23 June 2017

Cognitive Processing Therapy - Week 0

The last time I talked to anyone from the Department of Veterans Affairs (the VA) was at my last appointment with a social worker at the Lawrenceville GA clinic on April 28. I have specifically been trying to get into cognitive processing therapy (CPT) which is a 12-week therapy program that I've done before, but for different reasons. This time I want to focus on the Persian Gulf War and my experiences there.

I don't want to rewrite the whole story here, but before that I'd been to a Vet Center five times, primary care three times, trauma recovery once. and the Atlanta VAMC emergency room once. I've been trying to get help with the elevated level of PTSD symptoms I've been experiencing since around Christmas 2016 and have been unsuccessful. It's just been one referral, one consult, after another.

So let's call this part one:

At that last appointment, the social worker initially had nothing to offer. I repeated several times that I was feeling much worse, and that I felt very strongly about wanting to do cognitive processing therapy. Now. Today. Let's get started and do this so I can get better. After a while of this, it occurred to her that the person from trauma recovery who does CPT happened to be in the Lawrenceville clinic that day-- would Social Worker like me to ask him about CPT?

Yes, I wanted you to do something to get me into that therapy a month ago, and a month before that when I was in the emergency room.

So she goes and talks to trauma recovery guy, and the best he can do is put "me in the queue".

Now, trauma recovery guy knew who I was because my name had come up in Trauma Recovery, who instead of offering me CPT offered me the Intensive Outpatient Recovery Program (IORP). When I'd gone to talk to Trauma Recovery in April, I'd also indicated that I wanted to do CPT.  So anyone in TR who heard my name should have also heard "cognitive processing therapy" along with it, meaning either the psychologist I talked to in TR didn't mention it or TR just ignored me. But the trauma recovery guy who's down the hall in Lawrenceville swears I'm on the list.

I didn't make another appointment with the social worker from primary care because I saw no point in doing so; there was no additional data entry to be done, meaning there was no where else to send a consult to. So I was "in the queue".

Weeks pass, I handle family visiting very badly. I try writing a letter to my U. S. Senator to ask for help. After a number of attempts to write something coherent, I just spell it all out and send it. A request for a records release form comes from the Senator's office, I send that back, and then a week ago today I get a call from someone from the VA in Atlanta. This person is someone who is in charge of things and can get things fixed. After several days of telephone tag (which was partially due to me not sleeping on any kind of schedule), we have a long conversation in which I explain all of what's happened over the past nearly six months.

He contacts the trauma recovery guy who does cognitive processing therapy in Lawrenceville, the same one who "put me in the queue" back in April. Because of the phone tag delay, I wasn't able to get into the appointment slot that the trauma recovery guy had open last week; but would I like to get an appointment this Friday at 1400? Yes, yes I would. 

When I was talking to guy in charge the other day, he mentioned a couple of other things. 

First, there's a telehealth option where the VA gives me a tablet with internet access (I'm guessing an iPad that does cellular) so that I can do therapy from home. In almost six months, no one else even mentioned that this was an option.

Second, trauma recovery guy who does cognitive processing therapy had two open time slots in Lawrenceville in June. The first was last Friday, the second is today. Remember that I was "in the queue", according to the social worker I saw the last week of April, who said she'd talked to trauma
recovery guy. I was most definitely "in the queue".

Look, I wasn't fucking born yesterday. I'm a hacker, and I'm quite familiar with how a queue works because I've written code that uses them. I'm also a veteran, and have had enough hurry up and wait to last an entire lifetime. Finally, after all I'd been through already I knew it was bullshit-- even when I managed to get scheduled appointments, they never resulted in me being in therapy anyway. 


Part two

Last week, after finally talking to the guy in charge, the social worker who does cognitive processing therapy called and left a vociemail with a date and time. I called back and confirmed. A week ago Friday, I finally had an appointment to go to that wasn't an intake. SW and I had a frank discussion about everything that happened, including the part about "the queue". We also started discussing the actual therapy and how to get that started.

This week, today, is week one of cognitive processing therapy.

In trying to do some preliminary thinking about stuck points and trauma and all of that, I've realized that in all of the different kinds of therapy I've done, the only one that directly addressed the Desert was prolonged exposure therapy. All of the others-- mindfulness, acceptance and commitment, behavioral activation, wellness recovery action plan, transitions clinic (aka intensive outpatient recovery), even the stuff I did at the Vet Center, none of them included me directly thinking about what had happened during the Persian Gulf War.  

Now, all of that therapy talked about a lot of other things, ways to be calm and to cope in a positive way. They offered checklists, guides, explanations, to do lists. After going through all of it, and ending up being homeless for two years and failing out of college twice, then ending up on disability and wondering if ending my life would help matters, I can't help but wonder what the fuck any of the therapy (or the medication) was really supposed to accomplish.

Looking back lately, I'll be damned if it wasn't like trying to treat a broken leg by learning to use crutches more efficiently instead of setting the broken bone properly and putting it all in a cast or a boot first. I've had first aid classes at various times in my life, and one of the most important rules is always to try to stop the bleeding-- but you have to identify where the blood is coming from and why before you can make the bleeding stop.

In all but prolonged exposure therapy, it was usually against the rules to talk about specific traumatic events or triggers. More than once I wanted to raise my hand and ask "so what the fuck are we here to talk about then?" In prolonged exposure therapy, it was a just about the event (which in my case was being ass out of luck in a bunker), and not about reactions to it and feelings about it. I've honestly had very few times in my life since coming back in 1991 where I was able to actually sit down and talk about the really good shit, how I feel about it, how it relates or doesn't relate to the world I'm in now.

Nobody seems to want to hear about the morally ambiguous parts, where you realize that all of the videos you've seen of precision munitions blowing apart a bunker in Iraq are blowing up a command and control facility that is probably quite similar to yours. No one wants to hear that since 2003, the war that defined your life is now just a footnote to another generation's war. Certainly no one wants to hear that you're having trouble managing your life because you have all of this shit in your head, and it's crowding out the simple things that everyone takes for granted as easy.

I don't expect this round of cognitive processing therapy to answer all of these questions, or even any of them. What I do hope for, is that I can change the thought patterns that I've had going on over the past six months (and really, three plus years) into something that I can actually move forward from and maybe even build on. I have a lot of things I need to try to make peace with. Where I am now, both in terms of location and in terms of mental health, isn't allowing me to do that.

It took writing a far too emotional letter to my U. S. Senator to get into this therapy. I do have a lot more to say about that, but for right now I have to set that part of the story aside and focus on the therapy I've fought to get into.

It is a 12-week program, which means I'm going to be working on this all summer-- assuming no delays, done in mid-September. So I'm where I am until then. Once the therapy is done, I expect that my outlook on things will have changed, that I will feel differently than I do now, and that life is going to need to change. It's possible I'll stay here, if I find work that I can do. It's possible I'll just go back to Wisconsin for a while and try to figure things out from there again.

I'm going to try to post something every week through the 12 weeks. Depending on a lot of things, posts might not appear exactly every seven days.

So it begins.

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