This past week I traveled outside of Bagram Airfield to help in the initial set up of Telebehavioral Health equipment in another area of the region. Each time I travel I’m reminded of just how different life is for Troops depending upon where they are sent and what they experience there. Upon hearing a client has been deployed to Afghanistan, for example, it’s so very important for counselors/therapists not to entertain personal perceptions/assumptions based off that fact. More information is needed in order to get a more accurate feel for what a Service Member has been through.
Here are some things to find out from a military client who has been deployed:
Where and when was the client deployed?
For instance, a more remote area with poor living conditions and/or where fighting was more intense could impact one’s life differently than someone who was in an area where there is little to no fighting and where there are more amenities of “normal” life. You might also ask a client what it was like living in their area of deployment rather than jumping to any conclusions. For example, living here at Bagram isn’t stressful for me, but I do know others who worry about being hit by indirect fire (IDF). While the IDF is flying over my head, it is hitting other areas. Some people have had mortar land right beside their living quarters or even been hit. Some people stationed here have the job of providing security—so they are outside the wire daily, experiencing totally different things than those inside the wire. So even though we are in the same area, our experiences will be different.
Also the “when” can determine the difficulty living in a deployed area. For example, I know someone who was in Iraq in 2005 when the Sunni-Shi’a conflict was intense and this person saw many dead bodies. But I also know someone else who was in the same area last year and it wasn’t nearly as dangerous and he did not feel his life was at risk any more than back home in the States. Also if a base or camp is just starting to be built, this can be difficult since the housing will be more primitive (tents) as well as other structures (lack of showers available, long wait lines at the chow hall, no security walls/fences on the perimeter, etc.). So the same area may change over time as well.
What was the client’s job?
A Service Member’s specific job can greatly affect experiences while deployed. For instance, I am a Behavioral Health Specialist at the Division level. The majority of my time is spent doing staff work and I’m in a secure area. However, another Soldier with the exact same job title may be in a more remote area where fighting is intense. I know one Soldier with my same job duty, but he is in a smaller area so also has to pull other duties to include guarding the entrance to the base. He was involved in an attack where he was fired upon and people tried to raid the base and get in. So our experiences have been very different. Even Troops who have a job of Infantryman or Ammunitions might be in a secure area pulling gate guard, for example. Now one might think, “Wow, I bet that Soldier is glad to be doing a simple job in a safe area” and be very wrong. I had a client who loved his job of being out in dangerous areas, doing patrols and such. Much like a member of a SWAT team, for example, these men are specially trained and want to do their job—it’s often stressful for them NOT to get to do their job and just sit around.
What was the client’s rank/position?
This can potentially influence a Service Member’s experience as well. For example, many officers (depending on job and location, of course) may be in the same areas as other Troops but due to their rank they may be in the safest situations/environments possible for that area. Some may have personal security even, or armed drivers and guards. They may have more of a desk job, while the enlisted Troops are the ones doing the patrols in the area, for example. So this can make a difference as well.
What support did/does the client have?
Regardless of environment, difficulty, primitive living conditions, or combat exposure, I have seen time and time again that an individual’s interpersonal support system seems to be THE biggest factor in how he or she is able to cope. Let me reiterate I’m not saying this is ALWAYS the case. But it seems to be the most common denominator in whether or not someone has a difficult time coping with deployment stressors that range from missing family to a bullying supervisor to being ambushed by enemy fire. By interpersonal support I mean both back at home—family, friends, colleagues—and also while in the deployed setting—immediate supervisors, chain of command, co-workers, friends. I want to further evaluate this for my doctoral dissertation because I’ve just seen such a strong relationship in this area. For whatever reason, humans are designed this way. I just compiled data of every Service Member who has been AEROVAC’ed out of Afghanistan for behavioral health-related issues. Overwhelmingly I am seeing a lack of positive interpersonal support in these Troops.
What about the experience poses a challenge to the client?
Important for a counselor to note as a Service Member reveals military-related experiences, in my opinion, is to make a valiant attempt to remain neutral in thought while listening and assessing what those experiences mean to the client. This is difficult to put into words, but I’ve noticed at times (both personally and from accounts of others) someone’s own personal view of an experience overshadowing the Service Member’s view. In other words, a Soldier may tell a counselor he was involved in killing an enemy combatant and the immediate reaction from the counselor is to say, “Oh my gosh! How horrible! How traumatic that must have been!” This may seem like an accurate and appropriate response, and it may very well be in this situation too. Bu then again, maybe not--pay attention to the Soldier’s perception of this event. He may be more comfortable with having killed the individual than assumed. And if that’s the case—is this an issue to be addressed in therapy? Maybe yes, maybe no. More information and interaction must take place to assess accurately—jumping to conclusions may be narrow-minded and not very professional.
Should a police officer feel “guilt” or “trauma” for killing a murderer who is pointing a gun at a child, for instance? Should a Soldier feel “guilt” or “trauma” for killing someone’s whose sole intent is to kill him and his friends or innocent civilians? If he’s not feeling these things is it professional to assert the thoughts into his present perception? Is he just in denial? What’s important is to first grasp an understanding for what the client’s perception is…then go from there. Is he an anti-social, cold-hearted person? Or is he an individual who was placed in a life-or-death situation and reacted as he was professionally trained to do? Remember, it’s not how YOU would think or feel about the event, but how he or she thinks and feels based upon their circumstance and their culture—not yours. Are you, the counselor, aware of any possible personal bias you might have toward the military lifestyle? If so, how does this factor into treatment of a Service Member? Hard questions such as these may need to be asked in order to offer the client the most ethical and appropriate services possible. If unable to do so, perhaps a referral is a good option.
Just as a counselor who plans to work within another culture or country studies prior to beginning that work, so should a counselor take it upon himself/herself to learn about military culture as well. This includes current events and learning from multiple reliable sources to learn about what today’s Troops are experiencing—not just what mainstream media discusses. I’ve seen many biased and even incorrect bits of information to include “high suicide rates are caused by multiple deployments.” Without giving data, from my personal knowledge of such data this is not the “cause” at all. Correlation is not causation. The same goes for deployments “causing” behavioral health issues. Overall, I have not seen this to be true either. Can experiences from a deployment cause challenges in one’s life? Definitely. But let’s not jump to conclusions and limit our therapy. Let’s get to know the client a little more first. Let’s use the professional skills to truly get to what’s troubling clients and give them thorough, accurate assessments and interventions.
Natosha Monroe is an Army Reserve Mental Health Specialist stationed in Afghanistan. She is a counselor and PhD candidate passionate about increasing Troop access to counseling services. Her blog contents are not representative of the Army or Department of Defense in any way.