Overview
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Bar P Posted
The therapy modality that I have chosen to focus on for this course is Prolonged Exposure Therapy (PET) as developed by Edna Foa, PhD. I have worked with Cognitive Behavioral based methods for most of my career over the last 20 years, more specifically, Trauma-Focused Cognitive Behavioral Therapy working with children and adolescents since I took an intensive training course in 2007. With TF-CBT, PET, and Cognitive Processing Therapy (CPT) all being CBT based therapies, it is not a difficult leap to learn about and use each modality. I also used Family Directed Structural Therapy (FDST) developed by Don McLendon out of Kansas University (McLendon, 2005). CBT, TF-CBT, and FDST are all flexible in nature and can be blended in with each other fairly easily. I have been getting more familiar with CPT, developed by Resick, Monson, and Chard (Resick 2017) over the last 7-8 months though have not yet used it on a stand-alone basis yet. CBT on its own addresses a wider array of mental ailments and situations, where TF-CBT and PET were both developed specifically for trauma and resulting issues. I involved FDST more when involving the family and system supporting and surrounding the client. Another reason for stretching out beyond TF-CBT is that my current clientele are much older. I work with young adults age 18 up to 25 in a transitional living environment. While they are technically adults, many of them have emotional maturity that is still in an adolescent stage. TF-CBT is geared towards children and adolescents. With this in-between “peudo-adult” group I work with, TF-CBT still works well in some areas, and they take well to some of the younger themed interventions well. PET and CPT are useful to incorporate when the clients are able to maintain the homework incorporated into these methods. Many of these clients also have current addiction issues or are in recovery from substance abuse.
Elements that I am learning out of this model:
PET focuses a lot of energy on repetitive imagined and in vivo exposure (Foa, 2019). In vivo exposure is not a new idea, as it is a large part of TF-CBT, though PET seems to delve into it more in depth. Imagined exposure is not so much a new idea either, but is more differentiated in this method.
I do appreciate that PET and CPT have more emphasis on homework given to the client to do on there own in between sessions. PET uses the in vivo exposure, after the client has created a fear and avoidance hierarchy. The client practices exposing themselves to the very triggers and thoughts they have been trying to avoid. CPT will have more written assignment for the client in challenging their thoughts.
Being that TF-CBT, PET and CPT are CBT based therapies, I have been curious about what is the actual difference between them. CBT therapies emphasize psychoeducation about PTSD, processing the trauma narrative, and challenging maladaptive thoughts or perspectives in order to change feelings and behaviors.
A difference between CPT and PET is that CPT seems to use written accounts and focuses more on the thoughts that are produced out of the trauma, while PET is more concerned with the actual exposure process using the verbal narrative for imagined exposure and more active engagement with live trauma triggers using in vivo exposure.
PET takes generally takes 8 to 16 sessions that are generally 90 minutes long (Rothbaum, 2019). CPT takes around 12 sessions of 60-90 minutes (Resick, 2017). CPT is also more manualized with written worksheets for the client to complete.
TF-CBT is geared for children, so there is a large family involved portion to it, in addition to the elements of psychoeducation, homework, narrative, and exposure (Sascher et al., 2017). PET and CPT are largely individual adult focused.
Christian integration
PET so far has seemed to be a neutral modality in relation to Christian sensibilities. Depending on the client, if they are deeply spiritual, then their beliefs will of course be incorporated into treatment. If they are not spiritual, or of a different faith, that will be respected. God still requires of me to love others as I would myself (Mark 12:31, ESV ).
The larger concern I have dealt with in helping with traumatized clients is vicarious trauma, hearing countless stories of abuse and neglect, much less over and over again while creating and processing narratives.
Dombo and Gray (2013) encourage spiritually based interventions for the therapist in preventing vicarious trauma. This can be done with sabbaticals, supervision and support from like-minded spiritual cohorts, prayer. Supporting and nurturing the therapist’s spirituality can maintain conviction that healing is possible, there is more that to life than suffering, clinical efforts are valuable, but that recovery is also not solely the therapist’s responsibility (Harrison and Westwood, 2009). I also fall back onto the belief that God’s justice is perfect – each person will get the mercy or consequence they deserve.