Editor’s note: This article first appeared on The War Horse, an award-winning nonprofit news organization educating the public on military service, under the headline “‘We Need to Terminate Treatment’: VA Mental Health Providers Say They Are Under Pressure to Limit Care.” Subscribe to their newsletter.
It was a Friday last November when Robert H. got the news: He would no longer be able to see his VA therapist.
After nearly two decades as a Marine and military contractor in Iraq and Afghanistan, he had been working through PTSD with the same VA psychologist for 10 years after a suicide attempt.
“That one hour a month of emptying that five-gallon bucket of 10 gallons of shit was just heaven-sent,” said the 49-year-old veteran who shared his story and records from his VA medical files with The War Horse but asked to be identified by his first name and last initial to protect his medical privacy. “It let me reset every month.”
He was furious when his psychologist told him of a recent directive from management, spelled out in Robert’s medical notes: “We need to terminate treatment with pts [patients] who have been receiving long-term psychotherapy and are functionally stable.”
He could join a therapy group, but the one-on-one sessions were done.
“My anxiety was under control for a good time,” he said, “until this.”
When The War Horse reached out to the Department of Veterans Affairs to ask about Robert, a spokesperson said it was a mistake for his psychologist to have ended his care, and VA had contacted him to apologize.
But mental health providers in five states tell The War Horse that VA medical centers across the country have been instituting similar limits on one-on-one mental health therapy in recent years and transitioning veterans to lower levels of treatment. The trend has led to anxiety—and great debate—among both providers and patients.
Mental health providers in the Northeast have even been disciplined for seeing too many patients for too long, according to documents reviewed by The War Horse.
Yet when asked about the therapists’ concerns, a VA spokesperson insisted the claims of widespread caps on individual mental health sessions are untrue.
“This is false,” said Susan Carter, director of media relations at VA. “If the veteran still has clinical care needs, there are no limits on the number of VA appointments a veteran can have in mental health or any other areas.”
The dispute comes as a new report from VA’s inspector general found psychology was the most frequently reported area for severe clinical staffing shortages at VA medical facilities.
There is evidence that shorter treatments can successfully treat mental health conditions like PTSD. For many veterans, the model works well—and it allows a health system that is stretched thin to see more patients.
Robert is one of more than 1.7 million veterans getting mental health care at VA, with only about 10,000 psychologists and psychiatrists to treat them. He has made considerable progress, but is it enough to stop seeing his psychologist?
VA clinicians and psychology experts told The War Horse that directives that limit one-on-one therapy leave no flexibility for individual patient needs and clinical judgment.
“I think one of the obligations that we have to people who serve is to provide health care and not to limit that health care arbitrarily,” said M. David Rudd, an Army veteran and professor of psychology at the University of Memphis who researches military suicide prevention.
Stepped down from treatment
Carter, the VA media relations director, said there is no official VA policy limiting a veteran’s mental health sessions.
“VA works with veterans over an initial eight to 15 mental health sessions and collaboratively plans any needed follow-on care,” Carter 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.”
If you are struggling with your mental health, help is available. Contact the Veterans Crisis Line by dialing 988 then Press 1, or text 838255.
But six current and two former VA mental health providers who spoke to The War Horse insisted that they have been told to stop seeing veterans for long, indeterminate periods and instead move towards a limited number of sessions before referring the veteran to group therapy, primary care, or discharging them altogether.
VA’s response is “kind of maddening,” said Stephen Long, a former psychologist and psychoanalyst at the Northport VA Medical Center on Long Island who retired in 2024 primarily because he was being told to limit individual therapy sessions. “Most of the people who are on the ground in clinics, they see this happening, this is their lived experience.”
Clinicians who spoke to The War Horse said they were pressured to cut off individual therapy in most cases after anywhere from six to 24 sessions, depending on the medical center.
At a VA in the Northeast, mental health providers said they have been told to discharge patients after a maximum of 24 sessions and refer them to group therapy or primary care.
“The thing that’s scary is we’re going to get rid of people who need care, who are maintaining [stability] because they’re in ongoing care, and what’s going to happen to them in a few months, in a few weeks, in a few years?” said one provider, who feared retaliation for speaking out and asked not to be identified.
A provider at a VA on the West Coast said there has been a push in their medical center over the last seven months to “step down” veterans who have been utilizing more than 12 to 15 one-on-one mental health sessions. The provider, who also feared retaliation and asked not to be identified, described “a revolving door for veterans to get in, get quick care, hopefully get stabilized and then get out, because we’re just not going to have the number of clinicians to provide the care that ultimately they need.”
At a VA in Temple, Texas, therapists were instructed to limit individual therapy to six sessions, one every other month, according to Mark Jorges, an Army veteran and mental health counselor who said he left the Central Texas Veterans Health Care System in May due to frustrations over wait times and leadership.
For some veterans, Jorges said, six sessions were enough. “But the majority that I saw, they needed more than six sessions,” he said. “It’s kind of a wide spectrum that you’re dealing with in mental health. So putting a cap on it at six is inappropriate clinically.”
