Trauma Within The Ranks: Fighting Back Against Military Sexual Trauma (MST)

Abstract

According to the most recent statistic from the Department of Defense (DOD) dated April, 2012, females make up roughly 14% of the active duty military population, with service dating back to the Civil War. While it appears ample time has passed for the military to fully integrate and accept women as soldiers, a growing problem has surfaced, namely, military sexual trauma. The story of Molly* will demonstrate the effects of MST, highlight the lack of research that has been conducted on a relatively new diagnosis, as well as resiliency and wellness planning that is particular to such cases.

*Not her real name

Client characteristics

Molly, a 25-year old female active duty E-5 soldier appears quite young until one takes the time to look close enough to notice the early onset of Crow’s feet around her eyes, the creases around her mouth from smoking and the ruddy color around her nose due to broken blood capillaries. The yellowing fingernails have been chewed to nubs, chipping away the façade of youth and showing signs of wear in the armor she has been wearing to protect herself from the constant battle of stress.

The observable signs seen in Molly are common characteristics of an individual who has been experiencing chronic stress and trying to deal with it on their own, without sufficient coping skills. According to the Mayo Clinic, some unhealthy reactions to stress include: physical pain without an outside source of injury; overeating or undereating; explosive anger with little provocation; uncontrollable crying; depression that lasts longer than a bout of sadness; focusing on the negative aspects of life; and a marked increase in smoking or alcohol consumption.

Upon a brief discussion with Molly about her background, it is learned that she identifies as a Catholic (although admits that she has not been to mass in many years), has been serving in the military on active duty for the past six years. She reports being deployed twice to Iraq and once to Afghanistan as part of support units, sometimes being part of the lead crew, which ensures the path is clear of improvised explosive devices (IEDs), returning from her most recent deployment with her unit less than a month ago. Her family appears to be supportive of her career choice, however when it comes to her private life, they are not as supportive. Molly considers herself a lesbian and has been in a couple relationships with other women in the past, although due to the military culture, has had to hide that part of her life from her fellow soldiers. 

Counseling, ordered for Molly by her command due to a recent suicide attempt, is a common occurrence amongst both active duty and veteran military personnel. During the first 155 days of 2012, there were 154 suicides reported involving past or present military members (http://www.politico.com/news/stories/0612/77188.html), a statistic that indicates a 18% increase in suicides from the previous year. However, the difference in Molly’s case is that she is in the office, obtaining the services she needs to aid in the prevention of a successful suicide.

After gaining Molly’s trust and opening an effective therapeutic line of communication, she reveals that she was raped this past tour by a fellow soldier. The attack left Molly bruised, both mentally and physically; feeling powerless as the offender was higher ranking and threatened to keep her on lead caravans, risking her life each time, if she ever reported the incident. The rape also resulted in a pregnancy, causing an increase in mental torment since as a Catholic abortion is considered a sin. 

Molly’s increased alcohol intake and cigarette smoking were ineffective coping mechanisms, leading her to see suicide as the only other option of ending her pain. The shame and guilt associated with sexual attacks is often compounded when one has to rely on their attacker as in a military situation. In a recent study, the incidence of rape amongst female military members perpetrated by their male counterparts was discovered to be 28% (Williams and Bernstein, 2011). 

Military Sexual Trauma (MST) and Posttraumatic Stress Disorder (PTSD)

Molly’s presenting concern is primarily the sexual assault she experienced at the hands of another soldier. Military Sexual Trauma, or MST, is defined by the National Center for PTSD as, “unwelcome sexual attention including gender harassment, unwanted sexual attention, sexual coercion, sexual assault, and rape.” The DOD has reported a 16% increase in MST within military deployments to Iraq and Afghanistan, with many incidents going unreported, as in Molly’s case. The DOD has taken steps to address the growing incidents of MST, one of which was the addition of the Sexual Assault Prevention and Response (SAPR) program, which provides oversight of the DOD sexual assault policy. SAPR’s mission statement, “To enable military readiness by establishing a culture free of sexual assault,” is a good attempt at addressing the issue, but without feeling free to reach out and obtain assistance, some survivors turn to drugs, alcohol or suicide as a way to cope.

