Therapy for Soldiers

If you’ve heard about the Walter Reed Veteran’s Hospital Scandal in Washington, you probably have a sense of the kind of care that veterans have access to when they return home from conflict areas. It appears that soldiers who have sustained physical injuries get fantastic care initially, but the more complicated stuff, like compensation, disability claims, reintegration and psychological help get lost in huge amounts of red tape.

Folks returning from war can suffer from PTSD, depression, and in fact there has been a notable increase in suicide among returning soldiers. While these symptoms are disturbingly common, veterans as a group, seek help less often, and unfortunately has a culture that discourages people from showing any kind of vulnerability. While the majority of veterans seek help from within the verteran's system, some may opt for private therapy sessions. People struggling with experiences or injury in combat have unique issues, and being aware of what they may be coping with can help with the therapy process.

A few things to keep in mind:

  • Confidentiality is key. One article stated that it can take years for veterans to seek help, potentially because they may face professional consequences if they do. Any perceived weakness, mental or physical, could affect their ability to be seen as ‘fit’ for duty, or appropriate for promotion. Be extra clear about your confidentiality policy, including your duty to report child abuse and risk of harm to self or others.

  • Partner up with your colleagues to create a holistic plan. They don’t call it ‘shell shock’ for nothing: PTSD symptoms like flashbacks and nightmares are common for returning veterans, and massage and other soothing bodywork modalities can be a great help.

  • Be prepared to address shame and loss of identity issues. It’s important to have a social context for the work you’re doing, and so acknowledging the military culture that people are coming from is vital. Weakness, vulnerability and injury are the opposite of what a soldier is supposed to be: strong, brave, invincible. Be aware that your client may be judging himself/herself harshly (and may be judged by peers in this way as well).

  • Be prepared to use your professional authority to advocate if and when it’s helpful. As the Walter Reed Scandal revealed, it’s not always easy for veterans to get recognition and treatment for the emotional and physical wounds they sustain in action. If your clients want this kind of assistance, you may be able to help.

  • Anger may be a big part of the work. Conflict zones are described as places where the only safe emotion is anger; fear, sadness, and grief have to be shut off for the sake of survival. There are all kinds of therapies that encourage gentleness and self-soothing (essential for recovery from PTSD) that are less talk-intensive: think art and music therapy, pet therapy, recreational group therapies and of course massage and other body work. A little creativity can go a long way!

If you have experience with therapy issues related to military service, we’d love to hear them. Share your knowledge and let us all benefit.



OK Whereapy team; you asked for it - you got it! Although not a Veteran myself, both of my parents (one male, one female) and my father-in-law (Jewish and WWII - in an age and of a culture where MEN do not whine!) ARE Vets - and use the Veterans' healthcare system. I also have several Vet extended-family members, currently serving friends and acquaintances, and maintain close friendships with a few former combat soldiers through my social groups, too. And, I am an Advocate (among other things). So, what have I learned? Several things stick out for me regarding this article (which is very appropriately timed, and full of helpful information, too - nice job, Whereapy Team).

The first thing was touched on; and there is more. Pool your skills/modalities - yes. However, if you can find a healthcare provider (physical, psychological or bodywork) who is also a Vet - try to at least consult with him/her in caring for your client, if not actually tag-teaming the care. Vets are much more open to the ideas and advice of other Vets than us "civvies", who really haven't a clue - no matter how hard we try to "educate" ourselves.

Another suggestion I would offer is this: no matter your personal politics - thank your soldier client for his/her service to our country before beginning any real "work" with the individual. So many soldiers - and I know this is true for Vets from past wars as well as our current ones - feel unappreciated. It's hard to work with someone who does not feel valued by YOU - as a professional provider - towards them, as a professional soldier/military employee. Most often, a simple acknowledgement - by saying "thank you", will mean the world to your client - because they do not hear it enough in their everyday life, and because it relays that you care for them - they matter to you - as people.

Also alluded to is the fact that it can take your soldier/Vet client much longer to "open up" - even about physical issues - than it does your civilian clients. While all the reasons given in the article are true and valid; another one exists. The military also encourages - even today - that its' men and women keep it "close to the vest". My father-in-law speaks very little of his service time; a Nam Vet friend of mine recently confessed to me that he spends every Memorial Day with a core group of three or four buddies from his service unit - because he can't let anyone else - not even his doctors - see him cry; and he can't help it on Memorial Day - he lost too many good friends in battle and he owes them his tears once a year. So he purposely excludes himself from the company of any but these three or four guys. Who knows what would/will happen to him on future Memorial Days when those friends, too, may no longer be here or around to support him? (I am working on that with him - but as suggested by the article - very slow going). My friend is not an anomaly - many, many soldiers are like him. They need help - a few will seek it - but most won't; at least not without encouragement.

