Tag Archives: From Combat to Counseling

From Combat to Counseling: Survivors guilt, shame and moral injury

By Duane France April 6, 2020

“Moral injury” is a term that has emerged over the last thirty years that describes a particular reaction to events that occur in the course of a service member’s military experience. It is closely linked to, but also separate from, post-traumatic stress disorder (PTSD). Events that can cause a moral injury are also likely traumatic, catastrophic physical injuries, for example, or the loss of a fellow service member. However, moral injury can occur separately from PTSD.

The concept of moral injury emerged from clinicians’ work with veterans of combat who were experiencing difficulty readjusting to their lives after returning from conflict. The phrase was coined by psychiatrist Jonathan Shay based on observations made while working with veterans at a Department of Veterans Affairs outpatient clinic in Boston. In his book, Achilles in Vietnam, Shay introduced the concept of moral injury, defining it as the psychological, social and physiological results of a betrayal of “what’s right” by an authority in a high stakes situation. He goes on to describe how experiences in the military, and especially experiences in combat, can sometimes change service members’ beliefs about what is right and wrong.

Later the psychologist Brett Litz and his colleagues refined the concept, describing moral injury as an effect of acts that create dissonance and conflict because they violate assumptions and beliefs about right and wrong and personal goodness. Morally injurious acts include events such as “…perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

Moral injury and PTSD

Moral injury is a cluster of symptoms that is, as stated above, linked to but separate from PTSD. There is an emerging effort to distinguish between the two and recognize moral injury as a common and distinct syndrome that requires targeted treatment. Several factors complicate the establishment of this distinction. One of the difficulties is that an event that meets Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criterion A for PTSD — exposure to death, threatened death, actual or threatened serious injury — may also transgress deeply held beliefs. For example, an act may be morally injurious if the client believes it was indefensible or should have been prevented.

Identifying moral injury in individuals is complicated by the reality that service members are trained to overcome social taboos against killing or inflicting serious injury on others. In basic military training, trainees experience a dedicated effort to overcome an aversion to violence. Bayonet training, hand-to-hand combat and weapons training using realistic plastic human-shaped targets are all methods designed to help individuals overcome a natural tendency to not engage in violence. In his book, On Killing: The Psychological Cost of Learning To Kill in War and Society, Lieutenant Colonel (Ret.) Dave Grossman cites a study by military historian Brigadier General S.L.A. Marshall related to the firing rates of soldiers in World War I. Grossman states that Marshall found that a significant number of rounds that were fired did not hit the target, and that many soldiers were not aiming at their targets but instead firing away from them.

In “Assessment of Moral Injury in Veterans and Active Duty Military Personnel with PTSD: A Review,” a 2019 article published in the journal Frontiers in Psychiatry, the authors assert that moral injury can occur in conjunction with PTSD but is a separate syndrome.

Specifically, a service member or veteran can have PTSD without moral injury, can have moral injury without PTSD, can have both, or can experience events that meet criterion A, yet have neither.

Betrayal as a core concept

The core aspect of moral injury is one of betrayal: betrayal of one’s own core beliefs, a betrayal by others, or both. In my clinical experience, as well as my own lived experience, moral injury is a significant aspect of one’s military service. A service member or veteran’s reaction to or behaviors resulting from moral injury can cause significant distress. This, of course, complicates the transition to post-military life.

While there are a number of large egregious manifestations of moral injury such as My Lai in Vietnam and Abu Gharib in Iraq, there are also more subtle manifestations of moral injury. Growing up, I was always taught to obey traffic signals, go the speed limit—be a “good driver.” This behavior was “right.” When we got to Iraq and Afghanistan, however, things that were “right” became wrong. There are no stop signs in Iraq, no traffic signals in Afghanistan. A one-way street was whichever way we were going. This wasn’t because service members were bullies or unconcerned with local safety, but a security measure. Then, we had to return to a community of rules and laws and make the adjustment back to what was right but had seemed wrong while overseas.

