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Military

Suicide prevention strategies with the military-affiliated population

By Duane France and Juliana Hallows October 29, 2019

Every suicide is a tragedy affecting families, friends and whole communities, but when everyone works together to help those in need, suicide becomes preventable. All of us have a role to play in preventing service member, veteran, and military family (SMVF) suicide.

Within the Department of Defense (DoD), the Department of Veterans Affairs (VA), and the community, professional counselors play a critical role in providing support to this population. Through a community public health approach with dedicated partners and a willingness to learn and adapt to the changing needs of veterans, we can prevent suicide and help individuals live, work and thrive in the community of their choice. Because professional counselors approach mental health from a wellness perspective, they are uniquely qualified to not only support military-affiliated clients, but to advocate for wellness approaches in the communities where they live and serve.

The federal government is working diligently to address suicide in a number of different ways. The Centers for Disease Control and Prevention (CDC) has released a number of strategies created to reduce the number of deaths by suicide, and last year, the VA published a 10-year strategic plan outlining how all parts of the country can work together to support veterans. Additionally, President Trump recently signed an executive order known as the President’s Roadmap to Empower Veterans and End the National Tragedy of Suicide (PREVENTS), which establishes a task force to engage stakeholders nationwide in suicide prevention efforts.

Using a public health approach

Suicide prevention remains the VA’s top clinical priority, but the fact remains that no one person, organization or program can do it alone. The public health approach asks all facets of the community, including mental health professionals, to work together toward a solution. The VA, as a member of the community, has a critical opportunity to meaningfully connect to community stakeholders to save neighbors, family members and friends.

Every VA facility has a suicide prevention coordinator who is asked to step out of their facilities and into their communities to build relationships with community partners that are vested and connected to service members, veterans, their caregivers and their families. Through this model, researchers, clinicians and partners collaborate for suicide prevention by identifying community issues, developing and implementing strategies to address those issues (through maximizing protective factors and minimizing risk factors related to suicide), and creating an evaluative process for those implemented strategies.

Of the 20 million veterans nationwide, less than half use Veterans Health Administration services. That makes it challenging to identify veterans who may be at risk for suicide and to connect them with mental health care professionals, peer networks, employment, and other resources known to bolster protective factors and help with coping. As large and robust of a network as the VA is, this challenge cannot be solved by the VA alone.

Community hospitals, clinics, and health care professionals across the nation play a key role in preventing suicide because they are integrated into the local fabric of the SMVF community. VA partnerships with community health care providers expand access to care to SMVF members in the communities where they live, work and thrive. In addition, not all those who die by suicide necessarily access mental health care services prior to their deaths. This means that community organizations such as veterans groups, recreational teams, faith-based centers, and myriad other community supports can serve as potential collaborators to build on suicide prevention efforts.

Part of improving access and building a public health approach is identifying those who are part of the SMVF community. For example, the New Hampshire Legislative Commission on Post-traumatic Stress Disorder and Traumatic Brain Injury created an initiative for stakeholder agencies to add a question about service member and veteran status, thus improving referral and access to services within the SMVF community. By adding the question “Have you or a family member ever served in the military?” to intake, enrollment and health history forms, counselors create opportunities to discuss military experiences and their impact on clients’ lives. This provides the benefit of informing treatment and connecting individuals to SMVF-specific resources (see askthequestionnh.com/about/why-ask). Identifying the SMVF community can also happen across varying community services, thus strengthening care coordination and supports.

In addition to asking clients about their military status, professional counselors can be particularly helpful in building the public health approach by asking the following questions:

  • How is the community collecting and reporting data on SMVF suicides?
  • How are the local emergency rooms collecting data on suicide attempts?
  • Does the community have a strategic initiative to address SMVF suicides?

If there are no answers to these questions, counselors can work with their communities to implement more effective strategies. Communities can also implement these strategies beyond the service member and veteran populations to include caregivers and loved ones. There still is a long way to go in identifying and understanding all of the risk factors and protective factors for suicide among the spouses and children of service members and veterans.

Although the VA is expanding community care for the SMVF population, community health care providers need to develop the same level of military cultural competence as exhibited by providers within the VA. It is essential that health care providers understand the cultural issues related to military service that may give veterans mixed feelings about receiving health care. These cultural issues include:

1) Concerns that seeking care, particularly mental health care, will harm their careers, whether military or civilian.

2) Fears about how they could be perceived by others for seeking care, such as being seen as “weak” by their peers.

3) The belief that overall mission success is a greater priority than their own well-being.

In Phoenix, VA teams have partnered with the Arizona Coalition for Military Families to provide military culture training to local behavioral health providers. In Richmond, Virginia, the McGuire VA Medical Center partnered with the Richmond Behavioral Health Authority to include VA resources on the state’s behavioral health website.

In addition to building cultural competency, community health care providers need to be able to offer the SMVF population the same type of evidence-based practices provided through the VA. This may be achieved through partnering with local VA providers on trainings that build on clinical skills for suicide prevention. The VA developed a Community Provider Toolkit (see mentalhealth.va.gov/communityproviders/index.asp) to help community providers, including counselors, gain a deeper understanding of military culture.

Through the public health approach, everyone has a role to play in preventing SMVF suicide. By considering level of risk and the factors beyond mental health that contribute to suicide, communities can deliver resources and support to SMVF populations earlier, before they reach a crisis point.

