Skip to main content

Is this time of year harder than it is supposed to be? Ways to get support over the holidays

The Denning Center — counseling and accelerated resolution therapy

Finding and paying for ART

ART for veterans and military families: TRICARE, the VA and what to check

Neither TRICARE nor the VA has a separate benefit for ART. It is outpatient psychotherapy, so what matters is which route you are using and what that route requires before your first session.

Veterans, service members and military families can use Accelerated Resolution Therapy (ART) through the same routes as other outpatient therapy: TRICARE, VA Community Care, or paying privately. ART has no special status in either system, and it is billed as ordinary psychotherapy. The things to check are whether you need a referral, whether your route limits session length (TRICARE covers individual sessions up to 60 minutes outside a crisis), and whether the clinician is in the right network.

Where ART stands with the VA and DoD

Much of the ART research has involved service members and veterans. Its only randomized trial in PTSD was funded by the Department of Defense and enrolled 57 service members and veterans, comparing ART with an attention-control condition (Kip 2013). The developer of ART was a co-author, and the trial used self-report questionnaires rather than clinician-rated PTSD.

That is why the 2023 VA/DoD PTSD guideline found “insufficient evidence to recommend for or against” ART, noting that “No RCTs of ART included the critical outcome of clinician-rated PTSD.” The same guideline gives its strongest recommendation to Cognitive Processing Therapy, Prolonged Exposure and EMDR. A 2019 Defense Health Agency evidence brief reached a similar view: the evidence was “not mature enough to recommend ART as a front-line treatment.”

None of that means ART is unsafe or useless. It means it is less tested. If you want to start with the therapies that have the strongest guideline support, those are CPT, PE and EMDR, and that is a reasonable choice. I am trained in both ART and EMDR, and we can talk through which to start with. ART compared with other trauma therapies sets out the differences.

TRICARE in Texas: West region, TriWest

Since 1 January 2025, Texas has been in the TRICARE West Region, which is administered by TriWest Healthcare Alliance. Before that, Texas was in the East Region under Humana Military, which still administers the East. If you moved here from an East-region state, or your referral was issued before the change, your paperwork may still point to Humana Military. That is worth one call to check.

More detail for each: TRICARE, TriWest and Humana Military.

Who needs a referral

Referral rules for outpatient mental health care with a civilian network provider
Who you areReferral needed?Notes
Active duty service memberYes: a referral and pre-authorizationThe referral comes from your primary care manager, and there must be a reason you cannot be seen at a military hospital or clinic. No referral is needed to use outpatient mental health care at a military hospital or clinic itself.
TRICARE Prime (not active duty)No, for outpatient visitsExceptions: psychoanalysis and outpatient therapy for substance use disorder.
TRICARE Select, Reserve Select and other plansNoSame exceptions: psychoanalysis and substance use disorder treatment at a rehabilitation facility.
Source: tricare.mil Mental Health Appointments, and TriWest’s Behavioral Health Coverage and Requirements (June 2025). Rules change; confirm with TriWest before your first session.

TRICARE covers outpatient psychotherapy “when medically or psychologically necessary,” according to TriWest. Couples therapy is not covered.

The 60-minute limit

TRICARE’s service guidelines cover individual psychotherapy sessions up to 60 minutes, or up to 120 minutes for a crisis session. ART sessions in the research ran about 60 to 75 minutes, and in my practice they often run longer than a standard 50-minute session, with the length agreed before we book.

So a planned 90-minute ART session is longer than TRICARE’s standard limit. Before you start, ask TriWest how sessions over 60 minutes are handled on your plan, and ask your clinician how they handle it. The insurance page has a short script for that call.

VA Community Care

If you get your care through the VA and want the VA to pay for a civilian clinician, the route is VA Community Care. You need approval from your VA health care team before the first session (except in certain cases such as urgent or emergency care), and the clinician must be in VA’s community care network.

