Therapeutic strategies for working with veterans

Below are a few evidence-based treatment approaches to use. But it's important to remember success comes from adapting each approach to the client’s unique history, nervous system, and emotional tolerance. 

Cognitive processing therapy (CPT)

CPT helps to identify and challenge the “stuck points” or rigid beliefs that trauma can be rooted in. For example, a veteran may carry the burden of believing a negative outcome (such as the death of a fellow soldier and friend) was their fault, even when evidence proves otherwise. When adaptations are needed, use grounding techniques between processing or weave in values-based conversations when moments of moral injury surface.

Prolonged exposure (PE)

A strong therapeutic alliance and careful pacing is required for utilizing prolonged exposure, also known as PE. Known for being highly effective, PE is an evidence-based trauma treatment that helps clients gradually approach emotions, memories, and situations in a controlled and supported way. For many veterans, imaginal exposure, or repeatedly recounting trauma, may initially feel like losing control. Before beginning, it's important for the client and the therapist to agree on a strict time limit (ex: less than 10 minutes) before beginning their work together, providing the client with a sense of control from the overwhelming feeling of being “stuck” in a memory. Setting clear expectations, building strong coping skills, and managing exposure helps protect emotional safety.

Eye movement desensitization reprocessing (EMDR)

One of the most well-known treatment approaches for trauma reprocessing, EMDR uses bilateral stimulation to allow somatic memories to shift without requiring intensive recounting. EMDR is powerful for those who carry multiple traumas or struggle with verbal processing, and is adaptable. Slowing down sets of bilateral stimulations, taking time to build more resources, or pausing to ground and re-orient oneself during moments of activation are all accessible adaptations in EMDR.

While CPT, PE, and EMDR are commonly used, ACT, IFS, mindfulness, and behavioral activation can be used as additional approaches to support depression, identity, and reintegration challenges. Remembering that the work isn't about choosing one modality, but about offering the right method, at the right time, in a way that feels supportive to the veteran and their lived experience.

Trauma-informed care principles for veterans

When working with the lived experiences of military service, trauma-informed care becomes essential. As clinicians, it’s our job to use trauma-informed core principles to create a therapeutic environment that feels inviting, collaborative, and predictable, giving veterans a sense of control as they navigate their emotional experience. Some core principles include:

• Safety: Establish a consistent session rhythm (same time, same day) and check in on triggers such as room setup and environmental noises.
• Trustworthiness: Be committed to your word, even when it feels small. Remember that reliability builds credibility.
• Choice: Make shared decisions in goal setting, pacing, and interventions a common practice to reignite a sense of agency and autonomy in your client. 
• Collaboration: Using language like “Let’s do this together” builds partnership and reduces hierarchy in treatment.
• Empowerment: Highlighting strengths acquired in the military, like discipline, resilience, and leadership, honors and incorporates the clients’ identity and experience into treatment. Rather than enforcing rules or expectations, saying “I want us to work at a pace that feels comfortable for you and keeps you fully in control,” communicates respect, autonomy, and safety.

Integrating family systems in veteran treatment

Military service doesn't only impact the veteran, but the entire family system. Partners, children, parents, and loved ones often hold their own versions of fear, adaptation, and relationships with grief. Reintegration can bring a mix of emotional experiences, feelings of disconnect, or a mentality of “We aren’t sure how to do life together anymore.” 

When clinically appropriate, inviting family members into treatment can help bring dynamics to the surface that the veteran may struggle to identify or express alone. Work toward building an environment where communication, boundary setting, and shared meaning-making becomes part of the family’s story.