What are the levels of care available for CPTSD?

Part of an ongoing series about life with complex post-traumatic stress disorder

CPTSD is a serious diagnosis that is often accompanied by other co-occurring disorders (for example, someone may have depression, generalized anxiety disorder, and CPTSD and/or a dissociative disorder). It’s important to get trauma-informed treatment with providers you feel safe with. Sometimes, people may reach a point where they struggle to keep up with their activities of daily living. This is not something to be ashamed about, but may mean that they need a higher level of care than weekly therapy. When I first started trauma treatment, I didn’t know that there was anything available in the mental health space between weekly outpatient therapy appointments, and emergency hospitalizations. Turns out, there’s a whole world in between. See below an outline of the types of care from least to most intensive.

Outpatient Therapy and Psychiatry
Purpose: Diagnosis, stabilization, skill-building, trauma processing, and integration, as well as medication management
Frequency: 1–2x/week for 50–80 minutes
Average price range: $150–300/session for therapy, $300–700/session for psychiatry
Examples: Look for therapists who state they specialize in complex or developmental trauma, and that use modalities like EMDR, brainspotting, NARM, somatic experiencing, or sensorimotor psychotherapy.
Insurance coverage: Typically covered by most major insurance. Most trauma specialists in the US are out of network (because of this, it helps to have a PPO insurance plan), which means you will typically need to pay up front, then submit the claim to insurance for reimbursement. Insurance companies typically take 4–12 weeks to reimburse, so it is helpful to keep several sessions worth of cash on hand to cover sessions in interim. Most therapists also state on their website whether they have a “sliding scale” option, which means they may take on some clients with a lowered fee structure. Psychiatrists are more commonly in network with insurance plans and may only require a co-pay. Call your insurer or have the psychiatrist’s office verify in network coverage prior your first appointment so you don’t end up with surprise bills.

Intensive Outpatient Programs (IOPs)
Purpose: Stabilization, skill-building, and trauma processing
Frequency: 3 hours a day, 3–5 days a week
Sample programs: Reconnect Integrative Trauma Treatment Center, Trauma and Beyond Psychological Center
Average price range: The cost can range from $1000 out of pocket for several weeks of treatment if a program is in network, to over $1000/day in private out of network programs.
Insurance coverage: Some programs are in network, some are not. Out of network programs may be only partially reimbursed by insurance.
May include: Individual therapy (EMDR, brainspotting, somatic experiencing, NARM, or sensorimotor), group therapy (psychodrama, dissociative disorder, DBT, ACT, IFS, psychodrama, art therapy, processing, etc.), neurofeedback, yoga, acupuncture, qigong, psychiatry

Day Treatment Programs (aka Partial Hospitalization Programs, or PHPs)
Purpose: Stabilization, skill-building, and trauma processing
Frequency: 4–6 hours a day, 4-5 days a week
Sample programs: Reconnect Integrative Trauma Treatment Center, Trauma and Beyond Psychological Center
Average price range: Generally $5000–7000/week out of pocket, which are often out of network and require up front payment. Most programs require a minimum 2–4 week commitment and payment at admission.
Insurance coverage: Most PPO insurance plans reimburse a percentage of program costs, with the covered amount varying greatly.
May include: Individual therapy (EMDR, brainspotting, somatic experiencing, NARM, or sensorimotor), group therapy (psychodrama, dissociative disorder, DBT, ACT, IFS, psychodrama, art therapy, processing, coping skills, etc.), neurofeedback, yoga, massage, acupuncture, qigong, psychiatry

Residential Programs
Purpose: Stabilization and skill-building in an environment that promotes healing and supports activities of daily living. Staff are typically onsite 24/7 for support.
Duration: All day programming often in a retreat style setting with on site lodging and meals, usually 14–45 days
Sample programs: PCH, Bridges to Recovery, The Meadows Wickenburg/Willow House
Average price range: May be nearly free if in network, but many are out of network and cost $40,000–75,000 out of pocket per 4–6 weeks of care.
Insurance coverage: In and out of network makes a huge difference in cost here. In network programs may be free after someone hits their annual out of pocket maximum; out of network programs are typically covered at a certain percentage up to the maximum daily rate an insurance company will cover, but require up front payments.
May include: Individual therapy (EMDR, brainspotting, somatic experiencing, NARM, or sensorimotor), group therapy, neurofeedback, HeartMath, yoga, acupuncture, qigong, TMS, psychiatry, family therapy, tai chi, equine therapy

Inpatient Programs
Purpose: Stabilization and skill-building, especially in when the client is unsafe on their own, in a hospital setting
Duration: 2–4 weeks
Sample programs: River Oaks, Forest View (note: I was unable to reach Forest View to verify their modalities)
Average price range: Varies.
Insurance coverage: Typically covered by major insurers — have programs verify insurance prior to admission.
May include: Group therapy, individual therapy

Stabilization or Diagnostic Units
Purpose: Short term specialty stabilization and diagnostics
Duration: 1–3 weeks
Sample programs: Sheppard Pratt (dissociative disorders unit), Menninger, McLean
Average price range: ~$50,000 out of pocket unless in network
Insurance coverage: Some are “private pay” and out of network but submittable for reimbursement, some are contracted with most major insurers.
May include: Stabilization through coping skills and grounding, internal communication, psychoeducation, DBT, CBT, reality testing, safety plan development.

Voluntary and Involuntary Holds (Emergency Psychiatric Care)
Purpose: Crisis stabilization, protecting health/safety of patient or others
Frequency: 1–14 days
Samples: Emergency rooms. These are for crisis stabilization, not structured longer term programs. If people can make it to residential or inpatient units first, they generally choose that over emergency care.
Average price range: Varies widely based on insurance
Insurance coverage: To my knowledge these are covered similar to physical health emergency room visits. Some hospitals may be in/out of network depending on your coverage plan.

Keep in mind that many paths are not linear. Here are a few different sample paths (note that CPTSD treatment generally takes multiple years of therapy and psychiatry).
CPTSD client 1: 2 years outpatient trauma therapy and psychiatry -> crisis, 4 weeks residential -> 6 weeks PHP -> 8 weeks IOP -> 3 years of outpatient trauma therapy and psychiatry
CPTSD client 2: 1 year outpatient therapy -> 8 week IOP -> 4 years outpatient therapy and psychiatry
CPTSD client 3: 2 years outpatient therapy with general CBT counselor -> 4 years outpatient therapy with trauma therapist

Some people may be unable to work due to a disabling level of symptoms, others may only ever do outpatient therapy. These are all valid paths to treatment, and it does not mean that you are flawed or broken to need a higher level of care at any point. Mental health crises happen to the best of us, the same way physical health crises like heart attacks, cancer, or major surgeries do.

Note: I have not personally attended all listed programs. I have spoken with each of them to vet that they offer best in class modalities for treatment of complex or single incidence trauma, or crisis stabilization.