To be eligible you must be enrolled in, or otherwise eligible for, VA health care, and meet at least one condition. The ones that most often apply to mental health are:

  • VA cannot see you within its access standards. For mental health, that is a 30-minute average drive or a 20-day wait.
  • You and your VA provider agree that community care is in your best medical interest.
  • You need a service VA does not provide at any VA facility.
  • VA cannot provide the service in a way that meets its quality standards.

Ask your VA team exactly what an approval covers, how many visits, and when it ends, and raise an extension early rather than after the last session.

Vet Centers

Vet Centers are community-based counseling centers run by the VA. They offer free, confidential counseling to eligible veterans and service members, including National Guard and Reserve, and their families. That includes individual, group, marriage and family counseling, and counseling for PTSD, depression and the effects of military sexual trauma. The Vet Center call center is free, confidential and open around the clock on 1-877-927-8387, and can connect you to your nearest Vet Center.

A Vet Center is a good first call if cost is the barrier. For other local options, see veteran support organizations in San Antonio.

How I have used ART with veterans

I have used ART with veterans through the Lone Survivor Foundation, which ran free therapeutic retreats for veterans and their families until it closed in 2026. It is no longer a referral option. My San Antonio practice is in network with TRICARE, TriWest and Humana Military. More about that work is on the veterans and military page.

If things are bad right now, the Veterans Crisis Line is for veterans, service members and their families: call 988 and press 1.

Questions people ask

Does TRICARE cover Accelerated Resolution Therapy?

TRICARE has no separate benefit for ART, but it covers outpatient psychotherapy when it is medically or psychologically necessary, and ART is delivered as psychotherapy. Individual sessions are covered up to 60 minutes outside a crisis, so ask how a longer ART session would be handled.

Is ART approved by the VA?

No. The 2023 VA/DoD PTSD guideline says there is “insufficient evidence to recommend for or against” ART. It is used in some settings, but that is not an endorsement. The guideline’s strongest recommendations are for CPT, Prolonged Exposure and EMDR. See the treatment guidelines.

Do active duty service members need a referral for therapy off base?

Yes. To see a civilian TRICARE provider for outpatient mental health care, active duty service members need a referral from their primary care manager and pre-authorization, and there has to be a reason they cannot be seen at a military hospital or clinic. No referral is needed at the military hospital or clinic itself.

Can a military spouse use TRICARE for ART?

Family members on TRICARE Prime or Select generally do not need a referral for outpatient psychotherapy with a network provider. The same 60-minute limit on individual sessions applies. Confirm your plan’s rules with TriWest, because Texas is in the West region.

Who administers TRICARE in San Antonio?

TriWest Healthcare Alliance. Texas moved into the TRICARE West Region on 1 January 2025. Humana Military administers the East Region, so an older card or referral may still show Humana Military. See TriWest.

Sources

  1. TRICARE: Who are the East and West Region (T-5) contractors?
  2. TRICARE: Mental Health Appointments (referral and pre-authorization rules)
  3. TriWest Healthcare Alliance, Behavioral Health Coverage and Requirements (June 2025)
  4. TRICARE Overseas Program, Mental Health Care Service Guidelines (July 2025): 60-minute individual sessions
  5. VA: Eligibility for community care outside VA
  6. VA Vet Centers
  7. VA/DoD Clinical Practice Guideline for the Management of PTSD and Acute Stress Disorder (2023)
  8. Kip KE et al. (2013), Military Medicine: randomized trial of ART for combat-related PTSD

Read next

Next in Finding and paying for ARTCan ART be done online?

Written and clinically reviewed by Jim Denning, MA, LPC. Last reviewed September 24, 2026.

We review health content at least once a year, and sooner when clinical guidance, fees, insurance, or crisis information changes. Tell us if something here looks wrong.

You don’t have to do this alone.

Healing is possible. Tell us a little about what is going on and Jim will get back to you.

Get started210-714-3308
CallGet started