Tag Archives: veterans

Effective treatment of military clients

By Keith Myers August 1, 2013

militaryThere is sound research available that demonstrates the efficacy of certain evidence-based treatments when working with the military population. However, most of that research seems to disregard the necessary prerequisite for counselors in achieving reliable treatment outcomes — the ability to build trust with a client population that has a general disposition to distrust others, especially those outside of the military, which probably includes most of you reading this article. The prerequisite of trust illustrates the primary importance of establishing a level of multicultural awareness that will empower clinicians to achieve a more meaningful therapeutic relationship with military clients. In turn, this will lead to an improved quality of life for those clients.

Trust is the foundation for all meaningful personal and professional relationships. It is what causes a child to laugh when his father hoists him high into the air, knowing that he will always catch him on the way down. If a veteran does not trust you, then your treatment outcomes will have poor results virtually every time. One of my former military clients put it to me bluntly: “I’m not going to let you screw with my mind before I get to know who you are and what you represent.”

Therefore, each clinician should work diligently to establish that level of trust before proceeding with more intensive treatment such as trauma work or other aspects of a mental health treatment plan. Whether you currently work with this population or are simply considering it, I would like to offer some practical ways to build trust with military clients.

Be aware of their grit and character

Merriam-Webster dictionary defines grit as “sand, gravel; a hard, sharp granule.” Another definition includes “firmness of mind or spirit; unyielding courage in the face of hardship or danger; indomitable spirit.”

If you are planning on working with military veterans or active-duty members, then you should be aware of their inner character and grit. This grit is what helps keep them alive in theater, motivates them in spite of roadblocks and allows them to persevere under dire conditions. Military training and culture advances and enhances this inner fortitude.

This culture of character is evident in the language taken from an actual Army NCO Evaluation Report (officer evaluation). It states, “Army Values: Loyalty — bears true faith and allegiance to the U.S. Constitution, the Army, the unit, and other Soldiers; Duty — fulfills their obligations; Respect — treats people as they should be treated; Selfless Service — puts the welfare of the nation, the Army, and subordinates before their own; Honor — lives up to all the Army values; Integrity — does what is right legally and morally; Personal Courage — faces fear, danger, or adversity.” Each branch of service has its own set of values by which its members are expected to live and conduct themselves, but they all speak to an overarching theme of maintaining a high moral and ethical code.

It has been my experience that military clients can activate this grit while in treatment and that it can motivate them to achieve outcomes that might be more difficult for nonmilitary clients to achieve. Having an awareness of this “hard, sharp granule” within military clients gives you more insight into this population, thereby helping you to form trust and rapport earlier in the therapeutic process.

Respect their service

My late father, a World War II Navy combat veteran, would become both angry and empathetic when viewing TV footage of Americans belittling, mocking and even spitting on returning Vietnam veterans. He would exclaim, “How dare those people spit on our troops’ faces when those are the same people for whom they lost their lives!”

Regardless of your personal political views on the Vietnam War, I hope all of us can acknowledge the disrespect our own culture showed Vietnam veterans after they returned from service. It stands as a horrific example of how not to treat our veterans. Sometimes, the best lesson for learning what to do is deduced from learning how not to behave.

On the other hand, one practical way that counselors can show respect for their military clients is to honor all military holidays in their own practice or clinical setting. At the same time, counselors should be mindful that the holidays could invoke memories of buddies who were lost in service or some intrusive thoughts surrounding combat trauma. Some of these holidays include Memorial Day, Veterans Day and birthdays of the different branches of service.

Be comfortable with spirituality

Among the spiritual statements I have heard previous military clients make are, “I don’t know what happened. My spirit died out there” and “Before deployment, God told me that I would return injured but promised me that he would not let me die.”

It is common for spirituality and the veteran population, especially combat veterans, to be intertwined. Therefore, being comfortable with veterans exploring their faith and/or spirituality during a counseling session is vital to building trust and effectively treating this population.

Edward Tick, a clinical psychotherapist who has worked with veterans for more than 30 years, authored the influential book War and the Soul, which contends that posttraumatic stress disorder is a psychospiritual condition or “soul wound.” On the basis of his work during the past three decades, Tick further asserts that a significant part of this wound is caused and further exacerbated by the absence of warrior rites of passage that were present in ancient civilizations. He explains that these spiritual and communal rites of passage are oftentimes missing within the U.S. military system, especially when military members return home. Tick cites storytelling and reconciliation retreats as two such spiritual rites of passage. He further explains, “Reconciliation retreats are one of the most effective tools for addressing the healing needs of both veterans and nonveterans. Such retreats incorporate the individual, group, aesthetic and spiritual dimensions of healing, while relying on the healing power of the story.”

