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- [Voiceover] Good evening, everyone.

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I am delighted that we're
here for this lecture

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and for Kathryn Basham

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giving us a sense of the
richness of the scholarship

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and commitment she has made.

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This lecture is a result
of a sabbatical year

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but a long trajectory of work in the area

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of dealing with the
needs of service members

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and their families.

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As professor co-director
of the Ph.D program

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and editor of the Smith
College Studies in Social Work,

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Doctor Kathryn Basham engages in

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research, writing, clinical
social work practice,

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and education related to
the effects of deployment

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and combat stress on the
reintegration of service members,

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veterans, and their families.

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Doctor Basham earned both her

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MSW and Ph.D degrees in
clinical social work.

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She has been appointed to

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three congressionally mandated committees

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with the Institute of Medicine

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at the National Academies of Science,

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charged to explore issues
related to enhancing the

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mental health treatment of
military and veteran families.

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The current four-year committee

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that is producing two published texts

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focuses on the evaluation
of efficacy of treatment

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of PTSD with service members,
veterans, and their families.

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In this setting, Doctor
Basham co-authored four texts

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published by the Institute of Medicine,

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National Academies of Science.

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Titles include: "PTSD
Diagnosis in Treatment,"

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"Physiologic, Psychological,
and Psychosocial Effects

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"of Deployment Related Stress
with Gulf War Veterans"

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in 2008, "Provision of
Mental Health Counseling

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"Under TriCare" in 2010,

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and this past year, "The
Assessment of On-going Efforts

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"and the Treatment of Post
Traumatic Stress Disorder."

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I think what's important to note

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is that in the work
that she has been doing,

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she has often been the
only clinical social worker

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among an interdisciplinary team.

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She has held the voice of the field

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and the expertise of the
field extraordinarily well

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and is represented by the fact

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that she keeps getting
invited back to serve on

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these committees.

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In earlier years, she published
with Doctor Dennis Wheels

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a text entitled, "Transforming the Legacy:

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"Couples Therapy with
Survivors of Childhood Trauma."

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She's also focused her scholarship on

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intercultural practice
and pedagogy in diversity.

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She has authored and
co-authored numerous papers

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on these topics and has presented in both

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national and international forums

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including Walter Reed
National Medical Center,

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several Veterans
Administration medical centers,

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the Canadian Forces social work core,

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Austen Riggs Institute,

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and various professional organizations.

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Doctor Basham served on a major task force

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of the Council for Social Work Education

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to design military
social work competencies

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and participated on the
expert panel of NASW

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to design credentials
in military social work

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at the BSW, MSW, and
advanced clinical MSW levels.

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She is an active participant in the

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National Interdisciplinary Organization,

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the Alliance for Military
and Veterans Family,

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behavioral health providers.

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Doctor Basham has been awarded an

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"A Distinguished Clinical Practitioner"

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with the National Academies of Practice

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and maintains a clinical practice

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in Northampton, Massachusetts

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specializing in clinical
social work practice

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with individuals and couples and families,

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supervision, and consultation.

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What I would say about Kathryn is

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as I really worked on re-instituting,

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re-engaging the school much more actively

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in our commitment to service
members and their families,

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she has been just very much
there as a strong advocate

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and as someone who has
really put the school

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on the national scene in regards to

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the excellence in clinical
social work education

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that we provide here.

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She has represented us well

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and has done just an extraordinary
job for the profession.

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So I ask that you join me
in welcoming Doctor Basham

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to speak on women and the
military rewards and challenges.

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(applause)

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- Good evening to everyone.

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Thank you very much Carolyn
for your kind remarks.

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Can you hear me in the back?

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Okay? Good.

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Well, women in the military.

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You have that I have this here

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just to set the stage for some calm

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as we move ahead throughout
this presentation.

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I'd first like to thank a number of people

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as I was thinking about
this particular topic and

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think of the idea that it takes a village

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to present a lecture, well, yeah.

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I would like to thank a number
of women in the military

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who've been a particular
support team in consultation.

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Doctor Camille Hall who's
teaching the Beyond Combat class.

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This term teaching two sections of it.

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I'm also very happy to be
thanking Major Deborah Stone.

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She is one of our MSW
alumni who actually served

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both in Iraq and Afghanistan
as a clinical social worker

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embedded with her particular unit.

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Then I'm also interested
in thanking a retired

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Colonel Cameron Ritchie,
who's an army psychiatrist

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at Walter Reed Army Medical
Center for a good two decades.

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The Chief of the Department of Psychiatry,

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this is no small feat for a woman

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to be a Colonel in that setting.

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So I share this talk with you tonight

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and thank you for your wisdom.

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People often wonder why am I in this field

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and I only figured that
out oh, some time ago.

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But it wasn't fully evolved
until, I'd say, 10 years ago.

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Because I was reared in
a family in New York City

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and my father had served in World War II

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in the burning south China front.

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He was a newly minted physician
at the time sent off to war.

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He had had very little
practice experience, if at all.

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He was in a field hospital
which consisted of a tent,

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no running water.

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He was there for two years.

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No, very little contact, if you remember,

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with the World War II vets back home.

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He basically tended to the
wounded combat veterans

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as well as the veterans, and
the local community members

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who were suffering from tropical diseases.

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So upon return to life in New York,

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I was the post-appointed baby so

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and we think about what are the effects,

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so some of the inter-generational effects

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both positive and negative.

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So vulnerabilities and strengths,

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rewards and challenges.

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That's the talk that I'm
offering today as well,

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women in the military.

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And my early years were certainly formed

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by these experiences

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and my father never talked about it

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until I harassed him at about age 18

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and insisted upon hearing about stories

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and then he finally relented
and started telling some

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of various experiences that he had had.

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But his basic message to me was,

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"Don't push.

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"If people do not wanna
talk about these issues,

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"do not insist,"

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and that was a clear message.

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Be respectful of the pacing for people

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in talking about difficult experience.

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He said he saw too much
death, too much death

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and upon return, his hope was to distill

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some of the most positive experiences

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during the war.

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So growing up in New York,
my friends always asked me,

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"Why do you always, why
everyone in your family

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"whenever we come to visit you,

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"all the meals are curry?

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"Indian curry, Burmese curry,

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"and meals that, from the far east?"

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I said, "Well, I have no idea."

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Frankly, this is when I was little.

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Then I realized that even though he was

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Lithuanian and Hungarian background

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that we had adopted some
different cultural backgrounds.

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So this was a way of trying
to distill some of the

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really important features
of the legacies of war.

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So I just thought that I
would let you know that.

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I lived in D.C. for 20 years
where I worked and practiced

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and also saw many military
and civilian families.

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This is a depiction of some
of the differences between

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women in the military
between 1943 and 2013.

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Can you see what she is holding?

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I don't know if you could see it,

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but it's an MRE, meals ready to eat,

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as compared with Rosie the Riveter.

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She is currently in combat gear.

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So I'm gonna be talking about
what are the challenges,

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stressors, and rewards for women

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who served in the military

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and then how does research
inform our understanding

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of the effects of deployment and combat

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on women who have served in the military?

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The role of gender in the
military is absolutely crucial.

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Just thinking of,

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I'll amplify that as we
go throughout this talk.

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Want to look at what
are the balance of risk

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and protective factors
in coping with deployment

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and traumatic stressors?

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Then we're looking at what are
the psychosocial adjustments

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for women in the military
as they return home

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and reintegrate?

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What are the issues with
physical health and well-being?

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What are the mental health issues,

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specifically military sexual trauma?

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And then some of you, yes, bear with me,

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but you know the mantra.

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I find that it's important to think about

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what do we need to do in
clinical social work practice?

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Some of the major features
that I've considered

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in this model is to think
about relationally-based,

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culturally responsive,
theoretically grounded,

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research-informed clinical
social work practice.

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So let's talk a little bit about history.

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Women have served in the military

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for a very long period of time.

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With the War on Independence
in 1775 to 1783.

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Mothers, wives, daughters
basically joined the forces

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and cooked and washed clothes
and tended to the wounded.

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Then here, this picture is
depicted in the Civil War.

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Disguised as a man on the
right, Frances Clayton

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served many months in Missouri in

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Missouri Artillery and Cavalry
units in the Civil War.

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This was not uncommon.

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When detected, actually, and usually

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they would be banished and often punished.

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But it was very common
for women to be serving

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in combat positions during that time.

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Then in 1901, Congress
established the Army Nursing Corps

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and several years later,
the Navy Nursing Corps.

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So women have been acknowledged
in different service roles

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throughout decades.

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At the end of World War I,
49,000 women have had served

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as nurses, clerks, typists,
and telephone operators.

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However, when they returned from the war,

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they lost their jobs, mostly
they had lost their jobs

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that they had previously held.

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They had no benefits.

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There was no equity in
terms of their rights

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as service members.

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That was during the time
in World War I, you know,

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we often hear the origin
of the school in 1918

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where our social work
students were actually sent

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to their internships were in
Eastern Europe and Germany

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at the time.

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So it's quite incredible.

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You think, those of you who are students,

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if you think of traveling
just to California,

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this was a very different experience.

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It was a combination
of clinical social work

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and helping the actual service members

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who were dealing with shell
shock as well as nursing.

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So let's fast forward to Vietnam.

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You're all very familiar,
again, women were serving

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in many medical roles and nursing roles.

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But you also see a major presence

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in terms of support positions.

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In the 1990's, that's when women

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00:13:14.805 --> 00:13:17.073
were actually flying airplanes

259
00:13:17.073 --> 00:13:21.292
and serving on ships, driving convoys,

260
00:13:21.292 --> 00:13:24.183
you hear the increasing
degree of combat exposure

261
00:13:24.183 --> 00:13:26.474
as we have gotten through the decades

262
00:13:26.474 --> 00:13:28.889
and clearly within the last decade

263
00:13:28.889 --> 00:13:33.889
you see equity in terms
of their experiences.

264
00:13:33.965 --> 00:13:37.963
So if you can see the comments here.

265
00:13:37.963 --> 00:13:39.230
Okay ladies, you've been equipped

266
00:13:39.230 --> 00:13:41.473
with helmets and body
armor as we await orders

267
00:13:41.473 --> 00:13:43.949
to break through the glass ceiling.

268
00:13:43.949 --> 00:13:46.599
Some of you have probably
heard of this news.

269
00:13:46.599 --> 00:13:49.863
Certainly, was just this year,
which is pretty astonishing,

270
00:13:49.863 --> 00:13:53.704
but in January of this
year, women were basically

271
00:13:56.277 --> 00:14:00.050
acknowledged as serving in combat.

272
00:14:00.050 --> 00:14:05.050
The combat related ban was
lifted when the Pentagon

273
00:14:05.591 --> 00:14:07.972
released news that this seemed to be,

274
00:14:07.972 --> 00:14:10.096
basically what they had to determine

275
00:14:10.096 --> 00:14:13.384
was that by actually allowing so called,

276
00:14:13.384 --> 00:14:15.427
allowing women to be in combat roles,

277
00:14:15.427 --> 00:14:18.376
that it would not undermine
the readiness of the forces.

278
00:14:18.376 --> 00:14:21.558
So the claim was this took a while.

279
00:14:21.558 --> 00:14:25.540
But if you hear the history
of the women in combat,

280
00:14:25.540 --> 00:14:29.042
this does seem it certainly
did not make a lot of sense.

281
00:14:32.551 --> 00:14:35.642
Okay, this is a slightly
different scenario because

282
00:14:35.642 --> 00:14:38.822
most women who I've talked
with in the military

283
00:14:38.822 --> 00:14:42.418
they don't want to be viewed as vulnerable

284
00:14:42.418 --> 00:14:44.995
and different from their male counterparts

285
00:14:44.995 --> 00:14:46.129
in terms of their jobs.

286
00:14:46.129 --> 00:14:48.472
They don't want to be seen
as victimized or pitiful

287
00:14:48.472 --> 00:14:49.879
or somehow less than.

288
00:14:49.879 --> 00:14:54.686
They want to be equal in
terms of rights and pay

289
00:14:54.686 --> 00:14:57.514
and opportunities for advancement.

290
00:14:59.976 --> 00:15:02.519
I just want to talk about
the notion of gender as well

291
00:15:02.519 --> 00:15:03.340
because when you think about,

292
00:15:03.340 --> 00:15:04.739
do you wanna be completely equal,

293
00:15:04.739 --> 00:15:06.953
then is there room for difference?

294
00:15:06.953 --> 00:15:09.166
In the military, one of
the most important notions

295
00:15:09.166 --> 00:15:13.005
is that there's a universality of values.

296
00:15:13.005 --> 00:15:14.056
Then people would often say,

297
00:15:14.056 --> 00:15:16.871
"Well, why am I in just
military social work?"

298
00:15:16.871 --> 00:15:18.860
Well, if you look at the
values in the military,

299
00:15:18.860 --> 00:15:20.294
they're directly compatible

300
00:15:20.294 --> 00:15:21.849
with a social work code of ethics.

301
00:15:22.876 --> 00:15:26.312
If you hear the sense of
loyalty, pride, dedication,

302
00:15:26.312 --> 00:15:28.450
self-sacrifice, duty, honor,

303
00:15:30.045 --> 00:15:33.649
support of each other, self determination,

304
00:15:33.649 --> 00:15:36.746
these are parallels
with social work values.

305
00:15:37.946 --> 00:15:40.908
So if there's a world of
universality during combat,

306
00:15:40.908 --> 00:15:45.761
it is important for the service
members to pull together.

307
00:15:45.761 --> 00:15:47.374
Because they're united, they're defending,

308
00:15:47.374 --> 00:15:48.562
they're protecting each other.

309
00:15:48.562 --> 00:15:51.441
This is not the time for
diversity of differences.

310
00:15:51.441 --> 00:15:53.860
That's when people talk
about inter-spree decor.

