Tag Archives: From Combat to Counseling

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

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: 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

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: Characteristics of the military affiliated population

By Duane France August 13, 2019

When we talk about serving the military population as counselors, it would be easy to think that we’re talking about a group of clients who are similar and homogenous. It’s true that there are many common factors among those who serve in or are affiliated with the military, but there are a large number of differences too. Age, ethnicity, gender, period of service, full time or part time, combat or not — all of these factors have their own impact on the experiences of military-affiliated clients.

Because my goal is to help my fellow counselors understand how to address the unique needs of this population, it might be helpful to expand a bit on what I term SMVF: service members, veterans and their families.

 

Service members

This segment of the SMVF population seems easy to define: It includes anyone who is currently serving in the military. That broad definition is accurate, as far as it goes, but it is also deceptively simple.

When talking about a service member, it is important to understand a number of different things, including which branch of service they are in. Whether a client is currently serving in the Army, Air Force, Navy, Marine Corps or Coast Guard is an important distinction. Each branch of the service has its own sub-culture, a different rank structure, and vastly different experiences.

And even in each branch of service, there are subcultures within the subculture. Does the client serve in the Air Wing of the Marine Corps? Which occupational specialty does the client hold in the Army: Infantry? Military intelligence? Logistics and supply? Each of these sub-branches has its own unique outlook and experiences.

Even the current location of service helps to further define service members. For instance, there is a difference between the experiences of a Marine stationed at Twentynine Palms, California (not so great), and one stationed at Marine Corps Base, Hawaii (pretty great). Or the experiences of a soldier stationed at Fort Polk, Louisiana (one of the least desired duty locations), compared with a solider stationed at Fort Carson, Colorado (among the top five most desirable duty locations).

Currently serving military clients also include those drilling in the National Guard and Reserve. Each branch of the service has a Reserve force, and each state has a National Guard and Air National Guard unit. Typically, currently drilling service members in the National Guard and Reserve attend a weekend drill of anywhere from two to four days once per month and participate in a two- to four-week annual training each year.

Not all currently serving military members have equal access to mental health care. National Guard and Reserve service members, for example, have access to Department of Defense mental health professionals while they are on weekend drill or annual training, but not for the rest of the time. And the availability of mental health services, both on base and off base, differs with each duty location.

 

Veterans

Similar to the term “service member,” the term “veteran” is also deceptively broad. Title 38 of the Code of Federal Regulations defines a veteran as “a person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable.”

Although that may seem fairly straightforward, one glaring omission is former National Guard or Reserve service members who were never activated for full-time military service. This exclusion means that someone who enlisted in the military and, at minimum, participated in basic and advanced military training but did not serve on active duty is not considered a veteran.

The veteran community is further subdivided depending on whether the individual served in combat. There are currently four broad categories of combat veterans. The first is World War II and Korean War veterans, many of whom are in their 80s and 90s today. The next generation, the Vietnam veterans, are over age 65. The youngest veterans of the Gulf War (Operation Desert Storm) are in their 40s. Where things get complicated is with the fourth category of veterans. The senior leaders of the global war on terror, who are considered post-9/11 veterans, served in Vietnam, whereas the youngest members of the post-9/11 generation weren’t even born before Sept. 11, 2001.

Of course, that leaves a large number of individuals who served in the military but did not deploy to combat. They are identified as veterans, of course, but in the eyes of some (including, in some cases, their own view), they are not considered “real” veterans. These include people who served in the post-Vietnam era in the 1970s, Cold War veterans who served in the 1980s, and the post-Gulf War veterans who served in the 1990s. Regardless of whether people deployed to combat, however, the military is an inherently dangerous place.

According to a 2015 Congressional Research Service report, 2,392 active-duty service members died in 1980. Compare that figure to the total number of active-duty deaths in 2010: 1,485. There were two major conflicts in 2010, Operation Iraqi Freedom (Iraq) and Operation Enduring Freedom (Afghanistan). There were no conflicts in 1980. The reasons for this higher active-duty mortality rate in 1980 are speculative, but they likely have to do with advances in safety protocols and medical treatment that have increased the survivability of catastrophic injuries. Of course, if more members of the military population are surviving catastrophic injuries, then it means there are likely more individuals dealing with the psychological impacts of those injuries — which is another area where we can help as counselors.

