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Military Culture


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Title: Military Culture

Military Culture Treatment - 101AAPC SE
Region Kanuga ConferenceDate 10/24/2009
  • workshop to overview the culture of military
    families, effective treatments, and sources of

Peter McCall 770-329-6156
Presentation Goals
  • There are 3 goals of this presentation
  • Review the CareForTheTroops organization and
    understand the issues that drove the plan for
    the non-profit organization CareForTheTroops
  • Review at a high-level some of the military
    culture issues that may help in counseling
    military family members
  • Review the problems and issues faced by veterans
    and their families and clinical treatment issues
    for those who are serving and have served during
    periods of conflict.

Service Members at their swearing in ceremony
  • NOTE 3 dots represents a
    repetition break
  • Speaking these words has far more emotional power
    than these words on paper could ever convey.
    Anyone who has done this for real knows, in that
    moment, that they are agreeing to defend a
    principle with their very lives. It is a moment
    they never forget.

CareForTheTroops, Inc.
  • Who Are We Big Picture
  • CareForTheTroops is working to help the military
    and their extended family members receive mental
    health services and support from within the
    civilian elements of our society in the State of
  • CareForTheTroops is attempting to equip the
    civilian support services of society e.g.
    pastoral counselors and congregation leadership
    teams, with the capacities to be helpful.
  • We are working toward building a better net to
    catch those that need help before they fall too
    far and reach moments of desperation.

501c3 status has already been approved by the IRS
Current Board of Directors President Rev
Robert Certain, Rector, Episcopal Church of St
Peter and St Paul (USAF) Exec Director Peter
McCall (USArmy) Member Bill Harrison, Partner,
Mozley, Finlayson Loggins LLP
(USAF) Member William Matson, Exec Director,
Pathways Community Network, Atlanta,
GA Member Alan Baroody, Exec Director, Fraser
Counseling Center, Hinesville, GA Member Joseph
Krygiel, CEO of Catholic Charities, Archdiocese
of Atlanta (US Navy) Current Partners The
Georgia Association for Marriage and Family
Therapy (GAMFT) The EMDR Network of Clinicians in
Georgia Pathways Community Network, Inc Fraser
Counseling Center, Hinesville, Georgia (nearby
Fort Stewart) Episcopal Diocese of Atlanta
Presbytery of Atlanta and the Presbyterian Women
of Atlanta Catholic Charities and the Archdiocese
of Atlanta
Causes for Concern
  • Multiple deployments are common causing stress
    and family attachment issues
  • An April 08 Rand Study reported 37 have either
    PTSD, TBI, or significant Mental Stress (5 all
    3). Some estimate gt50 return with some form of
    mental distress
  • Suicide, alcoholism, domestic abuse and violent
    crimes rates are rising. Suicide is 33 higher
    in 07 over 06, 50 higher in 08, and almost
    equal to 08 by May of 09
  • Military Sexual Trauma (MST) is running at
  • In 2008, military children and teens sought
    outpatient mental health care 2 million times, a
    20 increase from 08 and double from the start
    of the Iraq war (03)
  • DoD and VA facilities are stretched the Aug
    2009 VA claims backlog is 900,000
  • Many more Reservists Guard than previous wars
    (54 as of mid 08) and they and families are
    more distant from DoD and VA support facilities
  • Other mental health, marriage, and family
    problems often occur with or leading up to PTSD
    requiring attention so they dont get worse
  • Rand Study estimates that PTSD and depression
    among service members will cost the nation up to
    6.2 billion in the two years after deployment.
    The study concludes that investing in proper
    treatment would actually save 2 billion within
    two years

Mission of
  • Work to improve the ability of the civilian
    mental health infrastructure in the State of
    Georgia, then nationally, to work with military
    family members
  • Facilitate connecting military families to
    providers of spiritual and psychological services
    familiar with the military culture and trauma
  • Focus on addressing combat stress recovery as
    well as other spiritual and mental health related
    problems impacting the marriages and families of
    military veterans
  • Educate and train clinicians, congregation and
    community leaders, extended family, and civilian
    groups about the military culture and trauma
    associated with military deployments in order to
    better assess and treat mental health symptoms,
    and provide more effective referrals and care
  • Provide opportunities for additional trauma
    treatment training to clinicians
  • Operate in an interfaith, non-political manner,
    focusing on the humanitarian interest that
    benefits the veterans and their extended family

