Treatment

Treatment is performed by a wide range of specialist mental health clinicians, including psychiatrists, psychologists, psychotherapists, counsellors, mental health nurses, mental health social workers and occupational therapists.

The Defence Mental Health Services provide treatment for anxiety, depression and post-traumatic stress disorder (PTSD), following National Institute for Health and Care Excellence (NICE) guidelines, up to six months after discharge from the armed forces. Mainstream NHS mental health services also make use of the Armed Forces Veterans Positive Practice Guide.

There are also various charitable organisations involved in the treatment of veterans, including Combat Stress, Help for Heroes, the Royal British Legion and Walking with the Wounded. In particular, the Veterans’ Gateway acts as a first point of contact and offers information, advice and support for veterans, as well as their loved ones.

NICE guidelines emphasise trauma-focused cognitive behavioural therapy (TF-CBT) or eye movement desensitisation and reprocessing (EMDR). Military clients, however, seem (from my own armed forces service and clinical work with veterans) not to focus on the range of psychological techniques available, but rather make their own personal assessment of the therapist sitting in front of them. Their study of the counsellor determines how much they are willing to disclose, and what is withheld, especially in light of various legal investigations into past conflicts, such as ‘The Troubles’ in Northern Ireland (late 1960s-1998), or more recent deployments in Iraq (2003-2011) and Afghanistan (2001-2021). I have found that if there is any doubt about the therapist’s ability to listen without judgment, nothing significant will be revealed and resolved.

It is suggested here, therefore, that the psychological treatment of members of the armed forces, or veterans, is less about the utility of specific techniques. It is perhaps more about the characteristics and ideals embodied in the therapist. As always, the relationship is crucial, but it must be founded on the therapist’s understanding and practise of various military values, and the mutual trust and respect that ensues, for the best outcomes to materialise.

Client-therapist matching

From my work with veterans, I consider that although it is possible for any therapist to see military clients, the latter usually want to see somebody who may have insight into their condition because of their own military and trauma experiences. Clients wish to see a brother- or sister-in-arms, who has been through the military system; someone who speaks their language.

There are certain ways of working, or rather ways of being, that render the clinician more successful in treating soldiers. Military personnel I have known frequently remarked of effective therapists that they: ‘Speak my language’, ‘Understand what I mean without my even having to explain it’, ‘Have experienced the same things’ and similar comments.

The therapist with military experience, therefore, has a huge advantage. Countless academic papers conclude that it is the relationship that makes the difference between therapeutic success and failure. Hence, the therapist with military experience has a huge advantage. As such, it would be useful (though not essential) for armed forces personnel to be seen by therapists who have been in the armed forces themselves.

The therapist with military experience, therefore, has a huge advantage. Countless academic papers conclude that it is the relationship that makes the difference between therapeutic success and failure. Hence, the therapist with military experience has a huge advantage. As such, it would be useful (though not essential) for armed forces personnel to be seen by therapists who have been in the armed forces themselves.

The cultivation of virtue

It is not so much how counsellors work, but rather the virtues that they possess. First among these must be ‘truthfulness’, without which all else must fail. Some personnel, for example, feel that they were pressured, or fed various lies, to persuade them to take part in high-risk operations.

To help improve outcomes, the therapist can consciously seek to develop certain virtues. One simple example is timekeeping and reliability. Furthermore, the therapist must possess other characteristics that demonstrate an understanding of the ‘warrior code’. The six core values of the British Army are courage, discipline, respect for others, integrity, loyalty and selfless commitment. The Royal Marines Commandos, part of the Royal Navy, speak of excellence, integrity, self-discipline and humility, combined with courage, determination, unselfishness and, in the face of adversity, cheerfulness. So, for example, if you have a commando as a client, it would be ideal to have already embodied such virtues in your own life. Indeed, it is always important to make positive changes in yourself before expecting anyone else to make similar changes. In this respect, the military service of the therapist provides an important baseline of trust, mutual language and experience. The therapist becomes almost ‘one of us’.

Your growth first

Today, virtue may not be a popular aspiration. For some people, it might evoke thoughts of strict religion and excess discipline. In the armed forces, however, virtues underpin their entire ethos, and personnel are committed to uphold them. Furthermore, they are prepared to live and die by them. Therapists who wish to work with the military, therefore, would do well to nurture self-discipline and a range of virtues in themselves to help facilitate the growth and unfolding of their clients. Indeed, if you cultivate any virtue sufficiently then it is much more likely that all the virtues will be demonstrated by your life. You will then be not just a therapist with a range of therapeutic tools, but a healer.

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