The veteran population is further segmented by the military subcultures mentioned earlier, which are influenced by factors such as time, location and branch of service. This goes to show that while we consider the word “veteran” to be a descriptive term, it covers a very wide area.

 

Military family members

The designation for the final portion of the SMVF population, military family members, can also be deceptively broad. My wife and I married after my deployment to Bosnia, and she was with me for more than three-quarters of my career. She and my children experienced four of my five deployments in a very different way than I did. They also endured hardships that were significantly different from mine, yet no less challenging.

Being a military spouse is not easy. My wife and I lived in eight different houses in our first nine years of marriage. Three of those years were overseas, and all of them were away from where we both grew up. The stress of constant movement, of nights alone and nights together, can be considerable.

On top of that, you have military brats — the children of those who served. I once had a conversation with my son about where he thought he was “from.” Children of service members, especially those who served significant time in the military, aren’t really “from” anywhere. Many people have roots in a place where they have family; they can point to a childhood home when they go back to visit. For instance, I am from St. Louis, and my wife is from Knoxville, Tennessee. But my kids were born in Germany, started school in Maryland, and have lived in Colorado for most of their lives — but they don’t consider themselves “from” any of those locations.

What further complicates the designation of military spouses and children is that it is used only to describe those who were with the service member while they were serving. My father was a veteran of the Vietnam War, but I wasn’t born until three or four years after he returned home. I never knew what he was like before combat. I certainly know the impact that combat had on him, however, because I saw it for 40 years.

Many veterans — and I’m using the term in its most broad and inclusive form — marry and start families after their military service has concluded. A spouse who was not with the veteran when that person was in the military has little to no understanding of the unique aspects of military life and culture. That spouse certainly experiences the aftermath, however, as does the veteran’s children. My wife was with me while I was serving in the military, so she lived it too. Thus, when I retired, she already had a frame of reference about military life. By the grace of God and my wife’s immense patience, we remained married after I retired.

Finally, when we consider the military family, we should also include parents and siblings. My mother and sisters experienced my military service — and that of my brother, who is also a combat veteran of both Iraq and Afghanistan — in a very different way. And that circumstance brings up an entirely different dynamic: When I left Iraq, my brother was enlisting in the military. Eight months later, he was stationed in the same combat zone I had just left. Less than two years later, he and I were in the same combat zone at the same time, in different locations.

Picture two brothers, one coming in from out of town, who decide to grab some breakfast together. They catch up on what’s happening, and then the in-town brother introduces his out-of-town brother to some of the folks he works with. Only, the out-of-town brother arrived on a Blackhawk helicopter, and the breakfast was at the dining facility on Forward Operating Base Shank, Afghanistan.

To further expand the concept of the military family population, we need to consider those family members who have lost their service member. Parents, siblings, spouses and children of service members who died in combat are called Gold Star families. Those family members of veterans who have died by different means aren’t called anything, but their loss is just as great.

 

Understanding the diverse SMVF population

As this article probably makes evident, talking about someone who is serving or has served in the military, or that person’s family, is not as easy as it might seem at first. The differences between this generationally, geographically, culturally and experientially diverse population may seem large. It is important to understand, however, that a common thread — military service in its many forms — still binds them together.

 

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Read the first From Combat to Counseling column.

 

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: Service members, veterans and military family mental health

By Duane France July 14, 2019

 

This is the debut article of what is intended to be a monthly online column about counseling military-affiliated clients.

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Service members, veterans and their families face some unique challenges both during and after military service. There’s the stuff that is widely known — deployments, constant moving, a regimented lifestyle — and then there’s the stuff that isn’t so well-known. This includes the experience of living in a mutually supportive community; a lack of individualism and getting used to relying on others while others rely on you; for veterans, a lack of purpose and meaning in post-military life; for family members, experiencing the aftermath of the military, because it’s a stressful job. No one is getting out of the military without a couple of dents in the fender.

