As a psychologist working in a Military Treatment Facility, I have had the privilege of providing care for some of America’s finest military men and women; those who have deployed to the Middle East in support of our most recent conflicts abroad. I have provided individual psychotherapy addressing deployment-related issues and concerns for the past five years and have also run a weekly post-deployment group for a little over four and a half years.
Over time, I have observed patterns of responding to the deployed experience and subsequently developed an adjunct clinical emphasis that appears to enhance overall treatment outcomes. The approach is insight therapy based and consists of three intuitive concepts: evolved perspective, integrating experiences and understanding deployment’s impact on the central nervous systems.
I say “intuitive “because individuals who have deployed seem to grasp and embrace these concepts and apply them readily in their efforts to reduce the emotional and psychological distress associated with the struggles and challenges inherent to post-deployment adjustment. This approach generally initiates as well as facilitates the crucial “buy-in” needed for individuals to take ownership of their recovery process. Additionally, over the past year I have ascertained a somewhat intuitive addendum to addressing the certain and continual complaint of sleep difficulties post-deployment that seems to also increase “buy-in” and consequently improve the outcome effectiveness of sleep protocols.
Evolved Perspective: In therapy, I begin by dispelling the notion that service members, upon return from deployment, can get on with their lives as if their deployment was a side trip that had no immediate or lasting influence on their psyche. In general, the expectation of an individual and his/her associated family and friends, is that he/she will continue on with their lives (feeling and believing as they had felt and believe before ever deploying). Their subconscious (i.e., “I hadn’t really given it any thought”) expectation is to approach post-deployment life utilizing the same worldview that they held prior to ever deploying. I begin by explaining that they have gained hundreds of experiences (if not thousands, depending upon the number of deployments), many of them novel, which they have added to their conscious and subconscious views of the world.
As a consequence, their perspectives on many elements of life have evolved (given the impact of newly acquired experiences) and their worldview is no longer what it was prior to deployment. In essence, they are not the same from a mental and psychological developmental standpoint as they were before having deployed. I am careful to avoid describing their perspective as having “changed,” because it implies psychotherapy can help change it back to its pre-deployment status. I go on to explain that contrary to the way they report feeling, they are not “broken” and are more appropriately struggling to adapt to known and unknown (conscious and subconscious) changes in their worldview. I encourage them to be patient with themselves and learn to accommodate their perspectives in an environment in which their evolved perspectives may no longer neatly fit.
Integrating Deployed Experiences: Consistent with the intent of such empirically validated treatment approaches as Prolonged Exposure Therapy, I make a determined effort to have individuals understand the connection between making their deployment-related experiences (whether negative or positive) a part of their psyche (i.e., integrating them into the self versus an attempt to suppress and/or avoid them). I explain that they have been integrating experiences into their psyche for all of their life. So much so that conscious attempts to avoid doing so results in adverse conscious and subconscious mental processes such as having unwanted thoughts and memories “creep” into consciousness when they try to “sit back and relax.”
I explain that that is a prime time for the subconscious mind to process emotional and psychological information that has otherwise been suppressed or avoided given that conscious efforts to keep that material hidden are at their lowest. I also point out that while they are attempting to sleep and as a result, are managing little to no control over conscious processes, the subconscious mind attempts processing of suppressed and/or avoided material through the dreaming process - resulting in one chief complaint being “nightmares” related to deployment experiences. The goal here is to have the individual understand that avoidance and suppression are unhealthy and that talking about (and/or mentally processing) deployment-related experiences, and in general, processing them as they would any other experiences, is healthier.
Ultimately, by doing so, the net result is a decrease in emotional and psychological disturbance related to the impact of harsh deployment-related experiences. I provide the following in terms of managing troubling thoughts, memories, and recollections as they enter (or intrude upon) conscious thought throughout the day. As we tend to do so naturally, I direct individuals to reflect upon the thought, memory, or recollection to the extent needed to have it move on through conscious awareness back into the subconscious. I explain that we have many thoughts, memories, and recollections that we reflect upon as we go about our daily routines. With a significant majority of these, we pay no attention to when they come or when they go. In hindsight, they seem to flow seamlessly through our minds.
In fact, the mind continually process material that is subconscious, and without significant disruption, moves on from that to something else. I ensure that my deployed patients are aware of this process and direct then to utilize it in a conscious manner with troubling deployment-related thought, memories, and recollections. That is, I direct them to stop pushing aside (suppressing and/or avoiding) deployment-related materiel, and instead, let the thought, memory, or recollection enter and flow through their thoughts to its natural end just as they might do with any other thought, memory, or recollection that enters consciousness (even if this thought, memory, or recollection happens to be an unpleasant one).
Keep an eye on the CDP’s blog where in my next “Staff Voices” column, I will continue this discussion with anecdotal deployment-related CNS observations and thoughts about sleep that seem to improve treatment outcomes.