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BEYOND BASIC
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BEYOND BASIC
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“Beyond Basic Training: Ethical Considerations in
Developing...
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DUANE FRANCE, MA, MBA, LPC
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• MA (Adams State Univer...
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MARCO A. BONGIOANNI, LMHC
(Personal Photo, 2015)
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• ...
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In 2016, the Military and Government Counseling Assoc...
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Advocacy represents counselors’ ability to understand...
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LEARNING OBJECTIVES
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Ethics represents counselors’ s...
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LEARNING OBJECTIVES
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Ethics represents counselors’ s...
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PRACTICING WITHIN BOUNDARIES
OF COMPETENCE
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C.2.a. B...
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Developing
sensitivity and
understanding of
another e...
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DEFINING MILITARY CULTURE
• Military Culture: Collect...
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DEFINING MILITARY CULTURAL
COMPETENCE
Multicultural O...
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EXPLICIT COMPONENTS OF
MILITARY CULTURE
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• While im...
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IMPLICIT COMPONENTS OF
MILITARY CULTURE
….”We review ...
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MILITARY ETHOS
• Warrior Ethos
• “Leave no one behind...
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MILITARY VALUES
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The attributes that soldiers, sail...
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• Initial Entry Training- socialization process to mi...
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• Family Tradition
• Transition to manhood/womanhood
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WHAT IS A PARALLEL?
Something that is similar in comp...
BEYOND BASIC
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• Breathing in Marksmanship
•...
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• Philosophy
• Stoicism
• Psychology and War
• Michae...
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BOUNDARIES OF COMPETENCE
ETHICAL DILEMMA
You have bee...
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AVOIDING THE IMPOSING OF VALUES,
ETC. ON A CLIENT (A....
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IMPOSING VALUES EXAMPLES
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Listen to the full
episod...
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DEVELOPING AWARENESS
War Attitude Scale is a 27 item ...
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CULTURAL AWARENESS, SELF
EFFICACY AND WAR ATTITUDE
Ex...
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Sayer et al. (2009) identified a number of barriers t...
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IMPOSING VALUES ETHICAL DILEMMA
You have been working...
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PROFESSIONAL RESPONSIBILITY TO
ENGAGE IN SELF-CARE AC...
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Scroggins, N. (Director). (2017). Heart of the Bull [...
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SECONDARY TRAUMATIC STRESS IN
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Secondary Traumatic Stress Scale
MEASURING TRAUMAT...
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Your weekly Vietnam Veterans Support Group has grown ...
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CULTURALLY AND CLINICALLY
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A....
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PTSD Consultation Program
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Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 1 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 2 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 3 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 4 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 5 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 6 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 7 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 8 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 9 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 10 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 11 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 12 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 13 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 14 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 15 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 16 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 17 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 18 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 19 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 20 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 21 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 22 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 23 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 24 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 25 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 26 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 27 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 28 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 29 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 30 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 31 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 32 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 33 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 34 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 35 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 36 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 37 Beyond Basic Training: Ethical Considerations in Military Cultural Competence Slide 38
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Beyond Basic Training: Ethical Considerations in Military Cultural Competence

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Presented at the 2019 American Counseling Association, Veterans and clinical mental health professionals Duane France and Marco Bongioanni discuss how the Military and Government Counseling Association Competencies for working with military populations correlate with the American Counseling Association Code of Ethics

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Beyond Basic Training: Ethical Considerations in Military Cultural Competence

  1. 1. BEYOND BASIC TRAINING ACA 2019 BEYOND BASIC TRAINING ACA 2019 “Beyond Basic Training: Ethical Considerations in Developing Military and Veteran Cultural Competence” Duane K. L. France, MA, MBA, LPC duane@veteranmentalhealth.com Marco A. Bongioanni, MA, LMHC marco.bongioanni@va.gov (DVIDS, 2017) (DVIDS, 2017) (DVIDS, 2017) (DVIDS, 2017)
  2. 2. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 DUANE FRANCE, MA, MBA, LPC 2 • MA (Adams State University, 2015); BS (Excelsior College, 2011) • Director of Veteran Services, Family Care Center LLC and Executive Director, Colorado Veterans Health and Wellness Agency • Outpatient mental health counseling for service members, veterans and their families, justice involved veterans, and grant- funded services to overcome barriers to care • Retired from the United States Army in 2014 after twenty-two years of service. Five combat and operational deployments (OIF, OEFX2, North Africa, Bosnia). Served two tours of Germany, one as a Recruiter, and the 82nd Airborne Division • 2015 NBCC Foundation Military Scholarship Recipient, Member of the MGCA Board of Directors, Member of the ACA Public Policy and Legislation Committee • Founder and host of Head Space and Timing, a blog and podcast dedicated to changing the way we think and talk about veteran mental health www.veteranmentalhealth.com
  3. 3. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 MARCO A. BONGIOANNI, LMHC (Personal Photo, 2015) 3 • MSEd. (Fordham University, 2012); BS (Cornell University, 2001) • Readjustment Counseling Therapist, Bronx Vet Center, U.S. Department of Veterans Affairs • Works in outpatient setting, primarily with combat veterans, family members, and veterans who have experienced military sexual trauma • Served on active duty in the U.S. Army for nine years to include two combat deployments to Iraq and service in the Republic of Korea, Germany, and Egypt. Currently still serves part time as a Civil Affairs Battalion Commander in the U.S. Army Reserve. • Mr. Bongioanni’s Disclosure: The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the U.S. Department of Veterans Affairs, the U.S. Department of Defense, nor the U.S. Government. Mr. Bongioanni has no relevant financial relationships to disclose relating to the content of this activity. Commercial support was not received for this activity.
