Suicide rates. Chain of command. Posttraumatic stress disorder (PTSD). Military jargon and slang.
For counselors, working with military veterans brings its own challenges and need for baseline knowledge.
“Just as with any other culture that is different from your own, it is not enough to simply want to help members of the military. There is a need for true cultural knowledge and competency,” says Natosha Monroe, co-leader of the American Counseling Association’s Veterans Interest Network.
The network, composed of roughly 85 counselors, serves as a sounding board for discussion and insights on counseling military service members, both active and retired.
From how better to advocate for nonmedicated therapies to strategies for navigating the Department of Veterans Affairs (VA), members of the interest network strive to learn from each other and stay current on issues that affect the military population, says Monroe.
Monroe, a practicing counselor in the Dallas area, is one of seven people who moderate the Veterans Interest Network. She served 13 years as a behavioral health specialist in the U.S. Army and is a sergeant first class in the Army Reserves. Monroe has provided mental health care, both in humanitarian efforts and support services for U.S. troops, in Haiti, the Dominican Republic, Afghanistan and Guantanamo Bay, Cuba.
“I am not an officer in the Army,” Monroe explains, “because currently no military branch recognizes our profession [of counseling]. All behavioral health care officers/providers are social workers, counseling/clinical psychologists or psychiatrists only.”
Q+A with ACA’s Veterans Interest Network
Responses written by Monroe, with input from network co-leaders Patrick Gallegos, Todd Burd, Xiomara Sosa, Keith Myers, Linda Sheridan and Tony Williams.
Why should counselors be aware of/interested in veterans issues?
Our group offers ACA members three primary things:
1) A place within ACA for veterans to come together to share and discuss similar interests, support veteran members who are deployed and to interact in a way that will hopefully resemble the camaraderie many of us have experienced in our military service.
2) An opportunity for counselors interested in working with the military population to share ideas and to learn more about the military population through conversation and observation.
3) A place to network with others who have like-minded ideas and issues specific to military counseling-related topics.
What challenges do counselors face in this area?
1) Veterans often have decisions made about their best interests but not so often are asked their opinions on what they’d like to see happen. This often leads to gaps in real needs being fulfilled.
2) Oftentimes counselors have never had any military experience and they see military clients without being culturally competent first.
What are some trends you’re seeing?
Service members are experiencing an almost exclusively medical model of treatment when they seek mental health help. Most are never given the option for nonpharmaceutical care and in some cases are reporting being given more medication when they report that the medication is “making them feel like a zombie.” It is very difficult for them to see LPCs (licensed professional counselors).
What would a new counselor need to know about working with veterans?
1) Just as with any other culture that is different from your own, it is not enough to simply want to help members of the military, there is a need for true cultural knowledge and competency.
2) Don’t jump the gun and take therapy or diagnosis down the wrong track. For instance, truly look at symptoms rather than seeing a person who’s been to war, has nightmares and then “bam,” label it PTSD.
3) Thoroughly examine your client’s previous diagnoses and don’t just go with it. Same with medications.
What would a more experienced counselor need to know?
Same response as above.
What are some tips or insights you’d give regarding veterans that could be useful to all counselor practitioners?
Out of respect and professionalism, take the time to learn things such as military rank and structure, military language/slang/terms and what current military operations are going on in the world. If you know none of this, what does that say to your client? Ignorance of military culture interrupts the therapeutic experience every time a counselor looks confused or has to stop a train of thought for a definition or clarification.
What are some current issues or hot topics that the interest network has been discussing?
We are passionately advocating for members of the military to have equal access to what our profession can bring to the table — nonmedication therapy for their mental health care needs.
1) Right now, the VA system blatantly discriminates and, in most cases, completely excludes [licensed professional counselors] from counseling positions.
2. Currently, there is a complete exclusion of licensed professional counselors in positions of behavioral health care officers in all military branches, making ours the only mental health care profession, along with marriage and family therapists, that is not recognized or allowed to serve in uniform.
3) Grandfathering in of non-CACREP counselors into the VA system and also for various health insurance policies.
4) Increase awareness and respect to the fact that service members fall within a unique micro-culture within the society as a whole and must be given multicultural consideration in therapy sessions by all counselors — meaning too that counselors must be culturally competent prior to beginning work with the military client.
5. Increasing awareness of specific mental health care concerns such as suicide rates.
6. LGBT integration into health and wellness benefits and rights.
What makes you personally interested in this area?
I (Monroe) am a veteran, and it’s frustrating not to be allowed to do my job in the Army. Also watching my fellow soldiers constantly being heavily medicated without being offered the option of seeing someone in our profession.
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The Veterans Interest Network is one of 17 interest networks open to ACA members. In the coming months, CT Online plans to highlight each network – from sports counseling to traumatology – with an online Q+A article.
