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  • Although this is not necessarily evidence based, after 30 years doing psychotherapy for vets and others with PTSD, I found that after about 2 years of a client being in weekly or biweekly individual therapy, and maybe some couples and group counseling, some did not improve much. After studying with the Modern Psychoanalytical Institute, I learned what I had not had in graduate school. Most of these types of vets and others had much earlier traumas, many times pre-verbal. Addressing their adult traumas of war or rape were not getting into these deeper ingrained traumas. I had to do a bit of adjusting for transference, negative and positive that brought out these earlier traumas. This is long term hard work and they do little training in this mode in graduate schools. Its not that you abandon the cognitive behavioral, or exposure therapy. It gets you in the door with traumas that are more easily accessible. Then you either settle for a reduction in some of the intrusive and avoidance symptoms and cut them loose, refer them to more analytical therapy, or get some damn good supervision if you are keeping them, and do some more studies.

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