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
“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.
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
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.
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.”
7290 Virginia Parkway, Suite 3100
McKinney, Texas 75071