Military culture is fraught with power struggles, be it between ranks, warzone conflicts or genders present within the military population. Many, often resulting in more questions than answers, have examined the unique culture of the military but some have produced rather startling findings, some of which are applicable to Molly’s case. The US Air Force was investigated following a rash of sexual assaults in 2003, complete with allegations of assaults and cover-ups, which hit the media causing the ugly truth of sexual assaults within the ranks to become known to the public at large. One study suggests that the power and control concepts contribute to sexual aggression, as new recruits are often devoid of power, causing a possible need for them to seek out other ways they can have obtain control (Callahan, 2009). 

While PTSD has been studied extensively (and still is) amongst the veteran population, MST is a relatively new addition to the trauma spectrum. Rape and sexual trauma is often found to cause more psychological harm than the more common military associated contributing factors to PTSD. The combination of being deployed in a warzone while experiencing sexual trauma can negatively impact the psychological wellbeing of a soldier more than experiencing each incidence separately (Williams and Bernstein, 2011).

Soldiers exhibiting signs of PTSD often come back from deployment with a combination of symptoms, including sleeplessness, nightmares, hostility management issues, flashbacks, panic attacks and a decreased ability to cope within society in a productive manner. Those coming back who have also experienced MST often return with a loss of self-respect, feeling as if they had lost control over their lives and were at a higher risk of self-harm (Benedict, 2007). Molly’s symptoms via self-disclosure during the initial meeting fit those associated with both PTSD and MST. A 2006 study suggests that women with MST had higher rates of PTSD as compared to those who had experienced other forms of trauma (Yaeger, Himmelfarb, Cammack and Mintz, 2006).

Confounding variables and effective coping

The repeal of the Don’t Ask, Don’t Tell (DADT) policy in September of 2011, which in the past had banned openly gay individuals from serving in the military, was a step in the right direction but did not end discrimination. Molly does not feel comfortable sharing the fact that she is a lesbian with her fellow soldiers, partially in fear of retribution or experiencing further trauma at the hands of those she works amongst and relies on for career advancement. The inner turmoil Molly is experiencing as she is caught between an unwanted pregnancy that is the result of a sexual attack and the morals of her religion, which define abortion as a sin, may have compounded her experience of distress, leading her to the suicide attempt. 

As a counselor, one has to separate any personal belief systems to assist the client in gaining a more stable foundation in which they are to rebuild their focus and proceed in life with a stronger and clearer outlook. Instilling a resilience plan and providing tools for the client that are specific to them is key in obtaining a positive and desired outcome. A wellness plan for Molly would need to be holistic in approach to work best, as it would address the biological, psychological, social and spiritual aspects of her presenting concerns (Gladding and Newsome, 2010). 

Providing a safe and secure location for her to share her experience would also be of benefit. Some current therapeutic interventions for MST include cognitive processing and prolonged exposure, with both showing promise as effective measures to help one deal with the traumatic experiences (Cater and Leach, 2011). The Veterans Administration is also conducting trials on new forms of therapy, including guided imagery therapy as a therapeutic adjunct to conventional talk therapy. Sadly, even with these treatment options on the horizon, many will seek out self-medication as effective ways of treating the symptoms, with the rates being higher amongst the military population in which mental toughness is seen as a positive attribute.

Employing effective stress management skills into Molly’s therapy would be an essential step to recovery. These would include an education about the cause of her stress, recognizing the physical and emotional effects of stress, and learn to use appropriate coping mechanisms to current and future stress (Gladding and Newsome, 2010). An ecomap may assist Molly in recognizing her sources of support, outside of the military as well as within. A visual representation of those in her life and their ability to influence, positively and negatively, can serve as a reminder when challenges arise. 