311
00:15:53.860 --> 00:15:56.869
But in the women in the
military, on the one hand,

312
00:15:56.869 --> 00:15:58.483
is there a way to assert

313
00:15:58.483 --> 00:16:02.000
the need for advancements in Civil Rights

314
00:16:02.000 --> 00:16:04.331
while also recognizing
that there are differences?

315
00:16:04.331 --> 00:16:07.429
Women experience combat
and deployment stressors

316
00:16:07.429 --> 00:16:08.369
in a different way.

317
00:16:08.369 --> 00:16:11.750
So it's at both end that
I'm hoping to convey today.

318
00:16:13.383 --> 00:16:15.157
Here, change, yes.

319
00:16:15.157 --> 00:16:17.431
As of January of this year,
this is very important

320
00:16:17.431 --> 00:16:19.077
that women are acknowledged in combat.

321
00:16:19.077 --> 00:16:22.441
Because now they can have
opportunities for equal pay,

322
00:16:22.441 --> 00:16:24.913
advancement, and benefits.

323
00:16:24.913 --> 00:16:27.798
That's all been denied even
up until this past year.

324
00:16:27.798 --> 00:16:29.086
But I love this cartoon here.

325
00:16:29.086 --> 00:16:31.010
We'll change when the
deciding about how much.

326
00:16:31.010 --> 00:16:32.064
You see the pool table?

327
00:16:32.064 --> 00:16:36.494
It has all the munitions
and different activities.

328
00:16:38.724 --> 00:16:42.696
So, I'll try not to go
into too much detail

329
00:16:42.696 --> 00:16:44.136
because it could be mind-numbing

330
00:16:44.136 --> 00:16:45.781
and at quarter to eight,
that's not a good thing.

331
00:16:49.038 --> 00:16:51.847
I think it's important,
I'm always reminded,

332
00:16:51.847 --> 00:16:55.831
I want to look at the
demographics and some of the data

333
00:16:55.831 --> 00:16:59.178
on this population
because it's so compelling

334
00:16:59.178 --> 00:17:01.820
when you hear the number
and also the situation

335
00:17:01.820 --> 00:17:03.605
and again, think of the both end.

336
00:17:03.605 --> 00:17:05.224
There's some similarities

337
00:17:05.224 --> 00:17:06.768
between male and female service members.

338
00:17:06.768 --> 00:17:08.613
There are differences.

339
00:17:08.613 --> 00:17:10.251
So total number of all service members.

340
00:17:10.251 --> 00:17:13.045
Over 2.2 million service members

341
00:17:13.045 --> 00:17:14.777
have been deployed since 2001,

342
00:17:16.093 --> 00:17:19.703
820,000 National Guard, 96,000 Reservists.

343
00:17:19.703 --> 00:17:20.876
That's a daunting number.

344
00:17:22.112 --> 00:17:25.387
With women, 50% of the current

345
00:17:25.387 --> 00:17:27.783
OIF stands for Operation Iraqi Freedom,

346
00:17:27.783 --> 00:17:31.428
OEF stands for Operation Enduring Freedom

347
00:17:31.428 --> 00:17:33.523
which occurred in Afghanistan.

348
00:17:33.523 --> 00:17:37.122
Of the population of
active duty armed forces,

349
00:17:37.122 --> 00:17:40.624
they're 15% of the total forces.

350
00:17:40.624 --> 00:17:43.179
That has been an increase in recent years.

351
00:17:44.896 --> 00:17:48.608
Children, 1.3 million,
dependent military children

352
00:17:48.608 --> 00:17:51.896
have been affected by deployments

353
00:17:51.896 --> 00:17:53.665
throughout these last 10 years.

354
00:17:53.665 --> 00:17:57.140
Again, I acknowledge the
importance of thinking about

355
00:17:57.140 --> 00:17:58.621
previous era veterans.

356
00:17:59.889 --> 00:18:01.703
Which is incredibly significant

357
00:18:01.703 --> 00:18:03.098
in terms of the work that we're doing,

358
00:18:03.098 --> 00:18:05.735
particularly in the VA systems.

359
00:18:05.735 --> 00:18:09.929
But I am deliberately focused
on the OIF, OEF active duty.

360
00:18:09.929 --> 00:18:11.638
Then there's the group of the OND.

361
00:18:11.638 --> 00:18:16.421
This is the group that
was in Iraq since 2010

362
00:18:16.421 --> 00:18:20.492
when troops were withdrawn and
the nature of combat changed.

363
00:18:20.492 --> 00:18:22.474
Okay, what do you think of this statistic?

364
00:18:22.474 --> 00:18:25.451
60,000,000 family members
have been affected

365
00:18:25.451 --> 00:18:29.160
by deployments and combat exposure

366
00:18:29.160 --> 00:18:31.783
and 57% of active duty service members,

367
00:18:31.783 --> 00:18:33.863
think of this one again, 57% of all

368
00:18:33.863 --> 00:18:35.337
active duty service members

369
00:18:35.337 --> 00:18:37.363
have primary family responsibility

370
00:18:37.363 --> 00:18:40.499
of a spouse, children, and or a dependent.

371
00:18:40.499 --> 00:18:41.894
That's daunting, isn't it?

372
00:18:41.894 --> 00:18:44.651
That you can think of,
just, it's worth noting.

373
00:18:46.685 --> 00:18:49.483
In terms of just the trends in the field,

374
00:18:49.483 --> 00:18:52.011
there's an increase in
Hispanic and new immigrants

375
00:18:52.011 --> 00:18:54.182
and a decrease in African-American troops.

376
00:18:55.854 --> 00:18:59.167
I want to, again, listen
to some of these data

377
00:18:59.167 --> 00:19:02.992
and just think of the
implications of a voluntary

378
00:19:02.992 --> 00:19:03.857
armed forces.

379
00:19:05.112 --> 00:19:07.786
In terms of race, in terms
of the color of troops,

380
00:19:07.786 --> 00:19:12.786
70% self define as White,
17% is African-American,

381
00:19:13.203 --> 00:19:18.203
but that's including Hispanics, 4% Asian,

382
00:19:18.294 --> 00:19:21.852
and when people are asked
to report their ethnicity,

383
00:19:21.852 --> 00:19:24.981
they actually say it's
18% of Hispanic origin.

384
00:19:24.981 --> 00:19:28.145
That's a significant sort of number

385
00:19:28.145 --> 00:19:31.240
and also growing number
in terms of concentration.

386
00:19:31.240 --> 00:19:34.157
You think of the forces and that

387
00:19:34.157 --> 00:19:37.807
exists both in enlisted
as well as officer corps.

388
00:19:39.719 --> 00:19:43.060
In terms of marriages with active duty,

389
00:19:43.060 --> 00:19:48.060
men, 59% are married in
a heterosexual marriage

390
00:19:48.436 --> 00:19:51.970
and 46% of women are married.

391
00:19:51.970 --> 00:19:55.660
If you switch to the National
Guard, 50% of men are married,

392
00:19:55.660 --> 00:19:58.252
37% of women, you hear the drop?

393
00:19:58.252 --> 00:20:00.415
So again just in terms of the data,

394
00:20:00.415 --> 00:20:05.342
there are more women who
are single in the military.

395
00:20:05.342 --> 00:20:07.412
They're caregivers of children, parents,

396
00:20:07.412 --> 00:20:09.586
and other family members.

397
00:20:09.586 --> 00:20:11.296
Then we move on to the rates of divorce.

398
00:20:11.296 --> 00:20:14.283
The rates of divorce
between service members

399
00:20:14.283 --> 00:20:16.874
and general community
are pretty much the same.

400
00:20:16.874 --> 00:20:19.407
However, the rates for
women in the military

401
00:20:19.407 --> 00:20:21.578
are two times the risk of having a divorce

402
00:20:21.578 --> 00:20:23.845
as compared to civilians.

403
00:20:25.455 --> 00:20:29.134
In terms of unemployment,

404
00:20:29.134 --> 00:20:32.779
this is a daunting set of data as well.

405
00:20:32.779 --> 00:20:36.925
12% of veterans at this
point are unemployed

406
00:20:36.925 --> 00:20:40.270
compared to the 7.4% rate.

407
00:20:40.270 --> 00:20:44.229
But if you look at just the
age range between 18-24,

408
00:20:44.229 --> 00:20:46.251
the percentage of veterans
who are unemployed

409
00:20:46.251 --> 00:20:47.911
kicks up to 30%.

410
00:20:47.911 --> 00:20:49.805
This is really significant.

411
00:20:49.805 --> 00:20:53.357
If you start actually
reviewing the seriousness

412
00:20:53.357 --> 00:20:54.612
of these data.

413
00:20:54.612 --> 00:20:57.527
These are unemployment,
these are service members

414
00:20:57.527 --> 00:20:59.548
returning home, separated
from the military

415
00:20:59.548 --> 00:21:01.278
looking for work.

416
00:21:01.278 --> 00:21:02.764
Whether maybe they're
reservists or the guard

417
00:21:02.764 --> 00:21:04.833
who had their jobs and
had lost their jobs.

418
00:21:06.351 --> 00:21:07.698
Homelessness.

419
00:21:09.284 --> 00:21:11.233
Generally, well the rates of homelessness

420
00:21:11.233 --> 00:21:13.923
are quite dramatic for veterans.

421
00:21:13.923 --> 00:21:17.414
14% for men of all veterans, 2% for women.

422
00:21:17.414 --> 00:21:20.482
So the number of women
veterans who are homeless

423
00:21:20.482 --> 00:21:23.703
is lower but then I went further.

424
00:21:23.703 --> 00:21:25.824
You could tell it was a little
obsessional exercise here.

425
00:21:25.824 --> 00:21:28.314
But I went further with this investigation

426
00:21:28.314 --> 00:21:33.314
and in this last year,
21,800 women were homeless.

427
00:21:33.744 --> 00:21:37.930
These are OIF, OEF veterans
just in the last few years.

428
00:21:37.930 --> 00:21:40.169
That's a very daunting number

429
00:21:40.169 --> 00:21:43.314
and they're right in
our backyard, homeless.

430
00:21:44.754 --> 00:21:46.907
So when you think about the U.S.

431
00:21:46.907 --> 00:21:50.269
and talking about our role in the military

432
00:21:50.269 --> 00:21:52.808
think about the floating
display of U.S. pride,

433
00:21:52.808 --> 00:21:53.743
remember that, the "Intrepid?"

434
00:21:53.743 --> 00:21:57.513
And then the sinking display
of U.S. pride, homeless vet.

435
00:21:59.739 --> 00:22:03.480
So this is another significant
change in the military.

436
00:22:03.480 --> 00:22:05.198
For those of you who
know about the reversal

437
00:22:05.198 --> 00:22:07.868
of "Don't ask, don't tell."

438
00:22:07.868 --> 00:22:10.851
Because if you noticed what was missing

439
00:22:10.851 --> 00:22:13.015
in my data analysis there
of the demographics,

440
00:22:14.245 --> 00:22:15.757
who knows how many gay and lesbian,

441
00:22:15.757 --> 00:22:19.253
bisexual service members
or veterans are there.

442
00:22:19.253 --> 00:22:21.184
We have a better counting for veterans

443
00:22:21.184 --> 00:22:23.132
because they may feel more open to

444
00:22:23.132 --> 00:22:25.680
disclose their sexual orientation.

445
00:22:25.680 --> 00:22:29.481
But again, in order to go
through with the reversal of

446
00:22:29.481 --> 00:22:32.446
"Don't ask, don't tell," in April 2011,

447
00:22:33.907 --> 00:22:37.592
President Obama, the Secretary
of Defense Leon Panetta,

448
00:22:37.592 --> 00:22:40.847
and the joint Chief of Staff,
retired Admiral Mullen.

449
00:22:40.847 --> 00:22:45.274
They certified that the lifting of the ban

450
00:22:45.274 --> 00:22:47.411
would not jeopardize troops.

451
00:22:47.411 --> 00:22:50.759
This is just within the
writing of the language, so,

452
00:22:50.759 --> 00:22:52.503
"Yeah, hope I'm not a
distraction to you boys.

453
00:22:52.503 --> 00:22:55.012
"No ma'am, we're married, to each other."

454
00:22:55.012 --> 00:22:56.626
So what we don't know right now is really

455
00:22:56.626 --> 00:23:01.483
the experiences of,
you can't sort of track

456
00:23:01.483 --> 00:23:04.245
some of the experiences
for those service members

457
00:23:04.245 --> 00:23:08.589
and who are identifying as
a gay, bisexual, lesbian,

458
00:23:08.589 --> 00:23:12.493
unless we start sort of helping them

459
00:23:12.493 --> 00:23:15.674
to express their identity.

460
00:23:15.674 --> 00:23:17.663
Because even though
it's been two years out

461
00:23:17.663 --> 00:23:21.339
into this new world of
supposed disclosure,

462
00:23:21.339 --> 00:23:24.013
there are still lots
of homophobic and other

463
00:23:24.013 --> 00:23:27.784
harsh experiences that
people are subjected to.

464
00:23:27.784 --> 00:23:29.099
Okay, so why do I have this up here,

465
00:23:29.099 --> 00:23:30.730
the biology of traumatic stress?

466
00:23:32.280 --> 00:23:35.172
I'm gonna shift into talking about

467
00:23:35.172 --> 00:23:37.726
different themes that are
particularly pertinent

468
00:23:37.726 --> 00:23:39.644
to women in the military then.

469
00:23:41.837 --> 00:23:44.338
I'm not gonna go over the typical reaction

470
00:23:44.338 --> 00:23:46.079
of the traumatic stress response,

471
00:23:46.079 --> 00:23:47.656
I will a little bit just because.

472
00:23:47.656 --> 00:23:50.082
But I think many of you know this.

