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PTSD and the "Difficult Client":

Using a Developmental Model to Inform Treatment

Fred D. Gusman, M.S.W.
Pamela J. Swales, Ph.D.
National Center for PTSD

About this Course Module

This course presents a model of life experiences and development known as the "Developmental Model" (DM). The DM surveys the client"s life history of pre and post-deployment/trauma development and offers the provider a basis for case-conceptualization and treatment of the client with traumatic stress reactions/PTSD. While these clients likely experience emotional, cognitive, and behavioral difficulties, some become so impaired that they may be experienced by providers as "difficult clients." Case examples applying the DM are used to illustrate: types of problems experienced by "difficult clients"; case-conceptualization; treatment issues, and, common provider reactions to these types of clients.

Goal: This course reviews many issues associated with traumatic stress reactions/PTSD and offers the Developmental Model as a basis for case-conceptualization and treatment of those clients who may be perceived by providers as "difficult" to treat.

Objectives: After listening to the presentation, the participant will be able to:

1. List and describe many of the cognitive, emotional, and behavioral difficulties experienced by those clients with combat stress reactions/PTSD
2. Outline and discuss the Developmental Model of case conceptualization and care
3. List common provider issues/reactions when faced with "difficult clients" and illustrate how the Developmental Model can be implemented to help address these