Delivering Intensive PTSD Treatment Virtually: The Development of a 2-Week Intensive Cognitive Processing Therapy–Based Program in Response to COVID-19

Of the many vulnerable groups affected by the spread of COVID-19, veterans have been especially impacted by the pandemic. Beginning in March 2020, nationwide shelter-in-place orders rapidly led to widespread job loss and economic upheaval; disruption and breakdown of multiple support systems; and increases in family stress, all of which may exacerbate underlying PTSD symptoms. Although telehealth has proven an effective means of delivering evidence-based psychotherapies for PTSD, little is known about the delivery of these treatments in an intensive, daily format over telehealth. There is growing need for intensive treatment options to reduce treatment-interfering barriers such as high dropout rates. In order to address this gap in the literature, this paper details several design considerations as well as patient selection procedures for a 2-week virtual intensive treatment program (vITP) for veterans with posttraumatic stress disorder (PTSD), consisting of daily individual Cognitive Processing Therapy (CPT) and other adjunctive interventions. We also describe two cases of veterans who successfully completed the vITP including their clinical outcomes, therapist reflections on the process, feedback regarding the program, as well as challenges patients encountered with the telehealth platform. Intensive evidence-based psychotherapy for PTSD delivered through a virtual format seems to show promise, but more systemic research is needed.     

Narrative of “Here-and-Now”: Cancer Survivors in a Group Psychotherapy Using SCT® (Systems-Centered Therapy)1,2

This study focused on “here-and-now” narrative and examined the process of group psychotherapy for cancer survivors using systems-centered therapy (SCT). In contemporary society, cancer survivors have a vital need for psychological support, and group psychotherapy and peer support are used as part of this need. In most of these interventions, participants are encouraged to speak freely and share their experience of cancer. This generally means speaking about “there-and-then” experience. It has been argued that one reason that narrative therapy produces a psychological effect is that the meaning of an experience changes when the experience is spoken about. SCT differs significantly from other group interventions in that it requires participants to talk about their here-and-now experience through the format of SCT's “functional subgrouping.” Functional subgrouping requires participants to listen, reflect, and build on similarities in their experience. In this study, we qualitatively examined how participants' experiences unfolded in the SCT group by directly addressing the group process. The study findings revealed that even though the participants did not directly share their cancer experiences in the group, they experienced an inexplicable sense of connectedness that had a positive psychological effect on them. They also experienced deep emotions through talking while using the SCT narrative style. In the process, the effects of the SCT narrative were discussed.     

Women's Psychological Experiences in a Narrative Therapy-Based Group: An Analysis of Participants' Writings and Beck Depression Inventory–Second Edition

The purpose of this study was to explore women's experiences in a narrative therapy-based group conducted to help participants re-author their stories. Seven women who were either patients or individuals enrolled in Transition Support for Employment at a psychiatric clinic participated in the meetings, one every fortnight. Each session explored a theme based on narrative therapy techniques such as externalization. The participants wrote their reflections during each session, and completed the Beck Depression Inventory-Second Edition (BDI-II) during the initial and final sessions. An affinity diagram was developed to classify their written reflections into 22 lower categories (e.g., new understanding of self, forward-looking-understanding of life) and 4 upper categories (“Insight,” “Sharing with others,” “Changes with understanding of lives,” “Higher motivation”). The relationship among five lower categories comprising “Insight” was explored, and it became apparent that clarification of participants' own thoughts about social problems functioned as a mediator promoting the process. The largest portion of depressed feelings emerged during the initial session, and four participants had lower scores for BDI-II items such as self-criticism in the final session. The results suggest that the group's purpose was realized. However, future studies should examine participants' feelings more closely, especially during the initial session.     

Adolescents coping with the COVID-19 pandemic: ‘every day is like another Sunday’

COVID-19 has upended the way analysts and psychotherapists practice. Many use the phone for their sessions, many are using video platforms, and many use a combination of the two. Work with adolescents is very challenging in this new modality because of the loss of in-person connection and immediate non-verbal cues. The public health restrictions put in place to manage COVID-19 spread are at odds with the adolescent tasks of adventuring, experimenting and gaining new experiences. In addition, increased anxieties about infection, contamination and invasion are often manifest and adolescents can regress in the face of them. Using seminal ideas from Bion, this article looks at two process examples from adolescent boys who struggled with parts of themselves that felt disturbing and unacceptable. The author discusses the clinical exchanges in detail and offers ideas about the difficulty of creating psychic space when working virtually.