Practically Speaking: Behind the Episode: A Visit to Dr. Ruzek's PTSD Group Laboratory
I’ve had mixed experiences with group therapy in my clinical practice. There’s no doubt that groups offer unique benefits beyond individual therapy. But they can also be difficult to initiate, in terms of recruiting group members, conducting screenings, and finding a time (and location) that works for all. And, in my experience, the choice to offer a group can sometimes be made out of necessity, as opposed to being a thoughtful recommendation based on the particular needs of the patient(s).
Listen to the full discussion here: A Visit to Dr. Ruzek's PTSD Group Laboratory
As we discussed in this episode of Practical for Your Practice, there have been times in my career where group therapy was encouraged not because of its unique benefits, but because it was a way to increase access in an overburdened system. A challenge that I mentioned was how to serve a group of patients who had completed an EBP for PTSD. The demands of the system I worked in included a long wait list of patients waiting for an EBP. With a full caseload, the only way to get new patients into an EBP was to move patients off my caseload once they completed a course of treatment.
In response to those demands, I started an “EBP Alumni” group at my clinic. My goal was to provide ongoing services to a group of patients who had received the best available treatment (and who were doing better, based on outcome measures), but who wanted or needed ongoing support. There was no intent to identify new treatment goals or improve symptoms further. In many ways, this was a “holding pattern.” At the time, I viewed this as a negative reality. In retrospect, that was a short-sighted perspective.
In this episode of Practical for Your Practice, Jenna and I talked with Dr. Josef Ruzek, a retired Director at the National Center for PTSD’s Dissemination and Training Division. Dr. Ruzek has a long-standing interest in group therapy and recently edited a book summarizing existing research and future areas for exploration. Dr. Ruzek’s passion for group therapy is contagious. As he says in the episode, when describing his history of leading group therapy within the VA:
“Out of that experience, I thought that groups are pretty marvelous things. The magic that happens in a group, the mutual support among people that have been through similar experiences can't really be recreated between a therapist and a client so much because you haven't walked in [patients’] shoes and they relate to each other. And I saw that magic and I realized it could do a lot of things.”
I witnessed this “magic” occur in my EBP Alumni group. While I was not tracking symptom reduction or other outcomes, the sense of connection and warmth in the room was palpable. This group of combat veterans, whom most people might see as “gruff” or “hardened,” shared their doubts with each other, hugged one another, and even shed a few tears together. Over time, they started spending time together outside of the clinic, building true friendships. My initial perspective of the group only serving a “holding pattern” was short sighted because it ignored 2 important questions: Are there treatment benefits outside of outcome based measurement? And are those benefits any less valuable?
According to Dr. Ruzek, the answers to those questions are obvious:
“We don't want to just reduce bad feelings. When we treat a person for PTSD, are they having more fun experiences, more good, strong, enjoyable emotions, more connections with other people? Is that happening more intensely and more often? It ought to because that's what having a good life means.
My interest has never been solely in symptom reduction. It's more in helping people build a better life for themselves. And groups are very good at doing a whole lot of things that individual psychotherapy would find more difficult.” You don’t want to miss this episode if you have an interest in group therapy. Dr. Ruzek shares research findings and aspirations for the future, not just for PTSD treatment, but for people with all kinds of needs and goals. I’m sure you’ll find his passion contagious, too.
Listen to the full discussion here: A Visit to Dr. Ruzek's PTSD Group Laboratory
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Carin Lefkowitz, Psy.D., is a clinical psychologist and Senior Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Lefkowitz earned her M.A. and Psy.D. in clinical psychology at Widener University, with a concentration in cognitive-behavioral therapy.
I’ve had mixed experiences with group therapy in my clinical practice. There’s no doubt that groups offer unique benefits beyond individual therapy. But they can also be difficult to initiate, in terms of recruiting group members, conducting screenings, and finding a time (and location) that works for all. And, in my experience, the choice to offer a group can sometimes be made out of necessity, as opposed to being a thoughtful recommendation based on the particular needs of the patient(s).
Listen to the full discussion here: A Visit to Dr. Ruzek's PTSD Group Laboratory
As we discussed in this episode of Practical for Your Practice, there have been times in my career where group therapy was encouraged not because of its unique benefits, but because it was a way to increase access in an overburdened system. A challenge that I mentioned was how to serve a group of patients who had completed an EBP for PTSD. The demands of the system I worked in included a long wait list of patients waiting for an EBP. With a full caseload, the only way to get new patients into an EBP was to move patients off my caseload once they completed a course of treatment.
In response to those demands, I started an “EBP Alumni” group at my clinic. My goal was to provide ongoing services to a group of patients who had received the best available treatment (and who were doing better, based on outcome measures), but who wanted or needed ongoing support. There was no intent to identify new treatment goals or improve symptoms further. In many ways, this was a “holding pattern.” At the time, I viewed this as a negative reality. In retrospect, that was a short-sighted perspective.
In this episode of Practical for Your Practice, Jenna and I talked with Dr. Josef Ruzek, a retired Director at the National Center for PTSD’s Dissemination and Training Division. Dr. Ruzek has a long-standing interest in group therapy and recently edited a book summarizing existing research and future areas for exploration. Dr. Ruzek’s passion for group therapy is contagious. As he says in the episode, when describing his history of leading group therapy within the VA:
“Out of that experience, I thought that groups are pretty marvelous things. The magic that happens in a group, the mutual support among people that have been through similar experiences can't really be recreated between a therapist and a client so much because you haven't walked in [patients’] shoes and they relate to each other. And I saw that magic and I realized it could do a lot of things.”
I witnessed this “magic” occur in my EBP Alumni group. While I was not tracking symptom reduction or other outcomes, the sense of connection and warmth in the room was palpable. This group of combat veterans, whom most people might see as “gruff” or “hardened,” shared their doubts with each other, hugged one another, and even shed a few tears together. Over time, they started spending time together outside of the clinic, building true friendships. My initial perspective of the group only serving a “holding pattern” was short sighted because it ignored 2 important questions: Are there treatment benefits outside of outcome based measurement? And are those benefits any less valuable?
According to Dr. Ruzek, the answers to those questions are obvious:
“We don't want to just reduce bad feelings. When we treat a person for PTSD, are they having more fun experiences, more good, strong, enjoyable emotions, more connections with other people? Is that happening more intensely and more often? It ought to because that's what having a good life means.
My interest has never been solely in symptom reduction. It's more in helping people build a better life for themselves. And groups are very good at doing a whole lot of things that individual psychotherapy would find more difficult.” You don’t want to miss this episode if you have an interest in group therapy. Dr. Ruzek shares research findings and aspirations for the future, not just for PTSD treatment, but for people with all kinds of needs and goals. I’m sure you’ll find his passion contagious, too.
Listen to the full discussion here: A Visit to Dr. Ruzek's PTSD Group Laboratory
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Carin Lefkowitz, Psy.D., is a clinical psychologist and Senior Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Lefkowitz earned her M.A. and Psy.D. in clinical psychology at Widener University, with a concentration in cognitive-behavioral therapy.