Military Member
CareForTheTroops Operations Overview
RAND study says over 33 of returning military
have some form of mental distress
CFTT will improve the overall mental health
infrastructure to better support military families
54 of those deployed are R/NG. GA is 6th largest

Improve support even in remote areas of the state

The next set of charts provide a simulation of
using the website with
pastoral counselors in mind
This is the top of the Home Page
This is the bottom of the Home
Page Highlights, New Items And Reports
Back to the top of the Home Page
Home Page The drop-down menu for Mental Health
Professional is opened up. In this case,
selecting the Enroll with CFTT page Note the
other options available
Top of the Enrollment Page The info asked is
completely voluntary. We do not ask you to
volunteer time and any financial info is left
between you and the client. We are looking for
people with background, training, and experience.
Home Page The menu for Congregation Leaders is
opened up. In this case, selecting the About
Congregation Programs page
Top of the About Congregation Programs
Page Click on the picture and this presentation
is available
Moving down the same page gets you to the Guide
Book info we have introduced in this
presentation. It also shows the TOC and the Intro
Letter in the document Clicking on the picture
of the book will let you download it.
Military Ministry Programs
Back to the top of the Home Page A key piece
of the web site is the Resource Library with the
4 selections shown. This material is updated
periodically. The reference material is weekly.
Home Page Another key section is the gathered
in the Stuff You Should Know Section. Our
goal here is to provide plenty of info on these
topics and also refer you to the top 3-5 sites on
these topics.
Home Page Finally, an important aspect of our
mission is to connect you to others that can
help. The Find a Therapist menu item discusses
how one might choose a therapist and then allows
you to search many ways.
This shows the first 4 search results for Fulton
County in the database. This is intended for
use by congregation sources, clinicians, and
people in need searching for a therapist who
wants to work with military families.
Training is key. This shows the training
events we are aware of. Both from CFTT and from
other organizations. Please visit it
periodically and also let us know of training you
hear about to share with others.
Back to the top of the Home Page
The EMDR HAP (Humanitarian Assistance Program)
Training organization ( ) will
conduct Weekend 1 (Part I) training Friday
through Sunday, Jan 15th to 17th in Athens,
Georgia. The training facilities used in Athens
are at Milledge Avenue Baptist Church, 598 South
Milledge Avenue, Athens, GA 30605. Weekend 2
(Part II) training will be scheduled 3-6 months
later with details TBA. This training is jointly
sponsored by the The Samaritan Counseling Center
of Northeast Georgia ( ),
GAMFT-The Georgia Association for Marriage and
Family Therapy ( ), and The
CareForTheTroops, Inc. non-profit organization
( ). AUDIENCE This
training is for licensed (and some licensable)
counselors working in a non-profit environment.
Specific details are available at the following
web location . COST
350 for each weekend. Lodging and meals are the
responsibility of the participant. SCHOLARSHIPS
A limited number are available to cover the full
HAP Fee for Weekend 2 (Part II) for those that
meet the criteria below. So please apply early
if one is needed. ENROLLMENT TRAINING Enroll
for the HAP Part I training is done on-line
through the HAP website
toregister/listEvents.php. Look for this events
description on the web page. SCHOLARSHIPS Apply
for the CareForTheTroops scholarship at .
Download the Application Document, complete and
email or mail it to the address shown on the
document. Additional information about this
weekend such as schedule, lodging, restaurants,
etc. can be found at the following web location .
HAP Participant Requirements EMDR PART I AND
PART II are available for licensed mental health
clinicians at the masters degree level or above,
or for masters level clinicians on a licensure
track, with permission of their licensed clinical
supervisor. In keeping with its mission, HAP
normally trains only clinicians working 30 or
more hours per week in community based,
non-profit settings. Exceptions have been made
for private practice clinicians who have made a
substantial commitment to pro bono service in the
  • CareForTheTroops(CFTT) Scholarship Criteria
  • It is the intent of CFTT to incent attendance of
    both EMDR Training Weekends (Part I and Part II)
    in order to increase the number of fully
    qualified EMDR Therapists to treat trauma in
    Georgia. Participants must
  • Practice in Georgia
  • Attend and successfully complete both Part I and
    Part II EMDR training by HAP
  • Enroll in the CareForTheTroops Therapist Database
    at the completion of Weekend 1 and stay enrolled
    at least 2 years. More Info about this is
    available at
  • Be willing to work with military clients and
    their extended family members
  • Pay the HAP Training Fee for Part I.
    CareForTheTroops will pay the HAP Training Fee
    for Part II which means you must attend a Part II
    by HAP
  • Attend and complete Part II within 12 months of
    completing Part I
  • Be responsible for all other costs, fees, and
    expenses associated with the training weekends.

