Staff Perspective: Back in the PE Therapist Seat

Staff Perspective: Back in the PE Therapist Seat

Reluctantly, I debated whether to try to get credentialed at the military hospital near me in pursuit of becoming a Prolonged Exposure (PE) therapist for a research study with Service members who have PTSD from deployment trauma. How would it feel to provide therapy when I hadn’t delivered clinical care for a long while? Was it worthwhile to pursue this PE therapist position when it would be outside my regular job?

When I decided to go for it and submitted my materials to the credentialing office coordinator in February, I thought my application would take about six weeks to process.  But after three long months of waiting—during which time I was told the credentialing board needed clearer copies of my degrees, a more updated basic life saving course certificate, and several other documents—I felt exasperated. “Okay- this isn’t meant to be”, I thought to myself.  I further engaged in self-talk, “At least I had tried. This was almost as hard as writing a dissertation—well not quite that bad.”  When I was told my paperwork had finally been sent to the first reviewer of the six required, I couldn’t help but think, “You’ve got to be kidding. How long would that take? Only five more reviewers to go after reviewer #1!  Maybe I should just retract my whole application.”

Then to my surprise in mid-July, I heard my application had been approved—finally  I was credentialed. Coincidently, a few days later the study team told me that there was a patient ready to be seen. A Service member had just completed the comprehensive intake and assessments and qualified for the study.  The individual was eager to begin.  There was no turning back now.

The study I am assisting on as a PE therapist is a fabulous randomized control trial being conducted at various military sites.  Since the research is still underway I can’t reveal details, but suffice it to say that different treatment conditions are being evaluated, including modifications to Dr. Edna Foa’s traditional PE protocol.

One of the most eye-opening aspects of the study has been uncovering the parallel processes at work while treating my first patient.  I learned that as my patient was facing the index trauma and getting more used to it by repeatedly retelling the full narrative and hotspots, I, too, was getting more accustomed to being a PE therapist again. Similar to my patient who was gradually habituating to the trauma memory and experiencing reduced levels of distress, I was regaining confidence that I could provide this gold standard treatment and my own levels of discomfort were decreasing session by session. Yes, by jumping in and doing it— coaching my patient, being fully present, and following the protocol, all of which built a strong therapeutic relationship—I was re-learning that delivering PE is a skill. Like a cyclist who hasn’t ridden on his or her bike for a long time, I needed to get back on the seat and begin pedaling over and over again and experience my own progress and discover that “I could” do this rather than “I couldn’t”.

Because I hadn’t used PE for a while and each session was videotaped to ensure fidelity to the protocol, I spent a good amount of time preparing each week. This included drafting my own session-by-session outline to use as a guide. From the beginning of therapy, I told my patient I would be looking at this guide periodically during our work, which the Service member reassured me was not a problem.  This transparent communication was positive for our therapeutic relationship. Additionally, by reviewing the DoD PE Therapist Adherence and Competence Rating Scale prior to each session, I prepared the essential points I would cover that week. These strategies worked well for me.

Ultimately, providing PE therapy to this Service member and seeing the positive results have been incredibly rewarding.  By the end of therapy, my patient had reclaimed activities in daily life that PTSD had stolen for years and was gaining more self-confidence. For example, the Service member was becoming more involved in the community; not letting anxiety or triggers get in the way of getting out and doing activities; feeling more in control of the trauma memory; experiencing less intensive PTSD systems; accepting more what had happened with less sense of responsibility and gaining a more balanced understanding of the roles she and others played in the traumatic event.  Scores on the PCL had gone down, suicidal thoughts were no longer being reported, and hope was shining through in a more positive outlook.

I’m glad to be back in the clinician’s seat as a PE therapist.  It’s been wonderful to work with a Service member and observe firsthand how PE can lead to remarkable improvement in less than three months.

For more information about CDP PE workshops and other trainings, please visit:

Paula Domenici, Ph.D., is a licensed Counseling Psychologist working as the Director of Civilian Training Programs at the Center for Deployment Psychology (CDP) at Uniformed Services University of the Health Sciences in Bethesda, Maryland.