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cognitive processing therapy -- forms
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My T is using PTSD forms to start my CPT program.

The form is PCL-5. If you want to look at it it's here: https://www.ptsd.va.gov/professional/assessment/documents/PCL5_criterionA_form.PDF It's not quite the same layout but it's pretty much identical wording.

I have 3 trauma eras:

  • Age 3 to 4 ? CSA where I was my brother's meat toy.
  • Age 5 to leaving home. Intermittent emotional neglect. Possible physical abuse.
  • Age 21 to 45. Job related trauma involving 15 deaths, 3 near deaths, two of the nears were on my watch, plus constant low grade stress.

Form below. The questions are in bold. my comments in plain text.

Briefly identify the worst event (if you feel comfortable doing so.)

Umm. How do you define worst? I have a host of problems that resulted from the concatenation of the traumas, but how to I attach these? Which one do I think had the biggest effect. Not sure that either. By the time I was 18 I was pretty self confident and chipper (I found some letters from that age.) So overall the third set.

How long ago did this happen.

Over a span of 25 years spread over 45 years.

Did it involve actual or threatened death, serious injury, or sexual violence.

Between the three the answer is yes, multiple times.

How did you experience it?

____ It happened to me.

____ I witnessed it

____ I learned about it happening to family or close friend.

____ I was repeatedly exposed to to details as part of my job.

____ Other, please specify.

Answer: Yes.

  • On several occasions I expected to die.
  • I saw three boys escape death under my watch, one came within inches of being smashed between a filled canoe and a cliff, one who had to be restrained from walking into the fire he was so cold, and one who passed out drying by the fire and fell twice, once head first into the fire.
  • I learned about the Temiskaming canoe tragedy only the fact of it's happening while running another trip, and had to hold that for a week getting to a phone. I knew all the staff on that trip.
  • That disaster came up for years as we analyzed our program and rebuilt it with safeguards.

If the event involved death of a close family member or close friend, was it to to accident or voilence, or was it due to natural causes.

____ Accident or Violence

____ Natural Cause

____ Not applicable. No death of close person

Finally something I can answer unambiguously. All of them are Accident or Violence.

***

Page 2 is questions "How much were ou bothered by during the last month... and then 7 typical PTSD questions that I answer zeros to. Then another bunch that are valid CTPSD questions.

Does anyone know of a similar form actually set ukp for CTPSD?

How do I fill this out?

Right now I'm looking at filling it out just like this in a word processor document with all the caveats and lots of "See attached note 17"

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Rape, emotional neglect, probable physical abuse. No memories.

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2 years ago