In a previous blog entry (entitled “New Experiences, New Perspectives - Improving Therapy Outcomes”), I discussed the clinical utility of having Service Members who have deployed work to integrate their deployment-related experiences into the self, versus suppressing and/or avoiding them. My discussion focused more or less on what might be accomplished in the individual psychotherapy situation. In this entry, I will briefly argue for its use in group psychotherapy, as I have seen improvements (i.e., a decrease in symptom presentation) in individuals’ general mood and dispositions related to their deployment experiences.
To begin, it seems that we have a predisposition to share our experiences with others (whether negative or positive). When introducing this concept in group, I generally use an analogy to make my point. First, I have them consider an automobile barreling through a red light causing them to swerve wildly to avoid a collision. Then I ask, “Do you think you’d tell anyone about that?”' Generally, it would it go something like this, “You wouldn’t believe what happened to me today!” I explain that in the process of “telling your story,” you are in fact processing that incident/situation on a conscious and subconscious level. This “processing” allows for a number of emotional and psychologically healthy conscious and subconscious processes to occur. Some are related to safety and security; others provide validation and support; while others might offer a sense of hope and mastery in an otherwise frightening environment. This process of sharing happens with are types of human experiences to include positive as well as negative ones.
Unfortunately, for Service Members who have deployed, the availability of an appropriate audience (individual or individuals) to share (or process) their deployment-related experiences seems to be unavailability in the non-deployed environment. That is to say, so few individuals have a “deployed” paradigm that the individual who has deployed is unlikely to find validation and support in the everyday non-deployed environment. Consequently, he or she is less likely to appropriately process their months (if not years) of deployment-related experiences. This lack of processing and validation results in deployment-related experiences being ignored or otherwise suppressed. This suppression results in emotional/psychological dysregulation because the experiences have not been processed and subsequently integrated into the self. Treatments for everything from pain to PTSD are likely to be less effective because an important part of the human experience is being neglected.
A “post-deployment group” consisting of individuals who have deployed, is an ideal setting that can provide the needed guidance and opportunity for deployed individuals to process (i.e., integrate) their deployment-related experiences. Here, they can have the opportunity to say, “You wouldn’t believe what happened to me.” and from there, move on to process and integrate their experiences and subsequently move forward rather than being “stuck” emotionally/psychologically in their deployment(s).
I run this group in a very simplistic fashion with the understanding that processing is integration and that integration is a necessary human process. Consequently, my primary goal is to have group members discussing their experiences on a physical, emotional, and psychological level. As facilitator, my objective is to keep them on topic –“How is the thought you’re sharing now related to pre-deployment, during deployment, and/or post-deployment experiences?” As well as to challenge them to share intimate emotional/psychological details of their experiences with each other - “Yes, I was afraid.” This consequently creates the integration needed in an environment of validation and support (i.e., an environment in which each individual can empathize with the other).
In terms of antidotal observations, it is best to have a separate group for men and women. I have discovered that there are differences in the deployed experience by gender and that in a mixed group setting, women are less likely to share intimate details of their experiences and ultimately shutdown and stop attending. I have also determined that when resources or available and the number of group participants is high, it is best to separate junior enlisted service members (E6 and below) from Senior enlisted (e.g., E7 and above and Officers) given that a primary emotional/ psychology component (and group complaint/emotional disturbance) for junior enlisted is the leadership experience.
A final observation is that providing the opportunity to share “what happened” in the physical world as well as an internal state, seems to make a significant difference for some individuals and they consistently report how helpful the group has been for them. I would encourage all providers working with Service Members and/or Veterans of recent wars to establish post-deployment group(s) to augment their deployed patients’ individual treatment protocols.
Dr. Anthony McCormick is a Deployment Behavioral Health Psychologist at Dwight D. Eisenhower Army Medical Center at Fort Gordon, Georgia. In this capacity, he provides behavioral health treatments interventions aimed at resolving the clinical issues and mental health concerns of Service Members. Additionally, he serves as a faculty member, instructor, and long-term supervisor of the Medical Center’s Clinical Psychology Internship Program.