Some VA therapists and patients say their treatment sessions are being limited, raising alarm
By Brian Todd, CNN
(CNN) — An edge comes to Michael’s voice when he speaks about his time serving in Afghanistan and his struggles living with post-traumatic stress disorder.
A hardened Marine veteran, Michael — who asked to use the pseudonym to speak candidly about sensitive health issues — describes in tones that are measured but laced with irritation what he saw in conflict: vehicles being blown up, children being exploited, cellphones that could trigger unexpected detonations.
Though he left the armed forces years ago, he still has flashbacks. To this day, he is “trying to figure out how to stop the nightmares,” he said.
It took him years to find a trusted VA therapist, who gave him a lifeline after he struggled with addiction and was hospitalized following multiple suicide attempts, he said.
But recently, Michael’s one-on-one sessions with the provider were suddenly terminated.
Some Veterans Affairs hospitals, including the one where Michael gets his care, have stepped up enforcement of a policy in recent years that limits the number of long-term therapy sessions available to individuals, according to half a dozen mental health providers and VA patients at locations across the country who spoke to CNN.
Under the policy, put in place under earlier administrations, patients initially get a certain number of one-on-one therapy sessions, which can vary between four and 24 sessions, depending on the type of treatment.
Mental health care providers at four facilities have told CNN that, whereas in the past they had discretion to extend the number of sessions based on their assessments of their patients, the VA is now pressing them to stop one-on-one sessions at the end of the allotted series, and more broadly reduce the number of patients who get this long-term care — without consideration for whether this is clinically appropriate. The providers asked not to be named for fear of retribution.
In some cases, providers told CNN that if they pushed back on the policy, they faced disciplinary consequences, which could result in their privileges to practice therapy at VA facilities being removed. CNN has viewed some of these documents discussing disciplinary measures. Some providers said they had to justify extending care to more sessions in writing — a change from previous practice at their VA facility.
Contacted by CNN, the VA denied veterans aren’t getting the care they need.
A spokesperson for the department said it was not aware of providers facing disciplinary reviews for challenging a policy to limit sessions.
“There are no limits on the number of VA appointments a Veteran can have in mental health or any other areas,” Peter Kasperowicz, the spokesperson, said.
The VA “works with Veterans over an initial eight to 15 mental health sessions and collaboratively plans any needed follow-on care,” he said. “As part of this process, Veterans and their health care team decide together how to address ongoing needs, including whether to step down to other types of care and self-maintenance, or continue with VA therapy.”
“The goal is recovery, healing and helping Veterans achieve greater independence and resilience.”
While some providers who spoke to CNN said they are given some flexibility to extend care, all said there has been a draconian effort to move patients out of individual therapy more quickly since President Donald Trump took office in January and installed Doug Collins as VA secretary.
“It’s really, really frustrating. These people need help,” one provider said. The person stressed that some mental health conditions are “chronic,” and those patients would need treatment for life.
Another provider described having to inform one of their patients that sessions would be ending, saying: “It was terrible. The timing wasn’t right. There were still things we were working on.”
“It felt like it was a moral failing on my part, even though it wasn’t my fault,” the provider said. “It’s re-traumatizing for the veteran. It almost feels like I’m a perpetrator of that, having to carry out those orders.”
Michael, the combat veteran, said that finding out his therapy sessions were to stop felt “like being abandoned — you’re thrown away like yesterday’s trash.”
“I’m not ready to address all my issues on my own yet,” he said. “It feels like they took the training wheels off before I’m ready.” He has re-applied for one-on-one care and is in the middle of a monthslong waiting period.
A larger debate
Some providers said they were told the rationale for the renewed push to limit therapy sessions is to free up room for more veterans to enter the VA system and receive mental health treatment, and to move patients through the system more rapidly.
Some studies do suggest that shorter-term, limited sessions can work well for particular veterans.
And the practice of limiting longer-term mental health care for some patients is also commonplace in the private sector. “Larger hospitals and health care systems do sometimes place limits,” said Caitlin Thompson, a former VA psychologist who oversaw the Veterans Crisis Line and suicide prevention program and now works in the private sector. “It depends on what’s clinically appropriate,” she added.