Maximizing protective factors

A critical component of SMVF suicide prevention is identifying the protective factors that prevent these individuals from getting into crisis. As noted in the CDC’s Preventing Suicide: A Technical Package of Policies, Programs, and Practices (2017), there are many strategies to build up protective factors. Some of these protective factors include promoting connectedness, improving economic stability, and increasing education and awareness about suicide within the population and throughout the community. These strategies fit well into Thomas Joiner’s interpersonal-psychological theory of suicidal behavior, in which he proposes that individuals die by suicide when there is a desire and capacity to do so. He posits that a sense of isolation, feelings of burdensomeness, and an ability to engage in self-harm all correlate with increased risk of suicide.

Connectedness

Promoting connectedness in the military population helps to reduce a person’s sense of isolation. This strategy has two critical components: peer norm programs and community engagement activities. 

Counselors in the VA leverage community partnerships, promote family engagement, and encourage those around SMVF populations to ensure they remain connected to their loved ones and peers. The Veteran Resource Locator, for instance, links veterans and their loved ones, or community providers, with programs and services in their area, both within the VA and in the community. Counselors consistently look to engage family members in veterans’ treatment to increase their support systems. Local VA facilities conduct extensive outreach in the community to form partnerships with organizations in which veterans and service members are involved. For example, in Billings, Montana, the VA and community teams developed a local veterans meet-up group to help service members stay connected to their community during transition from active duty. Group members meet regularly for cookouts and conversation.

Counselors in the community can also support efforts to improve connectedness. For example, counselors can become familiar with peer support programs in their communities or get involved in the development of such programs if none exist. If organizations exist within the community that provide opportunities for the SMVF population to engage with others while supporting their community (e.g., Team Rubicon; Team Red, White & Blue; The Mission Continues; Travis Manion Foundation), counselors can get to know who is in the organization. Counselors can provide referrals to these organizations and invite representatives to speak to their colleagues.

Economic stability

A suicidal crisis in a member of the SMVF population does not happen in a vacuum. Increasing economic stability is a significant protective factor in preventing suicide. As service members transition out of the military, whether they have served for four years or 24 years, the majority are young enough to be able to continue in another career. When housing, employment and finances are not stable, this can cause additional stress for this population and increase feelings of burdensomeness.

Counselors in the community can maintain a list of referral agencies that support housing, employment and financial support. These organizations play an important role in reducing SMVF suicide, whether they realize it or not. If a service member or veteran is in financial crisis, they may be in a psychological crisis too.

The VA is increasingly working to support veterans in financial distress through the Financial Assistance for High Risk Veterans program. This program, available at many VA facilities, creates a partnership between local VA facility suicide prevention coordinators and revenue staff. Should a veteran with high risk of suicide also require assistance related to financial distress, the suicide prevention coordinator would connect the veteran to revenue staff. These staff would work personally with the veteran to apply for a VA financial hardship program that best fits the veteran’s financial situation.

As counselors in the community and the VA become aware of how financial stressors are interacting with the sense of burdensomeness in their clients, they can incorporate clinical moments to discuss and assess suicide risk while also developing strategies to build economic support. Together, clinicians inside and outside of the VA can bolster the network of housing, employment and financial assistance through reviewing what is available in the community and developing strong referral processes.

Education and awareness

A third protective factor is increasing community education and awareness about SMVF suicide and suicide prevention. This is yet another area in which professional counselors can make an impact. Counselors who are familiar with suicide prevention efforts can help others become familiar with them too. Providing greater awareness in the community is important. It is also critical to educate medical professionals about the problem. A large number of those who have died by suicide saw their primary care providers a month or less before their deaths (see ncbi.nlm.nih.gov/pubmed/12042175). Counselors can support their communities by facilitating or promoting gatekeeper training for those serving the military-affiliated population.

The VA has invested significantly in education around suicide. VA employees take annual suicide prevention training. VA facilities also conduct extensive community outreach to ensure that partners are aware of resources available to veterans and their families.

Counselors in the community can also take the initiative to become educated on SMVF suicide. The VA has partnered with PsychArmor Institute to provide free online access to the S.A.V.E. suicide prevention training (available at psycharmor.org/courses/s-a-v-e). In addition, VA suicide prevention coordinators partner with community providers to offer in-person training to those who need it. In their role as advocates, counselors can work with local leaders to provide clinical expertise connected to community suicide prevention efforts, whether that be public awareness campaigns or participation in local SMVF suicide prevention efforts.

Minimizing risk factors

Unfortunately, no matter how much we invest in preventive efforts, the possibility still exists that a member of the military-affiliated population will experience a suicidal crisis. When this happens, the community needs to be just as prepared to identify and reduce risk factors as it is to identify and implement protective factors. Both the CDC and the VA have identified more than a dozen risk factors that may lead to suicidal thoughts and behaviors, but there are three areas where professional counselors can be especially helpful.

Access to care

Of all the risk factors and protective factors identified here, the area in which counselors are most likely to be naturally involved is improving access to safer care. When it comes to the military-affiliated population, this means improving culturally competent care, reducing barriers to care, and reducing the mental health provider shortage for those organizations that serve this population.

The VA has done much to improve access to care for veterans, including the expansion and promotion of the Veterans Crisis Line (VeteransCrisisLine.net), a 24-hour service that veterans can call, text, or chat with at any time to receive immediate support. The VA also provides same-day access for veterans in need of mental health care and has built a robust telemental health and call center network that can direct veterans to get the care they need. In addition, the VA sponsors Coaching Into Care (mirecc.va.gov/coaching), a free service that educates, supports and empowers family members and friends who are seeking care for loved ones who are veterans. In addition, the DoD expanded nonmedical mental health services for the SMVF population up to a full year after leaving active duty.

