Withers, R. (2013). Can Civilian Counselors Promote Effective Treatment of PTSD in Combat Veterans of the Wars in Iraq and Afghanistan? [Website article]. Retrieved from http://www.counselinginsite.com.
Since 9/11, the U.S. led Global War on Terror has seen sustained military action in both Iraq and Afghanistan for a length of time that rivals the War in Vietnam a generation ago. While combat fatalities have so far been considerably less in both Iraq and Afghanistan, the psychological toll of sustained action has nevertheless compromised the lives of hundreds of military men and women, and their families. Of particular concern is the rise in Posttraumatic Stress Disorder in Combat Veterans, a polarizing and potentially fatal condition that has prompted an alarming number of servicemen and women to commit suicide.
Statement of the Problem
The purpose of this study is to learn what makes an effective civilian mental health therapist, as it relates to working with combat veterans suffering from PTSD. The usefulness of personal experience is the subject of an age old debate, particularly in areas such as substance abuse counseling, where a counselor’s own experiences with addiction and/or alcoholism can conceivably foster a positive therapeutic relationship with the client. Can such a relationship be forged between a combat veteran and a civilian therapist who has never seen the face of war? If so, how is this accomplished?
Review of Related Literature
Literature about this specific issue is virtually nonexistent. While scores of articles have been written about the treatment of Posttraumatic Stress Disorder, research about effective characteristics of civilian mental health clinicians is sparse. There is, however, a prevalence of research on the methodology used to treat PTSD in combat veterans of the Wars in Iraq and Afghanistan, and none of it requires the therapist to have actually seen combat action themselves. It would seem that specific training and a thorough understanding of the breadth and scope of PTSD is far more crucial than having actually experienced it firsthand.
Garske (2011) notes that PTSD has been known by many names throughout the history of warfare. Going as far back as Homer’s “The Iliad,” Garske notes that the condition has been present, but it is a relatively recent addition to the DSM. It was first identified by name in 1980, five years after the cessation of hostilities in the Vietnam War (12). However, for as long as man has warred against one another, PTSD has existed in one form or another.Perhaps part of the difficulty of its treatment is its relatively nascent identification in diagnostic manuals.
However, just because it has only recently earned a place in the DSM does not mean that its effects are any less severe. Bernhardt (2009) notes that over 1.7 million Americans have seen action in the wars in Iraq and Afghanistan. Of those soldiers, 95% of US Marines and 89% of US Army soldiers have experienced at least one traumatic experience on the battlefield. This, as the author notes, is all that one needs to meet “Criterion A” in the the diagnosis of PTSD - “exposure to extreme traumatic stressor with response of extreme fear, helplessness, or horror.” (345-346). There are literally hundreds of thousands of American soldiers who have already developed or may develop symptoms of PTSD.
Pietrzak, et al. (2009) conducted an exhaustive study of military personnel that identified a major barrier to the treatment of PTSD. As the authors put it, “perceived stigma” (8) among many soldiers prevents them from seeking and receiving help. Embarrassment, substance abuse, and an inherent mistrust of the mental health field are some of the major roadblocks to recovery. Furthermore, Bernhardt (2009) notes regulatory issues that impede proper care. For example, substance abuse and PTSD usually go hand in hand. However, many Department of Veterans Affairs programs mandate total abstinence from drugs and alcohol before a service man or woman may seek treatment. However, individuals suffering from PTSD are often reluctant to give up their own form of self-medication, and this serves as a barrier to treatment as well (345-348).
The literature reveals that the most effective means of treating PTSD have little to do with personal experience and everything to do with proper techniques and a through an understanding of PTSD and its manifestations. Moreover, the treatment of PTSD must be holistic in nature, covering many areas of the patient’s life, from emotional and physical rehabilitation, to employment services and relationship counseling.
Statement of the Hypothesis
It was hypothesized that civilian counselors do not need combat experience to promote a therapeutic relationship with combat veterans suffering from PTSD. While such personal experience is indeed helpful, it is not a requirement. What counselors need is the ability to foster a positive therapeutic relationship with their clients. It was hypothesized that counselors can achieve this with the use appropriate counseling techniques, with an understanding of PTSD symptoms, and with a theoretical orientation heavily influenced by Cognitive Behavioral Therapy.
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