473
00:23:50.082 --> 00:23:53.886
I'm gonna give you a brief
clinical vignette later

474
00:23:53.886 --> 00:23:55.232
in the talk today.

475
00:23:55.232 --> 00:23:58.199
But I'll introduce you
to Sergeant Sanchez.

476
00:23:59.487 --> 00:24:02.767
She served in Iraq for a year as a medic

477
00:24:02.767 --> 00:24:07.707
and actually, this is
her brain at this moment.

478
00:24:07.707 --> 00:24:09.135
This is Sergeant Sanchez.

479
00:24:10.535 --> 00:24:13.851
During combat, she actually
witnessed many explosions

480
00:24:13.851 --> 00:24:17.627
and she was in the direct,

481
00:24:17.627 --> 00:24:22.627
directly involved in
an IEV blast of a truck

482
00:24:24.007 --> 00:24:28.493
sort of about 100 meters ahead of her

483
00:24:28.493 --> 00:24:32.642
carrying a number of
her buddies in her unit.

484
00:24:33.937 --> 00:24:35.852
A young man who's a
Private, who she had taken

485
00:24:35.852 --> 00:24:38.059
under her wing only at 18 years old

486
00:24:38.059 --> 00:24:41.318
was killed at the time.

487
00:24:41.318 --> 00:24:45.495
She ran to the truck, the
blazing truck on fire,

488
00:24:45.495 --> 00:24:47.680
and tried to rescue him.

489
00:24:47.680 --> 00:24:50.651
She herself suffered first
and second degree burns

490
00:24:50.651 --> 00:24:53.858
in that effort and he died in her arms.

491
00:24:53.858 --> 00:24:57.477
So this represented a
horrific experience for her.

492
00:24:57.477 --> 00:24:58.415
But when people think about,

493
00:24:58.415 --> 00:25:02.081
remember when those
events occur, the brain,

494
00:25:02.081 --> 00:25:05.474
the thalamus receives stimuli.

495
00:25:05.474 --> 00:25:08.262
It receives stimuli of smells and sounds,

496
00:25:08.262 --> 00:25:12.474
and the feel of the air,

497
00:25:12.474 --> 00:25:15.509
all sorts of visual stimuli
that are disturbing.

498
00:25:17.291 --> 00:25:21.843
At the moment, Sergeant
Sanchez is overwhelmed.

499
00:25:21.843 --> 00:25:26.012
She's not able to really
process the event of the blast.

500
00:25:26.012 --> 00:25:27.823
Even though she's running toward the blast

501
00:25:27.823 --> 00:25:30.632
to try to save him, her body is in full,

502
00:25:30.632 --> 00:25:32.013
sort of state of alert.

503
00:25:32.013 --> 00:25:35.903
So her thalamus is stimulated and you know

504
00:25:35.903 --> 00:25:40.429
that the amygdala is the alarm
system that signals the call

505
00:25:40.429 --> 00:25:44.608
for the sympathetic and
parasympathetic systems

506
00:25:44.608 --> 00:25:48.793
to activate both the
enervation and the innovation.

507
00:25:48.793 --> 00:25:52.730
The revving up and the
drawing down at the same time.

508
00:25:54.403 --> 00:25:58.700
For her, the hippocampus was
not recording any memories

509
00:25:58.700 --> 00:26:00.998
at the time, she was just on autopilot,

510
00:26:00.998 --> 00:26:03.514
just totally in an adrenaline rush,

511
00:26:03.514 --> 00:26:05.972
rushing to save this young man.

512
00:26:08.308 --> 00:26:10.767
We usually think of this as
fight, flight, and freeze.

513
00:26:10.767 --> 00:26:12.806
Remember that's the typical
phenomenon we think of

514
00:26:12.806 --> 00:26:14.181
with traumatic stress response.

515
00:26:14.181 --> 00:26:16.847
But there's some research that's been done

516
00:26:16.847 --> 00:26:18.956
for the last numbers of years.

517
00:26:18.956 --> 00:26:22.527
UCLA with Taylor and colleague and

518
00:26:22.527 --> 00:26:25.597
what's interesting is there
is a hormone that's released,

519
00:26:25.597 --> 00:26:27.471
that there are studies
between gender differences

520
00:26:27.471 --> 00:26:29.230
between men and women

521
00:26:29.230 --> 00:26:31.087
and many women actually

522
00:26:32.799 --> 00:26:35.196
produce higher levels of a hormone,

523
00:26:35.196 --> 00:26:37.465
which is called oxytocin.

524
00:26:37.465 --> 00:26:41.783
Oxytocin induces desire
for connection, calm,

525
00:26:41.783 --> 00:26:46.125
tenderness, pro-social
behavior, bonding, trust,

526
00:26:46.125 --> 00:26:49.239
and reduced fear and anxiety.

527
00:26:49.239 --> 00:26:50.197
Very interesting, isn't it?

528
00:26:50.197 --> 00:26:52.314
That's different from
fight, flight, freeze.

529
00:26:52.314 --> 00:26:55.791
So what was Sergeant
Sanchez doing at that time?

530
00:26:57.352 --> 00:27:00.405
There needs to be more research
to validate those findings

531
00:27:00.405 --> 00:27:05.249
but it seems pretty evident
that she ran toward that.

532
00:27:05.249 --> 00:27:07.724
She did not, she didn't freeze,

533
00:27:07.724 --> 00:27:09.524
she didn't fight, she didn't flee.

534
00:27:09.524 --> 00:27:10.572
Now again, she's a medic,

535
00:27:10.572 --> 00:27:12.557
so you'd say, "Well maybe
that's her training."

536
00:27:12.557 --> 00:27:15.752
But it seemed that it might be something

537
00:27:15.752 --> 00:27:16.970
we should think about.

538
00:27:16.970 --> 00:27:19.095
Are there gender differences?

539
00:27:19.095 --> 00:27:20.711
Again when you talk about differences,

540
00:27:20.711 --> 00:27:22.092
you always have to be careful.

541
00:27:22.092 --> 00:27:24.116
Let's not be stereotypical.

542
00:27:24.116 --> 00:27:25.670
I'm not suggesting that men

543
00:27:25.670 --> 00:27:30.124
would not have this
similar response as well.

544
00:27:30.124 --> 00:27:31.979
Just thinking of these,
some of the research data

545
00:27:31.979 --> 00:27:34.143
that support some of these differences.

546
00:27:37.866 --> 00:27:41.927
Okay, so we think about the effects

547
00:27:41.927 --> 00:27:43.939
for many of these families.

548
00:27:45.561 --> 00:27:47.856
There's no such thing as a
deployment cycle any longer.

549
00:27:47.856 --> 00:27:49.738
There's no just one deployment cycle.

550
00:27:49.738 --> 00:27:51.888
There are recurrent deployment cycles.

551
00:27:51.888 --> 00:27:55.646
So particularly, many members
of the Guard and Reserves

552
00:27:55.646 --> 00:27:59.532
as well as active duty
are all in pre-deployment,

553
00:27:59.532 --> 00:28:01.309
deployment-sustained, and post-deployment

554
00:28:01.309 --> 00:28:02.565
and just think of how that works.

555
00:28:02.565 --> 00:28:07.565
They may be home for a period
of month to year or further

556
00:28:07.622 --> 00:28:11.114
but then redeployed, return
home, redeployed, return home.

557
00:28:11.114 --> 00:28:14.210
So the multiple separations,
reunions, and strains

558
00:28:14.210 --> 00:28:18.481
are enormous in terms of
adjustments and reintegration.

559
00:28:20.792 --> 00:28:22.885
You think of, this is gonna be

560
00:28:22.885 --> 00:28:24.368
some of the effects of combat trauma,

561
00:28:24.368 --> 00:28:26.132
this is more universal.

562
00:28:26.132 --> 00:28:28.580
That this is often what people talk about

563
00:28:28.580 --> 00:28:31.460
in terms of some of
the fears and stressors

564
00:28:31.460 --> 00:28:34.236
for both men and women in combat.

565
00:28:34.236 --> 00:28:38.267
An unsafe environment, exposure
to combat and violence,

566
00:28:38.267 --> 00:28:40.708
exposure to dead and mutilated bodies,

567
00:28:40.708 --> 00:28:43.469
this is an important one, loss
of hope, sense of purpose.

568
00:28:43.469 --> 00:28:45.994
That's crucial because that
can determine effectiveness

569
00:28:45.994 --> 00:28:47.930
in all these different areas.

570
00:28:47.930 --> 00:28:51.090
Deprivation, that is just not having

571
00:28:51.090 --> 00:28:54.344
some of the same comforts
that one would have normally.

572
00:28:54.344 --> 00:28:56.836
One's life separation, this
one is very interesting because

573
00:28:56.836 --> 00:28:59.348
when there are a number of reports

574
00:28:59.348 --> 00:29:01.095
that the army does each year.

575
00:29:01.095 --> 00:29:02.899
They actually interview service members

576
00:29:02.899 --> 00:29:04.517
in the field in theater.

577
00:29:04.517 --> 00:29:06.645
They do focus groups

578
00:29:06.645 --> 00:29:11.645
and the separation from family
and community is as strong

579
00:29:11.765 --> 00:29:15.704
a stressor as the exposure
to combat and violence.

580
00:29:15.704 --> 00:29:17.031
Which I think people
don't often think that,

581
00:29:17.031 --> 00:29:20.027
but that's what they're
saying out there in the field.

582
00:29:21.418 --> 00:29:24.316
Fear and survivor guilt
is often very palpable.

583
00:29:24.316 --> 00:29:28.879
There's another one, I was
just citing some of the data.

584
00:29:28.879 --> 00:29:32.917
But there's a new phenomenon
that's extremely important,

585
00:29:32.917 --> 00:29:34.347
I should go back to that for a minute,

586
00:29:34.347 --> 00:29:36.623
very important in terms of
the effects of combat trauma,

587
00:29:36.623 --> 00:29:38.856
it's called moral injury.

588
00:29:38.856 --> 00:29:42.349
People often are experiencing

589
00:29:42.349 --> 00:29:45.509
the sense of challenge

590
00:29:45.509 --> 00:29:47.276
to their own code of ethics,

591
00:29:47.276 --> 00:29:48.336
if they have their own sense

592
00:29:48.336 --> 00:29:52.145
of their rules of
conducts and rules of war,

593
00:29:52.145 --> 00:29:54.990
and either they feel they
have violated in some way

594
00:29:54.990 --> 00:29:59.706
or if they feel they see
their fellow service members

595
00:29:59.706 --> 00:30:02.922
or command violating certain codes.

596
00:30:02.922 --> 00:30:05.215
They can suffer a tremendous sense of

597
00:30:06.905 --> 00:30:11.320
despair and what's called moral injury.

598
00:30:11.320 --> 00:30:12.985
It's very interesting because actually

599
00:30:12.985 --> 00:30:14.399
in talking with people,

600
00:30:14.399 --> 00:30:18.136
that seems to be more
predominant now than PTSD.

601
00:30:18.136 --> 00:30:21.210
Depression, moral injury,
and then moral injury,

602
00:30:21.210 --> 00:30:25.011
if that is unrelenting
leads to suicidal thinking.

603
00:30:26.278 --> 00:30:28.498
So, okay, I didn't wanna
leave you on that note.

604
00:30:29.822 --> 00:30:31.878
Most service members and I would say,

605
00:30:31.878 --> 00:30:35.544
just wanna go back to what we know,

606
00:30:35.544 --> 00:30:39.579
most service members return with

607
00:30:39.579 --> 00:30:43.244
out major mental health
outcomes or problems.

608
00:30:43.244 --> 00:30:45.075
It's very important that we focus on

609
00:30:45.075 --> 00:30:47.279
resilience and protected factors.

610
00:30:48.797 --> 00:30:51.090
So that just needs to be the backdrop.

611
00:30:53.450 --> 00:30:55.653
Working with fields for so many years,

612
00:30:55.653 --> 00:30:57.045
I'm so struck by people who

613
00:30:57.045 --> 00:30:59.461
one, two, three, four,
five deployments in,

614
00:30:59.461 --> 00:31:03.303
there are those individuals of
service members and families

615
00:31:03.303 --> 00:31:08.303
who are, look relatively
unscathed from the events.

616
00:31:08.818 --> 00:31:10.877
Meaning that they are not suffering

617
00:31:10.877 --> 00:31:13.113
some of the mental health impact.

618
00:31:16.397 --> 00:31:18.238
I wanna focus briefly on
the protective factors

619
00:31:18.238 --> 00:31:20.463
because how do people weather the storms?

620
00:31:22.568 --> 00:31:25.471
Proactive coping, we know
about training and leadership.

621
00:31:25.471 --> 00:31:30.130
This is relevant just
to military and combat

622
00:31:30.130 --> 00:31:31.378
because we know a lot about survivors

623
00:31:31.378 --> 00:31:33.458
of sexual and physical abuse in childhood

624
00:31:33.458 --> 00:31:36.167
and domestic violence in adult life.

625
00:31:36.167 --> 00:31:37.727
But this is crucial.

626
00:31:37.727 --> 00:31:40.679
For those units who've had more

627
00:31:40.679 --> 00:31:43.572
cohesive training and more
of a sense of collaboration

628
00:31:45.094 --> 00:31:47.969
and command that they could
really trust and value,

629
00:31:47.969 --> 00:31:49.849
they fare much better.

630
00:31:49.849 --> 00:31:52.539
Much, much better than those who,

631
00:31:52.539 --> 00:31:54.057
it's common sense if they don't trust

632
00:31:54.057 --> 00:31:57.186
their fellow service member,

633
00:31:57.186 --> 00:32:02.186
they're not gonna be in a
position of some safety zone,

634
00:32:02.502 --> 00:32:04.663
a psychological safety zone.

