Various organizations have provided treatment guidelines intended to aid therapists in deciding how to treat posttraumatic stress disorder (PTSD). Yet evidence-based psychotherapies (EBPs) for PTSD in the community may be difficult to obtain. Although strides have been made to implement EBPs for PTSD in institutional settings such as the United States Veterans Affairs, community uptake remains low. Factors surrounding clients’ decisions to enroll in EBPs have been identified in some settings; however less is known regarding trained therapists’ decisions related to offering trauma-focused therapies or alternative treatment options. Thus, the aim of the current study was to examine therapist motivations to initiate CPT in community settings. The present study utilizes data from a larger investigation aiming to support the sustained implementation of Cognitive Processing Therapy (CPT) in community mental health treatment settings. Enrolled therapists participated in phone interviews discussing their opinions of CPT, preferred treatments for PTSD, and process in assessing appropriate PTSD treatments for clients. Semi-structured interviews (N = 29) were transcribed and analyzed using a directed content analysis approach. Several themes emerged regarding therapists’ decision-making in selecting PTSD treatments. Therapist motivations to use EBPs for PTSD, primarily CPT, were identified at the client (e.g., perceived compatibility with client-level characteristics), therapist (e.g., time limitations), and clinic levels (e.g., leadership support). The results provide insight into the complex array of factors that affect sustainability of EBPs for PTSD in community settings and inform future dissemination of EBPs, including training efforts in community settings.

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Cognitive-behavioral conjoint therapy (CBCT) for posttraumatic stress disorder (PTSD) is a manualized therapy for couples designed to simultaneously decrease PTSD symptoms and improve relationship functioning. CBCT has only been tested in couples, not families of three or more members. Family therapy for PTSD may have merit given that there is a bidirectional relationship between PTSD symptoms and poor family adjustment. Adapting CBCT for families has the potential to broaden the impact of CBCT on multiple family members. We review the current evidence for CBCT, the familial impact of PTSD, and presently available family-focused treatments for PTSD. Next, we provide an overview of considerations for adapting CBCT to a family context, as informed by an initial effort to administer this intervention to a family of three. Considerations include lengthening the number and duration of sessions to accommodate hearing from more family members, replacing couple-specific content, tweaking instructions for worksheets, and ensuring that all members are included in the in-session and out-of-session practice. Logistical considerations when seeking to deliver family therapy during COVID-19 or virtual treatment are also described. Future research is needed to determine the efficacy of CBCT for treating PTSD within families. Public Health Significance StatementThis paper describes an initial effort to adapt an evidence-based intervention for PTSD (CBCT), designed for use with couples, for use with families of three or more individuals. It concludes that CBCT may be readily adapted to the family context, and it provides key considerations and recommendations for this approach.