We continue to get requests for a recap of my NICABMplenary 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:
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.
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.
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.
Informality, slang and swearing are OK with line soldiers and lance corporals, but best to watch your mouth with commanding officers.
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.
Flexibility, change, speedy decision-making and quick reassignments are the norm. Mulling, pondering and slow deciding can create impatience and irritation.
Being laconic is the norm. You speak to the point. You say what you mean (in actionable terms). And then you stop talking.
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.
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.
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... written by Elena Parsons-Wilson,
January 03, 2012
This was most helpful! Your experience thus far, Belleruth, can truly help all we therapists out there if we want work with our vets. Anxiously waiting for more. Thank you!
... written by Sue Hannibal, Army wife/PTSD therapist,
January 04, 2012
Right on the money. And I would add: "If you went on missions and never cleaned and maintained your weapon, that would put you and your battle buddies at risk, wouldn't it? Cleaning and maintaining your internal "hard drive" has to be done the same way. You have to be in top form mentally and emotionally as well as physically to execute the mission and make sure everybody gets back to base alive. Your focused mind and your M4 carbine are the weapons that will keep you and your buddies alive. Take care of both of them."
... written by Lynn Kennedy Baxter,
January 04, 2012
I grew up military. Your inventory of the norms is extraordinarily accurate and badly needed by the "touchy feely" therapists who cannot connect with a military man. The above comment about maintaining your weapon is a brilliant metaphor. We therapists need more coaching in this department. You have to speak the client's language for them to trust you and listen to you. Thanks.
... written by Belleruth,
January 04, 2012
Hard to argue with that one, Sue. Nicely put.
... written by Rebecca Cratin,
January 04, 2012
Thanks for the quick response to requests for this information. Please keep it coming.
Thanks again for all you are sharing and teaching us at this critical time in our nation's life.
... written by AnneS,
January 05, 2012
As usual, very helpful ideas, clearly articulated.
... written by Jane Twitmyer,
January 05, 2012
There is another approach that might be easier in the military culture. Start with the physical ... the hormonal, nutritional and basic building blocks that are so intimately connected with how the brain operates.
Places like Passages Mailbu, an addiction facility, do a uniique blending of analysizing and correcting individual physical functioning that is out of whack! Look for metabolic changes like the Functional Medicine people are doing with chronic diseases like Type2 Diabetes.
... written by Fania Chazen, MSW, LSCW,
January 05, 2012
Dear Belleruth, as usual : succint, well-thought of, excellent! and I really liked Sue Hannibal's addition!
... written by Deborah Kimmett,
January 05, 2012
I am a motivational speaker who got asked to do some work with the Canadian Military. So this article was SOO helpful. I now know why they looked at me like I had three heads.
... written by Belleruth,
January 05, 2012
Three heads are better than one.
... written by Nancy Mac,
January 05, 2012
How can we get access to your NICABM plenary talk from Hilton Head? I appreciate all that you wrote in this article, and am looking forward to reading more. And, any concrete examples of what you mention would help even more.
... written by Belleruth,
January 05, 2012
This insightful note came from a professor who does a lot of training with police officers:
I found your information on the service members very interesting. Some of what you talk about applies to my background and area of interest: policing. However, the chain of command hierarchy is very clear on paper but gets very confusing in application at the lower levels of the organization because of the officers needing to work with the community and solving their problems. However, the measurement of success, use of feelings, use of language etc. all of direct application to the police world.
Thanks
A Special Projects Manager Department of Public Safety
... written by MaryKathryn Simon,
January 06, 2012
Belleruth, All of what you say here is accurate, useful and valuable. Having grown up in a military family I know this and it is vital in working with servicepeople before the war ( firefighters, policeofficers, etc) with personnel during 9/11 here inNYC and in ongoing work with veterans and active military. Also valuable for any client who operates that level whether military background or not! Always appreciate your work. Thank you for all you do! Best, Mary Kathryn Simon NYC,NY
... written by Belleruth,
January 06, 2012
NICABM records all talks, and they usually have a copy that's sold to the general public. PO Box 523, Mansfield Center, CT 06250, (860) 456 - 1153.
... written by Sandy,
January 06, 2012
I'm an SEP grad. My Dad is a WWII vet and he's dying.
Several years ago when he was in his 80s, he asked me to help write his story. We wound up recording him telling it.
It it became evident he wanted to talk about World War II. His narrative started out with dates, places and events. The only thing I ever heard about the war was that the P38 was the best plane ever built. I asked what it was like flying it. He talked about the controls in the plane and the superior training they got in the field. He talked about the time his turbo charger blew and shrapnel hit him and burned his neck and leg. He knew he could fly home on one engine, but an enemy plane was coming after him. He couldn't outrun it. He knew he had superior guns - more reliable, accurate and farther range. He turned and chased the enemy away and made it home. He had to fly 50 missions to get home and he flew them.
