You Can Also Follow CombatCounselor on:

Welcome to CombatCounselor Chronicle, an E-zine dedicated to giving you the most current, pertinent information on cognitive behavioral therapy (CBT) and mindfulness-based CBT available.

Chris Sorrentino, a.k.a CombatCounselor, is a leader and expert in cognitive behavioral therapy. He combines 30 years of experience in psychology with the discipline from having served as a U.S. Air Force officer for 20 years, 4 of those in combat zones, retiring as a lieutenant colonel in 2005.

The Leader in Military and Veteran Psychology ... Follow Me to Mental Health!

Sunday, May 20, 2012

Checklist for Hiring a True Cognitive Behavioral Therapist (CBT)

As executive director of Kansas City Cognitive-Behavioral Therapy (KCCBT) and an expert in cognitive behavioral therapy (CBT), I receive many calls from people looking specifically for a therapist specializing in CBT. Because I rarely have any openings, I make a lot of referrals. Unfortunately, there ARE FEW TRUE COGNITIVE BEHAVIORAL THERAPISTS, at least in my area.

When I say "TRUE COGNITIVE BEHAVIORAL THERAPIST", I mean somebody who is an expert in CBT (which requires advanced knowledge of learning theory; e.g. classical and operant conditioning, relational frame theory, etc.) and practices using "primarily" cognitive and/or behavioral techniques. Easier said than done!

Many therapists call themselves "COGNITIVE BEHAVIORAL" even though they may know little, if anything, about CBT. Why? Because most therapists (licensed professional counselors, clinical social workers, psychologists, and psychiatrists) depend on health insurance as reimbursement for their services AND insurance companies ONLY reimburse for empirically supported treatments (EST), with CBT being the primary (sometimes only) EST for the vast majority of anxiety and mood disorders (which make up the vast majority of disorders being treated).

Many of my clinical colleagues will probably not be happy with what I'm telling you and to them, as the character Gilly on Saturday Night Live would say: "uh huh"..."sorry!". We ALL owe it to our clients to be honest and provide the MOST EFFECTIVE TREATMENT available for our client's particular condition, which in many cases means CBT (the most researched and scientifically proven treatments available for many, not all, conditions).

When looking for a cognitive behavioral therapist, I suggest doing an advanced search on Psychology Today's Therapist Finder, screening for therapists in your zip code specializing in CBT for YOUR CONDITION. Once you have narrowed the list, start calling them and ask the following questions:

1. Are you a cognitive behavioral therapist and, if so, what technique(s) do you use for people with my kind of problem?

Answer: Yes. Answers could include exposure, exposure and response prevention (OCD), prolonged exposure (PTSD), activity scheduling (depression), cognitive restructuring, behavioral activation or rehearsal, and contingency management among others. Exposure, in vivo, imaginal, and prolonged, just to name a few is the treatment of choice for most anxiety-based disorders (e.g. generalized anxiety disorder, OCD, PTSD, agoraphobia, panic disorder, social anxiety disorder, simple phobias)

2. Which CBT therapy do you adhere to and who is the person (theorist) influencing your practice the most?

Answers: Cognitive Therapy (Primary Theorists: Beck, Ellis); Cognitive Behavioral Therapy or Stress Inoculation Training (Primary Theorists: Meichenbaum); Acceptance and Commitment Therapy - ACT (Primary Theorists: Hayes, Strosahl, Blackledge); Dialectical Behavior Therapy - DBT (Primary Theorists: Linehan); Mindfulness-Based Cognitive Therapy - MBCT (Primary Theorists: Williams, Teasdale, and Segal); Mindfulness-Based Stress Reduction - MBSR (Kabat-Zinn)

3. Estimate the percentage of techniques you use in therapy that are STRICTLY cognitive behavioral.

Answer: AT LEAST 60 - 70% is acceptable, preferably more.