This is another complicating factor for moral injury. Some behaviors may be acceptable in one environment but unacceptable in another. In a 2018 interview for my podcast Head Space and Timing , psychologist Shira Maguen, a VA clinician researcher who is an expert in moral injury describes how a service member can engage in behaviors that are not morally injurious at the time, such as killing or violence directed towards an enemy. These actions are necessary and even encouraged while in the environment of a combat situation. However, when the service member returns to a non-combat environment or relative safety, these actions may not be considered acceptable, and therefore may become morally injurious.

Addressing moral injury

As mentioned, it is critical to explore whether or not a veteran is experiencing moral injury related to their military experience. Many veterans, like many clinicians, may have never heard the term, but after having the concept explained to them, understand it immediately. In discussing these distinctions with a fellow veteran (not a client), he said a light bulb went off in his head.

This veteran, a Marine who served in Operation Iraqi Freedom, was on a rooftop providing overwatch for a raid. He saw movement in the alley below, challenged the individual to respond with a password, and when he did not receive a response, opened fire on the figure in the alley. It turned out that the person in the alley was a fellow Marine, who had been wounded in the leg. While the wounded Marine ultimately recovered, my friend experienced significant guilt about the incident. After leaving the military and entering therapy, he was told repeatedly that he was struggling with PTSD. But, it wasn’t until he heard about moral injury that he understood that what he was experiencing was different than a traumatic stress reaction.

In the next few columns, I will be addressing other critical aspects of moral injury, including survivor’s guilt, the difference between shame and guilt, and the assessments and modalities available to help service members, veterans, and their families receive a measure of relief from the burden of moral injury.

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Duane France, LPC

Duane France is a retired U.S. Army noncommissioned officer and combat veteran who practices as a licensed professional counselor in Colorado Springs, Colorado. He is the director of veteran service for the Family Care Center, a private outpatient mental health clinic specializing in service members, veterans and their families. He is also the executive director of the Colorado Veterans Health and Wellness Agency, a 501(c)3 nonprofit that is professionally affiliated with the Family Care Center. In addition to his clinical work, he writes and speaks about veteran mental health on his blog and podcast at veteranmentalhealth.com. Contact him at duane@veteranmentalhealth.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

From Combat to Counseling: Getting started in counseling military clients

By Duane France January 29, 2020

We want to help people. It’s a common reason many choose to become professional counselors. Maybe we’ve been told we’re good listeners. Maybe we have lived experience with overcoming mental health concerns. Whatever led us to counseling, we want to use our skills to help people. At some point, we may decide we want to help people in the military population: service members, veterans and their families. Perhaps we want to help military kids because we have a couple of our own, or we were one. Or, we want to support military spouses in post-military life because they’re an underserved and under-resourced population.

Having a clinical focus on serving the military population is admirable. More importantly, it’s necessary. With critical mental health access shortages in the Department of Veterans Affairs (VA) and Department of Defense (DOD), and studies that show that community providers are not as culturally competent with the military population as VA and DOD clinicians, it’s essential to increase the military population’s access to timely and competent mental health services.

Counselors often ask me: How do I do it? I may want to serve veterans and their families, but how do I get there from here?

Here are some critical points to consider if you’re interested in working with the military-affiliated population.

Know why you’re doing it

Understanding your motivation for serving veterans is critical. More importantly, it’s an ethical responsibility for counselors. In order to give the highest quality of service to those we work with, as well as to be true to ourselves, we need to understand what it is that got us into this work and why we want to do it.

What are your personal and professional motivations to serve this population? Like me, are you a veteran yourself, or (also like me) a child of a veteran? Are you a military spouse who has the lived experience of your partner’s service? Or do you have no prior direct affiliation with the military, but happened to work with the population during your clinical training? Regardless of your background, it’s essential to understand why you chose this particular population to serve.

Photo by U.S. Army Master Sgt. Alejandro Licea/defense.gov

Understand your limitations

Along with why you’re doing it, it’s important to understand your limitations. This could mean that you may have some familiarity with one aspect of military culture but recognizing that you’re not an expert in all military culture. Or that you may come up against some things in your clinical work that you’re not prepared for, and you didn’t know would bother you. I remember several years ago when working with a veteran, a session in which they were recounting significant racial discrimination while they were in the military. This discrimination was the source of their depression rather than PTSD as most people (including the client) assumed. As I was listening to the veteran recount their story, I found myself getting angrier and angrier, to the point where I started to lose concentration and therapeutic objectivity. The former senior noncommissioned officer in me was offended at the experience.