Counselors in the community must be just as ready as their colleagues in the VA to improve access to care. It is incumbent upon counseling professionals to ensure that they develop and maintain an understanding of the unique psychological challenges faced by the SMVF population and that they are available to serve those individuals who do not access care through the VA or DoD.

Community counselors also have the ability to be important advocates for the profession through mentorship, collaboration and consultation. Increasing the number of veterans and military family members who consider careers in the mental health field is an excellent way to improve access to care for this population.

Lethal means safety

One area that deserves discussion but often goes unmentioned is the need for counselors to address the ability of clients to engage in self-harm. This includes talking about lethal means safety, particularly with those in the military-affiliated population.

Veterans are more likely to die from firearm-related suicide than are those in the general U.S. population, according to the VA’s 2019 National Veteran Suicide Prevention Annual Report (see mentalhealth.va.gov/suicide_prevention/data.asp). Safe storage of lethal means is any action that builds in time and space between a suicidal impulse and the ability to harm oneself. It addresses how to be safe from any lethal means, including firearms, prescription medications, and suicide hot spots.

This topic can be sensitive, especially because veterans have experience with and are comfortable with firearms. Effective lethal means safety counseling is collaborative, veteran-centered, and consistent with their values and priorities. Although the most preferred way of preventing SMVF suicide is to keep these individuals from going into crisis in the first place, lethal means safety plans are critical to preparing for suicidal crises should they arise.

The VA has made significant efforts to impact the conversation around lethal means safety. For example, it distributes free gunlocks to veterans and provides safe medication disposal envelopes at facilities across the country. The VA also recently instituted a nationally standardized safety planning template that ensures veterans have high-quality suicide prevention safety plans. Veterans and their providers work together to complete the plans, which identify innovative and feasible actions that can be taken to reduce access to lethal means. Suicide prevention coordinators within the VA have participated in firearm shows and fairs, providing materials and gunlocks directly to gun owners in their communities through partnering with local firearm groups.

Counselors in the community must be just as informed and prepared as counselors in the VA to discuss lethal means safety. They should be aware of locations that provide out-of-home firearm storage in the community and be able to have honest discussions with clients about when and how to use these resources. Counselors can partner with other community agencies to identify these resources. For example, the Colorado School of Public Health and the University of Colorado School of Medicine at the Anschutz Medical Campus have established the Colorado Gun Storage Map, provided for those community members seeking local options for temporary, voluntary firearm storage (see coloradofirearmsafetycoalition.org/gun-storage-map).

Counselors must take the same care when it comes to storage of prescription medications. In addition, community counselors may be more able than their VA counterparts to partner with local law enforcement to identify and mitigate suicide hot spots.

Postvention

A final area that counselors must address to reduce the risk of suicide in the SMVF population is postvention. Engaging service members, veterans, families, and providers after a suicide loss can promote healing, minimize adverse outcomes for those affected, and decrease the risk of suicide contagion. Postvention is critical to preventing additional suicides in the immediate social network of the person who died by suicide. Those bereaved by another person’s suicide have a greater probability of attempting suicide than do those bereaved by other causes of death. Those bereaved by another person’s suicide are also at increased risk for several physical and mental health conditions.

Community providers play a significant role in postvention. Clients who have attempted suicide are at a higher risk for future attempts unless the underlying problems that led to the attempt are addressed. Community providers are also important in addressing postvention needs in those left behind because of a death by suicide, such as the spouse and child of a service member or veteran. Whereas veterans may be served through the VA and service members may be served through the DoD, spouses and children of service members and veterans may not have access to the resources they need. This is where professional counselors in the community can offer support. For example, SAVE (Suicide Awareness Voices of Education) has excellent postvention resources for coping with loss (see save.org/find-help/coping-with-loss).

The VA has implemented processes to increase postvention efforts in its facilities. The VA provides its staff with suicide postvention guidance that can be tailored to meet the needs of each individual facility. Postvention efforts should include everyone who might have been affected by the death, including veterans, their families, and employees. Following a suicide, efforts are made to promote healing and support the deceased veteran’s family. Many local VA organizations have partnerships with the American Foundation for Suicide Prevention (afsp.org) and the Tragedy Assistance Program for Survivors (taps.org/suicideloss) to provide support to veterans’ family members and friends.

Additionally, the free, confidential Suicide Risk Management Consultation Program (mirecc.va.gov/visn19/consult) is available to assist staff with training on postvention. This program provides consultation, support and resources that promote therapeutic best practices for providers working with veterans at risk of suicide. It offers tailored, one-on-one support with consultants who have years of experience with veteran suicide prevention.

Suicide prevention is everyone’s job

The strategies to prevent suicide in the SMVF population are as complex as the risk factors for suicide itself. Unlike other challenges that SMVF clients face, such as homelessness and unemployment, success in reducing suicide is not clearly defined. If clients are housed, they are no longer homeless, and if clients are employed, they are no longer unemployed. The measure of success in suicide reduction is not just the absence of suicidal self-harm, however, but the presence of a life worth living and an overall level of wellness in the client.

