Challenges to optimal therapy outcomes

This chapter elaborates on the importance of balancing flexible administrations of cognitive processing therapy (CPT) with treatment fidelity. We review the universe of potential challenges that might arise in administering protocols such as CPT. Our intention is to illustrate the complexity of the disorder itself, the significant impairment in functioning often apparent in trauma survivors, the high rates of comorbid disorders that accompany posttraumatic stress disorder (PTSD), and the range of psychosocial stressors that often complicate engagement in treatment for PTSD. Our goal is to provide guidance in considering the breadth and scope of the patients’ clinical presentations in the development of a cohesive case conceptualization that guides treatment of PTSD with CPT, even in the most complicated cases. CPT was designed to treat PTSD and PTSD must be the primary disorder on the patient’s plate. However, other clinical issues relevant to the patient’s situation cannot be disregarded. The therapist’s case conceptualization must inform the administration of CPT.