To maintain multicultural relevance and effectively treat combat veterans, counselors and other mental health clinicians must possess knowledge about spirituality and faith as well as the spiritual effects of war.

Use some disclosure to enhance rapport

Regarding my own establishment of professional boundaries with clients in the past, I always erred on the side of caution when disclosing any personal information. Ethically speaking, disclosure comes with certain risks, including the possible crossing of boundaries. It can open the door for a role reversal of sorts if the client listens to the counselor’s issues and begins providing emotional support. As I often emphasize to my students, “You are the therapist, not the client.”

However, aren’t we being incongruent if we believe that authenticity is vital for clients yet never disclose any personal information at all in our role as counselors? Is there a way to balance being genuine with clients while simultaneously keeping other meaningful parts of our lives private? I believe this balance must exist if we are to be effective in treating veterans. Some amount of disclosure during the intake session can enhance rapport and trust, which strengthens the therapeutic alliance going forward in treatment.

I typically share three disclosures with military clients after informed consent: the personal meaning I derive from serving veterans, my previous work in clinical settings and that members of my family have served in the military. For example, I often inform these clients that helping them is rewarding to me because it allows me to “serve those who served,” which I consider to be one of the highest honors. Furthermore, I explain to them that I feel this allows me to give back in some indirect way to my family members who have served. Therefore, my “service” of working with veterans and active-duty members enriches my own purpose and meaning both on the professional and personal levels.

Several clients have reported that these disclosures significantly reduced their initial distrust of me and allowed them to be more open-minded in developing a therapeutic relationship.

Advocate for them

According to the Online Etymology Dictionary, the word advocate is a technical term derived from Roman law that refers to “one whose profession is to plead cases in a court of justice.” It can also mean “one who intercedes for another” or “a pleader.”

If counselors wish to build rapport and establish professional relationships with military clients, then they need to develop the skill of interceding on behalf of their clients. Counselors would be wise to learn from the sister profession of social workers, who have gained a reputation for being master advocates for the clients they serve. In order to remain true to the ACA Code of Ethics, counselors should be aware of the role that advocacy implies and address these expectations clearly with clients before moving forward.

Some practical ways to advocate for veteran clients include communicating treatment goals and progress with their other providers (such as primary care physicians and other providers within the Department of Veterans Affairs) and linking these clients to other community resources. A client once informed me, “I know you care because you are willing to be my voice.”

At times, clients have asked me to accompany them to their physician appointments so I could help articulate their needs. Because I work with clients in an intensive outpatient program, it is possible for me to meet that request. Depending on your practice setting and the level of care you provide, accompanying your client to appointments may not be convenient or even possible. But you might be able to help articulate your client’s needs to other providers by writing a letter that the client presents at these appointments.

Getting started

Maybe you are a clinician and have always been interested in working with the veteran population but are confused about where to begin. As many of us probably realize, the Department of Veterans Affairs has been slow to recognize professional counselors as having equal standing with social workers in job placement. There are a few other possibilities available for exploration, however.

First, it is helpful to discover the location of your closest Wounded Warrior Project chapter. Wounded Warrior Project is a national nonprofit organization whose mission is “to empower and honor wounded warriors.” This mission is accomplished in part by holding community events, providing mental health education to warriors and their families, and promoting recreational interests that connect wounded warriors with each other. By networking with your local chapter of the Wounded Warrior Project, you will be exposed to opportunities for obtaining counseling referrals to work with the veteran population.

Second, if you are independently licensed by your state, have graduated from a counseling program accredited by the Council for Accreditation of Counseling and Related Educational Programs and are providing therapy in a private practice setting, another option involves enrolling with the TRICARE panel. TRICARE is the insurance plan for the Department of Defense (DOD). Getting listed as a TRICARE in-network provider will make it possible to receive counseling referrals directly from the DOD. The American Counseling Association website has a “Private Practice Pointers” section that includes helpful information on starting the application process for TRICARE (from counseling.org, click on “Knowledge Center” and then “Private Practice Pointers”). Unfortunately, this process can take several months, so considerable patience is required.