635
00:32:04.663 --> 00:32:07.451
Family and social support,
those are standard

636
00:32:07.451 --> 00:32:11.058
resilience factors that we
know about across the board.

637
00:32:11.058 --> 00:32:14.280
This is crucial because
I talk about this topic

638
00:32:14.280 --> 00:32:15.662
in a lot of different settings

639
00:32:15.662 --> 00:32:18.939
and the focus is mostly on
individual service members still.

640
00:32:20.155 --> 00:32:21.487
We, our program, we specialize in

641
00:32:21.487 --> 00:32:24.210
a clinical social work practice so

642
00:32:24.210 --> 00:32:27.902
I'm leaning toward
talking about the clients

643
00:32:27.902 --> 00:32:30.199
that we're working with who have some

644
00:32:30.199 --> 00:32:33.506
mental health or psycho-social
concerns, their issues.

645
00:32:34.862 --> 00:32:39.377
In that realm, the
predominant narrative is

646
00:32:39.377 --> 00:32:41.903
individual, individual, individual.

647
00:32:41.903 --> 00:32:43.449
The family and social support,

648
00:32:43.449 --> 00:32:45.306
you have to emphasize regularly.

649
00:32:45.306 --> 00:32:47.372
In the more general communities,

650
00:32:47.372 --> 00:32:50.736
some working on bases or in
posts throughout the country,

651
00:32:50.736 --> 00:32:53.024
there is a huge amount of tension

652
00:32:53.024 --> 00:32:56.026
to family and social support
more in terms of prevention

653
00:32:56.026 --> 00:32:57.236
and resilience building.

654
00:32:58.588 --> 00:33:01.318
So this is a complex
intersecting social identities

655
00:33:01.318 --> 00:33:03.170
and other protective factor.

656
00:33:03.170 --> 00:33:05.286
Basically what that means is if

657
00:33:05.286 --> 00:33:07.936
a service member has a strong sense

658
00:33:07.936 --> 00:33:12.511
of military identity or veteran
identity and that is tied in

659
00:33:12.511 --> 00:33:15.072
with whatever their other identities are

660
00:33:15.072 --> 00:33:19.407
in terms of socio-cultural
or family identities,

661
00:33:19.407 --> 00:33:23.203
they weather these situations better.

662
00:33:23.203 --> 00:33:24.835
The risk factors you probably know.

663
00:33:24.835 --> 00:33:27.598
They're pretty well known in the field

664
00:33:27.598 --> 00:33:28.732
in dealing with combat.

665
00:33:30.020 --> 00:33:33.970
Those of people, the service
members who are younger,

666
00:33:33.970 --> 00:33:38.450
lower socio-economic status,
lower ranking, female gender,

667
00:33:38.450 --> 00:33:40.032
and previous mental health issues

668
00:33:40.032 --> 00:33:43.494
have increased risk for
mental health outcomes.

669
00:33:44.749 --> 00:33:46.672
Again, that doesn't
they're gonna have them

670
00:33:46.672 --> 00:33:48.359
but it's just a risk factor.

671
00:33:48.359 --> 00:33:50.679
It has to be counterbalanced
with the protective factors.

672
00:33:51.881 --> 00:33:54.531
This is a tricky one, the
previous mental health issue.

673
00:33:54.531 --> 00:33:55.647
Talk about childhood trauma,

674
00:33:55.647 --> 00:33:58.796
there's a lot of talk in
the field, military DOD,

675
00:33:58.796 --> 00:34:00.551
Department of Defense
settings or VA settings.

676
00:34:01.941 --> 00:34:03.493
Because most of the data suggests

677
00:34:03.493 --> 00:34:06.442
if there's childhood trauma
then that's a big risk factor

678
00:34:06.442 --> 00:34:09.506
for mental health problems in the field.

679
00:34:09.506 --> 00:34:12.190
That's been contradicted by some research

680
00:34:12.190 --> 00:34:14.443
that's coming out of Rachel Yehuda,

681
00:34:14.443 --> 00:34:17.512
who works out of the Bronx VA now.

682
00:34:19.134 --> 00:34:21.150
Her research suggests she's comparing

683
00:34:21.150 --> 00:34:24.668
some of the service members
who've suffered childhood trauma

684
00:34:24.668 --> 00:34:25.665
and those who haven't

685
00:34:25.665 --> 00:34:27.256
and looking at the differences in combat.

686
00:34:27.256 --> 00:34:30.851
The ones who had childhood
trauma who resolved their issues

687
00:34:30.851 --> 00:34:35.368
and demonstrated some mastery
and some sense of perspective

688
00:34:35.368 --> 00:34:37.223
do better in combat.

689
00:34:37.223 --> 00:34:39.636
So I think that's a
very important finding.

690
00:34:39.636 --> 00:34:43.186
I don't have that right
here but it's Rachel Yehuda.

691
00:34:43.186 --> 00:34:44.844
This is an important
one, a physical injury.

692
00:34:44.844 --> 00:34:47.523
Any of these service members
who've been injured in combat,

693
00:34:47.523 --> 00:34:48.738
they have three times the risk,

694
00:34:48.738 --> 00:34:51.729
three times the risk of developing PTSD.

695
00:34:53.449 --> 00:34:57.466
So you must be familiar with
the notion of secondary trauma

696
00:34:57.466 --> 00:34:59.578
because this applies to family members

697
00:34:59.578 --> 00:35:03.521
of people who have been
exposed to combat or

698
00:35:05.413 --> 00:35:07.705
but it's not just the family members.

699
00:35:07.705 --> 00:35:10.729
Guess who also is going to be exposed

700
00:35:10.729 --> 00:35:14.219
to listening to narratives
of traumatic events

701
00:35:14.219 --> 00:35:15.502
in working in this field.

702
00:35:15.502 --> 00:35:20.012
Or actually any of us here
in clinical social work

703
00:35:20.012 --> 00:35:25.008
are dealing with exposure
to traumatizing events

704
00:35:25.008 --> 00:35:26.036
hearing about them.

705
00:35:26.036 --> 00:35:30.641
And we are susceptible to
developing secondary trauma

706
00:35:30.641 --> 00:35:33.161
meaning that we may develop
some symptoms that are

707
00:35:33.161 --> 00:35:37.948
very similar to what the
person involved is dealing with

708
00:35:37.948 --> 00:35:41.331
in terms of having been
directly traumatized.

709
00:35:41.331 --> 00:35:44.965
So there might be symptoms
of hyper-arousal, agitation,

710
00:35:44.965 --> 00:35:49.543
poor sleep, detachment,
numbing, all of the above.

711
00:35:50.607 --> 00:35:51.952
I remember Jonathan Shay said

712
00:35:51.952 --> 00:35:53.490
a couple of years ago at our conference,

713
00:35:53.490 --> 00:35:58.490
we had the combat stress
conference here in 2008.

714
00:35:58.590 --> 00:36:02.427
He said that he sees it
as an occupational hazard

715
00:36:02.427 --> 00:36:04.385
to actually work in this field,

716
00:36:04.385 --> 00:36:05.559
when you're working
with traumatized clients

717
00:36:05.559 --> 00:36:09.541
so that every employer
should basically provide

718
00:36:09.541 --> 00:36:11.295
health insurance that specifically attends

719
00:36:11.295 --> 00:36:14.851
to secondary trauma and plans.

720
00:36:14.851 --> 00:36:16.625
Part of the insurance plan would be

721
00:36:16.625 --> 00:36:21.625
actually providing for yoga
and other regular massages

722
00:36:22.263 --> 00:36:25.772
and other avenues for reducing stress.

723
00:36:25.772 --> 00:36:27.727
So I just thought I'd share that.

724
00:36:27.727 --> 00:36:29.910
Actually, in some settings,
I've noticed they've done it

725
00:36:29.910 --> 00:36:32.155
and that's been impressive
when you see it in operation.

726
00:36:33.943 --> 00:36:35.239
What does secondary trauma do?

727
00:36:35.239 --> 00:36:39.891
It sets the stage for affecting
children and family members.

728
00:36:41.067 --> 00:36:42.333
There are a lot of data, unfortunately,

729
00:36:42.333 --> 00:36:45.805
to support that there are higher
rates of marital conflict,

730
00:36:45.805 --> 00:36:49.920
intimate partner violence,
and effects on children.

731
00:36:57.529 --> 00:36:59.014
This is an important theme,

732
00:36:59.014 --> 00:37:00.070
which I'm at the caregiving.

733
00:37:00.070 --> 00:37:03.332
Because for caregiving is tremo -

734
00:37:03.332 --> 00:37:06.733
remember that data that
I was sharing with you?

735
00:37:06.733 --> 00:37:10.925
On 65% of service members are then

736
00:37:10.925 --> 00:37:13.837
caring for a child or family member.

737
00:37:14.986 --> 00:37:17.267
When they're returning home,
they're gonna be dealing with

738
00:37:18.738 --> 00:37:20.511
that responsibility.

739
00:37:20.511 --> 00:37:23.818
So rather than just assuming
it's caregiving burden,

740
00:37:23.818 --> 00:37:25.816
which is people often talk
about caregiver burden,

741
00:37:25.816 --> 00:37:27.464
which of course is important

742
00:37:27.464 --> 00:37:28.810
because of the secondary trauma.

743
00:37:30.271 --> 00:37:34.165
There's also caregiving
satisfaction that there's

744
00:37:34.165 --> 00:37:36.308
more work in that area now,

745
00:37:36.308 --> 00:37:37.745
looking at caregiving satisfaction

746
00:37:37.745 --> 00:37:38.862
and post-traumatic growth.

747
00:37:38.862 --> 00:37:42.156
So it's not just a sense
of people really suffering

748
00:37:42.156 --> 00:37:44.382
with some of these difficult situations.

749
00:37:47.665 --> 00:37:49.757
What do we know about some of women in

750
00:37:51.429 --> 00:37:55.668
direct in deployment in combat arenas?

751
00:37:56.866 --> 00:37:58.292
First of all the environment,

752
00:37:58.292 --> 00:37:59.599
people in environmental stressors,

753
00:37:59.599 --> 00:38:04.599
when people often talk about 125,

754
00:38:04.609 --> 00:38:08.731
almost like last week, 130 degree heat,

755
00:38:08.731 --> 00:38:10.112
that's when it's insufferable.

756
00:38:11.198 --> 00:38:16.198
Sand, blinding sand,
insects, all sorts of toxins

757
00:38:16.449 --> 00:38:18.698
that could be problematic.

758
00:38:18.698 --> 00:38:21.596
These are some of the physical
environmental stressors

759
00:38:21.596 --> 00:38:23.505
that are very important.

760
00:38:23.505 --> 00:38:26.148
Also, many of the service
members coming back

761
00:38:27.573 --> 00:38:29.848
have major sleep problems.

762
00:38:29.848 --> 00:38:31.523
When you think about some of the issues,

763
00:38:31.523 --> 00:38:35.353
one of the major physical
issues is insomnia.

764
00:38:36.825 --> 00:38:38.756
If you have insomnia, you cannot sleep

765
00:38:38.756 --> 00:38:40.959
because you have been preoccupied with

766
00:38:40.959 --> 00:38:42.629
all these environmental stressors and also

767
00:38:42.629 --> 00:38:45.453
worried that you're gonna
be injured or killed

768
00:38:45.453 --> 00:38:47.473
or your buddies will be injured or killed.

769
00:38:49.016 --> 00:38:51.065
Sleep is not an easy phenomenon.

770
00:38:52.267 --> 00:38:53.972
At Walter Reed, that's
what I found fascinating.

771
00:38:53.972 --> 00:38:57.480
That the first thing they
do is try to get people,

772
00:38:57.480 --> 00:39:00.383
service members, on a sleep
regimen to regulate it.

773
00:39:00.383 --> 00:39:03.449
Because they cannot cope effectively.

774
00:39:03.449 --> 00:39:07.826
Also, lack of adequate sleep enhances

775
00:39:07.826 --> 00:39:11.212
any mental health problems
or also can create.

776
00:39:12.355 --> 00:39:14.690
If you don't have adequate deep sleep

777
00:39:14.690 --> 00:39:16.161
and adequate alpha sleep,

778
00:39:16.161 --> 00:39:20.267
it can actually induce
some psychotic experiences.

779
00:39:21.350 --> 00:39:22.347
Don't mean to scare people.

780
00:39:23.893 --> 00:39:27.065
It is an important phenomenon.

781
00:39:28.238 --> 00:39:30.991
Then many women, which I'm gonna back to

782
00:39:30.991 --> 00:39:33.121
talking about women in the military.

783
00:39:33.121 --> 00:39:36.861
Majority are in their
20's, 30's, and 40's,

784
00:39:36.861 --> 00:39:41.861
so dealing with menstruation
can be very difficult,

785
00:39:42.576 --> 00:39:44.159
hygiene and limited restrooms.

786
00:39:46.111 --> 00:39:47.209
I found this interesting.

787
00:39:47.209 --> 00:39:50.558
There's one study that
suggested 20% of the women

788
00:39:50.558 --> 00:39:53.795
who are interviewed, a very large sample

789
00:39:53.795 --> 00:39:58.778
have reported unintended pregnancies.

790
00:39:58.778 --> 00:40:00.137
What happened, is you
wonder, "Well why is that."

791
00:40:00.137 --> 00:40:02.137
Well, sometimes birth control

792
00:40:02.137 --> 00:40:04.113
was not available in the same way.

793
00:40:04.113 --> 00:40:06.544
So it was just more difficult
to take care of oneself

794
00:40:06.544 --> 00:40:08.585
and be able to manage

795
00:40:11.353 --> 00:40:13.720
basic gynecological care.

796
00:40:16.063 --> 00:40:17.516
I also talked to one woman who's saying,

797
00:40:17.516 --> 00:40:19.838
"Do you know what it's like
to go through menopause

798
00:40:19.838 --> 00:40:22.079
"in 130 degree heat?

