THEORETICAL AND PRACTICAL FOUNDATIONS OF AN INPATIENT POSTTRAUMATIC-STRESS-DISORDER AND ALCOHOLISM-TREATMENT PROGRAM

This article describes the structure and process of the first inpatien t program in the Department of Veterans Affairs for the treatment of p ost-traumatic stress disorder (PTSD) and alcoholism. The therapeutic c ommunity setting utilizes lifespan developmental and social learning m odels to provide patients with 1) a framework for understanding what h as happened to them, 2) tools for more effective coping in the future, 3) an arena to experience the discomfort of their previous coping mec hanisms, and 4) the anxiety/pleasure of creating and practicing a new and more effective repertoire of skills. The program is divided into t hree phases, roughly equivalent to Prochaska & DiClemente's (1982) Sta ges of Change. Phase I focuses on solidifying motivation for change th rough assessment, education, and some interpersonal work. Phase II rep resents the action stage, and incorporates exposure-based therapy in a developmental framework to address trauma issues. Additionally, the s econd section of the program pushes deeper into understanding and modi fying the patient's interpersonal behavior. Finally, Phase III emphasi zes maintenance and generalization of their learning; modified relapse prevention training provides the cornerstone of this final segment.