A final helpful tip for getting started is to attend national, regional and local conferences that offer education about veterans. Whether it is the national ACA Conference or a local conference offered by your state counseling branch, this can be a relatively simple way both to absorb more knowledge about this culture and to network with other clinicians about possible referrals.

Final thoughts

A client recently shared with me that another therapist had made the following statement to him during a session early in the counseling relationship: “Trust me. I’m your therapist.”

This phrase was insulting to the client because actions speak louder than any attempt at shallow reassurance. If simply offering verbal reassurance of your trustworthiness as a therapist was a helpful intervention with veteran or active-duty clients, this article would have been composed of one succinct paragraph. However, it is never that simple with any population, much less with veterans and active-duty members who have a heightened tendency to be guarded with others.

Developing practical skills related to how to “treat” military clients will bolster your ability to connect with them and advance the goal of building trust in the therapeutic relationship. Accomplishing this prerequisite goal will help your military clients to achieve greater clinical outcomes and ultimately lead them to an enhanced quality of life.

 

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Keith Myers is a licensed professional counselor in Georgia, where he works at the Shepherd Center’s SHARE Military Initiative program in Atlanta serving active-duty members and veterans who have traumatic brain injury and posttraumatic stress disorder. He is intensively trained in eye movement desensitization and reprocessing therapy and is a doctoral student in counselor education and supervision at Mercer University, Atlanta. He also serves as an adjunct faculty member with both Argosy University in Atlanta and Point University in East Point, Ga. Contact him at doc355@yahoo.com.

Letters to the editor: ct@counseling.org

 

Update: Department of Defense clarifies TRICARE rule in Response to ACA Request

March 15, 2013

acaLogo3012The Department of Defense (DoD) has clarified aspects of its interim final rule (IFR) establishing certification criteria for licensed mental health counselors participating in the TRICARE program, in response to a request submitted by ACA. In a letter to ACA Executive Director Richard Yep, Assistant Deputy Director Mary Kaye Justis confirmed that counselors who meet the education, examination and supervision requirements in effect during the transition period – now through Dec. 31, 2014 – will continue to be recognized as independently practicing mental health counselors after the transition period ends. ACA asked DoD to clarify this issue because several members were being told that they would not be recognized after the transition period ended. DoD’s letter expressed appreciation to ACA for bringing this issue to their attention, and stated “We have discussed this issue with the TRICARE Regional Offices to ensure accurate implementation of the IFR by the Managed Care Support Contractors who interface with applicants.”

During the transition period, the IFR allows certification of counselors with a degree from a regionally (but not CACREP) accredited program, completion of 2 years/3,000 hours of post-master’s supervised experience, and passage of the National Clinical Mental Health Counseling Exam (NCMHCE). When the transition period ends, on Jan. 1, 2015, the certification criteria will require that counseling degrees be from CACREP accredited programs.

In its letter, DoD stated that counselors wishing to become certified as mental health counselors within TRICARE under the transition period requirements must complete those requirements before the transition period ends. However, “…while these certification requirements must be completed prior to Jan. 1, 2015, the IFR permits an applicant to become a CMHC [certified mental health counselor] after the transition period if all of the certification requirements were completed before the end of the transition period.” [emphasis in original]

ACA has confirmed with DoD staff that while completing the requirements must happen before January 1, 2015, counselors can become certified after that date. ACA has asked DoD to consider both extending the transition period and to allow counselors to complete the supervision and examination requirements after Jan. 1, 2015, as long as they have met the degree requirement (which does not require CACREP accreditation) during the transition period. The supervision and examination requirements in effect beginning in 2015 are the same as are required of counselors with regionally accredited degrees during the transition period.

According to DoD staff, the agency will issue a final rule on counselor certification, which may include changes to the requirements.  There is no word yet on when the final rule will be released.

In other news, TRICARE will be impacted by the sequestration taking place across most federal programs and agencies.  TRICARE staff and civilian personnel may be furloughed for one day a week, constituting a 20% pay cut.  Contracts, however, should not be affected.  It is unclear at this point if, or how, TRICARE reimbursement rates will be affected by sequestration.

For more information on TRICARE issues, contact Scott Barstow with ACA at sbarstow@counseling.org.

 

Louisiana Counseling Association teams up with pups to help veterans

By Heather Rudow July 3, 2012

Beth Zilbert with Luke, her therapy dog.