Chapter WorkshopsMilitary Culture 101-Clinical
Treatment Issues
NOTE Check with your local GAMFT Chapter and
also with the web site
for changes and updates.
Final Comments Ref CareForTheTroops
  • Help For You
  • Use the web site as a resource
  • Information and reference material
  • Training
  • Referrals
  • Use you involvement with CFTT to help market your
    practice and or help your congregations
  • Help for Us
  • Enroll in the CFTT database if you qualify
  • Publicize CFTT to community and congregations
  • Would you consider being a Trainer using material
    similar to what you see today?


The next charts information about the military
Military Culture
  • Sociologists define culture as
  • Language - nomenclature acronyms, abbr.
  • Beliefs defenders of Democracy
  • Value Systems leave no one behind
  • Norms Rules formal informal conduct

Culture is associated with a social system and
unique to a given system.
Language Barriers for CiviliansGlossary of
Military Terms and AcronymsMilitary Cultural
OEF Operation Enduring Freedom it is a
multinational military operation aimed at
dismantling terrorist groups, mostly in
Afghanistan. It officially commenced on Oct. 7,
2001 in response to the September 11th terrorist
attacks. OIF Operation Iraqi Freedom - also
known as the Iraq War began on 3/20/2003. USAR
United States Army Reserve USANG United
States Army National Guard E1-E9
O1-O10 Enlisted Ranks Officer Ranks SPC
Specialist, rank of E4, often referred to a
Spec 4 First SGT First Sergeant, rank of E7,
lead enlisted person in a company. It and SSG,
Staff Sergeant are key leadership ranks with
lots of job pressures NCO Non-Commissioned
Officer, ranks E6 through E9 IEDs Improvised
Explosive Devices Sandbox Iraq and
Afghanistan Down Range Deployed to anyplace where
there is shooting. Outside the Wire Leave the
safety of the enclosed military base
(FOB) Taking the Pack Off Leaving mentally and
physically from combat Top Cover Making sure the
boss looks good
Military CultureBelief and Value Systems Norms
and Rules
  • Beliefs
  • Defenders of Democracy
  • Trust in the leadership
  • Role clarity
  • Distrust of civilians
  • Value Systems Leave no one behind The
    Group practically becomes a family system Top
    Cover-defend and support the boss Violence many
    have a history of violence which often plays a
  • Norms Rules
  • Formal and informal conduct Stigma of mental
    health and PTSD Cover of the boss (Top Cover)
    Back-logging trauma

Reserve and National Guard Units vs Regular Army
Reserve / Guard
  • Units are small based in local communities.
  • Part-time soldiers, often working with local
    police, fire, and EMS.
  • Families may be left in a town with little or no
    support services.
  • Mostly support units in Georgia (transport, MP,
  • Likely to work within local communities
  • Cant relocate easily when activated
  • Lack of military related health services - PCP
    not Tricare approved
  • Make use of family or local supports (church,
  • Units are based at major military
  • Full-time soldiers who expect to be deployed .
  • Families are left at their post where a variety
    of support is in place both on-post in
  • Are part of a larger fighting force including 1/5
    combat units.
  • Live on-post or nearby other family support
  • Less need to relocate when deployed
  • Access to a variety of health, welfare,
    educational services
  • Support groups in-place through soldiers unit