This is where professional counselors can play a role in their clients’ lives and in their communities. Members of the military-affiliated population have sacrificed and served, regardless of when, where and how they served. It is necessary — and possible — to serve them in return, providing them the life of wellness and stability that they desire and deserve.

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For more information and resources, visit mentalhealth.va.gov and veteranmentalhealth.com. Additional resources for veterans, families, and community providers can be found at BeThereForVeterans.com and MakeTheConnection.net

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Duane France is a retired Army noncommissioned officer, combat veteran, and licensed professional counselor. He is the director of veteran services for the Family Care Center, a privately owned outpatient mental health clinic in Colorado Springs, Colorado, that specializes in serving the military-affiliated population. He also writes and speaks about veteran mental health on his blog and podcast, Head Space and Timing (veteranmentalhealth.com), and writes the monthly “From Combat to Counseling” column for CT Online.

Juliana Hallows is a national board certified and professionally licensed counselor. She serves veterans, their families, and communities through the VA National Suicide Prevention Program, where she is a health system specialist for policy and legislation.

 

Letters to the editor: ct@counseling.org

 

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Related reading: Counseling Today‘s September cover story, “Making it safe to talk about suicidal ideation

 

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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.

Using reality therapy to help military families

By Nicole M. Arcuri Sanders June 14, 2019

Military children are the “Children of the world, blown to all corners of the world. [They] bloom anywhere.” Just like dandelions, military children never know where they will go and where they will grow.

Diane Townsend Davis is credited with creating the dandelion motto for military children. Understanding this motto is imperative for any counselor who wishes to work with military children, but especially for school counselors. The Department of Defense Dependents Education (DoDDE) estimates that 80% of military children (approximately 1.2 million) attend public schools.

Counselors who work with military children must understand the unique stressors that these children face, but counselors also must be prepared to help meet these children’s needs in a short amount of time because their families move often. To avoid having these children slip through the cracks, school counselors must be knowledgeable about rapport-building strategies with this population and meet their needs in a realistic time frame.

 

Reality therapy

Working with clients from their worldview is not a new concept for counselors. This is particularly important when working with a population connected to the military because these clients’ perspectives differ drastically from those of the civilian population. Being knowledgeable about the unique needs of the military culture is a necessity for effective counseling work. For instance, often as military children begin to find their niche in a school, their families will receive orders for relocation. Military families relocate 2.4 times more often than do civilian families (on average, military families relocate every two to three years).

Reality therapy offers this population an honest evaluation of their current choices and behaviors to determine if change is needed to obtain their desired outcomes. This modality offers something that is very important to consider for this population —an emphasis on what aspects of life the client has control over.

As noted, military children move often and therefore tend to be the new kid in school quite frequently. But these children are not like most other new children in school. These children:

  • Have parents who are willing to sacrifice their lives for the well-being of the nation and to safeguard its people
  • Have parents who often leave for extended periods of time to either train for combat-related situations or as part of combat-related missions
  • Know that a great deal of risk is associated with their parents’ jobs
  • Don’t always know whether their mom or dad made it back safely from work
  • Can go for months without being able to see their parent(s)

In an age of social media, these children may at times be able to connect with their parents, but they also might see or hear reports of attacks on the news. When a member of a military unit is killed in action, all communication is cut off at their deployment station to ensure that the family of the service member is notified prior to receiving any other communication. When military children are unable to connect with their parent, the fear of the death being their father or mother is very real. All of the above noted aspects are the reality for military children, and all of these aspects are out of their realm of control.

Reality therapy offers these clients the opportunity to form a relationship with their counselor based on understanding and nonjudgment. Clients have a voice when working with counselors who use reality therapy. The clients become empowered by being afforded the idea of having control over their behaviors and actions.

A basic tenant of reality therapy is aiding clients in having their basic needs met. Creating a safe place in which clients do not feel judged but do feel empowered is therapeutic in itself.

Reality therapy is founded on the idea that everyone is seeking to fulfill five basic needs:

1) Love and belonging

2) Power or sense of worth

3) Freedom or independence

4) Fun or a sense of pleasure

5) Survival (which is based on knowing that one’s basic needs are being met)

When one of these needs is not being met, mental health issues can arise.

For clients connected to the military, feeling loved and belonging might look different than it does for other clients. Because these clients are frequently separated from loved ones and move often, meeting their need to feel loved and belong can be challenging. Reality therapy provides these clients with the understanding that they cannot change or control others. So, the practical approach will be to solve problems through their ability to control themselves and their own behaviors and thus make choices that support their needs and desired goals.

Within the military, very little power is offered to the family or the service member. Ultimately, the family and service member follow orders from a multitude of levels within the Department of Defense (DOD). Yet each military-connected member can feel a sense of accomplishment through actions they choose to control. For instance, helping clients make a list of goals that they want to accomplish while living somewhere (i.e., making the best out of each duty station) can be empowering to them.

Gaining knowledge of a new area through exploration can also be empowering. Helping clients identify their interests (and what makes them unique) can further support their independence and wellness. Fun can also be part of that experience.

Of course, with each transition that military-connected clients face, their survival needs will be tested. For instance, they may need to realign their thoughts regarding shelter (housing). Yet helping these clients differentiate what is out of their control and what is in their control can aide them in pursuing actions that support the desired outcomes that are within their control. Clients may still be angry, confused or saddened by aspects that are outside of their control. But counselors can help clients see that rather than blaming others or relying on these aspects as an excuse, they can focus on and take ownership of their present time and actions.