Since Molly’s case is multifaceted, she may need a referral to additional support members, including a physician, drug and alcohol specialists and a counselor who may be more skilled in the Catholic faith, as that aspect combined with her unwanted pregnancy appears to add a significant amount of stress. Having a network in place for referrals helps both the client and the treating counselor.

Advocacy opportunities

Molly’s recovery process may be influenced by several factors, including personal characteristics that may hinder or assist the ability for her to achieve a positive and desired outcome. Some of these include her family not being accepting of her sexual orientation, the unique culture that is found within the military and her religious faith and beliefs. The more recent addition of alcohol use and pregnancy highlight the importance of tailoring a treatment plan specifically for an individual, rather than trying to make the individual fit the plan. 

There are several agencies, both within and outside the military and government that can assist in providing the needed guidance and support to effectively help Molly navigate her path to wellness. The first step of coming into the counselor’s office, by choice or by direct order, is a promising start. By branching out after establishing a trusting atmosphere to explore community resources, Molly will be able to obtain the needed support system that will aid her recovery. Depending on the status of the relationship between her and her immediate family, that may be an avenue to pursue. However, it should be done cautiously, as it may cause more stress to an already precarious situation. 

Upon instilling an effective treatment plan, complete with regular meetings both with Molly and her treatment team, depending on her progress, she may find additional strength in advocating for herself with the assistance of community resources. Within the military, some resources include Service Women’s Action Network, or SWAN which advocates for all military women at the local, state and federal levels to bring about change to create and support legislation that caters to the unique needs of female members of the armed forces. 

With the repeal of Don’t Ask, Don’t Tell, several military bases have started gay and lesbian advocacy groups, such as Gay, Lesbian And Supporting Sailors, or GLASS, and OutServe, which is an association of actively serving military members with 45+ chapters worldwide. Such organizations help to foster a supportive environment, helping to educate military members and spouses about the need to understand and respect others, regardless of their sexual orientation.

Conclusion

The case of Molly is far from rare, as indicated by the statistics on MST within the armed forces. Through education and advocacy, both by survivors and their support system, sexual trauma may come into the light, where it belongs. Only then can it be effectively addressed, both in legislation and in the counselor’s office. By becoming her own advocate, Molly is fostering her own resilience, as seeing a positive outcome from what was despair may help her to continue on the path of recovery. Counselors need to remember that the focus is and should be on the client and helping them to eventually help themselves, leaving any personal ethics aside that may hinder the growth of their client.

*References Available Upon Request

I've Never Met Anyone Like You Before!

This was a response for a discussion question assignment in my Human Development and Research course. The goal was to evaluate your own personal career development based on the concepts in the reading and to describe the important factors that influenced your own development.

As usual, I never fully realize just how "non-typical" my story is, as this brief shimmer into my past has elicited several responses from classmates as to how unusual and interesting it seems. To me, it's just how my life is...unusual.

**
Career choice is one of the more difficult and life altering decisions an individual can make, often experiencing many throughout their lives. According to Newman and Newman (2012), high school students who work long hours have an increased risk of cigarette smoking as well as alcohol and drug use, along with being more likely to drop out of school, as compared to those who either didn’t work long hours or at all. A contributing factor was a lack of social connections and socialization. I would be an outlier in the study mentioned, as I attended high school, adult school and college concurrently, as well as a holding down a part time job…after a period of experimentation. 

Other contributing factors are involved in career choice, including family, societal, socioeconomic, situational, individual and psychosocial aspects. Again, I would be an outlier to the studies that address these motivators, as I did not come from a wealthy family, yet graduated from college without having to rely on family to foot the bill. Upon earning my AA degree (at the age of 18), I joined the military. After serving for 12 years, I decided to continue my education, becoming the first person in my family to graduate with a 4-year degree, earning my BS in psychology. The positions I held while on active duty were both unrelated to my previous education and did not directly contribute to my desire to pursue my LPC licensure. 

While the skills I learned during my service time may not have much applicability directly within the counseling field, the ability to communicate effectively and respectfully, the understanding of the unique military culture and the desire to help my fellow brothers and sisters in uniform has influenced my desire to work within that specific population. The passion I have towards this particular group has even influenced some of my extracurricular activities, one in particular being increased physical training to participate in my first Tough Mudder.