The next few charts provide some background of
this war that might help you better understand
your client or congregation member and their
presenting story and issues
Why is this war different?
  • Volunteer vs. draft
  • Multiple deployments
  • Type of suicide bombings
  • Never any safety, no real recovery time
  • Use of civilians as shields and decoys by the
  • Deliberately targeting our moral code
  • COMMUNICATION! Internet, cell phones, etc.
  • IEDs, RPGs (TBI, hearing loss, neuro-chemical
  • Advancement in medical treatments

OIF/OEF - Statistics
  • As of 12/1/2008
  • 1.7M troops deployed
  • 4207 US Military killed in Iraq (excludes
  • 627 US Military killed in Afghanistan (excludes
  • 65,000 US Military wounded
  • 54 deployed are Reserve / Guard (4/08)
  • 1 of US population is directly touched by
    military service more if you consider civilian
  • Deployed as of 09/2009 130K troops in Iraq
    160K civilian contractors in Iraq 65K troops
    in Afghanistan (more are being sought as of Oct

OIF/OEF - Profile
  • All-Volunteer military
  • Many did not expect deployment(reminder GA is
    6th largest NG state)
  • Multiple deployments is the norm
  • 2008 Rand Study indicates
  • 53 of those that need treatment sought Mental
    Health treatment in 08
  • 16-23 have experienced MSTMST Military Sexual
  • 2yr post-deployment cost 6.2B
  • OIF vs OEF VA indicates a OIF vet is 2x likely
    to seek help than a OEF vet
  • As of 04/08, 120K mental health dxs, 50 were
    diagnosed w PTSD
  • Homecoming Concept alienation, detachment,
    isolation, avoidance, boredom

OIF/OEF - More Statistics
  • 15 wounded for every 1 fatality (Vietnam was 3
    for 1)
  • VA predicts that it will treat 263,000 OIF/OEF
    vets in 2008 and 330,000 in 2009
  • Current backlog of veterans is 400,000 (as of
  • Claims backlog is over 900,000 (as of Aug 2009)
  • Heaviest of that backlog is mental health (Ex
    Virginia VA community mental health services has
    a waiting list of 5,700 as of early 2008)
  • 550,000 school age children of active duty
    Service Members (Reg/Res/NG)
  • 52,000 children of Reserve and National Guard
    Service Members affected
  • 84 of Regular Military Service Members children
    attend public school, not DoD base schools
  • Georgia has over 750K veterans

OIF/OEF and some more Statistics
  • According to a new American Journal of Public
    Health study on veterans' mental health diagnoses
  • Of the 289,328 veterans who entered VA care in
    2008, nearly 37 had mental health problems,
    including post traumatic stress disorder (about
    22) and depression (roughly 17). (ref
    .150284v1 )
  • "Weekend warriors" over 30 years old in the
    national guard and reserves who left stable
    family, work and community environments for
    combat zones were especially susceptible to
    mental health problems.
  • A recent (July, 2009) US government
    accountability office report found that nearly
    20 of women veterans suffer from PTSD (ref
    http// )

OEF / OIF Experience - Summary
  • Indirect threats not so much direct assaults
    and attacks
  • IEDs, car bombs
  • RPG, snipers
  • Suicide bombings
  • Powerlessness
  • threat is indiscriminate
  • not dependent upon skill or mastery
  • relationship between loss of control and PTSD
  • This generations war
  • 1st Internet War (Vietnam was the TV War)
  • Blogs, email, cell phone (cameras) 24 hr new
  • New versions of the Dear John/Jane letter
  • Home trouble as a leading stressor (financial,
    intimate partner)
  • Reservists/Guard repeated, unpredictable
    separations from family/job


The next several charts will cover life within
the military family and clinical treatment
The Military Deployment Cycle or The Military
Family Life Cycle
Military Family At-Risk Factors
  • Frequent Relocation 3.3 years average
  • Previous Deployments 87
  • Longer Separations 7.3 month average
  • Larger Families 42 3 children
  • Younger Mothers 26.5 median age
  • Blended Families 31 step-parents
  • Education 21 w/o HS diploma
  • Working Outside Home 44
  • Median Income lt 30,000 (34)

  • Resulting from deployments, relocation, or
    training range from a few to many months
    disrupts life cycle transitions.
  • Emotional ambiguity stemming from physical loss,
    but expect maintenance of closeness.
  • Child family ties/problems within the larger
  • Heightening difficulties are the threat of death
    or injury of service member.