  4. 4. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 In 2016, the Military and Government Counseling Association appointed a task force to develop a set of competencies for professional counselors when working with service members, veterans and their families. The appointed task force developed and presented Competencies for Counseling Military Populations (Prosek, et al., 2018). COMPETENCIES FOR COUNSELING MILITARY POPULATIONS WWW.VETERAN MENTALHEALTH. COM/ACA2019 American Counseling Association. (2014). ACA code of ethics. American Counseling Association. Prosek, E., Burgin, E., Atkins, K., Wehrman, J., Fenell, D., Carter, C., & Green, L. (2018). Competenceis for Counseling Miltiary Populations. Journal of Military and Government Counseling, 87-99.
  5. 5. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 Advocacy represents counselors’ ability to understand and influence individual, system, and public policy efforts to increase access to mental health resources for military-connected clients and promote the role of counseling professionals working with military populations. PROPOSED COMPETENCIES Military Culture represents general information about the functioning and worldview of military service members and their families. Ethics represents counselors’ self-awareness and motivation to serve military-connected clients, as well as ethical considerations working with military populations. Systems Features represents general information about the nature and structure of the military lifecycle including, but not limited to, deployment, family, spouses and children, health and wellness, employment, and retirement. Assessment of Presenting Concerns represents common areas of clinical concerns that service members frequently present to mental health services to address. Identity Development represents the whole person concept of military life including one’s personal identity as a service member and connection to mission and core values of working in a high-risk occupation across the lifespan. Treatment represents general information about unique issues that may arise in the treatment of military-affiliated clients and approaches supported by research for military populations, including best practices of military care systems, as well as holistic, wellness-oriented services.
  6. 6. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 LEARNING OBJECTIVES 6 Ethics represents counselors’ self-awareness and motivation to serve military-connected clients, as well as ethical considerations working with military populations. Reference the MGCA Proposed Competencies for Counseling Military Populations (CCMP) (Prosek, et al.) and how these proposed competencies align with the ACA Code of Ethics
  7. 7. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 LEARNING OBJECTIVES 7 Ethics represents counselors’ self-awareness and motivation to serve military-connected clients, as well as ethical considerations working with military populations – 14 competencies n. Considers community referrals when in the best interest of the client. (ACA Code of Ethics Section A.11.a) a. Maintains competence by completing formal training for working with military personnel; and when possible, the training is experiential in nature. (ACA Code of Ethics Section C.2.a.) c. Brackets personal values and attitudes of war policies; addresses potential prejudices about military service or war; and recognizes their own political opinions of current and previous combat operations. (ACA Code of Ethics Section A.4.b) f. Actively adheres to a self-care routine to prevent burnout, depersonalization, compassion fatigue, and impairment. (ACA Code of Ethics Section C)
  8. 8. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 PRACTICING WITHIN BOUNDARIES OF COMPETENCE 8 C.2.a. Boundaries of Competence Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Whereas multicultural counseling competency is required across all counseling specialties, counselors gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent counselor in working with a diverse client population. 6. Ethics represents counselors’ self-awareness and motivation to serve military-connected clients, as well as ethical considerations working with military populations. The professional counselor: a. Maintains competence by completing formal training for working with military personnel; and when possible, the training is experiential in nature