The Louisiana Counseling Association (LCA) has teamed up with the Louisiana National Guard and a local animal rescue program to aid the mental health of the state’s veteran population and save dogs’ lives in the process.

The collaboration, called the Patriot Dog Program, will pair returning service members living with post-traumatic stress disorder (PTSD) with rescue dogs that have been trained to become therapy dogs. In a sense, both parties will get a second chance at life.

Beth Zilbert, president of the Humane Society of Louisiana, Southwest Louisiana Chapter and founder of the local rescue program A New Leash on Life, first approached LCA, a branch of the American Counseling Association, with the idea to incorporate veterans into the rescue program.

A New Leash on Life takes dogs that are rescued from natural disasters or abandoned by owners and brings them to the local juvenile detention center, where eligible residents have been taught by professional dog trainers on how to care for and train the dogs. Most dogs are then placed with area families.

However, Zilbert, wanted to expand A New Leash on Life — she envisioned training the dogs to become therapy dogs and pairing them with veterans living with PTSD. She says she saw the positive potential that dogs could have on the service members’ lives.

“Therapy dogs help people with PTSD from becoming too isolated, where the dark thoughts that plague them can take over and run their tragic course,” says Zilbert. “A person with PTSD has to get out of their house each day to walk and care for their dog, who also provides protection and comfort and a never-ending source of unconditional love. They don’t have to say out loud the fearful images that keep them up at night. They get instant understanding and comfort without speaking a word.”

Zilbert knows this from her experience with her own therapy dog, Luke. She was paired with her dog after a serious car accident in 2010.

“I was in the front passenger seat of the vehicle and was lucky enough to be pulled alive out of that car,” Zilbert says.  “The man who hit us — broadside in the middle of the day at 75 to 100 mph — killed my good friend who was driving the car and his wife who was a passenger in his car instantly. I was injured fairly seriously, with a crushed left arm that I almost lost, but never lost consciousness throughout the duration of the accident.  It took rescuers nearly an hour to get me out of that vehicle, the whole time they were working I was hanging suspended only by my seatbelt, bleeding over the dead body of my dear friend.”

Though she survived the wreck, Zilbert was later diagnosed with severe PTSD. She needed to learn how to readjust to the world around her, which was when Luke came into the picture.

“Luke made sure that I was never alone so that I could never really allow the dark thoughts to follow along to their tragic conclusion,” says Zilbert of her faithful companion, a golden retriever mix. “He made me have to go out, even when all I wanted to do was curl up in a corner of the bed. He made it so that there was a safety net of basic comfort and unconditional love always, constantly by my side.  He helped with the nightmares during thunderstorms. He still helps when some of the hyper-vigilance starts to kick in.  He also helped people begin to approach me with smiles on their faces, instead of sadness and pity. I am an attorney for a nonprofit, and I represent kids in court and domestic violence survivors, and he also helps me interview and work with my clients.  He is, in short, one of God’s wonders, and I cannot believe that he chose me in this life! I must not ever take that for granted.”

Zilbert wanted the veterans who were struggling the same way she had been to finally feel relief, and she knew that contacting LCA was a good first step in getting the ball rolling on her plan. LCA Past-President Brenda Roberts agreed, citing the organization’s longstanding involvement with and dedication to Louisiana’s veteran population.

“I attended a meeting regarding the expansion of [A New Leash on Life] and indicated that the Louisiana Counseling Association has a partnership with the Louisiana National Guard and that I believed we could make the connection between the program and the military,” Roberts says. “Many of the counselors in the state are already providing services to our military, and it is our hope that this program will be adjunctive to the counseling already being provided.”

Additionally, Roberts was the counselor who diagnosed Zilbert with PTSD, and the one Zilbert credits — aside from Luke — with saving her life.

Diane Austin, executive director for LCA, says that the organization’s partnership with the National Guard won the branch the 2011 ACA Innovative Idea Award.

“Several years ago, as the National Guard began to see a need for increased mental health services for the returning service men and women, and within this partnership, LCA has created several programs,” she says, “[such as] a referral list of licensed professional counselors, which is the … collection of toys for guard families, and now the Patriot Dog Program.”

“All veterans experience war differently, yet all returning veterans bring a part of the war home with them,” says Cindy Escandell, director of Psychological Health for the Louisiana National Guard, LCA National Guard Liaison and member of the LCA. “Some veterans are able to reintegrate back into home life and society with little or no difficulty. Unfortunately, some veterans find day-to-day life at home more challenging than being in the war zone.”