4. Can you tell me the difference between positive reinforcement, negative reinforcement and punishment?

Answer: Positive reinforcement involves increasing the likelihood of a behavior occurring in the future by rewarding the organism immediately following the desired behavior. Negative reinforcement involves increasing the likelihood of a behavior occurring in the future by removing an aversive stimulus immediately following the desired behavior. Punishment involves introducing an aversive stimulus immediately following a behavior you are trying to eliminate and may work for a short time, but research indicates that it is ineffective in the long-term for changing behavior.
If they cannot answer this question, they know little if anything about the most important aspects of CBT and should probably be eliminated).

5. Do you offer FREE initial consultations (preferably in person, over the phone by exception)?

Answer: Yes. In-office consultations are preferred. If a therapist wants to charge you, keep looking unless they are obviously VERY SKILLED in CBT and you have no alternatives.

6. Are you licensed in your state (LPC, LCSW, licensed psychologist/psychiatrist, etc) AND certified (by whom)? What is your license/certification number?

Answer: Yes. Not all licensed therapists are also certified by a recognized national certifying body (requires passing a national exam and paying annual dues), but those who are indicates additional credibility and professionalism. Ask for the certifying body and certification number, then look up the licensing and certifying organizations on the internet and check to see if they actually exist, are current, and free of complaints or violations.

Unfortunately, there are many unqualified, unlicensed people out there calling themselves therapists, life/executive coaches, spiritual healers, etc. and probably do not have the necessary education, experience, licensing, and certification required to help you solve problems of the mind. Read my post "Client Beware" for more details about therapist credentials and picking a therapist.

In conclusion, CBT is one of the most researched, proven, effective, time-limited and cost effective (many problems can be treated effectively in 3 months or less - one one-hour session per week)  therapies available today and the treatment of choice for many psychological problems. So if you are looking specifically for a therapist specializing in CBT, as many educated consumers are, the preceding information should be helpful.

With that said, there are many reasons why CBT may not be appropriate for you or your particular problems. There are many good therapies and therapists available, so I recommend you do some research and know what you are looking for when selecting a therapist. In any event, to reinforce the importance of my earlier point, MAKE SURE THEY ARE LICENSED (PSYCHOTHERAPIST) IN YOUR STATE if nothing else.

Feel free to contact me if you have any questions or need additional assistance finding the right therapist for you. GOOD LUCK!

Wednesday, May 9, 2012

Timely Reply from Managing Editor, Air Force Times

From: Becky Iannotta
Sent: Tuesday, May 08, 2012 9:26 AM
Subject: Letter to Air Force Times

Mr. Sorrentino,

Please allow me to introduce myself. I have been the editor at Air Force Times for about six months, yet I do not recall ever seeing a letter from you in my current role or in my previous position as news editor of Air Force Times. Your letter on accidents and redeploying troops makes it sound as if you have written on multiple occasions. I apologize if you have sent letters that went ignored.

I would like to publish your letter as it relates to the "thrill seeking behavior" and lack of qualified mental health providers, and your response to the suicide story. The letter will be edited for space and style, as is our policy.

Thank you for writing and for reading Air Force Times.

Becky Iannotta
Managing Editor
Air Force Times

and my reply...

Ms. Ianotta,

Thank you for responding and for acknowledging the importance of these issues by publishing my letter. 

I have written on several occasions to Dr. Bret Moore (Kevlar for the Mind – psychotherapy related issues such as these), Ask the Lawyer (regarding being discriminated and retaliated against – as a male/disabled veteran – by the University of Missouri-Kansas City, a case that the US Department of Education is investigating and has found “cause” for mediation), as well as a few to where I sent these emails.

I would finally like to point out in Dr. Moore’s May 7th follow-up piece on the “stigma” of mental health in the military.  I believe he missed a tremendous opportunity to fix some things that have been broken in the DoD and VA for a long time and even hurt the cause by “recommending” that military members go the “chaplains” if they want 100% confidentiality.  Of course, chaplains provide wonderful services and there is a time, a place, and a person best suited for that experience. But the problem is that these wonderful people are not (normally) qualified to properly treat our military with PTSD and other mental health issues.  These young men and women (military and veterans) are committing suicide in record numbers, or are not seeking the treatment they so desperately need, because THEY ARE AFRAID TO SEEK TREATMENT because it WILL ruin their career and/or they WILL lose their security clearance.  That stigma and paranoia carries over into the VA system where they see the same bureaucracy and lack of a sense of urgency in helping them as they saw in the military.  I have seen it first hand in my role as a licensed clinician on military installations and experienced it myself upon return from a year in the desert (Aug 01 – Aug 02).  Even as a mental health provider myself, I would not and did not seek treatment UNTIL I knew I was retiring and could not be hurt by “the system”.