  9. 9. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 Developing sensitivity and understanding of another ethnic group…Cultural awareness must be supplemented with cultural knowledge Familiarization with selected cultural characteristics, history, values, belief systems, and behaviors of the members of another ethnic group Has the ability to be appropriately responsive to the attitudes, feelings, circumstances of groups of people that share a common and distinct racial, national, religious, linguistic, or cultural heritage Can Function effectively and appropriately in diverse cultural interaction and settings Cultural Awareness Cultural Knowledge Cultural Sensitivity Cultural Competence Adams, D. L. (1995). Health issues for women of color: A cultural diversity perspective. CONTINUUM OF CULTURAL COMPETENCE
  10. 10. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 DEFINING MILITARY CULTURE • Military Culture: Collective • ‘We’ Culture • Fixed • The group’s goals placed ahead of personal goals • Learn first to manage people, then ideas • Success is measured by group achievement • Work is life (Profession…some might call it a vocation) 10 • Civilian Culture: Individualistic • ‘I’ Culture • Fluid • Emphasis is on individual achievement and self-reliance • Learn first to manage ideas, then people • Success is measured by individual achievement • Work is just a job (Occupation) What is the difference? Military/Civilian Gap or Divide? (PowerPoint Clip Art, 2017)
  11. 11. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 DEFINING MILITARY CULTURAL COMPETENCE Multicultural Orientation Has Two Domains: 1. Cultural Humility - Ability to maintain a personal stance that is nonjudgmental and other oriented. 2. Cultural Opportunity - Moments in session when a counselor can address and focus on a client’s cultural identity. ØMissed cultural opportunities are missed opportunities to improve your clients outcome. Three Main Areas of Multicultural Counseling Competency: 1. Counselor Knowledge About Different Cultures & Perspectives 2. Counselor Awareness About Their Own Heritage and How That May Affect Their Own Attitudes, Beliefs, and Judgements 3. Counselor Skills to Utilize in Culturally Appropriate Approaches ØMany Military Cultural Competence trainings for clinicians focus at the first point and often also address the second. Few capture the third. 11 (Sue and Sue, 1981) Sue, D.W., & Sue, D. (2008) Counseling the Culturally Diverse, Fifth Edition. Hoboken, NJ: John Wiley & Sons, Inc.
  12. 12. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 EXPLICIT COMPONENTS OF MILITARY CULTURE 12 • While important to understand these, it provides generally only a surface level understanding of military culture. • Explicit elements might include: • Branch Cultural Differences • Rank Structure • Hierarchies • Uniforms • Missions • Chain of Command • Uniform Code of Military Justice • Military and Veteran Specific Terms, Jargon, and Acronyms • Who makes up a military family • What was their job in military • Differences between active duty and reserve • Military demographics • Length of Service • Deployment History • Unique Challenges to Female, LGBTQA, minorities • Life chapter of a service member
  13. 13. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 IMPLICIT COMPONENTS OF MILITARY CULTURE ….”We review the elements of military culture that may be the most powerful and enduring just because they are implicit and intangible, and cannot be shed along with the uniform: the values and guiding ideas that the warrior ethos comprises.” (Litz, Lebowitz, Gray, & Nash, 2016) 13 • These Include Things Like: • Ethos • Values • Socialization Process • Reasons behind why somebody joined the military • Parallels Litz, B. T., Lebowitz, L., Gray, M. J., & Nash, W. P. (2017). Adaptive disclosure: A new treatment for military trauma, loss, and moral injury. Guilford Publications.