Reality therapy sessions are structured around the WDEP system — the client’s wants, doing, evaluation and planning. The counselor meets the client in the here and now and explores what the client wants. This realistic exploration of attainment notes what is in the client’s control and what is not. Clients then share what they are doing to help themselves achieve their wants. Next, the counselor helps clients evaluate whether what they are doing is supportive of or detrimental to their goals. Then, together, the counselor and client plan ways to change detrimental behaviors and fine-tune supportive behaviors to allow for the client to obtain his or her wants.

As the client is faced with new areas of need, the same WDEP system can be applied. Military-connected clients are faced with many hardships fostered by their culture. But reality therapy offers this population a real chance to be resilient by adapting to change and overcoming challenges.

 

Resilience

Military child resiliency largely resembles how well the stay-behind parent is doing. If the parent is unable to cope or transition with the needs of the family when the service member is not available to assist them, then a domino effect will occur. Children will have to fulfill adult responsibilities in the absence of the service member. The parental stressors will then be placed on the children’s shoulders.

For some parents, missing a spouse may be too much for them to handle. Other parents who are left behind may not be married or may not currently be together with the service member, but they may still rely on the service member for support with the children.

When there is a lack of available support, the additional stressors put these families at risk. A 2008 report from the Military Family Research Institute found studies to support that since 9/11, when the number of deployments for service members increased, military families experienced increased rates of marital conflict, domestic violence, child neglect or maltreatment, parenting stress, anxiety and depression.

On the opposite side, when the parent left behind is able to successfully juggle the transition and continue meeting both personal and family needs, children experience less turmoil. These children are better able to continue on as normal with minimal changes to other aspects of life. However, having resources available to these parents to support them in filling roles for which the service member parent was typically responsible is imperative.

Civilian school counselors and community mental health counselors should consider that the resources that military families rely on may not be readily available. For instance, counselors should note whether additional family support is local versus distant and how long the family has called its current community home. Again, reality therapy can provide these clients with a realistic perspective of addressing their needs. Therefore, it is important for counselors to know what additional supports are available to these families.

 

School counselors

According to the National Center for Education Statistics, children across the United States spend an average of 6.64 hours a day and a 180 days per year attending public schools. As noted previously, 80% of military children attend public schools.

Public schools have a duty to be aware of the needs of military children. In its 2012 national model, the American School Counselor Association (ASCA) asserts the necessity for school counselors to understand their students’ culture in order to provide effective support for students’ academic, career and personal/social development. ASCA further proclaims in its 2012 executive summary that school counseling programs can be effective only when a collaborative effort exists between the school counselor, parents and other educators, thus creating an environment that promotes student achievement.

School counselors who use reality therapy can support students’ academic, career and personal/social development. For each of these areas of development, the school counselor can address the student client’s wants and doing while also aiding the student in evaluating such efforts and making plans that support success. Yet without understanding the unique needs of the military lifestyle, school counselors will be unable to support these children in the schools or locate appropriate community resources to provide support outside of school. Therefore, when assessing the student client’s wants, a realistic perspective of the stakeholders involved will aid in developing goals that the student client has control over.

 

Community counselors

The same notion of understanding the unique needs of military children and military families is true for civilian community counselors. According to the ACA Code of Ethics, the primary responsibility of a counselor is to respect the dignity and promote the welfare of clients (Standard A.1.a.). This notion alone requires counselors to take the specific needs of their clients into consideration.

To best do this, counselors should not impose their own values on clients (A.4.b.) but instead should honor the diversity of clients and their uniqueness within their social and cultural contexts. Reality therapy promotes this understanding by developing a therapeutic relationship that embraces the client’s worldview and operates from that perspective in developing realistic goals.

 

Realistic intervention

As military children, family members and service members are blown to all corners of the world, professional counselors should be asking themselves a question: “How can we best serve these clients so that they can bloom?”

All counselors should have the same mission when working with this population — namely, devising goals that are realistic and attainable for these clients. Counselors must make themselves knowledgeable of the specific resources that are available to this population to promote therapeutic growth rather than presenting yet another barrier that these clients must face. There are many resources available exclusively to service members, veterans and their families of which civilian counselors may not be aware. When working with military families, it is imperative that counselors do their homework regarding these resources before leading clients blindly with an analysis of client control in establishing wants or goals.

Toward the end of this article, I will share a number of resources that are available to assist military families living off base. But let’s next consider what civilian counselors can do.

For starters, civilian counselors will want to build rapport with the military-connected client while being mindful of their cultural worldview (just as they would with any other client). This will require the counselor to be knowledgeable about the military population and the client’s role within the military family. As noted earlier, this is a unique culture, and being able to understand this lens of perception will be helpful when clients are processing and trying to navigate scenarios for realistic solutions or coming to terms with aspects that may be troublesome (again, following the tenets of reality therapy).

Second, whether working with the service member, the child or the stay-behind parent, consider infusing into the treatment plan the power of resiliency. Due to their lifestyle, military-connected clients are typically used to a great deal of adjustment in various aspects of their lives on a regular basis. Helping clients build off of their past successes to navigate new challenges can be empowering. Reality therapy supports counselors in evaluating with clients what is working and what is not.