The Patriot Dogs program officially began earlier this year. The first two veterans in the program will be matched with their new dogs no later than Thanksgiving. The veterans will be part of the training process, and the dogs will be specifically trained for the soldiers’ needs.

The dogs’ transition from rescue dogs to trained service dogs requires the dogs to pass through multiple hands. First, residents at the local juvenile detention center teach the dogs basic commands. Then, the dogs are taught more advanced commands at Calcasieu Correctional Center, a women’s correctional facility, in order to become service and therapy dogs.

Escandell says that service dogs are becoming a popular choice of treatment for veterans struggling with PTSD. “Veterans with PTSD may re-experience the traumatic event,” she says. “They may often avoid people, places or feelings that remind them of the event and may feel keyed up or on the edge all the time. The good news is that PTSD is treatable.  The bad news is that many veterans diagnosed with PTSD do not seek treatment due to stigma, embarrassment, shame or fear it will hurt their military career.  Currently, the main treatment options available include pharmacotherapy and psychotherapy such as Prolonged Exposure.  Many veterans do not like the stigma attached to taking medication or the possible side effects.  Others do not like the stigma of being in therapy.  More and more veterans are choosing service dogs as an alterative treatment for PTSD.  Service dogs are specifically and professionally trained to recognize symptoms of PTSD and react to calm their owners, to wake their owners up from nightmares or any number of services that would minimize the veteran’s reoccurring symptoms of PTSD.  The dogs provide a stimulus to break the loop and bring the veteran back to reality before they engage in harmful or reckless behavior.”

Many Louisiana National Guard members have had multiple deployments, which exposed them to a number of stressors, Escandell says.  “These stressors can alter their perception of life experiences when they return home,” she says.  “Many programs are available to help veterans adjust to their ‘new normal.’ The Patriot Dog Program is [an] initiative to help our veterans overcome the symptoms of PTSD and give them the opportunity to enjoy the freedoms they have fought for.”

According to statistics from the Department of Veterans Affairs, between 11 and 20 percent of veterans who have served in Iraq and Afghanistan have been diagnosed with PTSD.  The actual number of veterans with undiagnosed or untreated PTSD is unknown.

Roberts adds that the “suicide rate for soldiers returning from deployment is so high that this alone would say that we need something more than merely outpatient counseling to assist these people in dealing with what happened to them.” Roberts cites service dogs as a good first step.

According to current numbers, approximately 18 veterans across the country commit suicide every day.

Roberts says she would like to see LCA’s efforts with therapy dogs eventually stretch beyond service members with PTSD. “At some point in the future, I would like to see this program expanded even further to include training for all appropriate dogs and incarcerated inmates so that the therapy dogs could be matched with any person with appropriate mental health needs,” Roberts says.

Though it is still in the early stages, Escandell says LCA has already seen benefits stemming from the program.

“At the invitation of LTC Scott Adams, Reintegration Director for the Louisiana National Guard, [Zilbert] and her a service dog, Luke, were invited to attend a Yellow Ribbon reintegration weekend in New Orleans with returning veterans and their families,” Escandell says. “The Yellow Ribbon events provide service members and their families education on relationship issues, PTSD, traumatic brain injury, depression, anger management and substance abuse programs, resources, referrals, and services to minimize stress on families during the post-deployment phase. [Zilbert] and Luke received a warm welcome from all attendees.  Information on the Patriot Dog Program was given to service members and family members.  Several service members expressed interest in our program and are in the process of completing the paperwork.”

In order to fully educate all interested licensed professional counselors in Louisiana, Zilbert, Roberts and Escandell will give a briefing on the Patriot Dog Program at LCA’s annual conference in October.

Zilbert is grateful for her collaboration with LCA because of the “win/win” situation the Patriot Dogs Program provides: rescue dogs find happy, loving homes, and service members get to adjust to life after combat with less symptoms of PTSD.

“It is often difficult to believe,” Zilbert says, “in this modern world, where suffering and grief experienced in far corners of the globe is presented to us each day, with our morning coffee and evening meal, on the news, all day long across our computer screens at work, that there could be a simple act, with no bad consequences that can heal so many so fundamentally as the Patriot Dogs Program has the potential to do.”

A listing of licensed professional counselors in Louisiana who are available to work at military events is located on the LCA website.

