Yesterday, the Indianapolis Star obtained an email sent by a medical manager of a VA clinic that appeared to mock veterans’ mental health issues. This news is a reminder that while the wars in Iraq and Afghanistan may be winding down, the struggle of vets to deal with the emotional consequences of their service is ongoing—and so are the counterproductive reactions they encounter from those charged with helping them.
More and more vets are writing about their experiences re-deploying back to civilian life. One figure often in the background of these memoirs is the therapist or other caregiver trying to help. These therapists are essential to the healing process—and our ability to properly train them is crucial.
In David Morris’ recent article in the New York Times about how abandoned many vets feel when they seek treatment, he describes his first encounter with a young psych trainee advocating treatment that was ultimately of no value: “Now, I’m probably going to make some mistakes and say some stupid things,” the trainee said. “Are you going to be O.K. with that?”
I feel for the guy. The experience of being a young helping professional can be overwhelming. Back in 1970, I was a young psych trainee in a VA hospital, in over his head trying to treat the flood of vets returning from Vietnam before there even was a diagnosis of PTSD. The patients were talking about experiences I was not equipped to comprehend. On top of feelings of inadequacy, I felt ashamed that I had avoided the draft—first through a graduate-student deferment, then from a high draft lottery number. How could I understand?
Yet I tried, and fought through shame, terror and an unsettling sleepiness that would come over me while listening to my patients and their stories. My supervisors seemed equally adrift, many of them veterans of World War II, a war with a vastly different trajectory, outcome and aftermath compared to the war in Vietnam.
I began to develop troubling symptoms— becoming obsessive about what I was eating, exercising way too much, focusing on these things as if there were something I could do right. And there was that puzzling fatigue, as if the weight of what I was hearing was too much for me to carry.
It didn’t help that one of the psychiatric staff—a man I often sat across from at morning rounds—disappeared from the service one day. In whispered tones, we found out that he’d been hospitalized for manic symptoms. If it can happen to one of us, a person who was at the top of the mental health food chain, who was safe?
Yet no one talked about the emotional toll on the caregivers; this was years before we understood the “vicarious trauma” of therapists helping those who have been traumatized, the wounds of trying to heal the wounded.
Not one supervisor ever sat me down and tried to talk openly about what was happening to me as I tried to help the men in my care. Our focus instead was on techniques, some magic bullet that would “cure” the patient, not on the relationship of therapy or the way in which veterans were struggling to make meaning of what had happened to them, to tell their stories.
I wish I could have been more helpful to the wounded men and women I worked with. Only decades later have I begun to sift through those experiences to try and understand how they had affected me.
Now we have new generations of young trainees trying to learn how to be helpful to the suffering veterans from Iraq and Afghanistan. One thing we now know after decades of research is that the therapeutic relationship is the key to the effectiveness of therapy. In order to tell their stories, veterans need therapists willing to listen. Therapists, in turn, need supervisors willing to help them sort through the sometimes overwhelming content of these stories.
Yet, adequate supervision of young trainees is the elephant in the room for mental health training programs. Many students I encounter report a lack of supervision. Few of them feel comfortable raising the issue; the power differential is just too great. Most programs prescribe a certain number of hours of supervision, but few programs actually monitor what happens in supervision. And there is little formal training in how to be an empathic supervisor of psychotherapists.
If we want to help vets, we need to help the helpers learn how to better listen and respond.
At a lecture I recently gave, an older veteran in the audience, self-identified as struggling with PTSD, raised his hand to make an observation. The VA had failed him for years, he said, handing him drugs whenever he sought help. No one really listened. Recently, though, the small VA clinic in the town where he now lives has come to be the only place he truly feels safe. All because of a psychiatrist he has found. Why? “Well, she still talks too much, but if I let her go on for awhile, she begins to listen to me. And she does listen. That helps.”
Lead photo: Wikimedia Commons
Sam Osherson is a Professor of Psychology at the Fielding Graduate University, and author of The Stethoscope Cure.