Which leads to my final "two cents". The author is correct: if it is appropriate; and if your clients will allow it - YOU be his/her advocate for as much/many services/benefits that your client is entitled to. They have already fought. They are tired, hurt, and disillusioned. You can't serve their time in the field of battle; but you CAN serve their time in the field of "red tape". Yes, it is a royal pain in the rear-end. Yes, it may at times make YOU wish you could just disappear - out of frustration. But if and when you succeed, even if only in small measure - you will have a reward that is greater than any financial amount you bill for your time; and YOU, too, will have gained some more valuable and often "marketable" experience.

Thanks for the chance to speak my peace.

That's a great point about thanking a servicemen for their service - even if your politics doesn't jive with war and all that goes along with it, you can respect the well meaning intentions, and actions of a service person and note the sacrafices they have made.

I agree, Denise! I think the distinction between the people on the ground and the people making big policy decisions is such an important one- I think soldiers get a lot of hostility that should be aimed at politicians- anyone who has been through a war needs as much support as possible.

Dealing with the American health care system when you are sick is already a crisis in itself. How many time have I yelled, bowling, at secretaries and insurance people over the phone (I apologize, you were there at the wrong time). So I can easily extrapolate a vet's frustration and feeling of rejection; they were told they would be cared for, they risked their lives...

I am not a therapist or a vet, but I've dealt with immigration and health care after a move to a new place where I knew nobody while in a depression and it was hard. So I multiply it by about 100 and I have a slight idea.

When I read all this, I think that helping people with the red tape would be my priority. When you are in physical or emotional pain that requires medical attention, no amount of talking will help. Dealing with filling paperwork and calling people speaking in professional terms you've got no clue of and being required to wait for half an hour is sooooo frustrating, even healthy people sometimes give up.

In my case, after my husband (then boyfriend) understood that something was dreadfully wrong with me and that I was 1 inch from self mutilation he did the only thing is big grumpy WV bear can do: took care of business. He sat beside me and made the phone call passing the phone only so I confirm that he was speaking for me and such basic info. He was the one who was saying :"NO this answer is unacceptable. You'll have to do better than that or pass me to a superior." We were chatting while on hold. He was the one googling to figure out what form 434837239X is. To him, it seemed like such silly busy work. For me it had become a daily frustration of closed door and ridiculous answers. With him structuring me like saying: "ok today you need to fill as much as you can on this document and we'll figure out the rest tonight", or you need to call this person and ask for that, if it doesn't work forget about it we'll try something else. I saw THEM as an enemy and was very aggressive but suddenly I had an ally who fought for me, understood, and got things going...

If saying thanks feels better for them, an ally against a new enemy: bureaucracy, to fill out paperwork and find out who to call and when and ask for what exactly, should definitely help. Can you imagine how foreign and useless this all must sound to them after living in a state of emergency/survival for months or years?

Once my little physical booboo were taken care of, I was way more open to a therapist and was not sitting there just ranting about how ridiculous a system this was, but I was dealing with ME not THEM.

Finally on a more motivating note, I strongly believe that all therapists should have a therapy dog. Preferably one that loves to cuddle with perfect strangers. I suggest pugs.

leigh's picture

Excellent point Veronique - turning anger outward is an important step for peeps with depression - getting that frustration externalized and not having it fester inside yourself is a great push forward.

Oh and yes, therapy dogs are a great! I went on a walking tour of England not so long ago and a sweet little dog from the guide came everywhere with us - the walk + the dog companionship was one of the most therapeutic experiences I've ever had.

To make that entire discussion a big circle: I read an article recently about trained military dogs, their efficiency, their dealing with the canine version of PTSD, etc. And one of the commentaries the person in charge of the program made is that not only have they noticed that the dogs are more efficient than instruments for a lot of things, but also the sections who had dog assigned actually had a better morale. They were hoping to be able to put one dog per section in the future. Yes, it is sad, they didn't volunteer, but still it seem to be of great help and there was serious progress. The dogs sent to Vietnam were abandoned there after we retreated as "surplus material". Now we know better.

