By Richard Ganley, Ph.D.

Dick has been working with PTSD since 1995, initially with police officers, correctional officers, and injured workers. When soldiers began to return from the Iraq War he became increasingly aware that many were suffering from this disorder, and it soon became apparent to everyone that this was a widespread phenomenon being seen across the nation. With this as the backdrop, Dick sought advanced training in military cultural issues, started to see more veterans in his practice, and joined the Pennsylvania Branch of The Soldiers Project (TSP), then led by Dr. Nancy DeCesare, a Catholic nun and renowned advocate for veterans throughout the state. Dick joined her in providing pro bono services for veterans, training for other clinicians in TSP, and additional training for other professionals at statewide conferences for organizations engaged in providing services to veterans.

Early on, Dick noted that the SCT therapy he had trained in for many years, included exposure components similar to those found in the prolonged exposure (PE) he learned from Edna Foa, with the addition that SCT had mindfulness and body awareness components that increased affect regulation skills prior to the exposure. The combination seemed to make the work both deeper and easier to tolerate. This turned out to be particularly useful with veterans, who often had limited awareness of their emotions, had frequently been trained to ignore them, and needed extra help to get back in touch with what was going on internally. Dick also found that veterans’ resistance to working with their feelings could often be overcome, first by challenging them to pay attention to how strong the experience of the feelings actually is, with nearly all agreeing that it’s like someone dropping an 800-lb weight on them while they were working out, and then using this metaphor to formulate feelings as a large task that needs to be worked on together as a team to get it done. Veterans are used to working as a team, and to taking on tasks, so this taps into areas they are already familiar with.

Dick also realized that SCT engages veterans in the broad depth and range of feelings that typically surface in the eye movement desensitization and reprocessing therapy (EMDR) he had trained in with Francine Shapiro. In SCT, this is facilitated by teaching patients to explore their experience, rather than to explain it. Thus, for example, when veterans are working with anger they learn to pay attention to the burst of heat and energy in their chest and arms, and the desire to break things apart, rather than to the bitching and complaining about what triggered their anger in the first place. As therapy progresses, they learn to tolerate increasingly strong levels of feelings until, in about 20 sessions, they can come face-to-face with the terror, horror, helplessness, fear, rage, and shame associated with their trauma memories, and tolerate them until they begin to fade. When the work is done this way, veterans often express surprise that they had so much going on inside that they weren’t aware of. They also often say that their significant others like the therapy because, at home, they spontaneously begin to talk about the things that have been bothering them.

Finally, Dick noted that SCT also involves cognitive restructuring elements, protocols to reduce dropout rates by titrating treatment to where the patient is in the change process, work to build a therapy system/alliance in which the patient is an active partner, protocols for undoing defenses that interfere with processing feelings and internal experience, flexibility to address trauma- and non-trauma-related issues, and a focus on processing the traumatic experience in ways that enhance learning and growth. These features provided the underlying rationale to move into a research phase, and with two individual case studies already completed, the team is moving into doing a pilot study using SCT in groups with veterans who have combat-related PTSD.

Dick was moved to help veterans through the high need he saw for services to treat PTSD in those who were returning from Iraq and Afghanistan. As he engaged in this work through The Soldiers Project, and through other avenues in his practice, he discovered that in spite of significant progress in treatment outcome, up to 50% of patients in studies supporting evidence-based approaches, “still meet diagnostic criteria for PTSD at the end of treatment and at follow-up,” (Resick, et al., 2014, p. 429); even among those who don’t, high residual symptoms often remain (Bradley, Greene, Russ, Dutra, & Westen, 2005); and dropout rates of 39% continue to be reported (e.g., Gutner, Gallagher, Baker, Sloan, & Resick, 2016; Kehle-Forbes, Meis, Spoont, & Polusny, 2016). Findings such as these, and the better clinical results he saw using SCT, have led Dick into the research he is currently doing in an effort to improve treatment outcome for our veterans.

Dr. Ganley (Dick) is a clinical psychologist and certified group therapist, who works with individuals, couples, families, and groups in his practice just outside of Philadelphia, PA. He specializes in treating posttraumatic stress disorder (PTSD), while also working with a variety of other conditions, and doing psychological and neuropsychological evaluations. In addition, Dick is the Research Director for The Systems-Centered Training and Research Institute (SCTRI), and along with Jacquie Mogle, Ph.D. from Penn State University, is doing pioneering research in applying systems-centered therapy (SCT) to the treatment of combat-related PTSD.

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