Helping Our Heroes

By Christina
Garcia | Photos by Lee Ann Baker/LABphotography

She’s
not just a therapist for veterans, she is one. Carlene Maxie knows the
military path, while proud and deeply bonding, can result in some of the
toughest mental health issues to cope with alone. For many veterans, an
eventual return to civilian life offers slim relief. Maxie is there to help.
Now retired from a 30-year Navy career, the Licensed Master Social Worker
(LMSW) leads the group called The Front Line Program at Connections Wellness
Group in McKinney.

Tailored to serve
veterans and first responders, the program helps members process trauma in a
12-week partial hospitalization (PHP) and intensive outpatient (IOP) groups.
Outpatients are joined by PHP patients, who themselves attend one more hour
of group therapy per day.

“There’s a
level of trust,” said Maxie. In the West Indies-born vet who joined the
military out of East Texas, there’s also a level of respect. She approaches
therapy as a firm, consistent, and

caring presence.

“I can say,
‘Hey, I know you’ve done great things. Let’s see what you’re capable of

.’”

Connections
Wellness Group Executive Director Alyssa Evans says the group dynamic is
especially effective because veterans and first responders are used to
working as a team. This population relates to one another and sometimes holds
each other accountable in the safety of the group while maintaining a
supportive spirit. Some outpatient group members even choose to stay an extra
hour to bolster the inpatient group, said Maxie.

Accessible,
Intensive

The program
is new. The end of March saw The Front Line Program coalesce with sessions
available to all Texan veterans and first responders. Crucially the
flexibility of hybrid attendance makes mental health care more accessible.
While some patients live in McKinney, others drive in from hours away just a
few days a week and then participate online. On those days of distance
attendance, they’re projected on a big screen to be part of the group.

Joining the
group could be as easy as calling to say you need help. Connections Wellness
Group then performs an assessment and determines the appropriate level of
care relative to their offerings. For those who need it, group therapy runs
three to four hours per day, Monday through Friday, with no more than 10
people in a group. For intensive outpatient therapy, people attend the group
for up to six weeks, depending on individual symptoms and the severity of
those symptoms.

Some
patients will attend as part of a partial hospitalization. Those patients
will receive medication management twice a week and participate in four to
six weeks of the program, attending group therapy but also receiving
individualized therapy as well. Once PHP is completed, patients begin IOP
care, participating in three hours of daily group therapy, once a week
medication management, and individual

therapy sessions.

Discretion
is of the utmost importance throughout. For privacy and a feeling of safety,
the group is the only adult program in a professional office suite. “We are
intentional with how we have our rooms set up,” said Evans. “There’s no signs
that say what anybody’s walking into,” she said. For first responders like
the ER nurses, paramedics, firefighters, and police officers who still
respond to calls, this is crucial.

Targeted,
Helpful

Evans used
road rage as an example. “Have you ever been driving down the road and
somebody cut you off? Sometimes it’s fine and sometimes you lose your mind a
little bit. That’s because other things are going on. You’re not that angry
that someone cut you off. It’s more, ‘I got other things going on, and this
was the cherry on top.’ When a patient is in a trauma response and they’re
already activated and anything is gonna trigger them.”

Trauma can
cause a lot more than road rage. She told us personality disorders such as
borderline personality disorder and narcissism – neither of which is a mood
disorder – are also caused by trauma. The Front Line Program helps people
struggling with these trauma responses, and so much more.

Each
Connections Wellness Group therapist working with this population is trained
in cognitive processing therapy, but other modalities are used, such as
dialectical behavior therapy (DBT) and schema therapy. DBT, a form of
cognitive behavioral therapy, is used when people struggle to get into their
rational minds.

“A lot of
times when people have experienced significant trauma, they’re in one realm
or another. They’re intellectual and disconnected from their emotions or
they’re the opposite and they struggle to get into that rational mind,” said
Evans.

DBT teaches
people how to simultaneously
tap their intellectual and emotional minds. How? A lot of psycho-education.
Evans said mindfulness, distress tolerance, emotional regulation, and
interpersonal effectiveness can help treat PTSD, depression, anxiety, and
substance abuse disorders.

Schema
therapy combines cognitive-behavioral, attachment, and relational theories to
help people break out of the “schemas” they have created. Thoughts like
“everything has always gone wrong, so everything always will,” are one such
schema. Lots of this work can be done one-on-one, said Evans, but it engages
themes like attachment styles, abandonment issues, shame and guilt, social
isolation, failure, and anger.

Self-defeating behaviors, called maladaptive coping
skills, are also tackled. Each week of therapy addresses new themes, but as
topics are raised and the themes flow organically, changing when necessary.

Maxie told
us that younger veterans are motivated by older veterans, and the first
responders connect across their professions. Firefighters connect with ER
nurses, for example, and everyone talks about how they work through things.

“The group
dynamic is the most important thing for these individuals,” said Maxie.
“Being able to connect and relate. That makes this program stand out from
others… talking about what they see. They learn they’re not alone in what
they’re seeing and experiencing and they’re not alone in asking for
help.”