In 2008, the Military Family Research Institute found that the following stressors were considered normative for military children but not for civilian children:

1) Regular, and at times lengthy, separations from parents

2) Lengthy parental work hours

3) Permanent changes of station

4) Deployments for multiple and various purposes

5) Exposure to combat-related activities and equipment, including training

Just because the stressors are considered normal for the population, the events and circumstances experienced are not to be inferred as easy for military children to manage. Just like with any stressor for any client, the more sudden, serious, ambiguous or traumatic the loss, the more difficult the stress will be to manage. Many of these same stressors are applicable both to the parent who is left behind and to the service member.

It is common for military couples to experience marital distress due to a multitude of these stressors. Commonly seen mental health issues in the military population for the service member and veteran include mood disorders, trauma/posttraumatic stress disorder, sexual assault, suicide, addiction, adjustment issues and relationship concerns. Commonly seen mental health issues among military spouses and children include mood disorders, trauma, adjustment issues and relationship concerns.

To explore an issue that may plague any member of a military family, we will focus on working with a military-connected client who is experiencing relationship issues. Guiding these clients in exploring how to communicate with their families despite the physical distance between them and how to involve family members in their life even from afar can help with feelings of detachment. Reality therapy offers clients the ability to come to terms with aspects of their lives that are in their control as well as outside of their control.

Finding ways to help clients embrace the family dynamic even when changes occur can help sustain the idea of their family system. Highlighting previous resiliency efforts to help clients explore this new change, come to accept it, and adapt how they now fit into their family system can reinforce the idea of maintaining relationships. WDEP analysis for each consideration posed by clients offers not only a realistic evaluation of their current circumstance, but also celebrates their small victories and offers opportunities to modify aspects that are not supporting their desired wants.

Navigating the change within the family while assessing client strengths and processing their feelings regarding the change (as well as the realistic desires of the client, while still being mindful of the military lifestyle) can aid the client in managing more healthy relationships. This can be extended to other relationships outside of the family as well.

The idea of resiliency and understanding military culture is at the core of helping these clients. Reality therapy offers counselors the ability to seamlessly integrate into each session regardless of how much time they ultimately have with these clients.

 

Resources for all

To provide additional effective supports when working with children and families connected to the military, it is necessary to know where to turn. These additional supports are very important because these clients move frequently and are often far from family and friends who might normally offer assistance. And counselors cannot do it all by themselves.

The resources mentioned below are only a few of the many available to military families. However, they are a great place to start, whether you counsel military-connected children and their families in the school setting or in the community.

American Red Cross: Offers support with emergency communications with service member while deployed, financial assistance, information and referral services, deployment services, and Reunification Workshops.

Exceptional Family Member Program (EFMP): Program is intended to support service member dependents who have ongoing medical, mental health or special education needs (on both spectrums — gifted as well as challenges). To enroll, service members should complete and submit 1) DD Form 2792, the Family Member Medical Summary or 2) DD Form 2792-1, the Family Member Special Education/Early Intervention Summary to their installation EFMP office.

MIC3 (mic3.net/): This is the official website of the Military Interstate Children’s Compact Commission. The goal of the interstate compact is to replace the widely varying policies affecting transitioning military students with a consistent policy in every school district and in every state that chooses to join.

Military Child Education Coalition: The coalitions three goals are the following:

1) Military-connected children’s academic, social and emotional needs are recognized, supported and appropriate responses provided.

2) Parents, and other supporting adults, are empowered with the knowledge to ensure military-connected children are college, workforce and life ready.

3) A strong community of partners is committed to support an environment where military-connected children thrive.

Military family life counselors: Intention is to support service members, their families and survivors with nonmedical counseling worldwide. Counselors provide face-to-face counseling services, briefings and presentations to the military community both on and off the installation.

Military and Government Counseling Association (MGCA): MGCA is a division of the American Counseling Association with the mission of servicing those who serve. Its website says, “The purpose of MGCA is to encourage and deliver meaningful guidance, counseling, and educational programs to all members of the Armed Services, their family members, and civilian employees of Local, State and Federal Governmental Agencies. … Develop and promote the highest standards of professional conduct among counselors and educators working with Armed Services personnel and veterans. Establish, promote, and maintain improved communication with the nonmilitary community; and conduct and foster programs to enhance individual human development and increase recognition of humanistic values and goals within State and Federal Agencies.” MGCA publishes the peer-reviewed Journal of Military and Government Counseling. The journal publishes articles on all aspects of practice, theory, research and professionalism related to counseling and education in military and government settings.

Military Kids Connect: Military Kids Connect is an online community for military children (ages 6-17) that provides access to age-appropriate resources to support children dealing with the unique psychological challenges of military life.

Military OneSource: Military OneSource offers a range of individualized consultations, coaching and counseling services for many aspects of military life. Services include confidential nonmedical counseling, spouse education and career opportunities, document translation, financial and tax consultation, special needs, spouse relocation and transition, and education.

U.S. Department of Defense Education Activity school liaison officers: The purpose of this position is to serve as the primary point of contact for school-related matters; represent, inform and assist commands; assist military families with school issues (to include providing parents with the tools they need to overcome obstacles to education that stem from the military lifestyle); coordinate with local school systems; and forge partnerships between the military and schools.

Many of the resources available to military service members and their dependents (spouse and children) are free of charge. Noting this may be the difference in whether military families seek these resources out.

 

Summary

I hope this article has provided some insights regarding the needs of military children and their families. In order to provide effective school and community resources for this population, it is important to be aware that these children are not located only on military installations; they are also on public school campuses and in civilian communities. To safeguard the well-being of these children and their families, it is also imperative to understand the uniqueness of military culture.

