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Posted by Give an Hour Admin on April 7, 2016 11:45 AM EDT
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Couples and Family Therapy as Essential in the Treatment of Veterans

Written by Norbert A. Wetzel, Th.D., co-founder & director of training at The Center for Family, Community, & Social Justice, Inc., and co-founder & director at The Princeton Family Institute

1. The relational context:

For many therapists (psychiatrists, psychologists, even social workers) the focus is on the individual veteran and his experience, symptoms, actions, traumata etc.

Yet, it is obvious, even though often not recognized, that almost all the veterans returned to a spouse, children, family, parents, friends, colleagues etc. and, depending on the relational context, this group, particularly spouses and children, are also deeply affected by the experiences of the veteran, i.e. by her/his way of dealing with her/his experiences during her/his time in the military, especially if they participated in combat. In addition, family, friends, colleagues can make an enormous positive difference in the way how a veteran is “working through” her/his experiences. Clearly, the high number of homeless veterans is not the result of so many veterans having nobody at all connected with them.

So, I am proposing an initial workshop or training experience about how a therapist can in general successfully involve family members, spouses, friends etc. in the treatment process of a veteran. This is an art that has to be learned.

2. Forming a clinical hypothesis:

A next step may be to learn how to look clinically at a veteran and her/his relational context in such a way that a clinical hypothesis can be formulated that takes a much more comprehensive, relationally and contextually focused approach and can serve as a guidance for the clinical work. How we look at a veteran and her/his relational world defines what we see and hear in our clinical work. 

So we can learn to constantly define and reformulate our hypothesis, to engage the most important group (family, other veterans, former or present colleagues, friends etc.) and to change focus as needed from a relationally to an individually focused therapy and back. Such an approach has shown to increase the innate strength and resilience of veterans.

3. Justice oriented clinical practice:

Relationally and contextually centered systemic therapy invariably leads to a justice oriented practice in which ethnic culture, gender identity, sexual identity, socio-economic class status and many other aspects of our diversity from each other can be seen, acknowledged, and addressed as a source of richness as human beings. Adopting a trauma informed care approach already means to acknowledge the destructive power of physical and sexual abuse, i.e. the traumatic effects of the impact of the relational, social and physical environment in which a child is developing to become an adult. 

Many therapists may have to learn to look at their own and their clients’ world from the perspective of heightened sensitivity to the deleterious effects coming from war-related experiences or from growing up in a society with a structural racism that permeates every part of institutional society. Justice in clinical practice with veterans will mean to unearth the relational strength of a veteran, to assist healing from inside out, healing relationships, and to become justice oriented in their own lives. 

4. The conceptual underpinnings:

In another step, the colleagues who would like to learn to give their clinical service to veterans a relational and contextual focus with justice as a “meta-perspective”, could spend some time to reflect on the (philosophically speaking) basic options and conceptual assumptions underlying this approach. 

In this reflection on the way we think about trauma and suffering, we would include also the importance of family legacies, of how to heal from “ancient” trauma that happened generations ago, of why we cannot heal alone, of talking about the future, of meditating about our own change process as therapists etc.

5. The role of psychiatry and medications:

As this sequence towards greater competence to look at relational and contextual factors in the therapy of veterans proceeds, we would also spend a significant portion of time on understanding the function of context-focused systemic therapy compared to bio-physiologically focused psychiatry and the role of medication in the treatment of veterans. 

The interface of psychiatry and relational therapy in the treatment of veterans needs to be reflected and treatment providers for veterans need to be familiar with the latest research and recent shifts in the thinking of the AMA and, especially, the NIH.

6. Couples therapy:

Another aspect of a well-rounded initial training module would be to focus on couple therapy that is conceptualized as much more than helping a spouse to support the healing of her/his veteran spouse. Couple therapy focuses on healing the relationship which then will be essential for the well-being of the veteran and for her/his overcoming trauma, hurt, anger, guilt, and panic.

General Comments:

All the teaching would have to be exemplified by and include watching video-taped sessions that the trainees would volunteer to bring, but also live supervised sessions, either in person or over distances with protected software such as ReGroup Therapy or VSee. 

In effect, the training could be done as a webinar with those who are able to being present and with others from further away signing up and learning through digital presentations.

This teaching would be appropriate and could be geared to any licensed therapist. I am convinced it would save considerable money and professional expertise spent in the direct individually focused service to veterans.

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