  14. 14. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 MILITARY ETHOS • Warrior Ethos • “Leave no one behind” deep and enduring sense of loyalty and commitment to fellow service members • Emphasize the importance of teamwork • Infuse in each Service member a moral focus including the ability to make ethical decisions in situations that are morally ambiguous • The basic tasks of a service member are fourfold: prepare to kill, kill if ordered, prepare to die, and die if necessary • Profession/Vocation vs. Occupation • Instill a Bond of brotherhood/sisterhood lasts throughout their military career and beyond. This bond is highly valued, nurtured, and protected. This drives Unit Cohesion. After a service member separates, this is lost and can often leave a veteran searching for a substitute. 14Snider, D. M. (2005). The future of the army profession. L. J. Matthews (Ed.). Boston: McGraw-Hill. Substance Abuse and Mental Health Services Administration. (2010). Understanding the Military: The Institution, the Culture, and the People.Washington, D.C.: SAMHSA
  15. 15. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 MILITARY VALUES 15 The attributes that soldiers, sailors, marines, airmen and coast guardsmen gain during their military service changes who they are as a person in a positive way. Channeling their understanding of the military ethos & values culture can be a key technique in therapy. (SAMHSA Handbook, 2010)
  16. 16. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 • Initial Entry Training- socialization process to military culture: 1. Anticipatory 2. Encounter 3. Acquisition 4. Individual internalizes values and norms in identity • While Basic Training is a specific experience to enlisted service members, officers also have a similar initial socialization process. • Upon completing Basic Training, service members often attend more advanced schools to learn their specific technical job and then return to their assigned unit to train for potential future missions. Readiness through training is a key aspect of day to day military operations. 16 SOCIALIZATION PROCESS Andersen, R. & Rodriguez, A. (2015, August). Working with those who have Served? Learn Best Practices. Symposium conducted at the meeting of the Veterans Mental Health Coalition, New York, NY
  17. 17. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 • Family Tradition • Transition to manhood/womanhood • To serve country • Drafted (Ended in 1973) • Friends did it • Do something noble with their life • Give life (death) purpose • Protect people, country and way of life • Be part of a team – something bigger than self • Inherent sense of selflessness • College money, free medical care, travel • Way out from challenging psyco-social childhood/home environment 17 Understanding what an individuals motivation was to join the military can lead to a deeper understanding of the implicit factors that may still influence their lives REASONS CIVILIANS JOIN THE MILITARY Andersen, R. & Rodriguez, A. (2015, August). Working with those who have Served? Learn Best Practices. Symposium conducted at the meeting of the Veterans Mental Health Coalition, New York, NY
  18. 18. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 WHAT IS A PARALLEL? Something that is similar in comparison Possible Components of a good Parallel: • Metaphor: A term or phrase that is used to make a comparison between two things that aren't alike but have something in common. • Analogy: A comparison between two like things, typically for the purpose of explanation or clarification. • Allegory: Using storytelling and narrative to express an idea or teach a lesson. 18 • A parallel can be a way to reframe what the service member/veteran already knows in order to educate them about a psychological model • Most parallels are not unique to combat experiences and are frequently common implicit cultural experiences • If can be a way to normalize therapy for client and show your military cultural competence at same time. Ultimately, it can help build trust. Before using a parallel…providers should ask themselves: - Does the veteran/service member highlight their military experience as one based in positive or negative thoughts/beliefs/emotions? Most of the time you will get the details needed for you to make this assessment in the intake. - Impact of ‘Time Effect’- recently separated vs. separated 50 years ago NOTE: The methodology of using military parallels to achieve more positive therapeutic outcomes is mainly anecdotal and has not been tested in research or empirically proven. However we can look to research that shows establishing a better therapeutic alliance leads to improved outcomes and also research in the efficacy of using metaphors in therapy as likely guides for this model.
  19. 19. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019EXAMPLES OF PARALLELS 19 • Breathing in Marksmanship • Preventative Maintenance Checks and Services (PMCS) on Equipment • Negotiating a Military Obstacle Course • Military Planning • Importance of Physical and Health Readiness in Military • ‘Having their Shipmate/Battlebuddy Wingman’s Back • Vocational ‘Hard’ Skills • Resilience Training Currently In Military • Personal Protective Equipment • Military Values • After Action Reviews • Securing Sensitive Items • Heuristics • Moral Justification for Killing in War • Mindfulness Breathing • Need to sometimes perform maintenance on our minds • Obstacles in civilian life • Life/Goal Setting Models, Solution Focused Therapy, Reality Therapy • Whole of Health/Wellness Therapeutic Lifestyle Change Models • Helping them to find a new ‘unit’ in their civilian life • ‘Soft’ Skills for Civilian vocation • Positive Psychology • Dialectical Behavior Therapy (DBT) • Values Work (DBT & ACT) • Cognitive Behavioral A-B-C Worksheet • EMDR Container Exercise • Ways to Challenge Heuristic Thinking • Moral Injury, Spirituality, Cleansing Ritual, Community Healing
  20. 20. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 • Philosophy • Stoicism • Psychology and War • Michael Matthews: Headstrong How Psychology is Revolutionizing War • Civil Military Divide/Gap • Kori Schake & Jim Mattis: Warriors & Citizens American Views of Our Military • Karl Marlantes: What It Is Like to Got to War • Importance of Community in Healing • Sebastian Junger: Tribe On Homecoming and Belonging • Joseph Bobrow: Waking up from War • Moral Injury • Jonathan Shay: Achilles in Vietnam: Combat Trauma and the Undoing of Character • Nancy Sherman: Afterwar Healing with Moral Wounds of Our Soldiers • Brett Litz, Leslie Lebowitz, Matt Gray, and William Nash: Adaptive Disclosure 20 OTHER POINTS OF RESEARCH IN IMPLICIT MILITARY CULTURE
  21. 21. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 BOUNDARIES OF COMPETENCE ETHICAL DILEMMA You have been working with a client for three months on rebuilding his life and leaving the military after eight years with three combat deployments. As you have been building rapport and establishing a therapeutic relationship, he has gradually started to open up to you. During the most recent session, the client appeared more distracted than usual. When you inquire about his mood, he says, “We’re coming up on Black Sunday.” When you ask him to elaborate, he simply says, “Sadr City? April 4, 2004?” After inquiring further, he changes the subject and says he doesn’t want to talk about it. On April 4th, 2004, a platoon of infantry who had been escorting wastewater vehicles was attacked and surrounded in an ambush. Eight soldiers were killed in the initial ambush and subsequent rescue attempt, and dozens more wounded.