They also had a very sad story about a mine searching dog and its owner. One they the section was attacked, the owner was shot and died. They dog laid on him and would attack anyone who approached, even the soldier's team mates. The dog finally retired with the family of the dead soldiers. It helped them too.

Now I go off subject. But I am interested to know about your ideas to prevent or alleviate some of the trauma of the experience, or at least make the transition back home easier. Obviously we have to think finance and feasibility. But for one thing, I fail to understand how come the soldiers are not required to go to group sessions for a long while after they come back. All the worse stories I hear about PTSD, the person started by saying that they didn't know what was wrong with them.
Furthermore, what kind of programs can be put in place either before or after the service. Can some be offered reasonably inside or outside the military system?

leigh's picture

Heather researched a bit about successful therapy outcomes in world war 2.

Basically, outcomes improve with greater socialization and community acceptance. With these recent wars I wonder if that is possible? I mean the current wars are not popular, the public barely thinks about them let alone they have not been asked to willing sacrifice for a greater ideological cause (because fighting to maintain unfettered access to key resources is hardly a story that that warms the heart of the republic - Actually, I think that reason is more shaming than something to be proud of (the reasons not the soldiers) and that means that soldiers are coming home to country who appears to have no have no vested interest in their well being.

Another point - I've read that outcomes for PTSD are better if/when:
1. there is a sympathetic witness to the crime
2. proof in the form of physical bruises, broken bones, bullet holes etc.
3. authorities and people in general believe and support them

Trauma which is:
1. "meaningless"
2. uncorroborated
3. met with disapproval and multiple abuses after the initial trauma (cover ups, disbelief from authorities, threats of losing job/position/income due to the trauma)

... are factors that increase the chances of lingering PTSD.

I would guess the same is true for military PTSD - esp. women soldiers who've been sexually assaulted. Sad article:,9171,1968110,00.html

I hate to say it but... my guess would be that a meaningful, resonate "reason" or purpose for the wars would cut down the frustration and some cases of PTSD - because the soldiers would have the backing and good will of the public and hence the "public eye" watching them, caring about them and then perhaps behave better.

That's only one suggestion for one part of a whopping big problem.

Also, i think Vonnegut's Slaughterhouse 5 should be mandatory reading for all incoming recruits :)

Leigh - no doubt about it; public support is essential. Also, as I have heard from vets and is often stated even in mainstream viewing of war in general - in actual combat; the soldier isn't fighting for his/her country anymore; he or she is fighting for fellow troops - as part of a team. Once the immediate danger is over; and the soldiers return - the teams are often split up - and not every person reacts the same way to the same situation. And each experience is different - we all know a broken leg is different than a broken arm, though both are broken bones in an appendage. So it is also, but much less visible, with PTSD - military or civilian - we all manifest our "brokenness" differently, and therefore need individualized recovery programs.

While I agree wholeheartedly with your reasoning, and your recommended reading (might have to re-visit that one myself, now that you mention it!) - I wonder, here on this site for therapists, if we could not come up with some suggestions of how one person might make a small difference in the life of one other person, and in that way - one by one - do a few small actions to alleviate some of the burden on our vets, current soldiers, and their families. After all, as you pointed out, the reasons behind these current wars are bogus; that does not necessarily mean the soldiers should suffer for that - very few had anything at all to do with the decision-making that got them to where they are in need of help - physical or emotional. By the way, as I am sure YOU know, but perhaps not everyone else - PTSD in war is not new. They used to call it "combat fatigue" in previous wars - declared or not. And the same findings that Heather researched and you presented held true then, too - more treatment was available and successful to the soldier who in addition to having "something wrong in the head" could show a physical wound elsewhere on the body - or serious physical-medical head trauma. We have NOT come such a long way, baby. But perhaps we can - going forward? - Denise

Veronique - I may be able to BEGIN to address some of your questions regarding the military process for injured and grieving soldiers; and I DO agree with you about assigning canines to military units - though of course that will have the PETA people up in arms for sure. But consider - we use K-9 police officers on the domestic front all the time - and they get shot at, too - and those dogs also did not "volunteer" - at least vocally with informed consent the way humans do. There is a case to be made, though, that if you really know your dogs - it can be determined as to whether a dog wants to participate in ANY mission - or obey any command - including those from civilian "masters" or handlers. So - yeah - good point; let's add more specially trained dogs to our troop units, and let's treat them properly before, during and after their service.