  • Stressful because of adjustment required family
    functioning may have been enhanced in absentia.
  • Presence of service member alters household rule,
    role, time, routine structure.
  • Expect to return to normal functioning after long
    term separation what is normal?
  • Reckoning for misdeeds during service members
    absence (school failure, affairs, etc.)

  • Families in the military (U.S. Army in
    particular) relocate every three to five years.
  • Inconsistency of services b/w the installations
    (schools _at_ Ft. Hood vs. Ft. Stewart).
  • Requires readjustment for family members who may
    lag behind service member both physically

Deployment Related Stressors for Spouses
Warner CH, Appenzeller GN, Warner CM, Grieger T.
Psychological Effects of Deployments on Military
Families Psychiatric Annals 2009 14 56-62.
a closing thought on the Military Culture
  • The capacity of Soldiers for absorbing
    punishment and enduring privations is almost
    inexhaustible so long as they believe they are
    getting a square deal, that their commanders are
    looking out for them, and that their own
    accomplishments are understood and appreciated.
  • GENERAL Dwight Eisenhower, 1944

Demographics - AGE
Demographics - Young Adults in the Military
  • 46.6 of all service members are lt 25 yrs old
  • 53 of enlisted members are lt 25 yrs old
  • 24.8 reported binge drinking gt1x per week in
    the past 30 days vs 17.4 for same-age civilians
  • Higher smoking rates (40 vs. 35.4) than
    same-age civilians
  • Illicit drug use in the military was 5 in 2005,
    but nonmedical use of painkillers is the most
    common form of drug abuse.

Source Military Family Research Institute at
Purdue University.(2005). 2005 demographics
report. Arlington, VA Office of the Deputy Under
Secretary of Defense, Military Community and
Family Policy. Retrieved January 7, 2009, from
Demographics GENDER AND RANK
Women represent approximately 15 of the military
force. Representation of women is slightly
lower for Senior Enlisted and General Officers.
Divorce Trends
Marital Status
ACActive Duty RCReserves/Guard
Demographics Suicide
  • Two dominant factors
  • Financial Stress
  • Concerns with Intimate Partners
  • The 2008 overall Army rate was 24/100K, a 33
  • 70 increase reported from 2005 to 2007

Psychological Injury ContinuumASR to COSR to
  • ASR (acute stress reaction) produces
    biological, psychological, and behavioral
    changes. ASD means it has become disruptive
    and destructive.
  • COSR(combat and operational stress) is
    expected, common, and occurs throughout
    deployment to some degree. Pretty much everyone
    comes home with some version of combat and
    operational stress.
  • PTSD(post traumatic stress disorder) becomes
    classified if COSR symptoms are daily, interfere,
    and last longer than 1 month

  • HYPER-AROUSAL Fight/Flight/Freeze, Angry,
    poor sleep, argumentative, impatient, on alert,
    tense (hyper-vigilant), intense startle response,
    speeding tickets (once home) and other risky
  • NUMBING/AVOIDANCE Withdrawn, secretive,
    detached, controlling, removes all reminders,
    avoids similar situations, ends relationships
    with people associated with trauma, etc.
  • RE-EXPERIENCING Nightmares, flashbacks,
    intrusive thoughts

PTSD Cues or Triggers
  • Think full body memories are laid down in all
    sensory spheres (smell, sound, vibrations,
    colors, etc)
  • Terrain desert, urban
  • Weather heat wind, humidity
  • Songs
  • Smells
  • Driving signature trigger for OIF/OEF vets
    (assess driving safety !)
  • Nature of war in Iraq and Afghanistan
  • Need for high speeds, evasive maneuvers
  • Importance of a driving assessment
  • People automatic response to persons who appear
    Middle Eastern, children
  • Situational mimic loss of control powerlessness
    (e.g. dentist chair, anesthesia, OB-GYN exam,
    endoscopy, etc)

  • What does PTSD feel like
  • Sense of immediacy (happening right now)
  • Re-experiencing of original memories and sensory
  • Involuntary
  • Guilt
  • Rational or irrational
  • Understanding atrocities
  • Survivor Guilt, also guilt for leaving, being
  • Grief
  • Multiple losses without time to grieve
  • Affective numbing, anger/revenge
  • Impact of pre-war losses, post-war losses
  • Deaths of loved ones during deployment
  • Other Feelings
  • Anger at Government
  • Mistrust of Authority
  • Desire to return to the war zone
  • Damage to spirituality