He talked unemotionally about the emotional hardships others faced who didn't make it back from a mission. I asked what helped him survive. He said he got married. He imagined his going home to mom. How she would welcome him. He imagined starting a family, buying a house and so on.
The reality of coming home did not match what he imagined. It took three tries to talk about the home coming. He said he was so disappointed and angry he vowed he would never forgive mom. He truly believed she could not tell that he did not love her any more!
This past year a storm destroyed his home. His mental competence deteriorated. We went to see the VA representative about what was available for his needs. Dad was asked if he had any disability from the war. Dad said no.
When we got home Dad started to remember he had a problem with what he called the wobblies. His body started shaking so badly he couldn't fly. He said he took a week off, recovered and went back to flying and finished his 50 missions.
Then he started talking about the hardships others faced who didn't make it back. The gut wrenching horror and guilt of that time and events erupted. Both of us were bawling out the grief and loss. The emotions were so strong I was doubled over unable to move.
I am feeling a new kind of love for Dad. I also discovered Family Constellations. It seems to hit the spot for recovering generational trauma.
Thank you for sharing your experiences and thank you for the work you do.
Sandy
... written by Kathy,
January 07, 2012
with two returning warriors in my family/we are appreciating all the support and understanding we get
... written by Diane Gardner,
January 08, 2012
Your story really touched me Sandy and how sad your Dad had to be in is late 80's before his emotions could finally be released. All that time he had been taught by his training to never be emotional, no feelings, the enemy is just a target. On the inside his mates were being killed and they didn't come home to the people who loved them. He was killing people who had families too but THAT had to be OK. Yes it was a war to survive and to honour his country but for goodness sake these people are humans with emotions.
Who debriefed these soldiers after they came home back then? Usually nobody, they were just meant to go on with their lives being proud and don't talk about feelings while families tried to work out who their loved one was now and how distant and disconnected they seemed AND no wonder.
We are now seeing the results with the Vietnam war here in Australia now our vets are getting so much older. I don't know one Vietnam vet around me who is not in therapy and often their families too. They had the added distress of not even being welcomed home for doing their duty and following orders. So many were shunned.
Gary Craig worked some years ago with Vietnam vets in the USA and his results were outstanding BUT like you have said Bellaruth unless you follow the rules you are out. He had such a fabulous success that he was told not to come back and why because the psychologists and phsychiatrits would withdraw their services. So WHAT is the bottom line here? Who is this really about?
It is so wonderful Sandy that you now have a Dad who can FINALLY speak the truth about his feelings and be at peace before he passes and for a daughter who can love him with a difference and finally understand what he really went through, warts and all. Love and hugs to you both.
Sorry if this rambled maybe a little off topic but I guess I put human emotions and feelings as being a very big part of who we are and unless all our ducks are in order then how DO we function. In my many years of work as a therapist, many of these guys just needed permission to speak their feelings and be listened to and maybe that was because I WASN'T part of the military. Just my mindread.
Working within the military setting is obviously a totally different story and set of rules. I really admire you Bellaruth for taking it on and being so willing to follow the rules for the sake of these service men and women.
I know there will be some who will not agree with my view but that is just the way the world is.
Thankyou for "listening".
warm regards Diane Gardner Australia
... written by Erin Bernardi,
January 08, 2012
Belleruth, I stumbled across your work with the military. I am a school counselor and this information is very helpful in dealing with many of my families. At a conference dealing with various forms of PTSD, a man from Eugene painted a bleek picture of community resources to help our returning service members. I have been pondering doing some work in this area when I am able to retire. Please keep us posted on your findings and methods at Fort Sill.
... written by Belleruth,
January 10, 2012
Many thanks to Sandy for your beautiful story and to Diane for your eloquent response. Rambling?? NOT. And to Erin for reminding us that this challenge reaches everyone, one way or another, including through our schools.
... written by Sandy Stutz,
January 23, 2012
Dear Belleruth:
Congratulations……you’ve got this right! I served 29 years as a career distaff (wife/spouse) member of the Army. We relocated 23 times, serving our country around the world. I was always active in military family programs and represented many of the commands and installations at regional and national family symposiums. This prepared us for the work we do now……organizing fly fishing outings and pheasant hunts for our Wounded Warriors.
In my book, missions come first. When I broke my ankle one morning after just arriving in the DC area, I only remembered the phone number of a dear friend living close by. I called and asked her to give me a lift to the Fort Belvoir hospital. I couldn’t call my husband as I knew he had a very important presentation to make at military event. I told my friend to just drop me off at the hospital and I would call her after I had been cast. She kindly delivered me to our apartment some 7 hours later. My husband walked in that night……surprised. Those who really understand the military know, even with the spouses………….the mission comes first.
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, everyone!
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