Pieces to a Puzzle: Psychotherapy and Psychedelics

Psychotherapy Modalities for Military & First Responder Populations

High-stress, trauma-exposed communities need strategic, efficient, and culturally competent interventions. There are several effective modalities, due to their focus on the neurobiology of trauma, performance mindset, and relational disconnection: the three top challenges faced by those in uniform and their spouses. Also, note these are listed not in any particular order.

1. Cognitive Behavioral Therapy (CBT)

Best for: Anxiety, depression, transition stress, performance issues

How it works: Helps clients recognize and reframe unhelpful thought patterns that drive emotional and behavioral reactions.

Drawbacks: This therapy is focused on managing thoughts and does not deal with every symptom. This therapy also does not always deal with the root, it helps manage the impact of trauma and not the trauma itself.

Why it’s useful: Highly structured, goal-oriented, and appealing to individuals who prefer logic and tools over “talking about feelings.”

2. Cognitive Processing Therapy (CPT)

Best for: PTSD and moral injury

How it works: Focuses on identifying and challenging distorted beliefs that stem from trauma (e.g., guilt, shame, helplessness).

Drawbacks: This is a subtype of CBT that works on managing impact of thoughts however does not process physical symptoms. For example, you will commonly hear clients whom have successfully completed CPT say "I know this {thought} is not logical, but I still feel it."

Why it’s useful: Especially effective in military populations where trauma often collides with deep values like loyalty, justice, and leadership by reframing thoughts contributing to their distress.

3. Prolonged Exposure Therapy (PE)

Best for: Combat trauma, critical incident stress, avoidance-based PTSD How it works: Gradual, repeated exposure to trauma memories and avoidance triggers to reduce fear responses.

Drawbacks: While this decreases the level of distress exposure creates, it does not address all symptoms. Why it’s useful: Targets one of the most common trauma patterns—emotional numbing and behavioral avoidance—but can feel intense for some.

4. Eye Movement Desensitization and Reprocessing (EMDR)

Best for: Acute or complex trauma, moral injury, childhood or occupational trauma, anxiety and depression How it works: Uses bilateral stimulation (e.g., eye movements or physical) to help the brain reprocess distressing memories without being re-traumatized. Drawbacks: While you reprocess memories and decrease negative thoughts, emotions and physical reactions, this therapy does not work on habit changes Why it’s useful: Doesn’t require in-depth verbal disclosure, which appeals to clients who avoid talking about trauma directly. It is also fast-acting for many.

5. Internal Family Systems (IFS)

Best for: Identity fragmentation, moral injury, performance/perfectionism conflicts How it works: Helps clients connect with internal “parts” (protector, wounded child, etc.) and restore leadership from the calm, grounded Self.

Drawbacks: This therapy does not address all symptoms clients may be experiencing. Why it’s useful: Normalizes inner conflict and control issues; trauma is seen as “a part,” not a pathology.

6. Gottman Method for Couples Therapy

Best for: Marital stress, communication breakdown, emotional disconnection

How it works: Uses research-based tools to improve communication, conflict management, and emotional safety.

Drawbacks: Many military and first-responders struggle to connect emotionally and strive to protect their partners from the impacts of the job. While this therapy addresses marital conflict and some individual work can be done in context of marital therapy, many choose their own EMDR therapy in conjunction to marital therapy.

Why it’s useful: Especially valuable for first responder/military couples navigating shutdown, reactivity, emotional and communication disconnect, or hypervigilance at home.

A question I'm often asked is: "What about psychedelics?"

Psychedelic-Assisted Therapy: A Promising Frontier (With Critical Guardrails)

Substances used (in legal or trial settings):

• MDMA (commonly for PTSD; undergoing FDA approval)

• Psilocybin (for depression, existential distress, or stuck trauma)

• Ketamine (already legal in clinical settings for treatment-resistant depression/PTSD)

Why Psychedelics Are Gaining Attention

• They appear to disrupt rigid trauma loops and reopen connection pathways in the brain

• Clients often report breakthroughs in emotional openness, memory recall, and meaning-making

But Psychedelics Are NOT a Shortcut

Psychedelic sessions are only as useful as the psychotherapy that surrounds them:

Before:

• Preparation therapy sets intentions, builds trust, and helps regulate expectations

• Identifies trauma “targets” or emotional blocks

During:

• Must be guided by trained professionals in clinical or trial settings

• Psychological safety, grounding, and presence are crucial

After:

• Integration therapy is non-negotiable—this is where insights are translated into real-life behavior change, relationship repair, or healing narratives

• Without integration, even powerful experiences can become confusing or overwhelming

Final Word:

Psychedelics can unlock a door—but they do not replace the walk through it. For service members and first responders, they may offer a window of emotional flexibility that therapy then anchors into transformation.

No matter the modality you choose, there are options to support you reach your goals. Many clinicians integrate modalities to address challenges you are experiencing. There is no one size fits all approach- working with a culturally competent clinician utilizing an evidence base practice whom you are able to build a strong relationship with has been shown to have the highest outcomes. So be curious and find what works for you.