TBI Traumatic Brain Injury
  • Signature Injury of OIF/OEF
  • Prevalence hard to estimate
  • Approximately 2100 Afghanistan troops diagnosed
    since 2001 as of 08/2007
  • VA reports 61,285 OIF/OEF vets had preliminary
    screen, 11,804 were positive (20)
  • Prevalence has probably been underestimated so
  • Explosions account for 3 of 4 combat-related
  • Improvements in war zone medical treatment
    decreases fatalities but may impact rise in TBI
  • Soldier return home with poly-trauma
  • Symptoms headaches, tinnitus, dizziness,
    balance problems, sleep problems, persistent
    fatigue, speech, hearing and vision impairment,
    sensitivity to light and sounds, heightened or
    lessened senses, impairments in attention and
    concentration, memory problems more like dementia
    than amnesia, poor impulse and anger control

MST Military Sexual Trauma
  • 2008 Rand Study reported 16 - 23 experienced
  • Reported MST were 1,700 in 2004 and 2,947 in 2006
  • VA indicates that 1 in 4 female veterans using
    the VA reported at least one MST
  • The VA Day Hospital Program estimates 3-5 female
    referrals have MST
  • Treatment Considerations
  • May be compounded by combat trauma
  • Frequently unreported
  • Trauma occurs in context of where the solder
    lives and works (comparable to incest)
  • Military Culture emphasizes cohesion
  • Males victims as well as female
  • Female perpetrators as well as male
  • Largely male population in the VA where female
    veterans go for help

PTSD Treatments
  • Cognitive Therapy (CT)
  • Exposure Therapy (ET)
  • Stress Inoculation Training (SIT)
  • Eye Movement Desensitization Reprocessing
  • Generally individually oriented
  • and systemically focused One
  • size does not fit all

A Extra Word About The Children
  • Currently, there are about 230,000 American
    children and teenagers with an active duty
    mother or father at war. Another 320,000 from
    Reserve/Guard families. 550K total Nearly half
    of all troops deployed in support of the recent
    wars are parents most of whom are on their
    second or subsequent deployments. (Aug 09)
  • In 2008, military children and teens sought
    outpatient mental health care 2 million times,
    which was double the number at the start of the
    Iraq war (2003), according to an internal
    Pentagon document obtained by The Associated
  • An article published by the Associated Press
    (August 9, 2009) notes a Pentagon report
    indicating a 20 percent increase in the number of
    active duty dependent children hospitalized for
    mental health needs between 2007 and 2008.
  • The document revealed there was also a spike in
    the number of service members' children
    hospitalized for mental health reasons.
  • http//
    s_and_parenting/ http//

Realizing the bridge is down
  • Homethe place many think is the safe haven to
    find relief from the stress of warmay initially
    be a letdown. When a loved one asks, What was
    it like? and you look into eyes that have not
    seen what yours have, you suddenly realize that
    home is farther away than you ever imagined.
  • Down Range From Iraq and Back, by Cantrell
    Dean, 2005

Intake Scenario Interpreting It
Presentation Goals What We Did
  • There were 3 goals of this presentation
  • We Reviewed the CareForTheTroops organization
    and the issues that drove the plan for the
    non-profit organization CareForTheTroops
  • We Reviewed at a high-level some of the military
    culture issues that may help in counseling
    military family members
  • We Reviewed the problems and issues faced by
    veterans and their families and treatment issues
    for those who are serving and have served during
    periods of conflict.

In ClosingConsider These Next Steps
  • Look for more training opportunity to learn
    about treating the military. Visit
  • If not yet trained in a trauma treatment
    technique, consider getting that training, e. g.
    EMDR (Jan 15-17 Weekend I in Athens)
  • If you are willing to work with military
    families, and meet the qualifications, enroll in
    the CareForTheTroops database
  • Consider being a trainer to outreach to
    community organizations, congregations, and other
  • to participate in the CFTT initiative
  • to market your practice