What I didn’t realize was that this was a psychological reaction on my part to two different things: the blatant disregard for the military values that I hold dear shown by the veteran’s leadership, as well as my own unresolved emotional response to racial discrimination in my childhood. A classic example of countertransference. Counselors like me, who identify as military-affiliated, must assess for and address potential countertransference. Just because a counselor is a veteran doesn’t make them the best counselor for veterans, and we need to be aware of the limitations of our own personal experience.

Where do you start?

So understanding why we want to serve veterans is essential, and it’s also important to understand the limitations that we may face, but what about the practical aspects of serving this population? As in, specifically, how do you help? I often hear how difficult it is for professional counselors to serve in the VA (although the department is currently putting a lot of effort into creating more licensed professional mental health counselor positions). And if you’re not in the VA or DOD, but want to help veterans, where do you go? How do you find internships, post-graduate placement or positions for a fully licensed counselor?

There are several suggestions that I often give to those counselors who reach out to me, asking about how they find positions in the community that serve veterans. First, do some research in your area. Are there mental health clinics that primarily serve the military population? Organizations like the Cohen Veterans Network may be a useful resource for internships or to get your pre-licensure hours, or clinics like the one I work for, the Family Care Center, in Colorado Springs. Even if they are not currently taking interns, they may have some advice for you.

Another potential source for positions is to see if there are other veteran services in your community that would be willing to add a clinical component to them. For example, the Veterans Village of San Diego, a nationally recognized leader in serving homeless veterans since 1981, has 27 mental health interns as part of their staff. Organizations that provide employment, housing, legal and financial resources to veterans may be willing to include a mental health component to their services.

And finally, there is a national program that may be of some benefit. Give An Hour is a national network of volunteer clinicians who serve the military population. I often recommend it as a resource for those veterans and family members looking for support outside of my local area. It is also a way to connect with other like-minded professionals serving the military population. If you’re looking to serve veterans in your area, it’s a good idea to reach out to those who are already doing so and network with them. You can find a list of clinicians in your area who are working with the military by searching for providers in your zip code, and reaching out and connecting with them on LinkedIn or through email. It’s likely that you will find one or two who would be willing to sit down and talk and give some professional advice on what serving the military looks like in your location.

Serving those who served

Dedicating your professional career to serving those who served and those who care for them is admirable and not to be taken lightly. Like many other underserved populations, it is necessary to understand the unique culture of the military and how it impacts our clients. Through diligence in our preparation, we can make sure to provide the best care possible for those who sacrificed much on our behalf.

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Duane France, LPC

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

From Combat to Counseling: Veterans and the criminal justice system

By Duane France December 9, 2019

As I was preparing to retire, I was already on the path to becoming a clinical mental health counselor. I was finishing the first year of my master’s program in clinical mental health counseling and would start my practicum and internship in about seven months. Knowing that I wanted to work with veterans as a clinician, I reached out to our local veterans treatment court to see if I could observe some of the proceedings.

I had been in court before, having served a detail as a security escort for a court martial, but that was a military court—a legal venue that operates differently than the civilian justice system. This was a real courtroom, with the judge on the bench in a robe and everything. But that’s not what caught my eye when I first walked in. The first thing I noticed was a veteran sitting to the right in an orange jumpsuit, hands and feet in shackles.

I knew him.

We had served together about seven years before this; I was the company operations non-commissioned officer (NCO) in his unit. He was particularly memorable to me, not only because we were in the same company, but because I was there at the gate the day that he came back in from outside the wire after seeing his platoon sergeant wounded by a sniper. If there was a blinking red line from that incident in 2006 to him sitting in the county jail, I was at both ends of that line.

The time in between, for him, was filled with medical problems, homelessness, addiction, disrupted relationships and involvement in the criminal justice system. It was a shock for me to see someone I served with in that situation. But I understood; many of us do. Veterans are significantly affected by the extremely traumatic events they routinely witness.