Goals? Did Somebody Say Goals?

I am a very goal-driven individual. For as long as I can remember, I have been focused on what I am working towards. In the past, it has not always been a positive goal, I will admit. I am not one to sit back and acknowledge my own hard work, be it scholastically or physically. I enjoy looking forward to the steps I have to take in order to reach my goal, as I do not find resting on my laurels to be fun nor rewarding.

My current physical goal is to participate in my first Tough Mudder, which will happen in 39 days (according to my countdown app)…on 29 Sept. I first started training about a year ago, not for this in particular, but just to see what I could do with my body. This is where my…well, I guess fear is the word that comes closest to describing it, comes into play. After I finish my TM, what’s next? A few have suggested triathlons, to which I scoff, as I am not the strongest of swimmer, have not ridden a bike (for real) in years and I detest running. Therefore, who knows…it may be a personal challenge. 

A smaller goal of mine is to move all the weight on the leg press machine at the gym. I am fortunate to work with a client who needs to exercise on a regular basis, so I get to workout too (which provides me with an opportunity to do 2-a-days). Usually he walks for about an hour (at 1.5 mph), which gives me enough time to squeeze in a little of that stuff I loathe, cardio, and some weights as well. Cardio first, as it is like my veggies, with iron being the dessert. If I had my way, I would do nothing but weights. I love the feeling it gives me. I think I grow a small penis during lifting sessions. The rush I get from pushing weight, seeing people who use the machine afterwards have to cut the weight in half (don’t worry, it’s pin-adjusted…I would re-rack my weights…not a total douche).

When I am doing that mundane thing on the treadmill, I look at all the other cardio machines…everyone has a look on their face that lacks excitement or passion. Whether it’s the bike, elliptical or stairmaster, they all share the same zombie look. It’s sad really. While there is nothing wrong with it, I would never want to look like a “cardio bunny” for I am a fan of muscles and strength. I am a supporter of physical activity and increased health, but I workout for reasons other than aesthetics…which will be something for another post.

Banana Oat Protein Bars

The flavor will vary, depending on the flavor of protein powder used. Feel free to make any changes, as this recipe is basic and lends nicely to improvisation.

Makes 16 squares

2 cups old fashioned oats

4 scoops protein powder (have only tried with whey and casein)

¼-cup currants

¼-cup raisins

½ cup shredded coconut

2 ripe, mashed bananas (about ½-cup)

1 Tbsp coconut oil (melted)

6 egg whites

¼- ½-cup water (depends on consistency)

2 Tbsp sugar free flavored syrup of your choice (I like caramel)

Mix wet and dry ingredients separately. Incorporate wet into dry, ensuring all protein powder and oats are covered well. Pour (or rather dump via spoon) into greased pan (I use an 8”x8” square) and bake in 350F oven for 30 minutes, or until edges turn brown. Let cool and cut into squares.

Providing insight and guidance: Interview with Mrs. Spindler, LPC

Abstract

      The field of mental health counseling is unlike any other. The main goal within the counseling profession is to have clients stop coming and to “work your way out of a job.” Clients come to counselors, who are often complete strangers, and bare their inner secrets. Few vocations come close to these employment goals, so having insight for counselors-in-training is quite useful. Information, garnered through interviews and research, helps to prepare novice counselors in meeting their professional goals.

      The participant detailed in the following paper is Mrs. Rachelle Spindler, who is a Licensed Professional Counselor (LPC) and a Certified Alcohol and Drug Counselor (CADC) as well as certified via the National Board for Certified Counselors (NBCC).

Overwhelming Choices

When attempting to find a counselor to participate in an interview, several qualities are important to keep in mind. For example, what field and/or specialty they practice; the age categories and demographics they counsel; and what forms of treatment approaches they employ during therapeutic interventions. There are several websites that help facilitate bringing together client and counselor, as well as counselor-to-be and counselor. One such is The Therapy Directory facilitated by Psychology Today (http://therapists.psychologytoday.com), which lists treatment approaches, finances, qualifications, specialties, issues and demographics experienced in treating. Having the counselor’s bio assists in selecting one who has experience in certain areas of mental health and continuing education in the fields desired.

