Hello again. As promised, here are some of the treatment tips I presented in my talk at NICABM last month. Part one, on values and norms to be aware of was in an update posted a couple of weeks ago. We got such a strong response, I’m forking over Part 2.
I hasten to remind you that this is based on what I was told by a lot of Service Members who considered themselves Behavioral Health “washouts”. It pains me to say that some of this is stating the obvious and shouldn’t have to be said – they’re just the very basics of good treatment to anyone. But evidently reminders are needed in some quarters, so here they are- the unexpurgated list of “Do’s” – I may have to leave the “Don’ts” for another time, because this is pretty long for reading at the screen:
Do’s:
Listen carefully and patiently.
Be respectful.
Be authentic – phonies are quickly spotted and given the old heave-ho.
Make direct eye contact. (Ed. Note: Can you imagine coming home, feeling conflicted, confused and squirrely about some of the things you saw or did that felt “normal” at the time, and facing a therapist who can’t bring him- or herself to look you in the eye?? Oh, puh-lease.)
Lead with questions about physical or behavioral issues rather than feelings or emotions, unless they start there.
Let them tell the story in their own words, without interruption or interpretation or reframing, and use those words back in the conversation.
Rather than the standard “How does that make you feel?” you may want to try something more cognitive, like “What do you make of that?”
Empathic mirroring which works well in other contexts, like “That has to be hard” may be taken as an annoying invitation to whine and wallow.
Be aware that the moral injury warriors suffer when exposed to the worst that humanity has to offer, creates a profound existential crisis, unlike most of what you’ve seen. Treat this gaping wound with profound respect and compassion. Don’t judge. Open your heart and listen.
If you’ve been in the Service yourself, display proof around the office or bring it up in a casual way. This will be received with great relief.
If you haven’t, say that you’re aware that this is a disadvantage to you both; but that you are a pro and you can listen and learn.
Create a comfortable, welcoming, relaxed therapeutic setting – don’t sit (hide) behind the desk.
Engage in back and forth dialogue, respectful sharing and conversation about options, ideas.
Add psycho-educational components on the neuro-physiological nature of traumatic stress – get out of the realm of mental illness.
Don’t be abrupt with “Our time is up” – work a transition.
Dump the “D” in PTSD. Or call it combat or occupational stress.
Brush up on the concept of PTG or Posttraumatic Growth.
Learn some specific modalities that work for traumatic stress (I discuss this at length in Invisible Heroes but here’s a short list: guided imagery, EMDR, EFT, Somatic Experiencing, Trauma Incident Reduction, mindfulness or MBSR, yoga nidra, massage therapy, Reiki,Therapeutic Touch, biofeedback, neurofeedback, Trauma Releasing Exercises, etc.etc)
OK, hope this is useful. Let me know. And please add your own tips as they come to mind, or express your disagreement with some of mine. This is an important conversation for us to be having.
All best,
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I know your comments are focused toward the professionals, but we, the local folk, who organize the fly fishing outings and pheasant hunts for Warriors find your words very comforting. It helps us navigate conversations with Warriors when they come for a visit. Thank You....keep up the great work!
... written by J. T.,
January 18, 2012
Though not a veteran, I have had difficulty with providers of traumatic/chemotherapy brain injury rehab over the past 15 years...repeated injuries. Thank you for this list of "do's". I avoid therapists like the plague, now. Perhaps this list will help me access help that avoids "inattentional blindness". Your tapes have been a sanity-saver the past five years. At first I could only listen to the affirmations. In the last few months I can occasionally listen to the guided imagery. Thank you, thank you, thank you, Belleruth Naperstek! J. T.
... written by Mary Sise,
January 18, 2012
My favorite one is....drop the D in PTSD. Thank you for reminding us that the traumatic response is a "normal" response to something terrifying and overwhelming to the psyche, and also that the body is responding to the brain being stuck. Thank you for spreading the word that help and healing is available with all the new mind/body/spirit treatments. You are a gift Belleruth.
... written by Sandy,
January 18, 2012
One thing that hasn't been mentioned is Spiritual Emergency. The Near Death Experience is one of the better known. The data from the Spiritual Network indicates that trauma often kicks on an emergency. Things like a manic episode going into psychic opening or a life/death/rebirth experience being confused with psychosis is not going to be differentiated because the information is not being allowed into mainstream journals. It's tough because these are events that are growthful if helped through them, but not talked about because the experiencer knows they will be pathologized for talking about it.
... written by Sandy,
January 18, 2012
Oops - I meant to refer to the data collected by the Spiritual Emergency Network.
... written by Dr. George Patrin,
January 18, 2012
Belleruth, You are building a common bridge for us all between military providers and the civilian network. We need a common language to be integrated in our approach so the troops access a seamless and standardized team. Thank you for your sensitivity and flexibility in listening to our end-users.
... written by Jody,
January 19, 2012
If the wonderful above points are perceived as if 'different' from what is crucial to fostering any good connection and relationship building in community, in family, and therapeutically, or separate from foundational core understanding of trauma and post trauma living...then indeed we all owe further thanks to Warriors for creating a long overdue 'tipping point' in off known battlefields, too.
... written by Belleruth,
January 20, 2012
Big thanks to YOU, Col (R) George Patrin MD, for all your care and service, and for launching and setting up Patient Centered Medical Homes at Army installations across the country. Don't know how you did it all. And I hope you're enjoying your retirement!!!
Pat Alandydy, RNHats off to Pat Alandydy, RN, O.R. nurse, Reiki Master, health educator and integrative care innovator, who first approached the administration of Portsmouth Regional Hospital in Portsmouth NH back... + Full Story
Hello again. As promised, here are some of the treatment tips I presented in my talk at NICABM last month. 
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