  22. 22. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 AVOIDING THE IMPOSING OF VALUES, ETC. ON A CLIENT (A.4.B.) 22 A.4.b. Personal Values Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature. 6. Ethics represents counselors’ self-awareness and motivation to serve military-connected clients, as well as ethical considerations working with military populations. The professional counselor: c. Brackets personal values and attitudes of war policies; addresses potential prejudices about military service or war; and recognizes their own political opinions of current and previous combat operations
  23. 23. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 IMPOSING VALUES EXAMPLES 23 Listen to the full episode at www.veteranm entalhealth.com /hst004 Adamec, J. (2017, July 25). Accessing Mental Health Services with Jeff Adamec.(D. K. France, Interviewer)
  24. 24. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 DEVELOPING AWARENESS War Attitude Scale is a 27 item assessment to determine the respondent’s attitudes towards war. • 6-point Likert format • Higher scores indicate more accepting war attitudes. • Examples: “Even if there is not any hard evidence against another country (i.e. weapons of mass destruction), I would support war” “I believe that war is necessary to resolve conflicts”. Moral Foundations Questionnaire is a 32 item assessment to identify an individual’s attitudes towards five different foundations of moral beliefs: • Care/harm • Fairness/Reciprocity • Loyalty/betrayal • Authority/Respect • Purity/Sanctity Dupuis, E. C., & Cohn, E. S. (2011). A new scale to measure war attitudes: Construction and predictors. Journal of Psychological Arts and Sciences. Graham, J., Nosek, B. A., Haidt, J., Iyer, R., Koleva, S., & Ditto, P. H. (2011). Mapping the moral domain. Journal of personality and social psychology, 101(2), 366.
  25. 25. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 CULTURAL AWARENESS, SELF EFFICACY AND WAR ATTITUDE Experience working with veterans seemed to make a difference in both cultural awareness and self-efficacy (as expected) but not in attitudes about war Coll, J. E., Weiss, E. L., Draves, P., & Dyer, D. (2012). The impact of military cultural awareness, experience, attitudes, and education on clinician self-efficacy in the treatment of veterans. Journal of International Continuing Social Work Education, 15(1), 39-48.
  26. 26. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 Sayer et al. (2009) identified a number of barriers that keep service members and veterans from seeking mental health treatment. One category of barriers included an Invalidating Post-Trauma Socio-Cultural Environment IMPOSING VALUES AS A BARRIER TO TREATMENT Social network discouragement of help-seeking Societal rejection Negative homecoming experiences Withdrawal from social network or society Sayer, N. A., Friedemann-Sanchez, G., Spoont, M., Murdoch, M., Parker, L. E., Chiros, C., & Rosenheck, R. (2009). A qualitative study of determinants of PTSD treatment initiation in veterans. Psychiatry: Interpersonal and Biological Processes, 72(3), 238-255.
  27. 27. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 IMPOSING VALUES ETHICAL DILEMMA You have been working with a justice involved veteran as part of a court-ordered rehabilitation program. She pleaded guilty to assault with a deadly weapon after she cut her husband’s arm with a knife during a mutually combative altercation. During the therapeutic process, she reveals that her husband had previously been systematically physically abusive and she decided that she had “had enough.” The client also revealed that she had been sexually assaulted by her supervisor in Afghanistan, after which she was marginalized by her Chain of Command; it was only after the supervisor attempted to take his own life and admitted to the assault, and was subsequently court martialed, that the command took her accusation seriously. What personal values do you think would impact your ability to support the veteran in resolving the multiple traumas in this situation?