799
00:40:22.079 --> 00:40:26.495
"And also trying to serve and do your job

800
00:40:26.495 --> 00:40:28.167
"and maintain your fitness

801
00:40:28.167 --> 00:40:30.303
"and do your fitness routine everyday?"

802
00:40:30.303 --> 00:40:33.333
Yeah, okay. Well, no I don't
know but I can imagine.

803
00:40:34.643 --> 00:40:36.786
So childbirth and nursing,
that's very interesting

804
00:40:36.786 --> 00:40:38.922
because usually when somebody's pregnant,

805
00:40:38.922 --> 00:40:39.956
they're no longer deployable.

806
00:40:39.956 --> 00:40:41.475
But if they're pregnant in theater

807
00:40:41.475 --> 00:40:43.510
then they have to find
out they're pregnant

808
00:40:43.510 --> 00:40:45.670
and then they usually are sent home.

809
00:40:45.670 --> 00:40:46.627
Soon as they're sent home,

810
00:40:46.627 --> 00:40:50.308
then other members in the unit resent them

811
00:40:50.308 --> 00:40:53.972
because then somebody
else has to do their job.

812
00:40:53.972 --> 00:40:58.798
So if a man and a woman,
heterosexual couple,

813
00:40:58.798 --> 00:40:59.974
are dealing with a pregnancy,

814
00:40:59.974 --> 00:41:03.439
the man is not dealing with
problems with deployment.

815
00:41:03.439 --> 00:41:06.429
It's the woman in the
military who's dealing,

816
00:41:06.429 --> 00:41:08.108
has negative consequences.

817
00:41:12.803 --> 00:41:14.247
The nursing was very interesting.

818
00:41:14.247 --> 00:41:16.862
This is Colonel Richie was
talking about at Walter Reed.

819
00:41:16.862 --> 00:41:20.878
When she was on, she was
very focused on this effort

820
00:41:20.878 --> 00:41:23.890
in the early 2000's to
make sure that nursing

821
00:41:25.125 --> 00:41:27.692
sailors at the time, women sailors,

822
00:41:27.692 --> 00:41:30.821
would be able to provide
for nursing for their babies

823
00:41:30.821 --> 00:41:32.625
when they were on ships.

824
00:41:32.625 --> 00:41:34.464
She set up this elaborate program

825
00:41:34.464 --> 00:41:36.296
which was very important.

826
00:41:36.296 --> 00:41:37.747
She said that as long as the command

827
00:41:37.747 --> 00:41:40.259
would provide enough time,
you have to have time,

828
00:41:40.259 --> 00:41:41.758
and spacing and support,

829
00:41:41.758 --> 00:41:45.189
that they would allow the mother
to be able to express milk,

830
00:41:45.189 --> 00:41:47.546
save it, and actually
nurse to baby over time.

831
00:41:47.546 --> 00:41:50.065
This sounds so, it seems so basic, right?

832
00:41:50.065 --> 00:41:52.356
If you think of people who are back home.

833
00:41:52.356 --> 00:41:56.072
But what happens with a
nursing mother who then

834
00:41:56.072 --> 00:41:58.921
would have to automatically stop nursing

835
00:41:58.921 --> 00:42:01.514
or not even be with the baby?

836
00:42:01.514 --> 00:42:03.822
In some deployments, the
baby is somewhere else

837
00:42:03.822 --> 00:42:05.975
back home with other family members.

838
00:42:05.975 --> 00:42:07.988
So that's a stressor.

839
00:42:09.665 --> 00:42:11.315
Okay, mental health responses.

840
00:42:11.315 --> 00:42:13.253
These are the ones that are familiar to us

841
00:42:13.253 --> 00:42:14.473
who are doing the clinical work.

842
00:42:16.195 --> 00:42:19.592
Here, I do so much,
these committees I'm on

843
00:42:19.592 --> 00:42:22.539
are focusing on post-traumatic
stress now, PTSD,

844
00:42:22.539 --> 00:42:24.797
over and over and over and over and over.

845
00:42:24.797 --> 00:42:28.558
But as I said, the depression,

846
00:42:29.806 --> 00:42:33.079
moral injury, and suicidal
thinking is really

847
00:42:33.079 --> 00:42:35.640
as significant as PTSD.

848
00:42:37.235 --> 00:42:38.676
They're both significant.

849
00:42:38.676 --> 00:42:40.674
The scary thing for women in the military

850
00:42:40.674 --> 00:42:44.354
is that the rates actually
are higher for women than men

851
00:42:44.354 --> 00:42:45.552
in terms of post-traumatic stress

852
00:42:45.552 --> 00:42:48.184
and we have that validated
now for over years.

853
00:42:49.332 --> 00:42:52.268
With depression and suicidality,
that's not the case though.

854
00:42:52.268 --> 00:42:57.268
Women do not suicide at the
same rates as men, service men.

855
00:43:00.841 --> 00:43:03.038
However, when you think
of just the general data,

856
00:43:03.038 --> 00:43:05.966
we might find this important
because it's rather grim,

857
00:43:07.949 --> 00:43:09.155
compelling some meaning

858
00:43:09.155 --> 00:43:11.163
that we should do something about it.

859
00:43:11.163 --> 00:43:16.163
Last year, 349 suicides just in the army.

860
00:43:18.015 --> 00:43:20.781
There were 295 deaths in combat.

861
00:43:20.781 --> 00:43:23.317
The numbers of suicides are higher than

862
00:43:23.317 --> 00:43:26.253
the numbers of death
which is pretty daunting.

863
00:43:28.603 --> 00:43:31.997
When you think of the, with
every era, any combat era,

864
00:43:31.997 --> 00:43:34.795
there are different
issues that are central.

865
00:43:34.795 --> 00:43:39.241
With the conflicts in
Iraq and Afghanistan,

866
00:43:39.241 --> 00:43:41.437
the issues that have existed are,

867
00:43:41.437 --> 00:43:43.236
they're called signature injuries.

868
00:43:43.236 --> 00:43:44.234
They're a cluster.

869
00:43:44.234 --> 00:43:45.069
They're not just one.

870
00:43:45.069 --> 00:43:48.579
It's not just congested
here for depression.

871
00:43:48.579 --> 00:43:51.892
It's PTSD, I'd say
post-traumatic stress or PTSD.

872
00:43:51.892 --> 00:43:53.391
Most people coming back
are going to suffer

873
00:43:53.391 --> 00:43:54.588
some post-traumatic stress.

874
00:43:54.588 --> 00:43:56.262
I would argue that any of us

875
00:43:56.262 --> 00:43:58.596
in combat, we're gonna
have post-traumatic stress

876
00:43:58.596 --> 00:44:03.056
because it's a normal reaction
to abnormal circumstances.

877
00:44:03.056 --> 00:44:05.800
So they're symptoms but
it's not full-blown PTSD.

878
00:44:08.601 --> 00:44:11.857
But this cluster of
post-traumatic stress, depression,

879
00:44:11.857 --> 00:44:15.712
suicidal thinking, substance
abuse, traumatic brain injury,

880
00:44:15.712 --> 00:44:18.432
and intimate partner
violence, they go hand in hand

881
00:44:18.432 --> 00:44:20.624
and you see the incendiary effect of that.

882
00:44:21.999 --> 00:44:23.857
This is why we in our field,

883
00:44:23.857 --> 00:44:26.148
we need to be mindful of not
just of the service member

884
00:44:26.148 --> 00:44:29.021
but then the impact on the family.

885
00:44:31.107 --> 00:44:33.335
So this, you're familiar
probably with PTS,

886
00:44:33.335 --> 00:44:36.803
the clusters of re-experiencing
avoidance and hyper-arousal.

887
00:44:36.803 --> 00:44:40.948
If you think of in families,
which of these themes

888
00:44:40.948 --> 00:44:43.124
are most difficult for children,

889
00:44:43.124 --> 00:44:45.471
early on in my work here, I
thought it'd be hyper-arousal

890
00:44:45.471 --> 00:44:48.477
because that's scary when
family members are elevated

891
00:44:48.477 --> 00:44:52.204
and augmented and mad and rage storms and

892
00:44:53.593 --> 00:44:55.301
scary presence, but that's not the case.

893
00:44:55.301 --> 00:44:59.167
Children desperately respond negatively

894
00:44:59.167 --> 00:45:00.966
to the avoidance and numbing.

895
00:45:00.966 --> 00:45:03.089
That's a really powerfully
negative effect.

896
00:45:05.553 --> 00:45:08.031
We'll talk a little bit
about military sexual trauma.

897
00:45:10.257 --> 00:45:12.819
The Pentagon data of May of this year,

898
00:45:12.819 --> 00:45:15.111
it said 26,000 service
members were assaulted

899
00:45:15.111 --> 00:45:18.593
in the last year compared
with 19,000 the year before.

900
00:45:18.593 --> 00:45:19.986
Those of you probably know that

901
00:45:21.392 --> 00:45:24.183
it was all the attention
that has been paid

902
00:45:24.183 --> 00:45:26.858
in the recent months
in the Senate hearings.

903
00:45:28.138 --> 00:45:30.625
The messages are coming forward

904
00:45:30.625 --> 00:45:32.843
and I think there's much more attention,

905
00:45:32.843 --> 00:45:34.467
people are paying attention.

906
00:45:35.864 --> 00:45:37.249
One of three, one of the military assaults

907
00:45:37.249 --> 00:45:39.237
are compared to one in six civilians.

908
00:45:40.676 --> 00:45:44.664
That's sort of a general
number at this point.

909
00:45:44.664 --> 00:45:46.429
But again, that's very daunting.

910
00:45:46.429 --> 00:45:47.786
We're talking about
assault not harassment.

911
00:45:47.786 --> 00:45:51.261
Harassment, the data on
harassment are like in the range

912
00:45:51.261 --> 00:45:54.070
of something like 70% of
the people in the military

913
00:45:54.070 --> 00:45:56.614
suggest that they've been
harassed, both men and women.

914
00:45:56.614 --> 00:46:00.561
It's the assault that is more focused on

915
00:46:00.561 --> 00:46:03.768
in terms of the current
congressional hearings.

916
00:46:03.768 --> 00:46:05.827
And then why would you think this?

917
00:46:05.827 --> 00:46:07.371
The reports, you know this I think,

918
00:46:07.371 --> 00:46:10.566
the reports in the Department
of Defense are lower than in

919
00:46:10.566 --> 00:46:14.873
VA settings, in the Veterans
Administration settings.

920
00:46:14.873 --> 00:46:17.611
Well, if you report one of
the significant features of

921
00:46:17.611 --> 00:46:20.792
military sexual trauma
is that often the person

922
00:46:20.792 --> 00:46:25.105
who has offended is maybe in your unit,

923
00:46:25.105 --> 00:46:27.148
maybe your superior officer,

924
00:46:27.148 --> 00:46:28.785
maybe the commanding officer.

925
00:46:28.785 --> 00:46:31.769
So then many of the
women who are assaulted,

926
00:46:31.769 --> 00:46:33.649
and I say women because
men are assaulted as well,

927
00:46:33.649 --> 00:46:34.601
it's not just women.

928
00:46:34.601 --> 00:46:37.334
It's just the focus of this talk is women.

929
00:46:37.334 --> 00:46:40.963
But if they are then not
separated from the offending

930
00:46:42.409 --> 00:46:46.170
person who has injured them,

931
00:46:46.170 --> 00:46:47.714
they have to live with that.

932
00:46:47.714 --> 00:46:51.081
So not only is there a
deterrent to reporting

933
00:46:51.081 --> 00:46:53.577
because of safety, there's a deterrent

934
00:46:53.577 --> 00:46:56.479
because it would affect one's job standing

935
00:46:56.479 --> 00:46:58.184
and any opportunities for promotion.

936
00:47:01.238 --> 00:47:03.308
What we do know though,
is military sexual assault

937
00:47:03.308 --> 00:47:06.196
is directly associated with PTSD.

938
00:47:07.328 --> 00:47:10.847
Ms. Hemofarb conducted
a study a few years ago.

939
00:47:10.847 --> 00:47:13.854
It examined the relations
between military sexual trauma

940
00:47:13.854 --> 00:47:18.854
and the actual outcomes with PTSD.

941
00:47:20.355 --> 00:47:22.793
It's strongly associated with,

942
00:47:22.793 --> 00:47:25.826
rather than thinking that
it's associated with trauma

943
00:47:25.826 --> 00:47:28.601
before the military or after the military,

944
00:47:28.601 --> 00:47:32.167
it's strongly associated
with military sexual assault.

945
00:47:32.167 --> 00:47:33.376
That's one of the major reasons

946
00:47:33.376 --> 00:47:36.129
that you have these high number of women

947
00:47:36.129 --> 00:47:40.735
who are presenting with PTSD.

948
00:47:42.409 --> 00:47:43.945
So what I was going to mention,

949
00:47:43.945 --> 00:47:46.260
I'm not going to go into
much more detail about that.

950
00:47:49.588 --> 00:47:53.764
Jewish St. George who's an
A for T has been organizing

951
00:47:53.764 --> 00:47:57.579
a showing which will occur next Wednesday,

952
00:47:59.548 --> 00:48:03.974
7 o'clock in room 106, Sealy 106.

953
00:48:05.664 --> 00:48:08.088
This is a showing, a viewing,
of the Invisible War.

954
00:48:08.088 --> 00:48:10.061
For those of you who may or
not be familiar with that,

955
00:48:10.061 --> 00:48:13.847
it's a documentary that
won a number of awards

956
00:48:13.847 --> 00:48:15.346
within the last two years

957
00:48:15.346 --> 00:48:17.401
documenting the interviews with women

958
00:48:17.401 --> 00:48:19.398
who have suffered military sexual assault.

