Cognitive Processing Therapy: Treatment for Veterans in the Criminal Justice System
As of September 2011, there were approximately 63,100 veterans in Miami-Dade CCounty Florida data is running on par with national level data that shows that veterans account for nine out of every 100 people in U.S. jails and prisons (9 percent). The Miami-Dade Department of Corrections and Rehabilitation, eports that there are more than 110,000 bookings into jail annually and that the average daily population in Miami-Dade County jails is 6,005. It can be estimated that 9 percent of the daily jail population is 540 veterans. If 17 percent of those have been diagnosed with SMI, it can be estimated that on any given day the,ere are 92 veterans with SMI in Miami-Dade County jails.
Untreated psychological trauma
High levels of untreated psychological trauma are found in correctional populations, including among Veterans. VA’s National Center for PTSD reports that PTSD symptoms can indirectly lead to criminal behavior (for example, self-medication or acts related to hypervigilance) or through direct linkage of a traumatic incident to a specific crime . A 2008 RAND Corporation study found that nearly 20 percent of service members who had returned from Iraq and Afghanistan (300,000 at the time of the study) reported symptoms of PTSD or major depression, with only slightly more than half having sought treatment.
Mental Health Hospital
At Jackson Mental Health Hospital, we utilize Cognitive Processing Therapy (CPT), an evidence-based treatment model for Veterans who are involved in the criminal justice system. Often, we utilize a 12-session treatment ,which has been found effective for both PTSD and other corollary symptoms following traumatic events. Although research on CPT focused on rape victims originally, it has been used successfully with a range of other traumatic events. CPT is based on a social cognitive theory of PTSD that focuses on how the traumatic event is construed and coped with by a person who is trying to regain a sense of mastery and control in his life.
For example, it may be that hypothetical patient, Mary, is currently confronting legal issues, and believes that she will be overwhelmed by the amount of affect that will emerge if she stops avoiding and numbing herself. Perhaps she was taught as a child that emotions are bad, and told, “Don’t act like a girl,” implying that showing feelings is considered a weakness. In addition, she is so convinced that she will be victimized again that she refuses to go to her court mandated therapies anymore and has greatly restricted her ability to overcome legal difficulties.
Hypothetical case
In another hypothetical case, George, may have refused to talk about what happened with a therapist because he blames himself for “letting” the event happen and he is so shamed and humiliated that he is convinced that others will blame him too.George saw something so horrifying that every time he falls asleep and dreams about it, he wakes up in a cold sweat. In order to sleep, he has started drinking heavily which has lead to legal problems. Perhaps, he experiences survivor guilt and obsesses over why he was spared when others were killed. He feels unworthy and experiences guilt whenever he laughs or finds himself enjoying something. In these two hypothetical cases, thoughts or avoidance behaviors are interfering with emotional processing and cognitive restructuring and contributing to their legal problems.
After completing the 12 session protocol, we set up follow-up appointments with Mary and George for a month or two into the future. The follow-up session includes the same assessment measures that were used during treatment and will be used to get Mary and George back on track or to reinforce gains. This practice also helps in instilling them with the notion of episodes of care. Mary and George are encouraged to work as their own cognitive therapist on their stuck points and daily events that arise, and then present for treatment when they have difficulty resolving a stuck point or recent event.