Veterans treatment courts

If you’re not familiar with veteran treatment courts, then you’re not alone. Even though the number of courts across the country are increasing, they seem to be unknown to those who are not directly involved with them. Throughout the nation, there are over 300 of these specialty courts that serve veterans.

The first veteran courts in the country were established in 2008. They are what are known as “problem solving courts,” modeled after the drug courts that were established in the mid-1990s. Not all courts are the same, and the different models vary by location, but they all are designed to help veterans get treatment for the issues that led to their involvement with the criminal justice system.

The problem-solving court model is one that addresses a particular issue with similar defendants using an interdisciplinary team of professionals to address the needs of the participants. Drug court, for example, provides substance use recovery treatment while addressing other risk factors that could lead to continued involvement in the criminal justice system. Some jurisdictions have other kinds of problem solving models such as DUI/DWI or domestic violence courts.

Veterans who become involved in the justice system frequently struggle with the difficulties that these other courts address. However, they are often experiencing many of these issues at the same time—creating the need for, in essence substance recovery courts, DUI courts, mental health courts and domestic violence courts all rolled into one. Veterans treatment courts are designed to address these and other population specific needs with a multidisciplinary team that in addition to traditional court personnel such as a judge, the prosecution and defense, includes treatment providers, law enforcement, Department of Veterans Affairs representatives and a team of volunteer veteran mentors.

Some might argue that the regular criminal justice system has been handling veterans’ cases for years — why create special courts now? In the past, the elements that drove veterans to commit crimes were usually not unique to the military population. But multiple extended campaigns like those in Afghanistan and Iraq have created a large population of military members with extended conflict experience. As a result, there are situational and systematic influences on many current veterans’ thoughts and emotions that lead to poor choices and reckless, dangerous behavior. I’m not saying that all who are incarcerated are innocent and misunderstood victims– there are veterans who commit heinous and horrendous crimes. The majority of veterans who are currently in the criminal justice system, however, aren’t hardened criminals.

In addition, veterans are usually not repeat offenders with a history of criminal behavior. That is the challenge when working with justice-involved veterans – determining the underlying motivation and reasons behind the dysfunctional and antisocial behavior. Treating the emotional and behavioral problems that lead to criminal behavior is one of the keys to helping veterans get—and stay—out of the criminal justice system. As a society, we need to have veterans return from combat and reintegrate, to get back into the workforce, engage in the public process, go to school, and become scientists and scholars.

The challenge, however, is that there is a period of adjustment for many veterans, and the difficulties it poses are different for everyone. For some, a lack of a sense of purpose and meaning in their lives leads to a period of wandering and aimlessness, and their behavior never rises to the level of criminality. It is a very thin line, however, that separates behavior that is reckless from behavior that violates the law, and many times veterans cross that line.

The majority of veterans leave the service strong and resilient. Many, however, do not, and that is a fact. Remembering that there are veterans who face, and fail to deal with, significant challenges is just as necessary as encouraging those who meet those challenges.

For more information on the effectiveness of veteran courts, a number of published studies such as this one has shown that graduates from these programs have a lower recidivism rate than others in the criminal justice system.

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Duane France, LPC

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

From Combat to Counseling: Comprehensive mental health in the military-affiliated population

By Duane France October 17, 2019

Often, when talking about mental health in the military-affiliated population, the first thing that comes to many people’s minds is posttraumatic stress disorder (PTSD). This is true of mental health professionals as well.

Once, a colleague asked me how many deployments I had in my military career. When I told her that I had five combat and operational deployments, she said, “Well, of course you have PTSD!” In reality, the number of deployments doesn’t dictate the level of traumatic events to which a service member has been exposed. A client could have multiple deployments and not have experienced anything worse than separation from family, whereas another client could have experienced only one very serious and traumatic deployment.

It is important to understand what we are talking about when we discuss mental health in the military-affiliated population. It is critical to understand the culture of the military and to understand who we are talking about. However, as mental health professionals, it is equally important to understand the potential psychological impacts that our clients have experienced.