Approaches and Techniques

Mrs. Spindler started out as an 8th grade teacher, then decided to further her education and pursue her MA degree through an on-line university (Argosy) which she chose because like many distance learners, she already had a busy schedule. She has been licensed and practicing in Corvallis, Oregon for the past seven years, splitting her time between working with the Benton County Juvenile Court/Foster Care System and her private practice. 

      Some of the more difficult aspects to her job within the court and foster care system include conducting trauma narratives, which consists of clients recounting traumatic events in as much detail as possible. The retelling of traumatic experiences has been hypothesized to produce a more detailed and factual representation of the event (Foa and Meadows, 1997). However, such technique can be stressful for both the client and the counselor involved.

      

      The main treatment approaches used in Mrs. Spindler’s practice include Cognitive Behavioral Therapy (CBT) and Solution-Focused Brief Therapy (SFBT). Often these two therapeutic interventions work in tandem to produce quick results that are sustainable, as the client is the one that comes up with the solution to the problem. SFBT proposes that “the development of a solution is not necessarily related to the problem; the client is the expert” (de Shazer, 1985). Having the client come up with ways to fix the chief complaint, without trying to figure out the “why” may lead to a shorter therapy session, however, as with many therapeutic relationships, having an effective rapport between client and counselor will help to facilitate a positive and desired outcome (Bannink, 2007).

      Building rapport may not always occur, with the fault landing upon neither the counselor nor the client. Having a trusted referral list of counselors is important, to both parties involved. Such a list works both ways, between counselors whom have different specialties and experience, benefiting clients and mental health providers. At times a counselor may see little to no improvement on the part of the client, only for the client to come in for their next session stating that their last visit changed their outlook and something “clicked.” Such an instance serves as a reminder how important it is to maintain hope and an optimistic outlook, both as provider and as a client. 

      Sometimes a counselor needs to change their approach to create a better fit with their client. Such an example is the offering of therapeutic services outside of the normal office setting. Mrs. Spindler offers in-home sessions to clients, both within the juvenile system and her private practice, which began with a client who displayed signs of anxiety and agoraphobia. Meeting in the home of a client presents some challenges, including safety and boundary crossings. The latter, which differs from boundary violations, includes any form of touch, telephone sessions and seeing patients outside the office (Zur, 2007). Such crossings can benefit therapeutic sessions, as long as a risk-benefit analysis takes into account client specifics and results in maintaining a viable option. 

Challenges within the profession

As with most vocations, counseling has its challenges, which include terminating a client’s therapeutic relationship and self-care. It would be unethical to continue treatment past the time necessary. According to Mrs. Spindler, “One should not foster dependence, but rather let the client take the tools learned and become independent.” In her practice, she usually starts tapering off visits slowly, from weekly sessions, to every other week, eventually having the client make an appointment for the following month, with the option of cancelling without incurring repercussions. 

Self-care is an essential component to becoming a successful counselor. There are support groups that address the need, yet still maintain confidentiality, comprised of fellow counselors (Consult Groups), where one can obtain support and input for challenging aspects one may experience with clients. Another option, which in addition to the consult group used by Mrs. Spindler, is frequent vacations. However, one key piece of advice provided was; “When on vacation, do not tell people you are a counselor.”

Conclusion

With many different theories existing within the counseling field, it is imperative for a counselor-to-be to obtain guidance from a counselor who shares similar training and treatment approaches. Having an accurate picture of what to expect in practice, whether in a clinical, community or private setting, is tantamount to a reduction in additional unforeseen surprises. Knowing that soon-to-be counselors often contact practicing counselors for interviews, I look forward to providing my input when I receive that call, passing on the knowledge and insight I will have gained during my education and practice.

*References available upon request