Cognitive Processing Therapy With an Older Woman Veteran During COVID-19: A Case Study

Abstract

With advances in technology, telehealth has become an acceptable way of conducting psychotherapy. During the COVID-19 pandemic, telehealth and ways to modify treatments for delivery via telehealth have become increasingly important. Researchers and clinicians have issued recommendations on providing telehealth-based care in response to the COVID-19 global pandemic. However, recommendations are limited for audio only telephone-based care, which may be the only option for specific clients. This is a case study of an older adult who completed Cognitive Processing Therapy (CPT) for military sexual trauma. Halfway through her treatment, COVID-19 resulted in transitioning from in-person services to a virtual format. Client X did not have video capabilities aside from her cell phone, and it was determined she would complete treatment via telephone-based sessions. Client X’s outcome data is presented, and the reductions in her PTSD and depressive symptoms provide preliminary support suggesting that telephone-based care may be an acceptable method of receiving CPT. Recommendations for telephone-based CPT are provided.

Delivery of Distance Counselling to Survivors of Sexual Violence: A Scoping Review of Promising and Best Practices

“…Studies that examined or considered the comparative effectiveness of distance counselling to face-to-face counselling reported no inferiority of therapeutic outcomes or client satisfaction, 29 , 44 - 47 suggesting that it is distance counselling should not be assumed to be an inferior modality of delivery.…”

“… 30 , 32 , 34 , 44 , 45 Since the pandemic, the discussion of inclusion in distance counselling tended to be more vague, to suggest considering which patients will persist in treatment by distance, specifically exploring with clients how trauma-focused distance counselling would fit into their day-to-day lives given pandemic stress levels. 46 , 47 …”

“…Survivor safety was a central concern in all studies published since the pandemic, and was discussed in terms of: the transformed and intensified violence deriving from pandemic conditions and stressors exacerbating already existing disparities among sub-populations of survivors; new barriers to getting help due to isolation, coercive control, and changes to service provisions; and the acceleration of new forms of technology-based abuse and isolation. 36 - 38 Specific practices and processes to promote survivor safety were suggested, including: expanding IPV screening and support to all clients; inquiring about safety and privacy when scheduling and initiating sessions; confirming client location at outset of each session; implementing systems of counsellor/survivor passcodes, code words to signal risks, disguised apps, personalized PIN numbers, special stalker detection software, covert authentication and verification protocols; introducing new ways to share information and seek privacy (ie chat function), being flexible with and confirming best methods for communication and sharing of materials with each client; 36 , 38 , 39 , 41 , 47 and recognizing that the agency may be the only private or safe space available to survivor to keep doors open with strict protocols as last option for some survivors. 39 The studies that discuss safety planning suggest that these are collaboratively developed, inherently individualized, 41 , 43 , 47 and do not assume police or other formal first responders are safe and supportive avenues to address potentially violent situations.…”

“… 36 - 38 Specific practices and processes to promote survivor safety were suggested, including: expanding IPV screening and support to all clients; inquiring about safety and privacy when scheduling and initiating sessions; confirming client location at outset of each session; implementing systems of counsellor/survivor passcodes, code words to signal risks, disguised apps, personalized PIN numbers, special stalker detection software, covert authentication and verification protocols; introducing new ways to share information and seek privacy (ie chat function), being flexible with and confirming best methods for communication and sharing of materials with each client; 36 , 38 , 39 , 41 , 47 and recognizing that the agency may be the only private or safe space available to survivor to keep doors open with strict protocols as last option for some survivors. 39 The studies that discuss safety planning suggest that these are collaboratively developed, inherently individualized, 41 , 43 , 47 and do not assume police or other formal first responders are safe and supportive avenues to address potentially violent situations. 43 And still, several studies that relayed practitioner workforce experiences pointed to the rapid transition online and limited time to implement a full scope of survivor safety procedures, 41 and further point to the challenges of preserving client privacy and confidentiality for practitioners working from home within their own pandemic experiences (ie children present, unsuitable home working environments, etc.).…”

“…All articles published since the pandemic discuss the ways that the pandemic is impacting agencies and practitioners, with respect to the ways that the nature of the work has changed and intensified resulting in occupational stress and interpersonal tensions, as well as the ways that staff are taking on the brunt of the mis-match between demand for services and capacity for transitioning to offering distance. 36 , 39 - 43 , 47 Specific concerns relate to the professional isolation and increased risk of vicarious trauma, 40 the challenge for frontline workers to take time off putting them at risk of burnout, 40 working extended hours to meet increasingly complex needs of growing clientele, 40 burden to appraise and become familiar with safe use of new technologies, 36 a lack of reference points to practical guidelines or survivor specific evidence base, 41 against a backdrop of frequent shifts in workplace protocols amidst changing pandemic conditions. 42 Specific mention of the new ways of working involving more “task work” related to technology, 41 the need for new sets of resources to know and develop, 43 more check-ins due to concerns for elevated risks posed by pandemic, 40 , 42 expanded contact hours, 41 providing additional support outside of regular sessions, 46 and changed content of the counselling to reflect emergent or crisis needs-in-the-moment.…”