PTSD

Although PTSD is not representative of everything that service members deal with after the military, it is a condition that any counselor working with the military population must understand. It has been described in a number of different ways throughout history, including “soldier’s heart” in the Civil War, “shell shock” in World War I, and “battle fatigue” in World War II and the Korean War. After the Vietnam War, the symptoms that would come to signify PTSD were called “post-Vietnam syndrome.” It wasn’t until the third edition of the Diagnostic and Statistical Manual of Mental Disorders, published in 1980, that PTSD became an official diagnosis.

There are a number of PTSD diagnostic criteria outlined in the DSM-5, the most significant of which is that the service member must have been exposed to an event that resulted in death, threatened death, actual or threatened serious injury, or sexual violence. The service member or veteran must have been exposed either through direct exposure, witnessing the trauma, learning that a relative or close friend was exposed to such trauma, or experiencing indirect exposure to details of the trauma in the course of professional duties. This is significant. Just because a service member was deployed to a combat zone does not mean that the service member was exposed to an event that meets this criterion; this was certainly true for three of my five deployments. Being able to differentiate between PTSD and other psychological conditions is critical to supporting the client.

TBI

Another condition emerging as an important consideration is traumatic brain injury (TBI), which is also known as a concussion or mild, moderate, or severe TBI. Military equipment and medical response have improved significantly over the past 50 years, resulting in greater survivability on the battlefield. Injuries that previously might have been fatal are now being treated quickly and effectively. While this development has reduced the mortality rate in recent conflicts, it has led to an increase in the number and severity of catastrophic injuries.

Further complicating TBI is the fact that many of its symptoms overlap with those of PTSD, and many of the conditions that could cause TBI also meet criterion A for PTSD. Whether it is a blunt force trauma concussion from a direct blow to the head or a diffuse TBI caused by blast overpressure from an explosion, the causes of TBI could also be causes for PTSD (and vice versa).

Addiction

Addiction is another important mental health consideration in the military-affiliated population. This of course includes substance use. Many of us who served know that the military is a drinking culture. Drinking is normalized and used to relax, to celebrate, to memorialize. Regardless of rank or branch of service, alcohol is acceptable and available.

It is problematic, however, when the reason for alcohol use changes from celebration to self-medication, or using alcohol to reduce discomfort from psychological concerns. Additionally, the opioid epidemic in the veteran population typically begins during active duty. Because of the extreme chronic pain that results from multiple injuries, pain management is a necessary consideration, and painkillers are readily available.

In addition to substance use, it is also imperative to explore process addictions in the military-affiliated population. Whether it involves gambling, viewing pornography, compulsive eating or shopping, compulsive and addictive behaviors can cover the veteran’s or service member’s underlying concerns.

Photo by U.S. Army Sgt. Victor Perez Vargas/defense.gov

Emotional dysregulation

Difficulty tolerating and managing emotions is another significant aspect of mental health for the military-affiliated population. While there are certainly emotional components to PTSD, TBI and addiction, it is also possible for emotional challenges to exist apart from substance use, trauma exposure or physical injury. For many service members and veterans, the typical dysregulated emotions are depression, anxiety and anger.

Among the nontraumatic causes for an inability to manage these emotions are toxic leadership and systemic harassment. An inability to escape from an adverse situation can lead to feelings of helplessness and hopelessness. I will emphasize again that there are many situations in the military that could cause anger, anxiety and depression that have nothing to do with exposure to traumatic events. It is necessary to determine whether emotional dysregulation or substance use is the result of traumatic exposure or another cause.

These aspects of mental health are not unique to the military of course. Combat trauma is not the only cause of PTSD, and any significant blow to the head can cause TBI. Addiction is not a problem just for the military population, and emotional concerns such as depression and anxiety are widespread. Additionally, these conditions follow the medical model of mental health; there is a diagnosis for each of them and corresponding medications for each of them. Although these conditions can be debilitating in and of themselves, there are other factors unique to the military population that can complicate attempts to treat service members, veterans and their families.

Meaning and purpose

Although service in or affiliation with the military can be difficult, it can also be extremely satisfying. There is a collective effort toward a common goal, a sense of shared culture and community, and a feeling that the work you’re doing is important. Many veterans, upon leaving the service, struggle to find the same satisfaction in their post-military careers. Many are able to build a meaningful life after the military, but it is not automatic.