959
00:48:20.914 --> 00:48:23.110
It's very powerful, so
powerful that it was shown

960
00:48:23.110 --> 00:48:25.629
to a number of the male
commanding officers

961
00:48:25.629 --> 00:48:28.036
who had sat in the congressional hearings.

962
00:48:28.036 --> 00:48:31.812
What I have found out
since from Deborah Stone

963
00:48:31.812 --> 00:48:34.275
who's the Major, she's the
one who is a colleague of mine

964
00:48:34.275 --> 00:48:36.896
who's working in Fort Myer in D.C. now.

965
00:48:36.896 --> 00:48:41.667
She has said that the
U.S. Army SHARP training,

966
00:48:41.667 --> 00:48:44.469
that's this training, I have all these.

967
00:48:44.469 --> 00:48:48.008
This website, you can log
on and take a look at it.

968
00:48:49.953 --> 00:48:52.171
They actually have implemented

969
00:48:52.171 --> 00:48:54.540
very elaborate training
so they're trying to

970
00:48:54.540 --> 00:48:56.675
change the culture in the military.

971
00:48:56.675 --> 00:48:59.117
Some of this is pretty basic.

972
00:48:59.117 --> 00:49:02.937
Both in some basic
training as well as just

973
00:49:02.937 --> 00:49:07.328
general conversations and general
discourse in the military.

974
00:49:08.914 --> 00:49:13.150
People are often using misogynistic,

975
00:49:13.150 --> 00:49:17.875
bigoted, harsh, sexist language.

976
00:49:17.875 --> 00:49:21.014
That does not set the stage for

977
00:49:21.014 --> 00:49:23.694
a respectful, benevolent
environment, shall we say.

978
00:49:25.348 --> 00:49:29.711
This is the challenge
to the cultural typing

979
00:49:29.711 --> 00:49:33.090
that the Army has now implemented.

980
00:49:33.090 --> 00:49:35.391
I started looking at some of that today.

981
00:49:35.391 --> 00:49:37.495
I mean that they're taking it seriously,

982
00:49:37.495 --> 00:49:39.979
I hope they keep taking it seriously.

983
00:49:39.979 --> 00:49:41.654
What they were saying, it
was all that controversy,

984
00:49:41.654 --> 00:49:45.252
should they have reporting
outside of the command structure?

985
00:49:45.252 --> 00:49:48.375
But the conclusion, obviously
what they're doing now,

986
00:49:48.375 --> 00:49:51.338
is they think they're
trying to change the culture

987
00:49:51.338 --> 00:49:54.113
from the top, not just
from the lower ranking.

988
00:49:54.113 --> 00:49:56.962
Top down and mid-rank, so we'll see but

989
00:49:58.572 --> 00:50:01.449
I urge all of you to attend
the viewing next Wednesday

990
00:50:01.449 --> 00:50:03.388
if you'd like to see and hear

991
00:50:03.388 --> 00:50:05.204
more about these issues in depth.

992
00:50:06.488 --> 00:50:08.975
So okay, let's see.

993
00:50:08.975 --> 00:50:10.219
I'm going to shift now because

994
00:50:10.219 --> 00:50:13.039
I hope I've given you a lot of these data

995
00:50:13.039 --> 00:50:15.013
about what some of the issues are

996
00:50:15.013 --> 00:50:17.184
that women are coming back with.

997
00:50:20.450 --> 00:50:23.100
As clinical social
workers, how do we respond?

998
00:50:24.481 --> 00:50:25.949
These are some of the basic principles

999
00:50:25.949 --> 00:50:28.584
that I think they're all familiar to us

1000
00:50:28.584 --> 00:50:30.570
that are critical in any type

1001
00:50:30.570 --> 00:50:33.354
of clinical social work encounter.

1002
00:50:33.354 --> 00:50:37.036
The value of relationship,
therapeutic alliance,

1003
00:50:37.036 --> 00:50:42.036
cultural responsiveness,
research informed stance,

1004
00:50:42.664 --> 00:50:45.725
theoretical grounding, and a
social justice perspective.

1005
00:50:47.261 --> 00:50:48.864
Let me just introduce you to the

1006
00:50:48.864 --> 00:50:50.223
Sanchez family a little better

1007
00:50:50.223 --> 00:50:53.803
because then I hope that this will convey,

1008
00:50:53.803 --> 00:50:56.535
it's only a clinical and
yet, it's a composite.

1009
00:50:56.535 --> 00:50:57.777
But I'm hoping that the vignette

1010
00:50:57.777 --> 00:51:00.434
will capture some of the issues

1011
00:51:00.434 --> 00:51:01.676
that we've just talked about

1012
00:51:01.676 --> 00:51:03.841
that are facing many
women in the military.

1013
00:51:05.103 --> 00:51:08.629
I'm going to urge us to
think in a very broad sense.

1014
00:51:08.629 --> 00:51:11.252
Don't, think beyond just symptom relief.

1015
00:51:11.252 --> 00:51:13.237
Think of the complexity

1016
00:51:13.237 --> 00:51:17.197
of this client's situation.

1017
00:51:18.361 --> 00:51:20.321
First of all, I need to
ask you who's the client

1018
00:51:20.321 --> 00:51:22.276
because I've introduced you to Maria.

1019
00:51:24.068 --> 00:51:25.764
I've told you a little
bit about her so far

1020
00:51:25.764 --> 00:51:27.122
but I haven't told you
about the whole family yet.

1021
00:51:27.122 --> 00:51:32.122
So Maria is 37 and was
reared in Puerto Rico

1022
00:51:34.169 --> 00:51:36.311
in a family where she's the
eldest of four children.

1023
00:51:36.311 --> 00:51:37.389
She was reared in poverty

1024
00:51:37.389 --> 00:51:41.349
in a very difficult,
challenging home life.

1025
00:51:41.349 --> 00:51:42.706
Her mother was very physically ill

1026
00:51:42.706 --> 00:51:47.363
from very, for her early years onward.

1027
00:51:47.363 --> 00:51:50.051
So she was caring for
many of the siblings.

1028
00:51:50.051 --> 00:51:51.687
Her mother died when she was only four.

1029
00:51:51.687 --> 00:51:54.154
Mother died from a septic infection.

1030
00:51:54.154 --> 00:51:57.461
So Maria was sent at a very early age.

1031
00:51:57.461 --> 00:52:01.705
She was sent to family members
in New England to live.

1032
00:52:01.705 --> 00:52:03.974
But she was, described
herself as really marginalized

1033
00:52:03.974 --> 00:52:06.996
because she was taken in
by some distant relatives

1034
00:52:06.996 --> 00:52:09.551
and they, quote, felt sorry for her.

1035
00:52:11.099 --> 00:52:14.139
She, in her home life, that
had described that she was

1036
00:52:15.919 --> 00:52:18.063
beaten by her older brother regularly.

1037
00:52:18.063 --> 00:52:20.699
The father was very neglectful and harsh.

1038
00:52:20.699 --> 00:52:25.237
She just had an incredibly
difficult early years

1039
00:52:25.237 --> 00:52:29.685
and managed to thrive,

1040
00:52:29.685 --> 00:52:31.999
when we talk about the
nature of resilience,

1041
00:52:31.999 --> 00:52:34.333
in her new setting in New England.

1042
00:52:34.333 --> 00:52:37.177
She managed to go to school,
get through high school

1043
00:52:37.177 --> 00:52:41.368
and then met Carlos.

1044
00:52:41.368 --> 00:52:44.341
Carlos was reared Puerto Rican ethnicity,

1045
00:52:45.680 --> 00:52:49.025
oldest of four children, and his family

1046
00:52:49.025 --> 00:52:50.148
had lived in New England

1047
00:52:50.148 --> 00:52:55.148
for about 40 years.

1048
00:52:56.382 --> 00:53:01.382
Very educationally oriented,
solid, socioeconomic,

1049
00:53:01.569 --> 00:53:03.131
are you hearing the
differences in terms of

1050
00:53:03.131 --> 00:53:05.031
some of the socio-cultural background?

1051
00:53:06.521 --> 00:53:11.521
When they married, they
felt the commonality

1052
00:53:11.735 --> 00:53:14.857
in terms of religion,
ethnicity, shared values.

1053
00:53:14.857 --> 00:53:16.577
They desperately wanted
to have three children.

1054
00:53:16.577 --> 00:53:20.737
Antonio who's now 16,
Delia who's nine, and

1055
00:53:20.737 --> 00:53:22.095
Anna who's three.

1056
00:53:23.470 --> 00:53:26.100
They've been married 17 years

1057
00:53:26.100 --> 00:53:29.903
and Maria was in the Army
Reserves for eight years.

1058
00:53:29.903 --> 00:53:31.299
She wanted to join because she wanted

1059
00:53:31.299 --> 00:53:33.197
to continue with her schooling

1060
00:53:33.197 --> 00:53:36.801
and she had a sense of pride
because some of the relatives

1061
00:53:36.801 --> 00:53:39.699
in her family that adopted
her and took her in

1062
00:53:39.699 --> 00:53:40.996
had been in the military.

1063
00:53:40.996 --> 00:53:43.371
So here are the sense of identification

1064
00:53:43.371 --> 00:53:45.742
that was positive for Maria.

1065
00:53:45.742 --> 00:53:48.257
This family, basically

1066
00:53:49.944 --> 00:53:52.290
you sort of think of where they were

1067
00:53:52.290 --> 00:53:55.070
two years before her deployment.

1068
00:53:55.070 --> 00:53:56.990
They were basically
functioning quite well.

1069
00:53:56.990 --> 00:54:00.304
All three kids were doing what they needed

1070
00:54:00.304 --> 00:54:03.160
to be doing in school, some thriving.

1071
00:54:03.160 --> 00:54:04.448
Carlos was an accountant

1072
00:54:04.448 --> 00:54:08.059
and Maria was working in a
nursing home as a nurse's aide.

1073
00:54:08.059 --> 00:54:10.578
So Maria's unit called up.

1074
00:54:10.578 --> 00:54:12.064
She's deployed, goes to Iraq,

1075
00:54:12.064 --> 00:54:13.121
this is where you hear the story

1076
00:54:13.121 --> 00:54:17.677
that she had been, had the
experience of being a medic

1077
00:54:17.677 --> 00:54:19.783
and separated from,

1078
00:54:19.783 --> 00:54:23.184
at the time 15-year old,
eight-year old, two-year old.

1079
00:54:23.184 --> 00:54:24.709
Think of the implications.

1080
00:54:24.709 --> 00:54:27.728
Again, these are the ordinary
stressors of deployment

1081
00:54:27.728 --> 00:54:30.579
but the dramatic difference between

1082
00:54:30.579 --> 00:54:33.595
the two and three-year old,
eight, nine-year old and

1083
00:54:33.595 --> 00:54:35.969
15 and 16 year old are considerable.

1084
00:54:39.440 --> 00:54:42.217
Let me tell you what happened upon return,

1085
00:54:42.217 --> 00:54:44.378
return from combat.

1086
00:54:44.378 --> 00:54:47.153
Maria was not sleeping.

1087
00:54:47.153 --> 00:54:49.312
She had flashbacks.

1088
00:54:49.312 --> 00:54:51.332
She wanted to be dead.

1089
00:54:51.332 --> 00:54:53.708
She felt that she had
no reason to be living.

1090
00:54:55.836 --> 00:54:58.253
She was, felt completely
detached from the kids.

1091
00:54:58.253 --> 00:54:59.751
She didn't know how to engage with them

1092
00:54:59.751 --> 00:55:01.753
because she was getting
reports from school.

1093
00:55:01.753 --> 00:55:05.296
Antonio, the oldest, was
getting into trouble.

1094
00:55:05.296 --> 00:55:07.102
He was beating up other kids.

1095
00:55:07.102 --> 00:55:08.775
Delia was bed-wetting.

1096
00:55:08.775 --> 00:55:11.943
She was wetting her bed
every night and very anxious

1097
00:55:11.943 --> 00:55:15.003
and not able to sleep
and Anna would shriek

1098
00:55:15.003 --> 00:55:16.948
every time her mother
would go to pick her up

1099
00:55:16.948 --> 00:55:18.606
and she would start screaming.

1100
00:55:18.606 --> 00:55:22.623
So Maria felt like she
had lost everything.

1101
00:55:22.623 --> 00:55:26.053
She was no longer a decent
soldier in her perspective

1102
00:55:26.053 --> 00:55:28.095
because she was responsible,
this is her word,

1103
00:55:28.095 --> 00:55:31.392
she was responsible for the
death of that young man.

1104
00:55:31.392 --> 00:55:33.052
She was a terrible soldier.

1105
00:55:33.052 --> 00:55:35.027
She wasn't a decent mother.

1106
00:55:35.027 --> 00:55:37.755
She couldn't be a decent mother
to any of these children.

1107
00:55:37.755 --> 00:55:40.494
She felt that she failed
her husband as a wife

1108
00:55:40.494 --> 00:55:43.269
because they were fighting constantly.

1109
00:55:43.269 --> 00:55:45.568
She was not only despairing,

1110
00:55:45.568 --> 00:55:49.492
but she was not sleeping,
angry, irritable,

1111
00:55:49.492 --> 00:55:51.546
yelling, yelling at the kids.

1112
00:55:51.546 --> 00:55:54.228
He was just, he would try
to spend as much time away

1113
00:55:54.228 --> 00:55:55.586
from the home as possible.

1114
00:55:55.586 --> 00:55:57.323
So, alright.

1115
00:55:58.472 --> 00:56:01.103
We have enough of, at
least some of the cameo

1116
00:56:01.103 --> 00:56:03.108
of the vignette, so what do you do?

1117
00:56:03.108 --> 00:56:04.930
Who's the client?

