with Ronald Murphy, PhD
Large numbers of soldiers are returning from Operation Enduring Freedom (OEF: Afghanistan) and Operation Iraqi Freedom (OIF) with post-deployment adjustment problems, and unfortunately the majority of them don´t seek help or drop out of treatment. It is critical, then, that healthcare providers: a) understand the treatment barriers experienced by these and other veterans, and b) enhance veterans´ engagement in mental health treatment. Dr. Murphy will train Institute participants in clinical methods for enhancing veterans’ engagement in treatment for emotional and behavioral problems arising from warzone experiences.
The first part of the workshop will focus on identification of treatment acceptance and engagement barriers among combat veterans, especially Afghanistan and Iraqi returnees, including veterans´ own roadblocks to help-seeking, healthcare provider missteps, and therapeutic alliance issues which prevent returnees with warzone-related stress from accepting the help they need. Common veteran barriers to accepting help include ambivalence about problem acknowledgement, emotional and cognitive roadblocks like shame and self reliance, and beliefs and fears about mental health treatment. In the second part of the workshop, participants will learn and practice techniques from the PTSD Motivation Enhancement Group, a brief therapy intervention based on Motivational Interviewing principles that is designed to foster engagement in PTSD treatment. An uncontrolled study has previously shown increased problem recognition and high satisfaction ratings among PME Group participants, and early results from a randomized control trial show that PME Group participants stay in PTSD treatment program longer and are more likely to complete the program than controls. The intervention encompasses a number of approaches, including general therapist response style as well as specific techniques designed to enhance patient problem acknowledgement and engagement in treatment. These techniques include an intervention to reduce patient blaming and externalized attributions about the cause of their problems, norm comparison, decision balance, and identification of roadblocks to problem acknowledgement and treatment participation. Review of barrier issues and modifications of engagement enhancement interventions that are unique to OEF/OIF veterans will be emphasized. At the end of the Institute, participants will be encouraged to describe their most difficult cases for re-evaluation in the context of a motivation enhancement approach.
List 2 barriers to engaging veterans in PTSD treatment that are due to the veteran behavioral and/or personality characteristics.
State key factors in 2 theories of motivation enhancement, the “Stages of Change”model and the “Motivational Enhancement Interviewing” model.
Demonstrate 2 techniques for reducing resistance to PTSD treatment.