-practitioner.

You may need a Marriage and Family Therapists for help with your partner and relationship. But, more than likely if you are reading this you will need a therapist who practices evidence-based therapies to treat posttraumatic stress disorder, military sexual trauma and traumatic brain injury. In therapy you will need an empathetic hand to guide you through the wreckage of your mind.

Empathy is the ability to identify, internalize and experience another's emotional state. It's imperative to find a therapist you can connect with. The nature and structure of trauma leaves internal conflicts; the kernel of trauma-based disorders rest in the most recessed parts of our minds.

The most important aspect of therapy will be an empathetic connection with your therapist, a therapeutic window between the therapist and the patient to reach the deepest compartments. To access this information safely, we must bond with our treatment provider.

To begin the journey of recovery we must find a therapeutic window into our minds substrate. Without developing a rapport with your therapist, therapy will not work. Read that again.

Become an advocate for yourself and learn some basic information on how the Veterans Administration works. You can fire any doctor or therapist in the VA by going to the counter and asking for a Change of Provider form.

Write the reason you don't want this provider and you don't trust them. Generally it will take up to 3 months to get a new appointment so make sure you want to change. Go to at least 3 or 4 visits before you decide to fire your mental health practitioner.

I fired a therapists because she talked about her issues and was more depressed me. I fired a psychiatrist due to her inability to discuss my medications with me or her unwillingness to listen to what I had to say. I've changed therapists because they were not certified in Cognitive Processing Therapy (CPT).

There are many kinds of therapy and the one you will probably engage in the most is psychotherapy or talk therapy. Talk therapy consists of sharing about psychological distresses, social, life in general and family issues. The therapist listens, gives feedback and psychoeducation on your condition along with teaching coping skills to manage symptoms.

Talk therapy focuses on maintaining equilibrium and balance in life. The most effective treatments for the mentally wounded with the diagnosis of PTSD, MST and TBI is evidence-based therapies. The front-line treatments are Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT) and Exposure Therapy (ET). Ask your mental health provider if they use these therapies and if they have certification.

We'll cover two, since they are the most used. CBT examines the relationships between thoughts, feelings and behavior. By identifying beliefs that lead to self-destructive behaviors the therapist can offer coping strategies to help change thinking patterns over time. The therapies will be problem-focused and goal-directed for symptom reduction. Expect to have homework and if you want to heal actively participate.

Cognitive Processing Therapy, an exposure therapy, focuses on accessing trauma memories, identifying and challenging faulty beliefs about the event and resulting over-generalized beliefs in self. According to Cognitive Theory, trauma impacts our belief structures and how we categorize the world.

That two types of emotions follow trauma, natural and manufactured. Natural emotions are universal such as fear, anger, joy, happiness, sadness and loss. They have a natural course to run unless we feed into them, then they can become stuck points. Manufactured feelings result from the way we interpret events and not fact based.

I know a combat medic with four tours and many medals, the purple heart included. She was unable to return to active duty because of extensive damage received from an Improvised Explosive Device. She's fighting the belief that she let soldiers down because she couldn't return to her Mobile Army Surgical Hospital and deploy outside the wire under fire where she belonged.

Cognitive Processing Therapy starts with psychoeducation about your condition and symptoms, then therapy goals and identification of stuck points, and then 12 sessions centered around challenging beliefs and meaning of the event.

The structured sessions center around identifying thoughts, feelings and stuck points associated with the event. They challenge problematic thinking and address safety, trust, power and control, esteem, intimacy and meaning. This is an exposure therapy, a writing component starts with an impact statement and then writing about the trauma again from each perspective safety, trust, power and control, esteem, intimacy and meaning. The therapist and patient will examine the writing together with worksheets and writing exercises. I've used this therapy and it's the best one so far.

Keep a therapy journal. Write a list of questions and reminders to keep track of what to talk about. Write about your insights and revelations.

Write about your feelings, thoughts and trauma. In doing so you begin to take back your mental health one session at a time. A journal will keep you from forgetting the issues you want to discuss and a place to share your inner self.

Trauma telling is an important aspect of healing, it enables us to re-contextualize our experiences and find meaning where we once thought was none.


  1. Hi Scott, I think Cognitive Processing Therapy is the best to help us get out our traumas, It is hard takes a lot out of you but it helps to process it, you did a great job on this explaining everything I wish I had known this when I first went in but this will help so many. Well said..Kim H

  2. HI Kim, thank you for reading and commenting. It is a hard therapy to do. I'm starting another round with my therapist to work on more of my traumas, gotta keep at it till I get my mind back!

  3. Its interesting that for me I do the best with Exposure Therapy. I tend to be a few steps ahead of my therapists intellectually so exposure is a lot better for me. That is why this post is so great, all veterans are different and it is important that we take control of our own care and be informed.
    Awesome post Scott

  4. Thank you Joe, since I started learning how to get better care at the Va I have less stress when going to appointments. I'm getting ready to get back into Exposure Therapy next week. Take care of yourself today your future self will thank you!

  5. Hi, I was wondering if I could have permission to quote from your blog? I'm a college student from Essex and i'm making a short documentary on PTSD. I hope to mainly focus on the effects it has on soldiers and why and how it affects them. Thus far I have been struggling to gain access to any real life stories and or people who are sufferers or have been sufferers. If there is any way in which you could help I would be hugely grateful.
    Katrina McMullen

  6. Quote away and please use citation thanks for reading!


  7. Great article! Thanks for this info. I did an inpatient program and we used CPT. It helped tremendously, it was very challenging and at the end I felt like we had barely scratched the surface of my PTSD once I opened that “can”. There was no more space left for me to stay so I had to leave and since then I feel like I have lost most of the work we did. I would love to do it again to improve my quality of life but the VA wants me to do it outpatient and I do not feel safe doing this outpatient. I know myself, I know I’ll relapse on my drinking but the Psychologist thinks otherwise and does not want to see me unless I’m doing outpatient and does not want to suggest inpatient bc she feels I can handle outpatient. I will try to find another Dr. In my opinion she has been very unprofessional.

    Sorry for the ranting!, thanks again for this article.

    1. You're welcome, thank you for commenting. I tried EMDR again. This time we used the vibrating pads in each hand, it really lessened the hyperarousal and hypervigilance immediately.

      Keep trying to find an empathetic therapist, it makes a world of difference.

      Once it took me filling out a change of provider form a couple of times to find the right one. I would suggest filing one of these forms. Write on it the reasons why you want to change providers, and add you do not trust this one.

      Keep coming back to let us know how you are doing.


Please share your comments, stories and information. Thank you. ~ Scott Lee