1118
00:56:04.930 --> 00:56:05.945
Some of you are familiar with this.

1119
00:56:05.945 --> 00:56:09.404
This is my model that I try to use

1120
00:56:09.404 --> 00:56:11.232
when thinking about, this is the client.

1121
00:56:11.232 --> 00:56:12.095
So who's the client?

1122
00:56:12.095 --> 00:56:13.284
Is it just Maria?

1123
00:56:13.284 --> 00:56:14.179
And what about Carlos?

1124
00:56:14.179 --> 00:56:15.978
What about the whole family?

1125
00:56:15.978 --> 00:56:17.744
It could be an individual as a client,

1126
00:56:17.744 --> 00:56:20.455
it could be the couple,
it could be the family.

1127
00:56:20.455 --> 00:56:22.188
I would argue that it was the whole family

1128
00:56:22.188 --> 00:56:23.357
that was my client.

1129
00:56:24.614 --> 00:56:25.940
With every given client,

1130
00:56:25.940 --> 00:56:29.079
we need to pay attention to diversity,

1131
00:56:30.340 --> 00:56:31.703
let's see if that shows up here,

1132
00:56:32.707 --> 00:56:33.992
health trauma and addictions,

1133
00:56:35.376 --> 00:56:39.366
basic developmental themes,
family and community,

1134
00:56:39.366 --> 00:56:42.410
social policy and research,
sociopolitical context,

1135
00:56:42.410 --> 00:56:43.199
and ethics.

1136
00:56:43.199 --> 00:56:44.760
Does that make sense?

1137
00:56:44.760 --> 00:56:47.282
That with every single client,

1138
00:56:47.282 --> 00:56:49.813
we need to be mindful of these things

1139
00:56:49.813 --> 00:56:52.033
as well as, guess what,

1140
00:56:52.033 --> 00:56:54.715
the client is interacting with us.

1141
00:56:54.715 --> 00:56:58.429
So as clinicians, we're influencing this

1142
00:56:58.429 --> 00:57:00.333
therapeutic alliance
at every given moment.

1143
00:57:00.333 --> 00:57:03.817
We need to be mindful of all
of these factors as well.

1144
00:57:05.453 --> 00:57:08.285
So going back to the case,

1145
00:57:08.285 --> 00:57:10.061
if you were thinking of what would you do,

1146
00:57:10.061 --> 00:57:11.349
how would you assess,

1147
00:57:11.349 --> 00:57:13.413
and what theory models
would you draw from?

1148
00:57:15.204 --> 00:57:19.884
Did you hear in the
description with Maria?

1149
00:57:19.884 --> 00:57:24.884
With her sense, her
nightmares, her flashbacks,

1150
00:57:26.189 --> 00:57:30.276
her hopelessness, her
irritability, her hyper-arousal?

1151
00:57:30.276 --> 00:57:33.073
You're hearing pull for
trauma theory right?

1152
00:57:33.073 --> 00:57:34.453
Pulls for trauma theory.

1153
00:57:34.453 --> 00:57:36.844
Are you hearing the incredible
relationship disruptions

1154
00:57:36.844 --> 00:57:40.435
and the sense of
estrangement that pulls for

1155
00:57:40.435 --> 00:57:41.556
attachment theory?

1156
00:57:42.735 --> 00:57:46.097
Are you hearing the
alienation they have again

1157
00:57:47.343 --> 00:57:50.331
with their loved, their
families of origin.

1158
00:57:50.331 --> 00:57:52.254
They're no longer talking to them.

1159
00:57:52.254 --> 00:57:55.495
The family theory comes to mind.

1160
00:57:56.721 --> 00:58:00.185
If you think of how we try
to use the multiplicity

1161
00:58:00.185 --> 00:58:02.419
of theory models, it's not random.

1162
00:58:02.419 --> 00:58:05.253
It's actually based on what
are the presenting issues

1163
00:58:05.253 --> 00:58:07.701
and then pulling from the
different theory models.

1164
00:58:09.238 --> 00:58:11.491
So why do we care about
psycho-dynamic theory?

1165
00:58:11.491 --> 00:58:14.256
At least in this line of work,

1166
00:58:14.256 --> 00:58:16.850
if we really believe that
there are certain patterns

1167
00:58:16.850 --> 00:58:18.360
that are established in childhood,

1168
00:58:18.360 --> 00:58:19.671
that they're gonna influence

1169
00:58:19.671 --> 00:58:22.491
both strengths and
vulnerabilities in later life.

1170
00:58:22.491 --> 00:58:26.293
That will affect how our
female service members

1171
00:58:26.293 --> 00:58:28.640
are going to navigate these stressors.

1172
00:58:30.119 --> 00:58:31.994
Empowering the unconscious, and then

1173
00:58:31.994 --> 00:58:32.755
this is very important,

1174
00:58:32.755 --> 00:58:35.379
it's the unique meaning of a
narrative of an individual.

1175
00:58:35.379 --> 00:58:37.385
Rather than assuming in many settings

1176
00:58:38.573 --> 00:58:40.831
the treatment programs
are symptom-related.

1177
00:58:40.831 --> 00:58:45.334
So if a client has a
symptom picture of PTSD,

1178
00:58:46.990 --> 00:58:51.990
then they may be recommended
to particular protocol

1179
00:58:52.876 --> 00:58:55.157
that focuses on PTSD.

1180
00:58:55.157 --> 00:58:58.364
It might be cognitive processing
treatment, it might be CDT,

1181
00:58:58.364 --> 00:58:59.560
which is, would be fine.

1182
00:58:59.560 --> 00:59:03.090
Except you need to find out
what's the unique meaning

1183
00:59:03.090 --> 00:59:05.213
of the experience for the individual,

1184
00:59:05.213 --> 00:59:07.552
rather than just focusing
on symptom picture,

1185
00:59:07.552 --> 00:59:08.713
who's the individual?

1186
00:59:08.713 --> 00:59:11.348
Transfer and
counter-transference is pivotal

1187
00:59:11.348 --> 00:59:15.436
because it tells us how we
are reflecting on the work

1188
00:59:15.436 --> 00:59:17.011
and what role that has on the work.

1189
00:59:18.396 --> 00:59:20.882
I use attachment theory
regularly with this population

1190
00:59:20.882 --> 00:59:22.479
because it doesn't make sense that

1191
00:59:22.479 --> 00:59:24.998
with all the separations and reunions

1192
00:59:24.998 --> 00:59:27.121
and disengagements and re-attachments

1193
00:59:27.121 --> 00:59:29.966
that under the best of circumstances,

1194
00:59:29.966 --> 00:59:33.297
this couple, that couple,
had a secure attachment.

1195
00:59:33.297 --> 00:59:35.425
It was earned security.

1196
00:59:35.425 --> 00:59:37.779
Maria had more of a
disorganized attachment.

1197
00:59:38.886 --> 00:59:40.984
I'm gonna move through
this pretty quickly,

1198
00:59:40.984 --> 00:59:44.041
but if those of you who
are somewhat familiar

1199
00:59:44.041 --> 00:59:47.290
with attachment theory, you
realize that there are either

1200
00:59:47.290 --> 00:59:50.353
secure or insecure
internal attachment models.

1201
00:59:52.322 --> 00:59:53.923
This organized and disorganized

1202
00:59:53.923 --> 00:59:55.758
what Maria was dealing with as a child.

1203
00:59:55.758 --> 00:59:58.699
She had a relatively secure
attachment with Carlos

1204
00:59:58.699 --> 01:00:02.308
by the time she went off to deployment.

1205
01:00:02.308 --> 01:00:07.308
Their attachment systems were disregulated

1206
01:00:07.432 --> 01:00:11.832
based on the numbers of
stressors that bombarded them.

1207
01:00:14.074 --> 01:00:16.408
This is an important construct,

1208
01:00:16.408 --> 01:00:18.004
the interference with mentalization.

1209
01:00:19.541 --> 01:00:21.597
The part of attachment
theory that's a capacity

1210
01:00:21.597 --> 01:00:24.082
to actually be aware of one's feelings

1211
01:00:24.082 --> 01:00:26.554
and reflect upon them and
then be able to attune

1212
01:00:26.554 --> 01:00:28.347
to the feelings of other people,

1213
01:00:28.347 --> 01:00:33.347
and also reflect upon them
so that there's a capacity

1214
01:00:33.468 --> 01:00:36.080
to make sense of it in meaning making.

1215
01:00:36.080 --> 01:00:38.976
When there are enough combat
and deployment stressors,

1216
01:00:38.976 --> 01:00:42.741
this process, mentalization,
breaks down as well.

1217
01:00:42.741 --> 01:00:45.204
Think again, this is what gets interrupted

1218
01:00:45.204 --> 01:00:48.024
when you have enough stress,

1219
01:00:48.024 --> 01:00:51.219
the care-seeking of
attachment breaks down.

1220
01:00:51.219 --> 01:00:52.936
People don't always seek care.

1221
01:00:52.936 --> 01:00:54.294
Remember with Carlos?

1222
01:00:54.294 --> 01:00:55.917
He wasn't seeking any care,

1223
01:00:55.917 --> 01:00:58.842
she wasn't seeking any
care from each other.

1224
01:00:58.842 --> 01:01:01.585
They're not offering a
safe haven to each other.

1225
01:01:01.585 --> 01:01:04.501
There's no curiosity and
this is a crucial one.

1226
01:01:04.501 --> 01:01:06.916
The circle of security is broken,

1227
01:01:06.916 --> 01:01:10.305
that sense of connecting
back to the person

1228
01:01:10.305 --> 01:01:14.084
who or people who are most important

1229
01:01:14.084 --> 01:01:16.570
in terms of providing
comfort and security.

1230
01:01:18.840 --> 01:01:20.325
How about another model for a moment?

1231
01:01:20.325 --> 01:01:22.782
Why do we care about Winnetka?

1232
01:01:22.782 --> 01:01:25.363
First of all, Donald and Claire Winnetka

1233
01:01:25.363 --> 01:01:29.459
focused their entire careers
in early World War II

1234
01:01:29.459 --> 01:01:31.514
in helping children survive the blitz.

1235
01:01:31.514 --> 01:01:34.542
They took them to homes
outside in the countryside.

1236
01:01:35.836 --> 01:01:37.599
One would think, well would
they still be traumatized?

1237
01:01:37.599 --> 01:01:38.969
Because they were taken
away from their families?

1238
01:01:38.969 --> 01:01:41.117
No, because they provided homes

1239
01:01:41.117 --> 01:01:43.646
that had a good enough holding environment

1240
01:01:43.646 --> 01:01:46.734
and good enough mothering,
concepts from his model,

1241
01:01:46.734 --> 01:01:49.160
that helped to sustain them.

1242
01:01:49.160 --> 01:01:51.705
When reunited with their
families back in London,

1243
01:01:51.705 --> 01:01:55.949
they navigated those
separations quite well.

1244
01:01:59.741 --> 01:02:03.513
Victim, victimized, or
by-stander, why is this relevant?

1245
01:02:03.513 --> 01:02:05.673
Anyone who has suffered trauma

1246
01:02:05.673 --> 01:02:08.713
would know what it's like to be a victim.

1247
01:02:08.713 --> 01:02:10.304
You've had somebody who's offended you

1248
01:02:10.304 --> 01:02:11.395
and there's usually a by-stander

1249
01:02:11.395 --> 01:02:12.918
who hasn't done much of anything.

1250
01:02:15.081 --> 01:02:16.348
Why is that important?

1251
01:02:16.348 --> 01:02:19.310
Because in families, if
you think of Antonio,

1252
01:02:19.310 --> 01:02:21.964
go back to, no, Carlos.

1253
01:02:21.964 --> 01:02:25.507
Carlos the husband felt
like a helpless victim.

1254
01:02:25.507 --> 01:02:30.429
He felt victimized by his partner.

1255
01:02:30.429 --> 01:02:33.354
She felt victimized as well.

1256
01:02:33.354 --> 01:02:35.316
Neither of them were really recognizing

1257
01:02:35.316 --> 01:02:38.577
that they were aggressive
in victimizing each other.

1258
01:02:38.577 --> 01:02:42.218
These themes are important in
families as well as for us.

1259
01:02:45.070 --> 01:02:46.079
As long as we reflect,

1260
01:02:46.079 --> 01:02:48.430
we have a better chance
of helping our clients.

1261
01:02:50.074 --> 01:02:51.292
Back to the practice approaches

1262
01:02:51.292 --> 01:02:53.334
that those of you who work
in the Department of Defense

1263
01:02:53.334 --> 01:02:56.295
and VA settings, these are
probably familiar to you.

1264
01:02:56.295 --> 01:02:58.536
These are considered the
gold standard treatments

1265
01:02:58.536 --> 01:03:03.536
for PTSD and depression,
cognitive behavioral work,

1266
01:03:03.714 --> 01:03:05.793
cognitive processing
treatment, prolonged exposure.

1267
01:03:05.793 --> 01:03:08.256
They're all CBT models.

1268
01:03:08.256 --> 01:03:11.130
They all have very strong validity.

1269
01:03:12.332 --> 01:03:17.332
However, imagine with Carlos and Maria.

1270
01:03:18.774 --> 01:03:21.842
Can you imagine them focusing exclusively

1271
01:03:21.842 --> 01:03:23.676
on these models without paying attention

1272
01:03:23.676 --> 01:03:26.096
to couple and family
therapy and other methods.

1273
01:03:28.401 --> 01:03:31.442
What I want to, well let me
go back to this for a moment.

1274
01:03:31.442 --> 01:03:33.837
Just propose why would we
want to work with families

1275
01:03:33.837 --> 01:03:37.345
because I'm arguing with this need

1276
01:03:37.345 --> 01:03:39.636
for actually working
with this entire family.