There is also the challenge of navigating an identity shift. Whether it’s for four years, 14 years or 24 years, the service member’s identity is closely tied to the military. We were Soldiers, Airmen, Sailors, Marines, or Coast Guardsmen literally 24 hours a day. Even if not serving full time, as is the case in the National Guard or Reserve components, service members are always aware of a type of double life. When we leave the service, many of us ask ourselves, “Who am I if I’m not a soldier?” A friend of mine, a medically retired Green Beret, expressed this quite well when he stated, “The Army said I couldn’t be me anymore. What do I do now?

Moral injury

Another concept that has emerged over the past 25 years is moral injury. PTSD, at a very basic level, is an injury of the behavior. It is classic conditioning: When a triggering event occurs, a certain reaction is initiated. It is, of course, more complicated than that, but a significant aspect of PTSD is stimulus response. TBI, on the other hand, is a physical injury of the brain. Moral injury can be described as an injury of the soul: What a service member believes to be right and wrong with the world has been fundamentally changed.

In one of the first articles to fully develop an explanation of moral injury, Brett Litz and colleagues described moral injury as “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.” There is some disagreement as to whether moral injury is an aspect of PTSD or its own distinct condition. the fact is that one can have a morally injurious event that is not traumatic, and there are a number of traumatic events that are not morally injurious. Regardless, it is beneficial for anyone interested in working with the military population to familiarize themselves with moral injury and to at least explore the concept with these clients.

Needs fulfillment

The military is a highly connected communal society where tasks are divided among its members. When I was in Iraq and Afghanistan, I didn’t have to worry about where my food and water would come from because there were other service members or contractors who provided that. When my family and I arrived at a new duty station, we were provided housing, and there were people on base who gave us guidance on schools for our children.

Of course, when service members leave the military, those same needs still have to be fulfilled, but now it must be done in different ways. This isn’t to suggest that service members aren’t capable on their own, but challenges related to employment and housing — those lowest levels of Maslow’s hierarchy of needs — are widely known in the veteran population. Even our psychological needs, such as belongingness and esteem, are part of the military framework. Our peer group is provided for us; like them or love them, the people you serve with are your family. Your effort is recognized with rank or reward. Outside of the military, however, we have to learn how to meet those old needs in new ways … and for some service members, that can be difficult.

Relationships

The final aspect of mental health in the military-affiliated population that I’ll discuss is relationships. Our mental health affects our interactions with others, and our interactions with others affects our relationships. Whether it is frequent separation, moving households every three or four years, or relationships with people who are literally on the other side of the world, the relationships of those in the military population are necessarily different from those who have never served.

When considering how military service impacts relationships and vice versa, it is important to understand that this doesn’t just refer to intimate relationships such as spouses and children, or even parents and siblings. This also includes peer relationships (friends and acquaintances) and work relationships. Understanding how to integrate into a community that has a different cultural orientation than you do is difficult. Even if none of the other psychological concerns mentioned in this article are prominent, adapting relationships to a new lifestyle can be challenging.

Considering all aspects of psychological wellness

It can be daunting to consider how these various aspects may interact to provide an almost never-ending combination of circumstances for members of the military-affiliated population. One thing is clear though: The more of these areas that the service member, veteran, or military family member has difficulty in, the more at risk they are.

As professional counselors, we need to be able to understand the complexity of our clients’ conditions. We need to ensure that we have a full picture of their needs and then address those needs if possible. If an area is outside of our expertise — if we are not trained in an evidence-based practice for PTSD, for example — then we have an ethical responsibility to refer that client to someone who can meet their needs.

In this way, we are providing the best possible care for those who serve, those who have served, and those who care for them.

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Duane France, LPC

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

From Combat to Counseling: Cultural competence in the military affiliated population

By Duane France September 11, 2019

There were two things that I learned in my degree program regarding cultural competence. The first was that there is a need for the counselor to develop an understanding of how culture influences the unique point of view of a particular client. The second was that it was the responsibility of the counselor to develop that understanding on their own, not put the burden on the client to teach it to them. I’m certain there were more things that I was taught, but those two stand out the most.

