ACA Blog

Natosha Monroe
Feb 02, 2011

Actual Therapy vs. “Just Medicating”? What Should We Be Doing?

Since I’ve returned from Afghanistan, I’ve been asked numerous times to comment on reports of large quantities of medications being dispensed to Troops both overseas and back home: medications related to psychological matters. And so I am going to give my honest opinion among people I feel will understand where I’m coming from. Based solely on my personal observations and experiences shared to me by fellow Veterans, our Troops are being “treated” with too many pills and not enough actual therapy. And their “treatment” is often unacceptable. There. I said it. And you’ve surely noticed it too—unless you are among the throngs of “professionals” who are simply tossing pills and calling it a therapeutic session. Ok. So what do we do about this?

I know I refer to his wisdom often, but I think Irvin D. Yalom made a poignant observation we all should ponder: “An economically driven healthcare system [has mandated] a radical modification in psychological treatment, and psychotherapy is now obliged to be streamlined—that is, above all, inexpensive, and perforce, brief, superficial, and insubstantial” (from The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients, 2002). Strong words, but believe me the words I’d like to say are even stronger. But I’ll save that for another time. And Yalom noticed this almost a decade ago. What do you say, fellow ACA members? Was he right? I’d say yes. Perhaps this decrease of real therapy is a bigger issue than in the military. And I ask you again: what should we be doing about this? Is it enough to simply see clients each day, or is there more each of us can do to stop this deterioration of psychological health care in our country?

Let me be perfectly clear: My opinion is not based at all on statistics. I am not basing my opinion on any formal research. My opinion is my own and has been formulated over the years from my personal interactions with Troops (primarily Army Soldiers) who have received behavioral health care services while overseas from Psychiatrists, Psychologists, and Social Workers who are officers in the military (remember, there are no Licensed Professional Counselors or Licensed Marriage and Family Therapists serving as officers in the military. Period. Well, if they are, they are like myself and working in another capacity since our professions are not acknowledged). And once they are home from deployments, Troops sometimes receive behavioral health services from non-military professionals as well. (Recently and increasingly this group of professionals may also include LPC’s and LMFT’s, thank goodness!)

Guess what I have been told over and over and over, time and time again by my fellow Troops? They are being prescribed medications and not receiving therapy. They don’t always just come out and say that because they think what they are receiving IS therapy—they don’t know any differently. But they open up to me and often are confused or feel they’ve been wronged or disrespected and ask me questions. And so in talking I ask how long they were in the session, or how often they see the professional. I ask what they talked about. I ask if the medication seems to be working. I ask questions that would/would not point toward the diagnoses they’ve been given such as Depression or Post-Traumatic Stress Disorder and they tell me no one has ever asked them such questions. I ask what their therapy goals and/or gains have been and they look at me with confusion. Goals? Gains? I’ve seen and heard of Troops being told by “professionals” that they should leave the military due to their mental health and even have been recommended for and initiated out-processing procedures. I’ve even had a client kicked out of the military during the deployment in a manner that, despite three deployments, he would be denied any educational benefits he’d earned for himself and his young wife.

While on deployments outside of the United States, I’ve had Troops tell me they were thrown out of their sessions for not opening up. Ummm…last I checked that was part of the professional’s job, establishing positive rapport and getting the client to open up. Right? Troops have told me they were diagnosed with PTSD and only found out about it because it was in their record—no one ever discussed it with them in person and it later came as a surprise. One Soldier asked me if I thought he was Depressed and I said, “Heavens no!” and then he told me based on “some test” an officer had him take he said he was depressed. So he then sent the Soldier to a Psychiatrist officer who spoke with him literally 10 minutes before handing him a piece of paper for an antidepressant. He said he wasn’t even asked if he felt depressed. I could go on and on with similar cases.

It is my viewpoint that our Troops deserve the same psychological services and treatment options available to non-military clients. Since our professions are excluded from the equation, Troops are being denied the same level of care they could receive if not overseas. Is it because it would take more time to actually offer therapy? That can’t be it—because there are, in fact, military officers of the other professions who offer therapy. But in my experiences this has not been the norm. I was fortunate enough to work under the 101st Division Psychiatrist in Afghanistan, MAJ Sebastian Schnellbacher. This young but wise Psychiatrist was an inspiration to me and to his clients. He kept me from becoming completely frustrated some days when it seemed to me like others weren’t offering true therapy to Troops. I had to vent to a couple of military chaplains in order to not become overwhelmed with my frustrations over how I sometimes saw enlisted Troops treated by behavioral health officers. And this is an issue—their experiences are not represented because it is not enlisted Troops who are in meetings discussing behavioral health. No one speaks to them as they step out of a session to see how it went—the decision-makers speak to the officers. And officers who go into a behavioral health session are treated more respectfully.

I’ll discuss this more in future posts, since it’s a very complex topic. I have just recently returned to Washington, D.C. and have been told I’ll be working in a new capacity. I’ll be working in the Comprehensive Soldier Fitness program. From what I know so far about this program, it has great potential to help Soldiers by taking a proactive angle in focusing on resiliency. But my fear is that regardless of the wonderful programs the military implements to address behavioral health issues and suicide prevention, there remains the issue of a lack of true therapy that will continue to negatively affect the efforts. When Troops need help to the point they are in a session, they should be guaranteed the same ethical and professional treatment they would receive in any office in America as a civilian client. So why is this not always the case?

Natosha Monroe is a counselor and PhD candidate who is passionate about increasing Troop access to counseling services. Her blog contents are not representative of the Army or Department of Defense in any way.

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