As for why returning troops are not presently required to undergo prescribed therapy for PTSD as part of their de-briefing/re-entry program: the answer can be summed up in one word - MONEY. The VA system is already overloaded with diagnosed cases - both medical and psychological - from previous wars' vets, as well as current ones returning now - not to mention all the "peace time" vets that were promised services years ago that are now, and have been for several years - being cut to the bone. While the idea of preventative treatment is a solid one; the government sometimes has a way of being "penny-wise and pound-foolish" with their budgeting. This is true in the defense budget (for active duty soldiers) and in the "Entitlement Programs" budget (which covers VA services).

In my opinion, not much will change until ALL of us; soldier, vet, and conscienscious objector alike, stand up and scream loud and long that we want better treatment for ALL of those who protect our rights. On the other hand, we CAN do something - one by one - by offering small kindnesses and help, with whatever gifts we have been given, to those most in need. I, for one, am grateful to my friend's son for volunteering to fight in our wars (I am generally a pacifist, and do not like war of any kind - but it's important to separate the war from the warrior) so that MY sons will not be drafted against their will into a situation for which they would be ill-prepared. I am not overly patriotic (more of the one-world type, myself), nationalistic, and definitely not a promoter of violence as a means to resolve disputes. However, I live in this "real" world - and the facts are not always as I would have them be. Many of us "war protestors" need to learn to see the whole picture - and not just listen to the rhetoric. What better way to do that than by serving our military personnel in whatever way we can; and showing them the respect of common courtesy and thankfulness? Now, back to my crocheting of "combat caps" - liners for the helmets of soldiers on the front who must stay in full gear for days - sometimes weeks - at a time; the head gets itchy and abraded without the liners.
Thanks for opening the discussion, Veronique -

It is interesting. Sorry I am so talkative even if I am not a therapist. I think I have a lack of intelligent conversations down here.

I think that the American military is very badly managed in terms of budget (strategies is an whole other thing). They spend a lot on things that are not worth it and not enough on others. I have worked for the the Canadian Army for a junior program. I was a marksman instructor. The organization has no budget but obviously because they could bare scandals of depression suicide or sexual abuse with recruits the psychological aspect of service was a priority. Some things that I remember that could be improved on and help without money:

Soldiers (at least in Canada) have mandatory sexual arassment classes, every year; the same that they have to renew their first aid certification and marksmen qualification if applicable. They are not effective but they could be without and money. Most of the time they go through the rules and then we watch a silly little movie with ridiculously stereotyped video examples. This training should be given by a therapist, cover little insidious unacceptable behaviors, with reinforcement about the consequences.
The reporting system is also ridiculous. No one will go and report anything. They will hated by everyone else. I the program we had, we had weekly reports to do. It was just answer questions about morale, discipline, and issues. It was anonymous and MANDATORY. Now if someone reported so abuse the entire platoon would be lecture about arrassement, self-control, team spirit, pride, etc. This allow the people to speak but be vague enough so they are not identified. It also create a sense of resentment for the people who fucked it up for everyone else. It encouraged other people to report things they saw happen to other people, even voice out when they witness unactable things and therefore be a support although anonymous. It worked the same with trauma, depressed feeling, fears, exhaustion. When that was reported, we all had to sit together and "talk about it", they joked and called it psychoanalysis. But if everyone is forced to talk about one thing they saw that really messed them up, and one thing that was positive, sometimes it was hard and we got things like I saw a rock that was shaped like a baboon, it would just lighten up the group. Then nobody was called a crybaby, it was shared experience.
In WW2 this was impossible. the war was too much of a mess, there was almost no time to breath. The situation is not the same today. They need to TAKE the time.
Finally, the service rotation should be shorter, even if it means that the time off will also be shorter. Half of our soldiers lose their life partner, miss their child's growth, lose their parents... Way to come back to a happy place when discharged!
And now this is going to be really costly: They need to put a person to explain procedures and paperworks is each VA. The poor thing will probably get yelled at, but at least she will be informed of everything! The stupid info is scattered everywhere!

Finally, the USA need to socialize health care and do away with private insurance. ;)

About dogs, did you know that they had their equivalent to PTSD (with very similar symptoms like depression, agoraphobie, unjustified aggressively, nightmares)?