When it comes to serving the military-affiliated population, however, some counselors don’t consider these clients to be part of a different culture. Perhaps their perception of diverse cultures is based on geography (e.g., urban versus rural), ethnicity, religion or nationality. All of these cultural values are valid of course; any counselor working with a client whose life experience is rooted in a culture different from the counselor’s own can and should develop an understanding about them. Somehow, though, perceptions of cultural diversity do not usually include the military population. But they are of diverse geographic, ethnic and religious backgrounds, correct? Of course.

Added to that is the fact that serving in the military necessarily begins with an assimilation process. As I mentioned in the first article of this series, if you look at the various definitions of culture, they can be applied to life in the military. We have our own way of dressing, our own language (I’m fluent in “acronym” and often forget that others aren’t), and our own way of looking at the world.

Intergenerational transmission of knowledge

Merriam-Webster provides one definition of culture as “the integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for learning and transmitting knowledge to succeeding generations.”

If that’s not a clear description of the traditions that are passed down through generations of military service members, then I don’t know what is. For example, the Army’s Drill and Ceremonies manual can be traced directly back to the Continental Army and Baron Friedrich von Steuben’s Regulations for the order and discipline of the troops of the United States. Tradition is also preserved through established customs and standards. The rules of service etiquette for the various military branches and their academies are outlined in a 562-page monster of a book. The long and rich history of military culture is conveyed through its customs and courtesies, and even in traditional aspects present in today’s uniforms.

The accumulation of cultural knowledge begins when the service member first reports to their basic military training and continues throughout their time in the service. Some aspects of cultural knowledge are unique to the various service branches. For example, all Marines are aware — and consider it a point of honor — that the Marine Corps was born in a bar.

A common way of life

Merriam-Webster provides a second definition of culture as “the characteristic features of everyday existence shared by people in a place or time.”

There’s no denying it: Service in or affiliation with the military has some unique characteristics. As an old Army slogan put it, “We do more before 9 a.m. than most people do all day.” A typical morning in the military starts by 6 or 6:30 a.m. (and, for leaders, even earlier). Then there’s the constant movement, for both the service member and the family. My wife and I lived in nine apartments in two states and two countries in the first 10 years of our marriage. The high number of different schools that military kids attend is so common that it’s almost cliché. For my two, it was four schools in five years.

U.S. Army photo by Sgt. Henry Villarama/defense.gov

The military is also very hierarchical in nature. One glance and a service member knows where they stand in that hierarchy: above, below or on the same level. Built on a foundation of mutually understood respect and obedience from senior to subordinate, the daily life of service members is typically planned and scheduled from the minute they stand in formation to the minute they are dismissed. Does it always work that way? Of course not, which is also part of the culture — no plan survives first contact with the enemy, etc.

A common set of values

A third definition of culture from Merriam-Webster is “the set of shared attitudes, values, goals, and practices that characterizes an institution or organization.”

The military is as much a values-driven organization as it is a mission-driven organization. Starting with the Oath of Enlistment or Oath of Commissioned Officers, the common goal — to support and defend the Constitution of the United States, to bear faith and allegiance to it, and to obey the orders of the officers appointed over them — is clearly stated and immediately understood.

Each of the branches of service has its own core values. The Army’s values form the acronym LDRSHIP: loyalty, duty, respect, selfless service, honor, integrity, and personal courage. The Marine Corps uses less words for its values in favor of going straight to the point: honor, courage and commitment.

For those who haven’t served, it may seem archaic to be so obligated to a set of values. For those who have served, however, these are values that are instilled as core beliefs. When actions are taken that violate these values, either by the service member themselves or by others, it can be as difficult to overcome as the violation of any other core belief that we help our clients with. Sometimes I help my clients see that the cause of distress in their post-military lives is their failure to live according to these values.

Military cultural competency is necessary for counselors

Although many counselors recognize the unique nature of military service, it’s also essential that they understand how important that culture is to a member’s self-image. When I joined the Army, I stopped being a suburban St. Louis kid and became a soldier; when I left the Army, I became a veteran. It has become as much a part of me as any other label, such as father, husband or son. It has become my identity —not all-consuming and not my entire identity — but a large part of it. Chances are, if you are working with a service member, veteran, or military family member, it will be a large part of theirs too.

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Duane France, LPC

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