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Additional Considerations in Treatment Planning

A Multi-Modal Approach: As the table on Using Symptoms and Neurobiology in Considering Treatment Practices showed, veterans may experience many different “clusters” of symptoms. Clinicians who have the luxury of time will want to consider and use multiple approaches and practices, based on the veteran’s symptoms, stage of recovery, and stage of readiness.

According to van der Kolk and Pelcovitz (1999), “Fully effective treatment may require a strategically staged, multi-modal treatment approach. On the one hand, a treatment approach that emphasizes cognitive reorientation to the present, while disregarding past trauma, may insufficiently address the reliving of the trauma in images, feelings, or behavior. On the other hand, a treatment approach that focuses prematurely on exploration of the past may exacerbate, rather than relieve intrusive affective and somatic symptoms. With appropriate timing, however, different treatment modalities might well be employed in complementary fashion. Thus, recognition of the complex nature of adaptation to traumatic life experiences may lead to further developments of a more comprehensive treatment approach to trauma-based psychiatric disorders” (van der Kolk and Pelcovitz, 1999, p. 24).


Treatment Planning Resources from the National Center for PTSD: Although the evaluation and choice of trauma treatment practices is beyond the scope of these pages, the Department of Veterans Affairs offers a guidelines document called Management of Traumatic Stress (2004), Washington, DC: VA/DoD Clinical Practice Guideline Working Group, Veterans Health Administration, Department of Veterans Affairs and Health Affairs, Department of Defense, December, 2003 (update targeted for 2006). It is available from the Department’s Office of Quality and Performance Publication 10Q-CPG/PTSD-04, and available for download.

According to the National Center for PTSD’s web site, “the goal of that document is to promote effective management of acute stress responses (ASR) and acute stress disorder (ASD), early identification of probability of developing PTSD, and effective management of PTSD in primary care and mental health settings. It is presented in an algorithmic format that leads the reader through recognition of these conditions, makes recommendations for treatment and treatment objectives. The document also provides guidelines for determining whether or not recommendations and recommended treatment approaches are supported by the evidence.” Among the resources in this document are guidelines for looking at the evidence behind the practices that are available.


The Importance of Strengths and Resources: One important hope is that the SUD treatment field’s focus on recovery and strength-based treatment planning will inform and inspire treatment planning processes in services for veterans with post-deployment stress effects. Strength-based approaches are important for most people, but particularly important for veterans, who come from a culture that traditionally emphasizes strength and stigmatizes people with combat stress injuries.

Treatment plans should:

  • Be custom-built for the individual veteran
  • Be developed in a collaborative process between the veteran and the clinician
  • Use language that the veteran finds relevant to his or her journey toward and through recovery
  • List important strengths and resources—in the individual, the family, the community, and beyond—first identified in the assessment process, then updated as treatment progresses
  • Center on the veteran’s own goals for his or her treatment and recovery
  • Detail approaches that use the identified strengths and resource to pursue the identified goals
  • Include or intersect with the veteran’s plans for ongoing recovery, re-balancing, and self-care (see Ideas for Recovery, Re-Balancing, and Self-Care)
  • Be continually re-evaluated and improved as the veteran progresses through treatment, refining goals and finding new sources of strength, resilience, and resources

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The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.

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