  28. 28. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 PROFESSIONAL RESPONSIBILITY TO ENGAGE IN SELF-CARE ACTIVITIES (C) 28 Section C: Professional Responsibility …In addition, counselors engage in self-care activities to maintain and promote their own emotional, physical, mental, and spiritual well-being to best meet their professional responsibilities. 6. Ethics represents counselors’ self-awareness and motivation to serve military-connected clients, as well as ethical considerations working with military populations. The professional counselor: f. Actively adheres to a self-care routine to prevent burnout, depersonalization, compassion fatigue, and impairment
  29. 29. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 Scroggins, N. (Director). (2017). Heart of the Bull [Motion Picture]. http://veteranmentalhealth.com/heart-bull-short-film-nicolas-scroggins/
  30. 30. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 30 SECONDARY TRAUMATIC STRESS IN MILITARY AND VETERAN CAREGIVERS Burnout Countertransference ReactionVicarious Traumatization Compassion Fatigue Secondary Traumatic Stress The natural and consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other – the stress resulting from helping or wanting to help a traumatized or suffering person Bride, B. E., & Figley, C. R. (2009). Secondary trauma and military veteran caregivers. Smith College Studies in Social Work, 79(3-4), 314-329.
  31. 31. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 31 Secondary Traumatic Stress Scale MEASURING TRAUMATIC STRESS AND COMPASSION FATIGUE Compassion Fatigue Short Scale Adams, R. E., Boscarino, J. A., & Figley, C. R. (2006). Compassion fatigue and psychological distress among social workers: A validation study. American Journal of orthopsychiatry, 76(1), 103-108. Bride, B. E., Robinson, M. M., Yegidis, B., & Figley, C. R. (2004). Development and validation of the secondary traumatic stress scale. Research on social work practice, 14(1), 27-35.
  32. 32. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 Your weekly Vietnam Veterans Support Group has grown considerably for the past two years. For many of these veterans, the emergence of a new generation of combat veterans, combined with the natural consequences of aging, has led them to seek treatment for the first time in their lives. The group members are responding well to the group dynamic, and many of them indicate that you are the first therapist that they felt like they’ve been able to trust. Most of them also indicate that the group is the social highlight of their week. You have had a long-planned family vacation scheduled for the first two weeks in August; and you have been notified that you have been selected to attend a month- long professional development course that is in your area of interest. You will be unable to hold the group for six weeks, and none of your colleagues will be able to take the group over on a temporary basis. Do you cancel the professional development, vacation, neither, or both? How do you handle this conversation? SELF CARE ETHICAL DILEMMA
  33. 33. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 CULTURALLY AND CLINICALLY APPROPRIATE RESOURCES 33 A.11.a. Competence Within Termination and Referral If counselors lack the competence to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors discontinue the relationship. 6. Ethics represents counselors’ self-awareness and motivation to serve military-connected clients, as well as ethical considerations working with military populations. The professional counselor: n. Considers community referrals when in the best interest of the client.
  34. 34. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 PTSD Consultation Program 34 Veterans Crisis Line Vet Center Call CenterNational Resource Directory FURTHER TOOLS FOR MILITARY CULTURAL COMPETENCE TRAINING
  35. 35. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 35 Make the Connection Coaching Into Care About Face PTSD Decision Aid Have You Served? FURTHER TOOLS FOR MILITARY CULTURAL COMPETENCE TRAINING
  36. 36. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 36 Center for Deployment Psychology Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury VA Community Provider Toolkit VA PTSD 101 FURTHER TOOLS FOR MILITARY CULTURAL COMPETENCE TRAINING
  37. 37. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 PsychArmor Institute The Training Institute at Home Base Task & Purpose 37 2 Good Ted Talks Head Space and Timing The War Horse FURTHER TOOLS FOR MILITARY CULTURAL COMPETENCE TRAINING
  38. 38. BEYOND BASIC TRAINING ACA 2019 WWW.VETERAN MENTALHEALTH .COM/ACA2019 38 38 @veteranmentalhealth @ThCounselingVet www.linkedin.com/in/dklfrance www.veteranmentalhealth.com duane@veteranmentalhealth.com marco.bongioanni@va.gov QUESTIONS AND COMMENTS

Presented at the 2019 American Counseling Association, Veterans and clinical mental health professionals Duane France and Marco Bongioanni discuss how the Military and Government Counseling Association Competencies for working with military populations correlate with the American Counseling Association Code of Ethics

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