Indiana Psychological Association News
PsychByte: Cultural Competency with Military Veterans
Cultural Competence with Military Veterans
As of 2014, there were approximately 22 million veterans in the US population (Department of Veterans’ Affairs, Office of the Actuary, 2014). Veterans’ use of health services is increasing (National Center for Veterans Analysis and Statistics, 2014), while the percentage of the overall population with exposure to military service—their own, or their family members’—has shrunk considerably. Among other implications, this means that veterans are frequently encountering civilian healthcare providers who may have limited understanding of military culture and its lasting impact.
While veterans are not a monolithic group, they do constitute a “distinct subculture” based on—among other things—shared language, shared beliefs, values, and behavioral norms, and shared training and socialization experiences (Strom et al., 2012). Military service is a significant dimension of personal identity. To prevent misunderstandings and misperceptions and to build effective working alliances, mental health professionals should apply principles of cultural competence to their work with veterans, striving for greater awareness, knowledge, and skills, and examining their own assumptions, attitudes, and biases about this population. This is particularly important in psychotherapy, given that a strong client-therapist alliance is one of the best predictors of successful treatment outcome (Duncan, Miller, Wampold, & Hubble, 2010).
Strom et al. (2012) summarized a number of cultural considerations for clinicians and trainees working with veterans. Factors that should be incorporated into assessment, case conceptualization, and treatment include: branch of service; occupational specialty; active vs. reserve status; rank; cohort differences (e.g., Vietnam era vs. OEF/OIF era); and number and nature of deployments, if any. All of these factors convey critical information about stressors veterans have been exposed to, the intensity of their socialization experiences, and the complexity of their reintegration experiences. Strom et al. also emphasized the importance of understanding common, and dearly held, beliefs and values among military veterans. These include: prioritizing the mission and the welfare of others above oneself; placing great importance on discipline, hierarchy, order, and rules; and remaining stoic in the face of very distressing circumstances.
Koenig et al. (2014) also provided guidelines for using “culture-centered communication” with veteran clients in a healthcare context. They conducted semi-structured interviews with 17 male and 14 female OEF/OIF veterans, inquiring about postdeployment readjustment challenges and soliciting advice that participants would give to other veterans. Grounded Practical Theory was used to analyze participants’ responses, and challenges were grouped into the intrapersonal, professional/educational, and interpersonal domains. All participants described tensions between military and civilian identities and cultures, a form of “reverse culture shock.” Veterans described feeling socially isolated and “out of sync” with former friends and supports. They missed the camaraderie of the military and the faster pace and higher intensity of deployment duties (compared to civilian jobs), and found their well-honed “survival skills” (including being vigilant and “on guard”) were maladaptive in civilian contexts. Koenig et al. also noted, however, veterans’ application of military values to their new realities can be a source of pride and resilience. The authors emphasized knowledge of these challenges and resilience factors can inform communication strategies and thus help healthcare providers foster trust, set realistic expectations, anticipate and normalize challenges for their veteran clients, and gauge treatment acceptability.
Mental health professionals and other providers who want to enhance their cultural competence working with military personnel and veterans can explore training resources (for free) through the Center for Deployment Psychology (
http://deploymentpsych.org/) and the Military Family Research Institute at Purdue University (
https://www.mfri.purdue.edu/Default.aspx).
References:
Department of Veterans Affairs, Office of the Actuary. (2014). Veteran Population Projection Model 2014 (VetPop2014). Accessed 7/20/16 at
https://www.va.gov/vetdata/Veteran_Population.asp.
Duncan, B.L., Miller, S.D., Wampold, B.E., & Hubble, M.A. (2010).
The Heart and Soul of Change: Delivering What Works in Therapy (Second Ed.). Washington, DC: American Psychological Association.
Koenig, C.J., Maguen, S., Monroy, J.D., Mayott, L., & Seal, K.H. (2014). Facilitating culture-centered communication between health care providers and veterans transitioning from military deployment to civilian life.
Patient Education and Counseling, 95, 414-420.
National Center for Veterans Analysis and Statistics (2014). Trends in the Utilization of VA Programs and Services: FY2009 to FY2013. Accessed 7/15/16 at
https://www.va.gov/vetdata/Utilization.asp.
Strom, T.Q., Gavian, M.E., Possis, E., Loughlin, J., Bui, T., Linardatos, E., Leskela, J., & Siegel, W. (2012). Cultural and ethical considerations when working with military personnel and veterans: A primer for VA training programs.
Training and Education in Professional Psychology, 6(2), 67-75.
Contributor:
Charity Tabol, Ph.D., HSPP
West Lafayette, IN
"PsychBytes” is a weekly educational resource from the Indiana Psychological Association (IPA) provided for psychologists, their colleagues and their patients. We hope you will use and share this material!
