Sometimes I am amazed how we teach and do therapy, counseling or coaching using the same old ways, oblivious to changes in the world around us. Psychotherapy Networker (November/December 2010), focuses on victims and veterans of war, showing how the needs are enormous, the mental health community is overwhelmed and resources are limited. Conventional therapeutic approaches often are ineffective and unsuited to military culture. Methods and models that focus on individual treatment do not mesh well with the communal values of the military including its resistance to mental health professionals, especially civilian outsiders. The Networker magazine (currently online here) focuses on veterans and their families but many conclusions extend to other kinds of trauma.
Traumatic situations can involve people in three roles. Predators cause trauma. For many reasons, including military training, people learn to fight, to hurt others. The prey are the victims of the trauma. Their natural impulse is to flee. Witnesses are those who observe trauma and often freeze, sometimes unable to move. Each of these predator-prey-witness experiences makes a unique biological impact. Each can require a unique form of treatment. People in trauma may experience only one of these roles but the military is among the environments where all three occur at the same time. Troops are trained to be tough predators. In combat they are prey, always alert to danger. In battle they witness and experience significant stress. Many also believe that good soldiers don’t go for therapy believing this shows weakness and can block promotions.
Here are some thought provoking conclusions that apply broadly:
- Therapy as usual often can’t serve the needs of traumatized people including returning troops and their families.
- Trauma work is cross cultural. To be credible and effective, care givers must learn about military or other cultures, including common terminology, expectations, values, and accepted ways of handling stress.
- Diagnoses like PTSD may turn survival responses of the automatic nervous system (fight, flight, or freeze) into psychiatric diagnoses that lead to long term hopelessness, helplessness and despair.
- In many situations, including postmodern or communal cultures, community based approaches work better than individual therapy.
How do you respond?