For more information on ACA’s interest networks or to get involved, see counseling.org/aca-community/aca-groups/interest-networks.
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Bethany Bray is a staff writer at Counseling Today. Contact her at bbray@counseling.org.
Follow Counseling Today on twitter @ACA_CTonline
Very interesting read. Ms. Monroe offers several useful perspectives related to the challenges veterans face and its connection to the field of counseling. The veterans interest network provides a forum in which individuals with this interest can commiserate.
There is also a division of ACA called the Association for Counselors and Educators in Government (ACEG) that focuses on counseling military members and their families. We have several resources designed to support counselors working with this population such as our journal and annual professional development institute. More information can be found at http://www.acegonline.org
Thanks again for the interesting piece.
Seth Hayden Ph.D.
Natosha,
Thanks for leading this effort to raise more awareness!
And thanks to Seth for mentioning ACEG.
Keith
A timely and useful article! I highly support the use of “nonmedicated therapies” as mentioned in the article. I am also glad there is at least some recognition of counselors by Defense, VA and Tricare. One of the biggest roadblocks in providing counseling to this population is the bureaucracy’s current insistence on graduation from a program accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP). No other mental health profession (e.g. psychologists or clinical social workers) has had such an additional requirement imposed. To put this issue in context: The programs at Harvard, Johns Hopikins, and the Ohio State University — just to name a few — are not yet CACREP accredited.
Hey,
First off, I really enjoyed your article. As an 8-year veteran of the United States Marine Corps, as well as a mental health counselor who works with Vets, I think articles like these are most timely.
That being said, I wanted to challenge some of these ideas in the hopes of engaging in a dialogue benefiting all who might take a peek!
You noted that it is, “not enough to simply want to help members of the military, there is a need for true cultural knowledge and competency” and that:
“Out of respect and professionalism, take the time to learn things such as military rank and structure, military language/slang/terms and what current military operations are going on in the world. If you know none of this, what does that say to your client? Ignorance of military culture interrupts the therapeutic experience every time a counselor looks confused or has to stop a train of thought for a definition or clarification.”
I agree that it is important for counselors to act in accordance with Sue, Arredondo, and McDavis’ (2013) Multicultural counseling competencies, as with any client, counselor self-awareness of knowledge gaps regarding CT-cultural identity should be explored. The military, however, as you acknowledged, is enormously complex, including rank-hierarchy, jobs, branches, duty statuses, branch-specific jargon, unit-specific jargon, etc. etc. etc. Is it reasonable to assume all of this can be taught or learned through psychoeducation of counselors, particularly ones who have not served? Are counselors expected to know these things prior to working with military clients?
I would argue that a basic understanding of military branches (e.g., and their respective missions) might help build therapeutic trust, but it is not reasonable to assume counselors should know client jargon like ‘POGs’, ‘Grunts’, etc. prior to working with military vets. In my opinion, what may build even stronger trust within the therapeutic alliance is a counselor who recognizes her or his own gaps in knowledge (e.g., regarding rank, jargon, etc.), presents this lack of knowledge in a transparent way to the Veteran, and empowers the Veteran to educate the counselor on the intricacies of military-multicultural complexity.
Even as an eight year veteran of the US Marines, I know darn little about the trials and tribulations of even most other Marines, much less service members from other branches. I have heard many civilian counselors discuss concerns regarding working with military clients because they feel unprepared to empathize or ‘understand’ Veterans’ issues having not served. I would challenge this belief to suggest that those counselors who come into a session with a Veteran appearing to ‘know’ how they felt (often an issue with counselors who have military service backgrounds) because of some knowledge of jargon or similar experiences may run the risk of over-generalizing the Vet’s experiences. Truth -be-told, I know about as much about other military branches (such as acronyms, jargon, MOS, etc.) than the average civilian counselor who never served in the military.
That being said, not knowing the military culture, I think, actually provides a lot of benefits, one of which being having the opportunity to collaborate with the client to learn not just her or his jargon, but what it means to them specifically. Transparency, in my experience, is perhaps a counselor’s biggest ally in working with Vets, so I would like to challenge anyone interested in working with this population to show respect to their clients not in having pre-knowledge of the intricacies of military life, but in transparently acknowledging gaps in knowledge and working collaboratively to come to find common ground.
Thanks for entertaining this response, and like always, feedback is humbly welcomed! Just as our sisters and brothers ‘in-arms’, we are all fighting the same war for Veterans’ Mental Health!
Be well,
Aaron Smith
USMC(R)
University of New Mexico
a.smith.unm@gmail.com
Thanks to all of you for replying. Glad you enjoyed the piece. Natosha does a great job! And you should consider joining the VIN if you haven’t yet. :)
Great article. Thanks for sharing it.