PTSD and trauma treatment for Miami — CPT, PE, and EMDR to protocol.

For clients in Brickell, Coral Gables, Aventura, or Pinecrest, RECO Health's Delray Beach campus is roughly 65 minutes up I-95 — close enough for family involvement, far enough that avoidance patterns tied to Miami's social scene lose their grip during treatment. Our trauma therapists are trained to protocol in Cognitive Processing Therapy, Prolonged Exposure, and EMDR, not doing generic "trauma-informed" work. Onsite psychiatry manages the SSRI, prazosin, and comorbidity pieces so trauma processing and medication management move together rather than sequentially.

The drive from Brickell or Coral Gables to RECO Health’s Delray Beach campus runs roughly 65 minutes up I-95 — far enough that most Miami clients enter residential or sober-living onsite rather than trying to commute to a partial hospitalization schedule from home. For post-traumatic stress disorder, that geographic separation from the neighborhoods where the trauma happened, the social scene that reinforces avoidance, and the venues where drinking or benzodiazepines became the coping mechanism is not incidental. It is part of what makes exposure and reprocessing therapy possible.

RECO Health treats PTSD, complex PTSD (ICD-11), and subclinical trauma syndromes at PHP and IOP levels of care with the three modalities that carry the strongest evidence base — Cognitive Processing Therapy, Prolonged Exposure, and EMDR — sequenced after a stabilization phase when the client’s window of tolerance requires it. Our PTSD and trauma treatment program is staffed by clinicians trained to protocol, not by generalists doing “trauma-informed” work.

Assessment: the PCL-5 and the trauma history that isn’t in the chart

Intake begins with the PCL-5 — a 20-item DSM-5-aligned self-report that anchors PTSD severity at baseline and tracks response through treatment. A total score of 31 to 33 is a reasonable threshold for probable PTSD, and we readminister at two-week intervals to see whether the four symptom clusters (intrusion, avoidance, negative alterations in cognition and mood, hyperarousal) are moving. The PHQ-9 and GAD-7 run alongside for the depressive and anxious comorbidity that is present in the majority of PTSD presentations.

The more consequential assessment, however, is the trauma history interview. Many clients arrive having never disclosed the index trauma — or the earlier traumas that produced the developmental attachment injuries underneath the acute event. RECO’s protocol builds enough safety in the first sessions for that history to surface without the client fleeing treatment. The differential between complex PTSD, classic PTSD, adjustment disorder with anxious features, and dissociative disorders is not academic; it changes the sequencing of exposure work, the choice of adjunctive medication, and whether phased stabilization is required before any memory-focused therapy begins.

Cognitive Processing Therapy, Prolonged Exposure, and EMDR

CPT is a 12-session structured protocol built around identification of “stuck points” — the assimilated or over-accommodated beliefs (safety, trust, power, esteem, intimacy) that fix the trauma memory in the present. The client writes an impact statement, works Socratic dialogues on stuck points, and completes challenging-questions worksheets between sessions. It is the modality of choice when a client can tolerate cognitive engagement but the avoidance load makes in-vivo exposure premature.

Prolonged Exposure adds imaginal exposure to the trauma narrative (recorded and reviewed between sessions) plus an in-vivo hierarchy of avoided situations. PE tends to be the higher-yield choice when avoidance is the dominant clinical feature and when the client’s substance use is sufficiently controlled that a distress spike will not immediately be medicated away. EMDR uses bilateral stimulation during targeted memory processing and is often the first choice when dissociation, somatic symptoms, or preverbal trauma make sustained narrative work difficult. Roughly a third of our trauma therapists are trained in two of the three; presentation drives the choice, not clinician preference.

Pharmacotherapy for PTSD is adjunctive, not primary

Sertraline and paroxetine are the only FDA-approved medications for PTSD. Both reduce hyperarousal, intrusion, and avoidance symptoms modestly, but neither remits PTSD as monotherapy, and the effect size is well below what protocol-driven psychotherapy achieves. Venlafaxine is a reasonable off-label option, particularly when comorbid major depression is a driver. Sertraline is typically initiated at 25-50 mg and titrated toward 100-200 mg over four to six weeks, with the PCL-5 and PHQ-9 tracking response.

Prazosin is our standard for trauma-related nightmares and sleep-onset disruption, dosed at 1 mg at bedtime and titrated by orthostatic blood pressure toward a typical target of 2 to 15 mg. Mirtazapine (15-30 mg qhs) can address sleep and appetite when SSRI-induced insomnia becomes a barrier. Benzodiazepines are avoided outside acute withdrawal management — they interfere with fear extinction, worsen long-term outcomes, and complicate any co-occurring substance use disorder. Antipsychotics carry weak evidence in PTSD and are reserved for narrow indications such as trauma-related psychotic features or severe treatment-resistant hyperarousal.

Stabilization before trauma processing

Trauma processing without stabilization retraumatizes. For clients who arrive in acute crisis, active substance use, or dissociative overwhelm, the first phase of treatment is skills-based rather than exposure-based. DBT distress tolerance modules (TIPP, self-soothing, radical acceptance), grounding practice for dissociative episodes, sleep restoration through behavioral protocol and prazosin, and medication stabilization for co-occurring depression or bipolar spectrum illness come before any formal CPT, PE, or EMDR begins.

For clients arriving with active alcohol or benzodiazepine dependence, medical detox using CIWA-Ar-guided taper precedes trauma work entirely. Opioid use disorder is managed with buprenorphine or extended-release naltrexone before exposure is considered. Rushing to trauma work — a common failure mode in outpatient settings and in less structured residential programs — is what produces the “trauma therapy made me worse” reports. The RECO protocol treats stabilization as a discrete phase with its own completion criteria, not as an obstacle to the “real” work.

What the first two weeks look like

Week one is assessment-heavy: full psychiatric evaluation, PCL-5, PHQ-9, GAD-7, ASRS if attention concerns are present, ASAM Criteria dimensional assessment when substance use is a factor, and a graded trauma history interview across two to three sessions. Medications are adjusted or initiated; sleep is prioritized because untreated sleep disruption blunts every subsequent intervention.

Week two typically opens formal group programming — trauma-focused psychoeducation, DBT skills, relapse-prevention group when indicated — and the treatment team decides between CPT, PE, or EMDR based on presentation, dissociation load, and avoidance profile. Individual trauma-focused sessions begin twice weekly. Family sessions, when clinically appropriate and the client consents, are scheduled from week two onward.

Insurance and admissions from Miami

RECO Health is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans. Admissions runs verification of benefits within a few hours of the initial call and provides a written estimate of client responsibility before admission. For Miami-based clients, transport from Miami International Airport, Aventura, or Pinecrest is coordinated directly; most clients arrive by car or by our staff pickup. Same-day admission is available when clinical acuity requires it.

Serving residents of: Brickell, Coral Gables, Coconut Grove, Aventura, Pinecrest.