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Things You Should Know about the Military (If You’re Going to Be Treating Warriors & Their Families)

02 Jan

Hello again, everyone!

We continue to get requests for a recap of my NICABM plenary talk from Hilton Head.  It was the result of hearing from too many Service Members diagnosed with combat stress, all the ways that mental health providers had let them down (with some notable exceptions, of course).  Some of it had to do with the edginess of the warriors – it didn’t take much to drive them out of treatment, given the biochemistry of combat stress.  But a lot had to do with the way the clinicians didn’t understand military culture or the experiences these warriors had been through.

And the criticisms weren’t just leveled at civilian providers, I was surprised to see.  I got an earful about behavioral health specialists in the military, too.
The general statistics are pretty grim, actually.  According to some of the most recent surveys, of the 40-50% who will actually try going to a therapist, at least 60% will drop out – many after one session (or a fraction thereof, which is to say they’ll walk out before the hour is up).
We need to do better than this – especially because more and more civilian providers are going to be called upon to treat traumatized, depressed, addicted and/or troubled service members and their families.
So, I thought, given my own steep learning curve over the past few years, I could probably share some useful insights and save some of you some time and trouble - at least give a heads up about what to look for.  I kid you not: I scrambled like crazy to understand norms, language, culture, acronyms, hierarchical structure and the overt rules and regs that drive military life.  I still don’t know half of it, but I’m way ahead of where I was.

There’s way too much info to put in one update, so I’m going to break it up. I’ll start here with some of the norms and values to be cognizant of, because otherwise they could trip a therapist up.  In later updates I’ll cover language, Do’s and Don’ts and more.
Here’s Part One on norms:

  1. For starters, they’re called “service members” because it’s about service.  It’s not about the self - it’s about the team and the mission.  It’s critical to understand (a) that we health professionals haven’t cornered the market on altruism; and (b) that the goal of therapy – to explore the fascinating inner workings of the Self – is not going to be given high value if there isn’t a larger goal driving this – to be of greater use to the team or the mission or the family.

  2. Unlike civilian life, where your status initially comes from being good-looking or wealthy or well-educated – things most 20-year-olds have little control over – in the military you get status from behaving with courage and watching out for others – an acquired behavior that can be learned.  For this very democratic reason, pretentiousness, hiding behind credentials, playing up your authority or being impressed with your own resume is seriously frowned upon and will get a therapist an immediate heave-ho.

  3. It’s not about how you feel; it’s about what you do.  Feelings are not the point; it’s all about actions taken or not taken.  So the therapeutic conversation needs to be adjusted for that.  That all-time, favorite therapy question, “So, how did that make you feel?” may need to be tweaked into something a little more cognitive and open-ended, like “So, what did you make of that?”.  You can get to the same place without worshipping at the altar of feelings.

  4. Informality, slang and swearing are OK with line soldiers and lance corporals, but best to watch your mouth with commanding officers.

  5. In keeping with #4, be aware of the very interesting interplay between the democracy and the hierarchy of the military, because it flavors everything and can seriously mess with your civilian head.  A One-Star may be astonishingly accessible and friendly, and may introduce himself as “Jack” and sign his emails that way, but he’s still “Sir” to you.  It’s probably the open, explicit hierarchy, reflected on everyone’s cap and sleeve, and the fact that everyone knows where everyone else stands, that allows for this powerful culture of social equality.  

  6. Flexibility, change, speedy decision-making and quick reassignments are the norm.  Mulling, pondering and slow deciding can create impatience and irritation.

  7. Being laconic is the norm.  You speak to the point.  You say what you mean (in actionable terms).  And then you stop talking.

  8. People don’t make excuses unless specifically pressed to explain how something happened.  You take your lumps without (heaven forbid) whining, take responsibility for failures and graciously give credit to others.

  9. All things being equal, military people will say “no problem” whether there’s a problem or not, so take this ubiquitous ‘can do’ attitude with a grain of salt.

So, I hope this is useful.  And if you tell me it is, I’ll follow up with other segments.

And just so you know, I’m still working on the writing for the new TBI imagery – haven’t forgotten about that. And we’ve had to rework our findings from the Fort Sill study, as we found errors in the earlier analysis.  We’re going over that now, and will be reporting back to the post at the end of this month.
Take care and be well.

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award