Implementing brief Dynamic Interpersonal Therapy (DIT) in a VA Medical Center

Abstract

Background: Given increasing mental health needs in the VA, identifying strategies to deliver new services is critical.

Aims: This paper describes the process of navigating provider, patient and systems barriers of an initiative to increase choice, access and quality of psychotherapy at the VA by incorporating an evidence-based short-term, psychodynamic psychotherapy.

Methods: Brief Dynamic Interpersonal Therapy (DIT) was selected as a viable model for implementation. Data were gathered on the process of implementation, barriers, Veterans seen, and access to psychodynamic psychotherapy.

Results: Nine psychologists and 22 masters level pre-doctoral psychology externs have delivered DIT to 73 Veterans. Veterans referred for psychodynamic psychotherapy annually increased 360%. Furthermore, DIT has become the dominant form of psychodynamic psychotherapy requested of the psychology service representing 70.1% of psychodynamic psychotherapy referrals. Strategies are presented for addressing: (1) provider ability, flexibility and motivation, (2) Veteran perception of relevance, distinctiveness and adaptability to complex presenting issues and (3) administrative support.

Conclusions: Implementing an evidence-based short-term psychodynamic treatment option in the VA is feasible. VA mental health providers can be trained in brief psychodynamic psychotherapy and can successfully implement those approaches in VA settings. Finally, psychodynamic treatment approaches may serve as a promising alternative to currently available treatments.

Keywords:

• psychotherapy
• implementation
• psychodynamic
• mood disorders

Notes

¹ Not all veterans referred for DIT were offered DIT. In our clinic, Veterans could be referred to multiple psychotherapies (e.g. CBT, Behavioral Activation) and were offered treatment based on the availability of therapists with expertise in the specified approach.