In any event, it is nice to have you on board as editor and am glad that you took the time to read my concerns and publish them.

Best wishes,


Chris Sorrentino
Chris Sorrentino, LtCol, USAF (Ret)

Tuesday, May 8, 2012

Letter to the Editor - Air Force Times

I'm not sure why I bother sending these emails because I have never even been acknowledged, but I feel compelled to speak out anyway. Maybe it is time to retire dinosaurs such as Bret Moore and Robert Dorr, hiring writers who are more in-tune with the realities of current military issues.

Regarding the subject article from your May 7th issue, Ms. Jowers omitted a critical cause of accidents for Redeploying troops, "thrill seeking behavior". After 8-15 months in a combat zone going 100 mph, figuratively, not literally, coming back home is a huge adjustment. It is widely known among anybody familiar with human behavior and the military that thrill seeking, such as speeding or driving while impaired, increases dramatically upon return to home post/base. If you've been in combat, and I have, you are on an adrenaline rush for months on end and crave that rush upon returning home. It should come as no surprise and, if records were kept during previous periods of combat operations (WWII, Korea, Vietnam), you would see exactly the same trends. How could your writer miss such an obvious variable?

As far as your editorial and reporting on the "lack of qualified mental health providers" in the DoD and VA, excuses both have been making for years, your writers have omitted another critical fact. The federal government has refused to acknowledge and hire master's-level licensed counselors for years! How can you, and they, whine about shortages of qualified clinicians when there are literally tens of thousands of licensed clinicians around the country, many looking for work, including me. I, for example, am a retired Air Force lieutenant colonel, combat veteran, disabled veteran, and licensed professional counselor (LPC) specializing in cognitive behavioral therapy (CBT) for post-traumatic stress disorder (PTSD). I have 30 years of education and experience working with anxiety and mood disorders, 21 of those licensed and nationally certified, yet the government readily hires social workers or psychologists fresh out of school over an "unqualified" clinician such as myself. Get a clue! Granted, not all LPCs have the experience I have, but if just 10% had the qualifications, the VA could easily fill those 1,900 vacant positions. Stop the whining and reporting half truths.

As far as Mr. Dorr is concerned, I'm sure I'm not the first person to mention this, I am sick and tired of his slanted, archaic, self-promoting chatter. Who the hell is he to tell the Air Force Chief of Staff which planes to keep and which ones to get rid of? I think it's time for some fresh blood and a current perspective in such a powerful role as is his. By the way, I'm not a volunteer for the position should you decide to join the 21st Century.

One more thing. In regard to the article on "Suicides" in the same issue, please read my blog and the post on The Stigma Killing Young American Heroes.
Capt Julie Hanover is quite right when see says "they believe it will hurt their careers", but quite wrong when McCarthy says "we need to educate airmen" about the 97% "adverseless" action rate. Do you really think Airmen will seek treatment when they have a 3% chance of ending their career? Are you serious? Airmen, soldiers, sailors, and Marines WILL NOT SEEK MENTAL HEALTH TREATMENT until there is 100% protection and limited confidentiality as is the right if every non-military citizen!  Do you and DoD leadership really think that it is better or safer to have people avoid treatment and keep their clearance? If you do, I have some oceanfront property here in Missouri you might be interested in!

This information will be posted on my blog,, so it won't go to waste when you ignore me once again. I have plenty of followers eager to hear what I have to say.

Thank you.

Chris Sorrentino, LtCol, USAF (Ret)

Follow me on Twitter @CombatCounselor
and on YouTube