One former VA mental health care provider, who is now in the private sector and didn’t want to give their name, said: “When insurance is paying for mental health care, utilization review is standard practice. It’s not open-ended. There are weigh stations.” It is often important to set goals and timeframes in treatment to track progress, they added.
However, VA providers who spoke to CNN said there were problems with how the limits were being implemented at their VA facilities.
One provider said that while they agreed with the objective to bring more veterans into the system to access care, “it should be agreed upon between the patient and the therapist” regarding when treatment should end — and not be imposed by the institution.
Another mental health care provider at a VA facility in the western US said that because of the intensified push to limit sessions, “we have been hemorrhaging staff ” as some mental health providers quit in frustration over the policy — at a time when the VA already has a severe shortage of psychologists, according to a recent VA Inspector General report.
Stephen Long, a former VA psychologist at the Northport VA Medical Center on Long Island, told CNN that he retired in 2024, in part because he was told to limit one-on-one sessions with patients.
Longer-term, more open-ended therapy builds more trust between veterans and their therapists, he said. “If you can’t have this kind of therapy, you’ll miss opportunities to develop that trust.”
Some veterans will need therapy for the rest of their lives, Long said. Treatment needs for physical illnesses would never simply be cut off — “If you need insulin for your diabetes, you don’t stop it,” he said — and mental illnesses should be treated the same. Some providers who spoke to CNN also said veterans often have issues that lend themselves to needing longer-term care.
Mark Jorges, a former psychotherapist and mental health counselor at the VA hospital in Temple, Texas, says he resigned this May in part because of his frustrations over the mandate to limit sessions. “I brought it up all the time” to leadership at his hospital, Jorges told CNN.
He says from the time he started working at that VA facility in 2021, there have been various attempts to have therapists limit sessions.
But setting a set number of sessions “as a directive is not appropriate clinically, because veterans have different pathologies according to what they’ve been through,” Jorges said. “You could be talking about someone with PTSD, depression, anxiety, acute stress disorder … that’s the majority of patients I saw. You can’t put a cap on it. It’s just not appropriate.”
The American Psychological Association, the largest scientific and professional organization for psychologists in the US, told CNN it is aware of reports from VA psychologists of mental health visits being limited for some veterans, and is looking into them.
“Veterans deserve individualized, recovery-oriented care based in shared decision-making between the provider and the Veteran,” Katherine McGuire, the APA’s chief advocacy officer, said in a statement.
“The VA has a great history of providing excellent mental health care by exceptionally skilled providers apt at assessing veterans’ needs and appropriate treatment options.”
Patients were offered other options for treatment, such as group therapy or the chance to re-apply for one-on-one treatment.
But some veterans who have come to depend on their trusted therapists say those are not palatable options.
Michael said he was offered group therapy, but does not want to take it as he feels uncomfortable speaking about his issues in a group setting. Even when he is approved for one-on-one treatment, which can take months, he is not assured of seeing the same therapist.
He feels uneasy about potentially seeing another therapist, he said. “It took me a long time to open up” to his trusted therapist, he said.
Jake Pannell, an Army veteran who’s been receiving one-on-one mental health treatment for PTSD and anxiety at a VA facility in Washington state for several years, told CNN that in recent months, providers have told him that “unless there’s an active crisis, they are no longer going to do just check-in visits.”
“I’ve continuously received one-on-one treatments at the VA for many, many years,” Pannell said. “And as we’re starting to get notified of these things, even the providers that are taking care of these veterans are telling us that, regardless of what the condition is, or regardless of what the veteran’s going through at the time, they are limiting a certain time frame down to 8 to 12 visits.”
Pannell, who now works for a federal workers union, has himself previously worked as a VA behavioral health counselor specializing in drug and alcohol rehabilitation.
“We’ve got veterans with severe PTSD, drug and alcohol issues. And that requires continuous maintenance,” he said. “Once that crisis happens, so — we have to wait ‘till veterans threaten to kill themselves before they get care?” he asked. “I’m scared to death. I’m scared to death for my veterans.”
“We just want the care that we were promised,” the Afghanistan combat veteran said. His main concern as he’s waiting for a new set of therapy sessions, he says, is “just lettin’ everything take back over.”
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