Inside the Effective Clinician

The Clinician’s Self-Knowledge:  According to Dan Taslitz, OIF veteran and trainer for a Colorado-based organization called ONE Freedom, three of the most important personal qualities that a civilian clinician working with veterans might have are:

  • An openness and curiosity about the individual veteran and his or her experiences and realities
  • An understanding of the clinician’s own experience of trauma, and progress and stability in the conscious process of addressing and resolving any issues attached to that realm of experience
  • The ability to keep any agendas the clinician might have about the war or the veteran’s participation in it (e.g., political issues, feelings or opinions about war in general or the war in which the veteran was engaged) completely separate from the therapeutic process

Only someone who has lived in the presence of war can truly understand the experience of war.  But each of us has had difficult and intense life experiences that can inform and deepen our understanding of trauma and healing and our ability to respond effectively.  So although there will be many times when only someone who has “been there” can fill the need, there is still a significant role for civilian clinicians in this effort.  As any skilled helper knows, it is possible to find elements of one’s own experience that allow for greater identification with the experience of another, without comparing the two or giving them equal weight.  This both normalizes the veteran’s experience and respects the ways in which it is different from the civilian’s.

In the words of Steve Robinson, another veteran and consultant to ONE Freedom, “Simply be in touch with your own life trauma.  Don’t share it with them;  you’re supposed to keep it businesslike.  But for clinicians it’s very important to connect with your own life experience on a human level while you’re connecting on a professional level.  They need to know that you know what they’ve been through.”  

And the last of the qualities mentioned above—the ability to separate agendas from the therapeutic process—requires a thorough knowledge of one’s feelings, opinions, and possible agendas concerning any of the issues connected with the veteran or his or her service.  One of the most serious mistakes a clinician can make might be to (consciously or unconsciously) use the veteran to confirm an opinion about the war, its viability, or whether or not it should ever have taken place.  If you are not certain that you are ready, willing, and able to keep your own feelings and opinions far away from the therapeutic process and relationship, then you have the right and the duty to decide you are not ready to treat veterans.

Take Care of Yourself:  Most trauma specialists emphasize the importance of self-care in working with survivors of any kind of trauma.  For example, psychotherapist Lia Gaty (2008) spoke of several self-care practices:

  • Keep your self-inventory current, so you know how you are reacting and know your needs.
  • Recognize your own limitations, and make sure you have the resources you need to stay healthy.
  • Keep the “therapist’s ego” out of the way (“I am THE one who can help!”), and remember that you may be only one step in a long process that leads to, and through, recovery.
  • It is important to have good supervision and support from others who are doing similar work.  If your agency has an atmosphere in which it is not safe to talk about the issues that might arise in your emotional responses to your work, find a group or a set of mentors who can help you gain the perspective and support you need.
  • Seek consultation when you feel as if you are out of your depth or sphere of expertise.
  • Remain vigilant for the countertransference issues (the clinician’s feelings and issues projected into the therapeutic relationship) that are easily triggered in work with trauma survivors, and seek help in resolving those issues.
  • If you find that you do not like a client, chances are that his or her “radar” will perceive the dislike, and you are likely to be less effective and possibly harmful in the therapeutic relationship.  In these cases, it is better that the client be assigned to another therapist.

Self-care can be particularly important in working with combat veterans, because of the extreme nature of the experiences they may describe.  Even if you are strong and committed, you will want to remain vigilant for:

  • Vicarious traumatization or “secondary trauma,” the process by which the listener can develop trauma symptoms from exposure to the traumatic experiences of another
  • Compassion fatigue, a state of emotional exhaustion or a loss of interest or empathy following overexposure to traumatic material (Boscarino, Figley, and Adams, 2004).

People who have been through the experience of war—or of any traumatic circumstance—will tell you things that are completely overwhelming, very difficult for your own emotions to bear.  But perhaps great difficulty is the only appropriate reaction to deeply traumatic material.  As Lia Gaty said, “If it’s not difficult, you’re not listening” (Gaty, 2008b).  Here are two things to consider: 

  • In absorbing the veteran’s narrative, you are bearing a small part of an enormous burden that the veteran has carried and few others have even considered carrying.  Even if on a particular day you are shut down and wondering why you feel nothing, you are still helping to carry the load.
  • You owe it as much to your client as to yourself and your family to get all the rest, self-care, and support you need to keep your own balance while you do this work.


Next: The Individual and the Military Culture

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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.

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