Currently, there is a gap in services for military families living in the civilian realm. The purpose of this article is to build confidence among civilian school counselors and community counselors by suggesting realistic resources that will help them to better support this population. You never know if a dandelion will blow into your community and need assistance to bloom.

 

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Nicole M. Arcuri Sanders is a licensed professional counselor and core faculty at Capella University within the School of Counseling and Human Services. Clinically, she engages in practice with the military-connected population. Within this specific area of focus, she has also completed research, published, and presented at local, regional and national conferences to advocate for effective clinical services to meet this population’s needs. She has previously worked as a DoDEA district military liaison counselor, substance awareness counselor, school counselor, psychiatric assessment counselor, anti-bullying specialist and teacher. Contact her at Nicole.ArcuriSanders@capella.edu.

 

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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.

 

Hooah! Thoughts and musings on Operation Immersion

By Janet Fain Morgan January 3, 2017

Hooah: Military slang referring to or meaning “anything and everything except ‘no.’” Used predominantly by soldiers in the U.S. Army.

 

My father was in the U.S. Army for more than 30 years. I grew up as a military dependent, relocating every few years (and attending more than 20 schools) until I graduated high school. I joined the Army Reserve, later married my husband, a U.S. Navy submariner, and he eventually ended up retiring from the Army after 20 years. My eldest son joined the Army out of college and is currently on active duty.

I have been a licensed professional counselor in Augusta, Georgia; Bamberg, Germany; Lakewood, Washington; Fort Knox, Kentucky; Columbus, Georgia; and most recently, Somerset, Kentucky. As a member of the American Counseling Association and the Military and Government Counseling Association (a division of ACA), I am concerned about the rising number of suicides among our military veterans. On a related note, I am also concerned by the limited number of education and training opportunities available to counselors who are dedicated to the specific needs of military clients.

This past year, the Kentucky Counseling Association (KCA), a state branch of ACA, advertised a training program for counselors called Kentucky Operation Immersion. The program offered an immersion experience into military culture that aimed to help counselors become aware of the unique culture and specific needs of military clients. The training educated counselors on how better to help soldiers as they transition back from wartime environments overseas and reintegrate into a civilian society.

Only about 1 percent of the U.S. population actually serves in the military. Many people do not understand the difference between the military mindset and the civilian frame of mind. For that reason, I was impressed and excited to see that KCA was addressing a very important topic that can make a difference to our military members.

As a counseling professional and former soldier, I jumped at the opportunity to train with the Army National Guard at the Wendell H. Ford Regional Training Center. The Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID) and the Kentucky Army National Guard presented and sponsored the training, and many of their respective department members joined in the training. I had no idea what I had signed up for, but sometimes ignorance is bliss.

I arrived to join approximately 30 other participants from a variety of specialties, including drug and alcohol counselors, psychologists, school counselors and Kentucky Department of Veterans Affairs employees. The participants ranged in age from their 20s to their 70s.

Day One: Basic training

On the first day — basic training — we were introduced to the training leaders, department heads and Army National Guard soldiers who would mentor us throughout the training. We were issued our field equipment, including Kevlar helmets and flak jackets, which we would wear during our training for the next three days. Removing the metal plates that are normally part of the bulletproof garment decreased the flak jacket’s weight. Even so, the jacket was still heavy and served as a constant reminder of what soldiers wear to protect themselves during deployment.

Our first training exercise was an introduction to platoon formation and marching, but this version was much kinder than what I had experienced in my Army basic training days. Regardless, I found myself unable to maintain the pace of the platoon. This bruised my ego and provided a gentle indicator of the physical limitations I might encounter in the training exercises to come. And come they did …

The author, second from right in the back row, with fellow members of her Operation Immersion training squad.

The Field Leadership Reaction Course was a team-building exercise (obstacle course) that further introduced me to my counselor peers. We had fun coordinating our navigation of the ropes, walls and boards to achieve successful outcomes. Then Kentucky weather intervened, and we headed for shelter from tornadoes, storms and heavy rains. Chow took place in the mess hall with service members who invited us to ask them questions about the military and their military experience.

That evening we met Bobby Henline, an American hero, comedian and motivational speaker who served four tours of duty in Iraq. During his fourth tour, he was the sole survivor of a roadside bombing that left a third of his body burned. He shared his survival story and his outsize sense of humor with us. Bobby participated with us throughout the training and was an inspiration to us all. His humor helped lighten the serious moments, and his encouragement was invaluable. It was a true honor to meet him and a blessing to spend time with him.

Sleep was sweet after such a full first day.

Day One counseling takeaway: Military training is demanding physically and challenging mentally. Build relationships with military clients by asking about their training and work environments. Ask questions about any military-specific acronyms that they use. Many people know what an MRE (meal ready to eat) is, but fewer are familiar with what FOB (forward operations base) or TOC (tactical operations center) represent. Get to know these clients’ personal stories. This can shed light on what might be troubling them and why they are seeking counseling.

Day Two: Mobilization

Day Two arrived early — at 5 a.m. — and there we were, in formation, doing PT (physical training). Mobilization day started with breakfast in the chow hall, and then we had a class on sexual assault prevention. That morning we also heard personal stories of deployment from individual soldiers. Their stories spoke of bravery, tragedy, courage and, sometimes, boredom. All the stories touched our souls. In fact, when the program participants looked back over those days of classes, physical challenges and training, we decided the deployment stories were what we would remember most.

