Helplessness and powerlessness are vicious components of the traumatic experience, so it is important to look at ways of making your services as empowering as possible and using them to reduce the stigma associated with post-deployment stress effects.
Much of the information on this page comes from interviews with individual veterans who not only have served in the wars in Iraq and Afghanistan, but also have worked professionally and/or on a volunteer basis with veterans suffering from combat stress injuries.
Healing the Effects of Stigma in the Military Culture: The military culture has a long history of stigmatizing post-deployment stress effects, in both overt and subtle ways. Many veterans with post-deployment stress effects have deep levels of shame about these effects and fear of having others judge them for their reactions—or for the events that led to those reactions. And the civilian society that now surrounds them holds a strong stigma toward substance use disorders. So the language you use to frame their experiences, their effects, and the work of therapy may have powerful effects on their engagement, participation, and retention in treatment.
Younger Service Members, who have less experience and grounding in adult civilian life, are in general more likely to be thoroughly steeped in the military culture and the tough, “macho” mind-frame. They are also more likely to:
Younger veterans will often require the strongest efforts to normalize and destigmatize their experiences, reactions, and symptoms.
A diagnostic label such as “PTSD,” “substance abuse,” “addiction,” or “depression” may or may not be helpful in working a particular veteran. For some, particularly older veterans, the label might be a useful educational tool, putting a name and a knowledge base to an experience that would otherwise have seemed chaotic and menacing. For others, it might be a label of shame that carries with it images of weakness, cowardice, and a life sentence of inferiority.
Words tend to gain toxicity from the negative ways and situations in which they are used (Woll, 2005). Explaining that your words really do not mean all those negative things will not be enough, just as explaining that fireworks are only fireworks does not keep the amygdala from telling the rest of the brain and body to “hit the dirt!”
If you need to use diagnostic labels for reimbursement purposes, you might want to explain them in that context. Then the most empowering approach might be to negotiate with the veteran the words you will both use to describe what is happening.
View Framing Services for Empowerment and Destigmatization
Empowerment: An important part of empowerment is the right and ability to choose. In the therapeutic process, this includes the ability to make informed choices about treatment approaches and techniques. According to Lighthall (2008), most veterans seeking help for their post-deployment stress effects will be looking for something that is:
Veterans with these priorities are more likely to seek and accept services that provide education, training, and resources that can give them power over their symptoms. And given the short amount of time many clinicians are able to spend with clients, this may be a safe and rational way to approach treatment. Framing Services for Empowerment and Destigmatization offers some ideas for civilian clinicians who want to focus and frame their services in terms of education and training that will help veterans:
The military culture is one in which power is of great importance. All forms of helplessness—including all the forms of helplessness that contribute to and spring from the trauma of war—are unwelcome. In general, the more empowering the process is from the start, the sooner veterans will engage and the more likely they are to stay with the process (Lighthall, 2008).
The therapeutic use of images or feelings of helplessness or powerlessness (e.g., metaphors of powerlessness in 12-Step recovery programs) may not be a strong selling point for your approach, at least not at the beginning of treatment. If veterans have co-occurring substance dependence disorders and choose to seek recovery through 12-Step groups, you might want to help them:
No matter how much confidence or pride veterans might bring into your office, they have faced experiences strong enough to jar their stress and survival systems. These experiences—and the violent reactions that arise in their bodies and emotions later—can leave veterans with significant questions and challenges to their sense of:
The better you are at teaching empowerment and removing stigma, the more your efforts will help, no matter what treatment practices you might choose.
Avoiding Confrontive Traditions in SUD Treatment: Although in the past several years most experts have been spreading the message of respectful and empowering treatment, the SUD treatment field had a long early history of harsh, confrontive approaches toward client care. These approaches began in the 1970s, when the early therapeutic communities sought to tear down the addictive ego, believing they could rebuild the human being in more perfect form. This often led to disastrous results (White, 1998).
For SUD treatment practitioners serving veterans with post-deployment stress effects, the warnings against these confrontive approaches are even stronger. Given the easily kindled stress systems and badly shaken self-concept that many veterans bring home with them, it is essential to leave all traces of harsh confrontation behind, replaced with respect and empowerment.
Next: Rituals and Reintegration
The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone: Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities. This draft is copyright © 2008, Pamela Woll. Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.