Veronique - yes, actually, for myself - I DO know about canine PTSD, but I doubt most of the general public, and even the majority of therapists for humans, know of it. Give me a few days, and I will be back to the comment section with references to some works that are applicable to this situation - for those that are interested. Denise

leigh's picture

V. I dream of single payer healthcare :) It can't be anymore bureaucratic than it already is with insurance companies.

Have you ever sent one of your pups for massage therapy? - dogs love it! Look around at the massage schools near you and you can usually volunteer to bring them in during canine and animal therapies ;)

Oh and talk all you want... this site is for anyone who is interested in therapy, and thinking about what is and what could/should be.

Veronique: - You may want to check this out as a place to find more information/validation of the your concern about canine PTSD. Also, there are several good articles online about what service dogs can do for humans suffering PTSD and other mental illnesses, too. Disclosure - yes, I have a bias. Our Siberian Husky was obtained under ADA for our son with a mental illness - and she has become a great source of comfort to him over the years. Does SHE get stressed; yes, sometimes. We need to keep an eye out for that, but there is help available. To humans and to dogs. As Leigh said, an animal massage would be something to look into for treatment. - Denise

Yes, socialized health care... You should see how easy it is to get care in Canada. Yes, sometimes you have to wait for very specialized treatments because we have limited specialists especially in rural areas. But in most cases, you go in, show your little photo ID, they scan it, you sign it and you never hear about it again in your life. (unless of course you need a follow up). Forgot your card? bah, no problem. Give your info with another ID and we will treat you and then send you an invoice with a form to fill and mail to the government without any money with the pre-addressed, no postage needed envelope. Once again, you'll never hear about it again (well unless you're not really Canadian).

On the subject of diagnostic and treatment of PTSD: do you think that one of the problem is the old fashion thought that seeing a therapist means you're crazy? Not to mention that the army tends to be a macho culture (sorry soldiers, maybe not you, but on a general scale...) Do you think that as the trouble gets more and more discussed in the media the mentality will change?

And yes! conditional love, attention and trust from a dog might actually be a more versatile drug than Aspirin. Have you heard of those cancer sniffing dogs? I tell you, they are like Vulcans they can read your mind and control it.

Veronique - I'm glad you spoke so specifically about the socialized health care in Canada. You should hear/see how many US citizens are completely ignorant of the WHOLE system; and only point out it's (relatively few) flaws; like the long wait times for specialized procedures in rural areas. I also have contacts in Canada - and when we compare what we pay (in the US) to what they pay (in CA) for the same things - and especially insurance premiums! - it's downright sinful (and I don't use THAT term lightly:) - Will it ever change here? I sure hope so, but some of our Congress people have been trying to get such measures passed for over 50 years now! So, while I hope - I do not expect; though I would very much like to be proved wrong. I think we would actually need an anonymous national referendum on the ballot - so our representatives could see that it's not just us "fringe liberals" who want quality care for EVERYONE! All we can do at this point is hope, pray, and petition our leaders in every way that we are able. And many of us are doing that.

I would agree with you. I don't see the United Sates getting socialized health care any time soon.

Did you know that there are government paid therapist also? Anyone can see them, but there is a maximum appointment you can have. Usually, the personal insurance cover a part of the extra sessions you would need. The government paid emergency cliniques offer information on planned parenthood. The government pays for abortion, after 2 (or 3?) mandatory sessions with a psychologist and one doctor appointment. And no one stands in front of the door with pamphlets... It's... different.

It requires too many laws and restriction on companies and physicians to make it work within a free market capitalist political system like in USA. Canada in general is a social-democrate system with a economically liberal tendency (although it is shifting); so basically we are capitalists who like to help each other.

Veronique - Again, not to sound like "little miss know-it-all" or "old madam know-it-all" in my case:), but...... yes, I have a fair amount of accurate information on Canada's health-care system, and a more limited (but still way larger than most US Americans') grasp on the political system there. Je parle francais, juste un petit peu auusi, quand c'est necessaire! And yes, I am quite envious of both the healthcare system and the political atmosphere. So why haven't I emigrated? It's cold up there, my dear! Still, with every health care hassle and social intolerance I face, and there are many in my own personal life, I fantasize about the Great Maple state. Complain when appropriate; but count your blessings, too. And thanks again for spreading the word, to the US and to the international Whereapy community - about what the United States COULD be like. Denise