Rosanna Sposato, PsyD, specializes in CBT for a variety of disorders and presenting problems. She has led Beck Institute workshops geared toward mental health professionals as well as organizations. In her work with our Training for Organizations program this year, she has provided trainings focused on treating veterans, active-duty military, and their families for Cohen Veterans Network, Fort Hood, and the US Air Force.
Prior to providing trainings for BI, Dr. Sposato completed her postdoctoral internship studying under Dr. Aaron T. Beck at UPenn and stayed on as a staff member. She began working with the Beck Initiative and Dr. Gregory K. Brown, who runs the Penn Center for the Prevention of Suicide. This was her first experience working with suicidality in the military, and it prepared her well to provide these trainings.
What trainings are you providing to those who work with active-duty military, veterans, and their families, and what does your typical trainee look like?
The majority of my trainings have suicide prevention as the focus, but they also cover anxiety disorders, depression, and substance use issues. There have been a range of trainees, including graduate students; chaplains; Master’s and Doctoral level clinicians who treat active-duty military, veterans, and their families; as well as non-mental health professionals who interact with this population or other members of the multidisciplinary treatment team. Something unique about these trainings is that, often, there are therapists who have served in the military themselves. This provides a welcome perspective, and I feel that I get to learn a great deal from them as well.
Can you speak more about therapists who have served in the military and how their lived experience plays into your trainings?
It’s amazing to learn from these trainees because they can use their own experiences to inform the care they provide. This also helps them build credibility with their clients, an important aspect of the therapeutic relationship. I have such admiration and respect for those who serve in the military, and it is a privilege to hear about their experiences.
Something that stands out to me about therapists who have served is how much their values influence them; they have such passion for what they do. I see an eagerness to learn and talk about how to help those in their communities, even when they are managing large caseloads or feeling burnt out. They have a special dedication to their clients that makes it really enjoyable to work with them.
What else differentiates these trainings from the trainings you provide to those who work with clients in the general population, or not exclusively with clients in the military community?
There is typically more stigma around mental health services in the military population, for a variety of reasons. Clients in the military community may have had negative experiences seeking out mental health services, or there may be concerns about confidentiality and how their mental health struggles might impact their ability to continue serving. For example, a client in the military may be hesitant to disclose suicidal ideation because they are afraid that they will be limited in terms of their assignments, or that others in the community will find out details about their treatment. I talk a lot with trainees about how to assuage these fears and reassure their clients.
A question I hear frequently from trainees working with the military community is how to engage or motivate clients who are resistant to beginning therapy or have a hard time opening up. For these clients, there are multiple strong values and ingrained ideologies that feel antithetical to what occurs in therapy. Military service is associated with a strong sense of pride and bravery, and vulnerability is not always seen as a positive from their perspective – especially when being unemotional may serve them well while doing their job or when they want to advance in their careers. I work a lot with trainees on finding creative ways to communicate the benefits of talking about emotions in a safe space. This is vital, especially for clients who have experienced trauma.
Can you expand on the role that trauma plays in your trainings?
So many clients with military experience have had traumatic experiences, and even though we may not always be doing trauma-focused work with them, we must always keep an eye on how it influences their cognitive case conceptualization. In these trainings, I often get asked about whether to target trauma or suicidality first in therapy, so I talk a lot about the importance of decreasing suicidal risk before targeting trauma or PTSD symptoms. Unfortunately, once suicide risk is down, many clients may believe treatment is over; however, there are often other difficulties or symptoms that the client would benefit from working on in therapy that would enhance their quality of life.
There is also a lot of shame that must be addressed surrounding trauma, PTSD, and mental health issues in general for those in the military community. Therapists who work with military clients may hear thoughts such as, “I shouldn’t be as affected as I am,” or, “I chose this; I want to serve. I shouldn’t be feeling this way,” or, “Why am I having these symptoms?” This has a lot to do with the stigma we discussed earlier. Although there has been a lot of work surrounding acceptance of PTSD and training for therapists to address it through multiple modalities, there is still a long way to go, especially in this population.
Is there anything else that has stood out to you in these trainings that you want to speak about?
Training those who work with the families of those who serve or have served is a unique experience, sometimes more so than working with military clients themselves. There is a lot of difficulty surrounding family and reintegrating into one’s previous life after going away for long periods of time. We talk a lot about psychoeducation to help family members understand mental health struggles, as well as working with families to enhance communication skills so that family members may better support loved ones who have served or continue to serve. There are considerations to be made both in terms of readjusting to the home environment and being mindful of post-deployment obstacles. This piece can be even more complex than helping them cope when their loved one is on deployment.
The last thing I’ll say is that I know there are clinicians who believe they are doing trauma work by virtue of the fact that they are talking about trauma. This is, however, just the first step, and there are many methods and resources that must come into play around how the trauma is discussed as well as what occurs after the trauma is discussed. Something that I work hard to emphasize in these trainings is that at times it is necessary to focus several sessions or more on trauma and that there are a variety of empirically-supported methods to choose from when addressing it. By educating their clients about these options, they can empower them to play an active role in their treatment and in choosing which treatment options they are willing to pursue. Continuing to give clinicians access to more training and education surrounding evidence-based treatments for trauma as well as other psychological conditions is vital, in this population as well as the general population.