After a class on combat-related trauma, we headed to the SIM (Simulation) Center, where we ate MREs and enjoyed the virtual combat simulators in the forms of EST (Engagement Skills Training with Night Vision), IED (Improvised Explosive Device training instruction), HEAT (Humvee Egress Awareness Training Simulator) and CSF2 (Comprehensive Soldier and Family Fitness).

That evening, we were briefed by the commander, Capt. Michael Moynahan, and heard another personal deployment story from Maj. Amy Sutter, a licensed clinical social worker. Her mental health perspective on deployment was invaluable, and we also gained insight on deployment from a female viewpoint.

Day Two counseling takeaway: Deployment is rough, both mentally and physically. The living arrangements are complex, and soldiers have many challenges related to isolation and loneliness. At the same time, privacy is often limited. Build the therapeutic relationship by asking your military clients about any and all deployments. Each deployment offers military members challenges and unique perspectives. These could be explored through open-ended questions about their personal experiences. Be aware that some of these clients have seen or done things that they do not want to disclose or remember.

Day Three: Deployment

Deployment day again came early, with PT that included a warmup and running track. Classwork began with a briefing on substance abuse, posttraumatic stress disorder and traumatic brain injury. After listening to a suicide prevention panel, we headed out on a bus to the Gwynn City MOUT (Military Operations on Urban Terrain) site for our deployment training.

The Army National Guard launched a few simulated IED attacks in the direction of our bus and also created a machine gun simulation to get us “in the mood” for our urban warfare exercises. Command Sgt. Maj. Matthew Roberge led the military demonstrations and the exercises to prepare us for clearing a building of enemy personnel. The smooth, precise and sharp Army National Guard soldiers modeled the intricate procedure for us, and in teams of four, we attempted to reproduce the action with our military-style paintball weapons.

Our attempt was a less than perfect assault, with paintballs flying everywhere and Kentucky counselors doing their best to come out of the training exercise unscathed. That said, there was much laughter and excitement throughout, and everyone emerged feeling abundant respect for our U.S. military, and especially the group of professionals who worked with us during our training experience.

Dinner that evening was a relaxing outdoor cookout, during which we said goodbye to many of the soldiers who were leaving for their drill weekend. Awards were given, speeches were made and the treasured “challenge coins” — engraved with a unit’s or organization’s insignia or motto and given as a sign of respect — were secretly passed from palm to palm.

Day Three counseling takeaway: Military members face death often and rely on their training and peers to stay safe. Their training is precise and has to be executed perfectly every time, or the soldiers and their companions run the risk of becoming casualties. A high level of stress accompanies each operation, and sometimes that stress may last for days, weeks or even months, with little or no downtime for the soldier. The residual effects from this intense training and the soldier’s subsequent experiences can last a lifetime. Counselors should understand the deleterious effects of combat. Even if operations are carried out perfectly, casualties can occur, accidents can happen and the effects can be devastating.

Day Four: Demobilization

Demobilization day was early to rise — 4:50 a.m. — so we could clean the barracks, pack our bags and return the gear. Breakfast was quick, but then our first speaker arrived to awaken our senses. Capt. Phil Majcher spoke about his role as battalion chaplain and the duties that were part of the military chaplaincy. He didn’t sugarcoat anything, giving many of us moral points to ponder.

Linda Ringleka, military and national liaison from Lincoln Trail Behavioral Health System, joined Capt. Majcher. Together, they led a workshop on suicide prevention and ACE (Ask, Care, Escort) training. The counselors participated in small group activities that included role-plays and real-time suicide scenarios.

Sgt. Brooks, a female soldier, offered to speak with the female trainees about her experiences as a woman in the military with two deployments under her belt. Gathering together as women, we heard her personal story of courage, determination, struggling as a single mom and the challenges of being female in the Army. Her story was incredible and touched each of us. I must also mention that watching Sgt. Brooks throughout the entire training was like witnessing a master of all trades. She did everything that her male counterparts did, and with effortless perfection.

As we wrapped up the training, pictures were taken and awards were announced. Heath Dolen, DBHDID program administrator, presented each of us with a certificate, and a coveted challenge coin was passed secretly in a handshake.

As I drove home, I reflected on the immense amount of information and knowledge we had all gained as mental health professionals. This training was invaluable in providing us with skills to help soldiers as they return from difficult and sometimes horrific experiences. Many of these potential clients need to know that the counselors assisting them do actually understand some of the hardships they have endured. Counselors must gain the trust of hurting service members before many of them will disclose the horrors that they witnessed or even participated in during a deployment to a war zone.

The rules that we typically live by in our society do not always correspond to the experiences that soldiers see and live through. The camaraderie of this very tightknit community is exceptional, and counselors must understand the underlying military culture and gain the trust of these soldiers to be as effective as possible. Of that, I am certain.

I highly recommend that all mental health care professionals who take care of our soldiers undergo the type of training offered in Operation Immersion. Our heroes deserve the best that mental health professionals can give them, and this training definitely moved us in that direction.

 

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Janet Fain Morgan is a military family life counselor licensed in Kentucky and Georgia. She is a faculty member of William Glasser International and a member of the Military and Government Counseling Association, a division of ACA. She is also a former soldier. Contact her at JMFainMorgan@gmail.com.

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Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having your article accepted for publication, go to ct.counseling.org/feedback

 

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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.