Multiple providers told The War Horse that shortening wait times and opening new mental health appointments for more veterans was one reason they were instructed to limit the number of therapy sessions.
Right now, it takes an average of 19 days for a new patient to get an individual mental health appointment at VA nationally, according to data provided by a VA spokesperson, though time varies by region. As of Aug. 25, wait times at the San Francisco VA Medical Center for new mental health patients was 45 days, while the wait time at the VA Medical Center in Wilmington, Delaware, was 12 days.
These are much lower than wait times for the general population, where more than half of psychologists don’t have new patient openings, and it can take approximately two months to see a psychiatrist in person.
VA is facing a different problem, however: It is quickly shedding mental health providers. According to VA workforce data published in late July, the Department has lost a net total of nearly 150 psychologists in the 2025 fiscal year so far.
One solution is obvious, said Russell Lemle, a senior policy analyst for the Veterans Healthcare Policy Institute and former chief psychologist at the San Francisco VA Health Care System: “The right answer is just to hire enough psychologists.”
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Can fewer sessions work?
Despite the frustrations of providers and veterans, there is evidence that short-term treatments do work for many veterans.
For years, VA has followed what it calls “evidence-based” guidelines for mental health treatment— practices supported by decades of rigorous research, much of which has been funded by VA. And the research is clear: Short bursts of specialized therapies can effectively treat PTSD for vast swathes of veterans. VA’s work in suicide prevention is also very effective — suicide rates were lower for veterans who received care at VA compared to those who were treated by outside providers through VA’s community care program, according to a VA report.
Alan Peterson, an Air Force veteran and psychologist at UT Health San Antonio who researches PTSD in veterans and service members, said there are a few evidence-based PTSD treatments that work particularly well. Two of the most common are prolonged exposure therapy, which uses talking and breathing techniques to confront past trauma, and cognitive processing therapy, which uses writing and talking to confront negative thought patterns about trauma.
For many veterans, a short course of sessions “should be sufficient,” Peterson said, assuming the therapist is properly trained and the patient completes all sessions.
In fact, Peterson has studied ways to make the treatments shorter and more intensive so that service members can participate in them while still on active duty, allowing even more access to mental health treatment.
The psychologist who developed cognitive processing therapy, Patricia Resick, told The War Horse that veterans often have more trouble than civilians when it comes to successfully healing from PTSD. “People get them ready to go to war, but they don’t get them ready to be at home,” she said, “so they keep that sense of always being in danger.”
Resick, now a professor emeritus in psychiatry and behavioral sciences at Duke University School of Medicine, agreed that CPT for veterans can effectively be done in short courses of treatment. However, she said, many people with PTSD also grapple with other issues like substance use, depression, and eating disorders. “Even if you treat the PTSD, they may need more sessions,” she said.
Rudd, the psychologist who researches military suicide prevention, said some veterans with complex PTSD may need treatment for even longer. “For people with complex or chronic PTSD, they need ongoing and oftentimes lifetime support to be able to manage the upset and distress that’s associated with the trauma, particularly when they’re non-responsive to treatment,” he said.
Robert H., the Marine veteran, appears to fall into that category, according to his medical notes.
“It is not expected that Mr. [H.] will enter full or partial recovery nor remission,” wrote a VA medical center assistant chief of mental health in a medical letter reviewed by The War Horse.
Robert’s PTSD got worse when he was forced to return to the office for his job as a Department of Defense security specialist, where a firing range nearby shook his building and rattled his nerves.
“I don’t like to go into crowded places,” he said, noting that he only goes into town once or twice a month since taking DOD’s deferred resignation option in the spring, and “I wouldn’t do that if I could get Walmart to deliver my groceries.”
When Robert was mistakenly “stepped down” and offered group therapy, he turned it down. “You want me to be honest? You want me to rip off Band-Aids and scabs? I ain’t doing it in the middle of a group,” he said.
Asked about Robert’s case, Peter Kasperowicz, VA’s press secretary, told The War Horse, “It’s clear episodes of care best practices were not properly followed…and VA has contacted him to correct the situation and apologize.”
Robert said he did get a call from a social worker offering to book him with a new VA therapist in several weeks. He also got a letter offering appointments with a psychologist in the community on VA’s dime. A recent VA announcement extended the authorization of community care mental health services for a year, making it easier to see the same provider for longer. But Robert isn’t sure what he wants to do.
“I’m not gonna say I’m surviving just fine,” he said. It’s a “broken system.”
Are you a VA mental health provider or patient who would like to share your story? Reach out to our reporter via email at leah.rosenbaum@thewarhorse.org or leah.rosenbaum@proton.me, or on Signal atleahrosenbaum.01.
Sonner Kehrt contributed reporting to this story. It was edited by Mike Frankel, fact-checked by Jess Rohan, and copy-edited by Mitchell Hansen-Dewar. Hrisanthi Pickett wrote the headlines.