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A distinct culture

By David L. Fenell June 14, 2008

On Sept. 11, 2007, the Global War on Terrorism entered its sixth year. As of February 2007, more than 1.5 million U.S. warriors had been deployed to the combat zone. According to the American Psychological Association Presidential Task Force on Military Deployment, more than 500,000 warriors have served two combat tours, and 70,000 have served three or more tours. At the present time, there are more than 154,000 U.S. troops in Kuwait and Iraq, 26,000 troops in Afghanistan, 1,500 troops in Kosovo, 1,700 troops in the Horn of Africa and 600 troops in the Sinai.

The high operational tempo and frequent and multiple deployments required to fight the Global War on Terrorism have placed unprecedented levels of stress on this nation’s warriors and their families. As of February 2007, 700,000 U.S. children had a least one parent deployed to a combat zone. According to recent reports, one out of every five troops returning from combat deployments reported Soldierssome type of behavioral health problem such as anxiety, depression, marital problems, post-traumatic stress disorder or traumatic brain injury. There is a critical need for professional counselors and other mental health professionals to provide services to these warriors and their families.

To provide competent care to returning warriors, mental health professionals should have appropriate training, personal qualities and specialized counseling skills. To be most helpful to military clients, counselors should apply the multicultural counseling competencies developed by members of the Association for Multicultural Counseling and Development and endorsed by the American Counseling Association. By viewing the military as a distinct culture and developing interventions based on the recommendations contained in the multicultural standards, counselors can increase their ability to help their military clients.

Because the U.S. military is a highly diverse organization composed of members of various races, ethnic groups, religions and cultures, not all counseling professionals agree that it constitutes a unique culture. But although there is cultural, religious and ethnic diversity within the military, the military is a culture in its own right. When warriors are asked about their ethnicity, it is not uncommon to hear the response “We are all green” from members of the Army and Marine Corps or “We are all blue” from those in the Navy, Air Force and Coast Guard. These service members have chosen to acculturate to the military, but they do not relinquish their individual ethnic, cultural and gender identities. Each has voluntarily elected to be part of a culture of warriors charged with defending the freedoms of citizens of the United States.

The military culture is further identified by three key documents. All military service members swear to support and defend the Constitution of the United States against all enemies, both foreign and domestic, when they take the oath of office. They learn what is required of them in combat by adhering to the Military Code of Conduct and abide by a unique set of laws and regulations defined in the Uniform Code of Military Justice. Because the military is a unique culture, its members are best served by counselors who are prepared to employ multicultural counseling competencies.

The multicultural counseling competencies provide a useful model to support counselors in developing the qualities needed to provide effective counseling services to members of the military culture. There are three major multicultural competencies in this model. The first is the counselor’s self-awareness and recognition of personal assumptions, values and biases. The second is the counselor’s ability to understand and appreciate the worldview of the military client. The third is the counselor’s ability to develop and implement appropriate intervention strategies and techniques for military clients.

Counselor self-awareness and adaptability

The counselor, based on his or her own life experiences, family roles, culture and ethnicity, brings assumptions, values and biases about the military to the counseling session. Counselors who have not had frequent contact with military personnel may hold perceptions and biases about the military culture and its members that hinder development of an effective counseling relationship. The effective counselor should be actively involved in the process of becoming aware of his or her assumptions about human behavior, values, biases and preconceived notions as they relate to military service and military clients.

The military, like other cultures, has been stereotyped. Effective counselors will examine their stereotypes about the military and develop the knowledge and skills needed to ensure these biases do not adversely impact the counseling process. If the military client detects counselor incongruence about the military, the client won’t return. Counselors must be genuine about their beliefs and values without letting those beliefs and values negatively affect their ability to demonstrate respect and understanding of the military client’s worldview.

Ability to understand and join the client’s worldview

The worldview of the military client is based on the individual’s cultural experiences before entering the military, coupled with the enculturation process that takes place in basic and advanced military training. The military client’s worldview is defined as the way he or she views self, social relationships, human nature and political, educational and economic positions. These views are shared by others in the military culture.

To join with the worldview of military clients, counselors need to recognize several common values shared by military personnel, including:

  • Always maintain physical fitness.
  • Train hard before deployment to reduce casualties.
  • Never abandon your fellow warriors in combat.
  • The mission and the unit always come before the individual.
  • Never show weakness to fellow warriors or to the enemy.