Sometimes, the challenges faced by the military population turn into crisis. The high rate of suicide in the service members, veterans and their families (SMVF) community is well-known. Given a higher level of exposure to trauma, service members and veterans may be more likely to develop posttraumatic stress disorder and other psychological conditions. And with greater physical danger comes a higher risk of catastrophic injury, which comes with its own problems, including the need to adjust to a new reality.

This is where the counseling profession comes in. As clinical mental health professionals, we are uniquely qualified to help the SMVF population live the life that they desire and deserve. We look at mental health from a wellness perspective, not an illness perspective. People with a military background will reject the concept of “sickness” and “brokenness” because, to them, that’s equal to weakness. If someone approaches a service member, veteran or military family member with pity, as if they’re a broken-winged bird, there will probably be a bit of a confrontation.

I know, because I’m a member of this community.

Who am I?

I retired from the U.S. Army in 2014 after a 22-year career. After retiring, I took on a new mission to help my brothers and sisters in arms, and their families, adjust to the circumstances that put some of those dents in their fenders. After several years of clinical work, I realized that my lived experience combined with my clinical background could help others. Which is where this column comes in.

Over the coming months, I’ll be sharing some of my insights about the culture and character of the military. Even though the need is great, the counseling profession doesn’t include a lot of people like me — former service members who have become professional counselors. As a matter of fact, that is what brought me to the profession — a chance encounter at just the right time and someone saying exactly the right thing to someone who was open to hearing it.

I was not a mental health professional when I was in the Army. I was in logistics, which is the Army’s euphemistic way of describing supply and transportation. In 2007, knowing that I would eventually have to leave the military, I started going back to school while I was deployed to Iraq. I was looking for a degree with the least amount of math possible and came across an associate degree in counseling and applied psychology. I thought that might make me a better leader, and I was interested in psychology, so I figured why not?

Fast-forward nearly a year. My unit was redeploying from Iraq after 15 months, and we were participating in post-deployment reintegration sessions. We all went to a conference center at a local hotel, where we were presented with breakout sessions on not going too wild with our drinking, not being mean to the neighbors … that kind of thing.

One of the breakout sessions was led by a counselor from the local Vet Center. For those of you not familiar with Vet Centers, they are outpatient mental health clinics that are part of the Department of Veterans Affairs (VA) but separate from the main VA health care system. The counselors at the Vet Centers are typically veterans themselves, as was the case with this clinician. She introduced herself and said that she was a retired Air Force officer. I don’t remember much of what she talked about that day, but something she said struck me then and stays with me now: “By the way, if any of you are interested in psychology, consider a career in the mental health industry. There are not enough combat veterans in our field.”

That’s all it took. Up until that point, I had not considered becoming a mental health counselor. After that, I started on the path that I’m on now and, with the help of many mentors along the way, currently work as a counselor at a private outpatient clinic in Colorado Springs, Colorado, that primarily serves the military population.

What the counselor said that day was correct then, and it still holds true now: There are not enough veterans in the counseling career field serving others in the military population. At the same time, that truth does not minimize the need for mental health counseling for the military population. There are two solutions to this: Bring more veterans into the counseling profession, and help those clinicians in the counseling profession who are not veterans to understand more about the unique needs of the military population.

As professional counselors, we recognize the need to be culturally competent with whatever client populations we work. We can’t work with someone from another culture without knowing about that culture; the ACA Code of Ethics clearly identifies this.

In that sense, the military population is an entirely different culture. Anything that defines the characteristics of a culture — ways of dressing, language, conceptualization of the world — applies to the military. I often describe it this way: It’s as if I went to England to live for 22 years and then moved back to the United States. Sure we spoke the same general language in those two countries, but there were also significant cultural differences between them and, therefore, adjustments that I needed to make. That’s how service members and their families feel after military service.

So, the goals of this column will be:

  • To provide insights into the culture of military-affiliated clients
  • To support counselors who find themselves working with service members, veterans and their families
  • To answer questions (if you have any, feel free to drop me a line at duane@veteranmentalhealth.com)

Thank you for your willingness to serve the military-affiliated population and for your willingness to learn more. Your efforts are greatly appreciated

 

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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.