I make a practice of providing free help and advice for anyone who has developed a psychological problem as a result of active service in our UK armed forces. It doesn’t matter to me whether they are active or veterans – in my view we all owe them more than we can ever repay. As I am not connected with any of the excellent Services Mental Health Charities, I get my armed forces clients by word of mouth. Obviously there is a limit to how many such pro bono clients I can take on at any given time.
One thing that I have learned is that there is no such thing as ‘the military mind’. These people are all very different, very individual – even those who belong, (or belonged), to units with very strong traditions and a high degree of esprit de corps. Service people are usually very proud of themselves, their regiments, their ships, and their squadrons. In all branches of the service, the driving ethos seems to be a gung-ho, can do, crack on, sort of attitude. However, this impressive strength is also a huge weakness. Anything less than complete success is often seen as failure, a sign of weakness. Therefore, it can be hard for people from a services background to admit they need help. ‘Toughies don’t cry’!
Of course there are many top-notch national organisations that provide lots of help for current and retired services people. In addition, the armed services all have very good in-house welfare provisions. On the surface the military and the ex-military seem to be well catered for. However, what I have noticed is a marked reluctance, (at least amongst many of those whom I have met), to contact the ‘official’ sources of help. A common fear is that either their service branch or their comrades, (past and present), might find out that they have contacted a psychotherapist or a counsellor and that they would therefore be stigmatised as being weaklings. Quite often my military patients, both still serving or retired, avoid contacting local therapists and purposely travel a long way to see me because they hope that distance equals anonymity.
Obviously with any client from any background, establishing a productive therapeutic relationship, a Working Alliance, is vital. When working with armed services clients this seems to be the element of the therapeutic intervention that needs very, very, careful handling. It should never be rushed. All clients come along to see their therapists carrying lots of emotional baggage from their various pasts. However, military clients seem to increase their loads by shouldering all the group baggage that comes from the personalised demands arising from the traditions and histories of their service branches.
Working with ex, or current, forces members presents therapists with a number of difficulties. One problem for the therapist personally is to overcome any unrealised anti-military prejudice unknowingly absorbed during encounters with the inbuilt liberal ethos of the caring professions. Another difficulty might come from therapists being unaware of the personal and group values inherent in military life that might not be so common in the civilian world. Yet other difficulties might arise if therapists don’t learn to speak the military lingo. All of the units have their own, almost secret, languages. It’s how they recognise each other and those who sympathise with them; it’s how they build their relationships. Good therapists learn a bit of ‘military speak’. Finally, therapists of all persuasions often talk about the need to challenge their clients. The problem with military clients is that they thrive on challenges. They are more used to meeting challenges head-on rather than reflectively examining them. So, therapists need to be especially careful when presenting military clients with challenging reformulations.
Working with current or retired military personnel is very rewarding and does, I suspect, present its own demands. Obviously services people and their families have all the same sorts of issues and concerns as everybody else. However, I have to say that in my experience, any therapist who works with clients from a military background needs to have a good knowledge of trauma. It is certainly not the case that they all either have, or are about to have, Post Traumatic Stress Disorder. Of course some do and in the worst cases might need to be referred on to a specialist service. However, most traumatised veterans, (at least the ones that I have seen), usually present with the less intense trauma/anxiety conditions such as Acute Stress Disorder, an Adjustment Disorder, or Generalised Anxiety Disorder. Another common issue, especially for retired personnel is bereavement. This is not just the case for those who have lost comrades to enemy action. It also includes the profound sense of loss that is encountered by those who, having left their units, inevitably leave behind ‘service group families’.
All in all, I would argue that the therapeutic professions don’t pay enough attention to the needs of serving or retired soldiers, sailors and airmen/women. The sad fact is that the proportion of ex-military people amongst the homeless or the prison population far exceeds that which should be expected from the warrior/civilian ratio in the general population. Clearly, as a caring society, one that supposedly honours the Military Covenant, we are doing something wrong. Therapists cannot put that right but the well-prepared therapist can certainly help some of the heroes who keep us all safe.