The stigma associated with mental health treatment in the military, especially in the Marine Corps and the Army, is real. Despite efforts by senior military leaders to remove the stigma, the military cultural norm of not wanting to appear weak and vulnerable to fellow warriors persists. This prevents many warriors from seeking counseling services, especially those offered on the military installation, where confidentiality may not be guaranteed. This reality provides an opportunity for civilian counselors to be the mental health care providers of choice for warriors who want discrete and confidential services that will not be reported back to the military unit.

The effective counselor understands how the military culture can inform the client’s thoughts, actions, feelings, values, beliefs and assumptions about human behavior. The counselor must be able to communicate a nonjudgmental understanding of the client’s worldview. If the counselor cannot honestly convey an understanding and respect for the client’s military service, the client is unlikely to return. Effective understanding of the client’s worldview does not mean the counselor must share — or even pretend to share — that worldview. Rather, the counselor should be able to communicate acceptance of the client’s worldview as legitimate, although different from the counselor’s worldview.

Military clients do not assume that counselors’ attitudes, beliefs and values will be similar to their own. In fact, many warriors stereotype civilian counselors as holding liberal personal and political values and being opposed to military efforts in the war on terrorism. Moreover, many warriors believe counselors will make negative judgments about military service. Counselors should keep these client concerns in mind as the counseling relationship is initiated. If the counselor can communicate unconditional positive regard for the military client, the probability of the counseling being successful is enhanced.

Skills to meet the needs of military clients

The effective multicultural counselor should develop a set of specific skills to work within the military culture. While members of the military culture share common values and beliefs, it is a mistake to view military clients in a monolithic fashion. As is the case in any cultural group, there are as many differences among individuals within the group as there are differences between cultural groups.

The effective counselor needs to use basic relationship and communication skills such as accurate reflections of content and feelings and accurate summarizations of important aspects of the military client’s disclosures. In addition, the skilled counselor will deliver congruent verbal and nonverbal messages to the client. The effective multicultural counselor will encourage the military client to teach the counselor about the military culture and the important problems, values and traditions that are part of the client’s life. In response, the counselor will ensure the military client knows that the messages have been clearly received by accurately reflecting the content and associated feelings communicated in the message. When military clients feel understood, heard and respected by the counselor, they are more likely to deepen the counseling process by taking interpersonal risks and delving into the significant issues that have brought them to counseling.

The counselor should be equipped to employ a variety of interventions. As a rule, the stereotype of military clients being uncomfortable disclosing sad or scared feelings is often accurate. Therefore, the counselor may want to begin the counseling process using cognitive and behavioral interventions. As the counseling relationship is strengthened and as trust builds, the counselor may then move to a discussion of the client’s feelings. The counselor must be proficient in interventions that focus on thoughts, feelings and actions and be able to discern which approach to apply in various circumstances.

In addition, the military culture has a language of its own. The effective counselor will take the time to learn as much about the language of the military as possible. When clarification is needed, the counselor should be comfortable asking the client to explain a term or acronym. This technique empowers the client, strengthens the therapeutic relationship and adds to the counselor’s knowledge base of military culture.

Effective counselors have skills in consultation and are open to seeking assistance (with client permission) from experts with specific knowledge about a client concern. The counselor uses the knowledge gained from the consultation to enhance the effectiveness of the counseling session. Additionally, effective counselors are able to employ assessment instruments and are aware of cultural influences that may impact the test results. For example, military personnel applying for special assignments are required to complete a battery of psychological assessments. In the zero-defect world of the military culture, warriors are less likely to admit weaknesses and vulnerabilities that most people in the civilian culture would likely acknowledge. Counselors must be aware of this tendency to underreport weaknesses and vulnerabilities when interpreting test results.

There is a significant demand for well-qualified, multiculturally competent counselors to provide services to military personnel. The demand will only grow as the war on terrorism continues. Professional counselors will be successful in working with military clients if they have an understanding of the military culture and utilize the three major multicultural competencies identified by AMCD and endorsed by ACA.

 

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David L. Fenell is a professor in the University of Colorado at Colorado Springs Department of Counseling and Human Services and a colonel (retired) in the U.S. Army Medical Service Corps Reserve. He chairs the ACA Special Committee on Military and Veteran Affairs. Contact him at dfenell@uccs.edu.

Letters to the editor: ct@counseling.org

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