Being Tender yet Tough with Veterans

As any subgroup of Americans, military veterans cover a wide spectrum of personality types and pre-service adjustment history. While there is almost universal agreement that veterans should be honored for serving, across the board admiration without constructive criticism may be unwise. Not every hero acts heroically all the time. Sometimes folks with adjustment difficulties need tolerance and tenderness; but sometimes they need toughness and truth. Military veterans are no different. Three points worth considering in detail come to mind.

The alarming suicide rate may not simply be due to cultural and economic difficulty in reintegrating “into the world.” Many times suicide is an extreme case of rage and anger expression meant to hurt others deemed responsible for the pain felt by the suiciding individual. Unfortunately any person having difficulty expressing strong emotion prior to enlisting might likely be at greater risk to demonstrate unhealthy emotional expression after being stressed by military life, especially combat. Help for such predisposed individuals probably requires retraining in emotional intelligence where a certain “tough love” adherence to abstaining from careless emotional and social acting out is enacted. Like a substance abuser needed to work a program of sobriety, emotionally immature vets might need to increase careful self-discipline when attempting to convey strong and complicated emotion.

Second, it is not accurate to say that services in the VA system are unsatisfactory or unavailable. Well over 85% of veterans report being highly satisfied with help gotten in this system (Even though surveys are oft used for political agendas and there are at times horror stories of care gone wrong). Plus is it not a complete picture to conclude there are unacceptable wait times in the VA system. Since 1979, veterans have been able to use the walk-in, storefront clinics of 300 Vet Centers nationwide to get immediate support, social service and counseling. For over three years in the 1980’s at the Memphis Vet Center I personally conducted a weekly, open ended support and therapy group in which hundreds of men and woman worked through a full range of issues. There is no wait in these “store-front” services, veterans just “walk-in.”  Additionally, there are currently available online and smartphone delivered services for those who suffer from PTSD. Any veteran who wants and needs treatment can get it in a timely fashion.

https://tango.uthscsa.edu/ssads/040/

Additionally the detail, quality and efficiency of treatments available for PTSD is increasingly outstanding. Here’s a website, cptforptsd.com, that explains the treatment in clear terms and provides a searchable list of therapist certified to conduct it.

Welcome

Finally, it could well be that something else is operating in the lives of those veterans who do not avail themselves of services before taking self-destructive action. Recent efforts by dedicated VA mental health practitioners are focused on discovering the parameters that make veterans reluctant to seek treatment (such as Strong Star, https://tango.uthscsa.edu/strongstar/).  A number of helpful resources are beginning to emerge which address such reluctance, like Donald Meichenbaum’s Roadmap to Resilience for veterans and their families or my forthcoming book with Beth Fehlbaum, Trauma Recovery: Sessions with Dr. Matt. These books provide information about what recovery treatment is like and hopefully give inspiration to overcome the reluctance.

Most experienced trauma therapists know that timing is crucial in successful treatment. Sometimes, tenderness and tolerance is required where authentically “being with” someone without judging helps. Other times, a more tough approach is needed to challenge with helpful truths a person who is stuck in a devastated life. If we agree that military veterans deserve our best support, we probably have to dig a little deeper to determine what they need. In the meantime, welcome back, guys; and Happy Veteran’s Day.

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Introduction to our book: Trauma Recovery: Sessions with Dr. Matt

For the past year, I have been collaborating with Beth Fehlbaum to write a book entitled: Trauma Recovery: Sessions with Dr. Matt. The first draft of this book is in the process of editorial submission and review but here we begin to discuss its purpose and anticipated impact.

An overview of the book is provided below as an introduction to what we think is a unique and entertaining fusion of non-fiction self-help writing with fictional storylines of true-to-life trauma survivors as they face the arduous process of rebuilding life after catastrophe. Coming entries to this blog will elucidate and augment both major and minor topics examined in Trauma Recovery: Sessions with Dr. Matt. We welcome you into the inside processes of creating and disseminating this important new book.

OVERVIEW

Exposure to traumatic events has become the “black plague” of the 21st century: it’s everywhere! It is generally believed 70% of all people will experience a traumatic event in their lifetime. 20% of those will go on to develop PTSD. Thus, recovery from trauma has become a major health and human services issues.

This book addresses recovery from trauma in a highly unique dual format.  First, the book is a non-fiction treatise of the current scientific and clinical understanding of the formation of PTSD and its treatment. At the same time, the book is a fictional depiction of seven individuals being treated by a professional psychologist for PTSD secondary to a variety of traumatic events. The fictional sections of the book are used to illustrate the scientific and clinical non-fictional material presented. The combination of the conceptual information with emotionally-charged human examples yields more complete understanding; one that leads the reader to take the action required to recover from traumatic experiences.

While exposure to trauma results in strong negative emotional and behavioral experiences, PTSD happens when the trauma victim gets stuck in a cycle of negative emotion and harmful avoidance behavior to the exclusion of pursuing and/or approaching meaningful and valued life activity.  In fact, over 40% of those exposed to trauma will eventually say they are stronger for having been through such a life-changing event. This leads to a vital question: what is missing in the 60% who don’t experience “post-traumatic growth”? This book carefully outlines why some trauma victims get better; even stronger, and some don’t.

In fact, it is because of the very nature of being stuck that trauma victims with PTSD find it very difficult to seek and complete treatment. Their lives remain in a suspended negative state of fear, shame, anger, isolation and hiding. These patients think no one can understand them and that nothing can be done to help them.

Fortunately, modern psychological treatments are highly effective, but victims first must be convinced to come out of hiding and seek the truth about how their lives have changed. Trauma Recovery: Sessions with Dr. Matt convinces those victims in a unique and effective manner.

This book will appeal to four groups:

  1. Reluctant patients who are stuck in the pain-avoidance cycle: they can find hope from the narratives of seven fictional patients brought to life in the book whose recovery process is described in an engaging format.
  2. Motivated patients: those ready and eager for treatment, can find help from the parts of the book which describe in clear terms the science behind their PTSD symptoms and the collaborative process of treatment for those symptoms.
  3. Therapists who treat patients with PTSD will find it useful to have the book on their shelves to share with either motivated or reluctant PTSD clients.
  4. General readers of fiction and non-fiction alike will find the characters and their recovery stories highly informative as well as entertaining. General readers will also find the scientific explanations of PTSD psychopathology and its effective treatment provided in the book to be enlightening and useful.
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