1277
01:03:39.636 --> 01:03:42.097
And that's to promote secure attachments.

1278
01:03:42.097 --> 01:03:43.965
We help them reconnect,

1279
01:03:43.965 --> 01:03:46.775
reduce the mental health symptomotology,

1280
01:03:46.775 --> 01:03:48.946
minimize secondary trauma,

1281
01:03:48.946 --> 01:03:50.111
help them with learning more,

1282
01:03:50.111 --> 01:03:52.552
and then restoring a
sense of reconnection,

1283
01:03:52.552 --> 01:03:53.683
social vindication.

1284
01:03:55.001 --> 01:03:57.359
So this is a trauma informed
model that I've been working on

1285
01:03:57.359 --> 01:04:00.471
that's geared to military
and veteran families.

1286
01:04:02.830 --> 01:04:04.630
It's similar to a lot
of trauma inform models

1287
01:04:04.630 --> 01:04:07.383
where the first stage if
safety, stabilization.

1288
01:04:07.383 --> 01:04:09.555
Second, reflection on
the trauma narrative.

1289
01:04:09.555 --> 01:04:12.573
Third, consolidation of new perspectives.

1290
01:04:12.573 --> 01:04:15.932
But what I'm going to emphasize
is the attachment piece

1291
01:04:15.932 --> 01:04:20.932
because getting back to the
case of Carlos and Maria.

1292
01:04:22.358 --> 01:04:24.017
They needed to have a sense

1293
01:04:24.017 --> 01:04:25.863
that there was a safe environment at home

1294
01:04:25.863 --> 01:04:27.419
because you hear the volatility?

1295
01:04:27.419 --> 01:04:28.197
Wasn't clear to me

1296
01:04:28.197 --> 01:04:30.365
if there was intimate
partner violence or not.

1297
01:04:30.365 --> 01:04:32.621
Had to do a risk assessment
to establish safety.

1298
01:04:33.940 --> 01:04:35.955
The whole realm of self-care was crucial.

1299
01:04:37.692 --> 01:04:40.828
The affect regulation was just thrown off

1300
01:04:40.828 --> 01:04:43.441
not only for Maria who
was the combat veteran.

1301
01:04:43.441 --> 01:04:45.776
but for her husband.

1302
01:04:45.776 --> 01:04:46.553
Does that make sense?

1303
01:04:46.553 --> 01:04:49.343
In their years where
they had more stability,

1304
01:04:49.343 --> 01:04:52.639
they were able to relate
in really harmonious ways

1305
01:04:52.639 --> 01:04:54.880
and to be able to self-soothe

1306
01:04:54.880 --> 01:04:56.844
and to be able to manage their emotions

1307
01:04:56.844 --> 01:05:00.564
without having these incredible
ups and down, rage storms.

1308
01:05:00.564 --> 01:05:03.514
This feature was absolutely critical.

1309
01:05:03.514 --> 01:05:07.808
The bio-behavioral strategies
for stress reduction,

1310
01:05:07.808 --> 01:05:12.199
that's repeated there, I guess
I'm trying to make the point.

1311
01:05:14.226 --> 01:05:16.357
Stress reduction,
self-soothing after regulation.

1312
01:05:16.357 --> 01:05:18.721
This couple was completely disregulated

1313
01:05:18.721 --> 01:05:21.977
so this was the major
focus of the self-care.

1314
01:05:23.840 --> 01:05:27.193
In addition, in this
early phase of the work,

1315
01:05:27.193 --> 01:05:28.882
remember the physical health?

1316
01:05:28.882 --> 01:05:30.449
Neither of them were sleeping.

1317
01:05:30.449 --> 01:05:32.227
Not just Maria.

1318
01:05:32.227 --> 01:05:33.330
Carlos wasn't sleeping

1319
01:05:33.330 --> 01:05:36.615
and the little one, Anna, wasn't sleeping.

1320
01:05:36.616 --> 01:05:38.612
Delia was wetting her bed.

1321
01:05:38.612 --> 01:05:40.352
The only one sleeping was Antonio.

1322
01:05:40.352 --> 01:05:43.351
The whole household had
problems with physical health.

1323
01:05:43.351 --> 01:05:45.779
Mental health, you heard the issues.

1324
01:05:45.779 --> 01:05:48.577
Maria needed to have a
referral for a psychiatrist

1325
01:05:48.577 --> 01:05:52.537
to see if she needed help
with sleep, depression,

1326
01:05:52.537 --> 01:05:55.760
check out any possible suicidality.

1327
01:05:55.760 --> 01:05:58.085
She was also drinking
several glasses of wine,

1328
01:05:58.085 --> 01:06:00.127
two or three, four
glasses of wine a night.

1329
01:06:00.127 --> 01:06:03.972
So had to be checked.

1330
01:06:03.972 --> 01:06:08.185
This is where you can pull
in, if you are the clinician

1331
01:06:08.185 --> 01:06:13.185
who's actually providing the support.

1332
01:06:13.373 --> 01:06:14.528
At this moment, you're providing

1333
01:06:14.528 --> 01:06:16.069
a supportive psychotherapy role.

1334
01:06:16.069 --> 01:06:18.285
You're doing a extended assessment

1335
01:06:18.285 --> 01:06:19.794
and building a therapeutic alliance

1336
01:06:19.794 --> 01:06:22.675
while connecting with this
whole cast of characters.

1337
01:06:22.675 --> 01:06:25.276
The psychiatrist,
physicians, nutritionists,

1338
01:06:25.276 --> 01:06:27.345
other clinicians who are working.

1339
01:06:27.345 --> 01:06:30.213
The school system who
are the school counselors

1340
01:06:30.213 --> 01:06:33.516
who are dealing with the
children who are suffering.

1341
01:06:38.179 --> 01:06:40.650
Psycho-education
regarding post-deployment.

1342
01:06:40.650 --> 01:06:44.552
This is also a piece of this
for many of couples then,

1343
01:06:44.552 --> 01:06:47.930
the partners need just basic understanding

1344
01:06:47.930 --> 01:06:49.127
of some of the stressors

1345
01:06:49.127 --> 01:06:50.726
that they may have been dealing with.

1346
01:06:52.671 --> 01:06:56.363
So once again, it's understanding safety

1347
01:06:56.363 --> 01:06:59.360
and developing in
attachment theory language.

1348
01:06:59.360 --> 01:07:01.497
What they were doing is developing

1349
01:07:01.497 --> 01:07:04.841
secure attachments and
re-connections once again

1350
01:07:04.841 --> 01:07:06.192
so they're able to move on.

1351
01:07:07.221 --> 01:07:11.863
Moving on means actually trying to address

1352
01:07:11.863 --> 01:07:15.054
some of the traumatic experiences.

1353
01:07:15.054 --> 01:07:18.014
At that point, Maria is ready for being,

1354
01:07:18.014 --> 01:07:20.301
for entering cognitive
processing treatment.

1355
01:07:20.301 --> 01:07:22.716
She's in a position
where she's stable enough

1356
01:07:22.716 --> 01:07:26.311
to be able to withstand
recalling the content

1357
01:07:26.311 --> 01:07:28.437
of the horrific traumatic events.

1358
01:07:28.437 --> 01:07:31.930
So Maria gets her own
individual therapist.

1359
01:07:31.930 --> 01:07:34.010
But what do we do in couples therapy?

1360
01:07:35.180 --> 01:07:38.114
She starts to talk about
how devastated she was

1361
01:07:38.114 --> 01:07:41.677
of being lost and not having
any role in her family,

1362
01:07:41.677 --> 01:07:44.037
of losing her husband,
losing her children,

1363
01:07:44.037 --> 01:07:47.537
losing her sense of being a
soldier, wanting to be dead.

1364
01:07:49.202 --> 01:07:54.148
He then becomes Carlos, much
more compassionate because

1365
01:07:54.148 --> 01:07:57.108
at this point, they are
starting to talk to each other

1366
01:07:57.108 --> 01:07:58.779
and talk about how
they've missed each other,

1367
01:07:58.779 --> 01:08:00.382
how they've lost each other.

1368
01:08:00.382 --> 01:08:05.109
The grieving, this is
a phase of grieving and

1369
01:08:05.109 --> 01:08:06.826
it's not just sharing of trauma events,

1370
01:08:06.826 --> 01:08:09.126
it's the grieving of those experiences

1371
01:08:09.126 --> 01:08:13.004
and the grieving of whatever
was lost during the deployment,

1372
01:08:13.004 --> 01:08:14.984
the lost years with these children.

1373
01:08:16.430 --> 01:08:18.774
So this couple was actually able to go

1374
01:08:18.774 --> 01:08:21.199
from a sense of bitter estrangement

1375
01:08:21.199 --> 01:08:24.274
to really connecting with
each other in a powerful way.

1376
01:08:25.775 --> 01:08:26.948
Why does this matter?

1377
01:08:26.948 --> 01:08:29.282
The pattern of victim,
victimized, by-stander?

1378
01:08:30.551 --> 01:08:33.771
They were each blaming the other.

1379
01:08:33.771 --> 01:08:36.394
She kept saying to him
that he seemed so passive

1380
01:08:36.394 --> 01:08:38.693
and hopeless and helpless
and she couldn't stand it.

1381
01:08:38.693 --> 01:08:40.517
He kept saying she was
so agitated and angry

1382
01:08:40.517 --> 01:08:44.417
and furious and hard to be
around, he couldn't stand it.

1383
01:08:44.417 --> 01:08:48.411
So they were unable to
tolerate the other's qualities

1384
01:08:48.411 --> 01:08:51.051
and they were victimizing
each other constantly

1385
01:08:51.051 --> 01:08:52.837
back-and-forth,
back-and-forth, back-and-forth,

1386
01:08:52.837 --> 01:08:55.855
back-and-forth and ultimately
as they were talking about

1387
01:08:55.855 --> 01:08:59.652
what they had lost, what
they felt they had grieved,

1388
01:08:59.652 --> 01:09:02.090
they were able to then actually

1389
01:09:02.090 --> 01:09:04.190
establish more of a connection.

1390
01:09:04.190 --> 01:09:06.674
He said to her that he
hated her bitterness.

1391
01:09:06.674 --> 01:09:10.099
That she'd become a bitter
old woman, old, she's like 38.

1392
01:09:10.099 --> 01:09:12.038
Bitter old woman who
he just couldn't stand

1393
01:09:12.038 --> 01:09:13.755
being around anymore.

1394
01:09:13.755 --> 01:09:16.140
And she also, another
part of this that happens

1395
01:09:16.140 --> 01:09:18.999
with a lot of combat veterans,
and I think it's this

1396
01:09:18.999 --> 01:09:21.602
important phenomenon, she had a lot of,

1397
01:09:21.602 --> 01:09:26.218
she just hadn't sounded so
racist and bigoted before.

1398
01:09:26.218 --> 01:09:28.981
But she certainly did after combat.

1399
01:09:28.981 --> 01:09:31.220
She only had vicious
things to say about anybody

1400
01:09:31.220 --> 01:09:34.262
who looked as if they had
Middle-Eastern ancestry,

1401
01:09:34.262 --> 01:09:38.350
ethnicity, and family background.

1402
01:09:38.350 --> 01:09:42.150
She would hurl all these nasty comments

1403
01:09:42.150 --> 01:09:44.917
and really sound quite vicious.

1404
01:09:46.063 --> 01:09:47.686
He said he couldn't live with somebody

1405
01:09:47.686 --> 01:09:51.354
who was so vile and so hateful.

1406
01:09:51.354 --> 01:09:54.166
As she kept talking about what happened

1407
01:09:54.166 --> 01:09:57.775
when she saw this young
man killed in holding her,

1408
01:09:57.775 --> 01:10:00.275
in her arms, she said,
"I hate all of them.

1409
01:10:00.275 --> 01:10:01.513
"I hate them, I hate them."

1410
01:10:02.958 --> 01:10:03.958
Then he said to her,

1411
01:10:03.958 --> 01:10:07.371
"Why are you hating an
entire group of people?

1412
01:10:07.371 --> 01:10:10.238
"When one person, one person, killed?

1413
01:10:10.238 --> 01:10:13.112
"And even that one person is just a human

1414
01:10:13.112 --> 01:10:15.597
"who was fighting just the
way you were fighting?"

1415
01:10:17.062 --> 01:10:21.511
She then sank into a state
of tremendous sadness

1416
01:10:21.511 --> 01:10:26.059
and helplessness and
powerlessness and fear and anxiety

1417
01:10:26.059 --> 01:10:29.763
and reowned, she reowned what
had been projected onto him

1418
01:10:29.763 --> 01:10:33.389
as being helpless and
frightened and insecure.

1419
01:10:34.825 --> 01:10:36.993
So do you hear the unpacking of the,

1420
01:10:36.993 --> 01:10:39.953
there was an unpacking
of racialized hatred.

1421
01:10:39.953 --> 01:10:42.100
Because if people are
trained to see the enemy

1422
01:10:42.100 --> 01:10:46.279
as bad and evil, and good and
bad, and you kill the enemy,

1423
01:10:46.279 --> 01:10:49.079
don't expect that to change necessarily

1424
01:10:49.079 --> 01:10:50.849
automatically upon homecoming.

1425
01:10:52.099 --> 01:10:55.661
Some of those, sort
of, deep-seeded beliefs

1426
01:10:55.661 --> 01:10:57.855
can really settle in.

1427
01:10:57.855 --> 01:10:59.875
Fortunately hers was not that deep-seeded.

1428
01:10:59.875 --> 01:11:03.631
It was the unpacking, the
hatred, was tying in with her

1429
01:11:03.631 --> 01:11:06.058
inability to stick with her powerlessness.

1430
01:11:07.166 --> 01:11:09.407
For him, what was interesting,
what was he disowning?

1431
01:11:09.407 --> 01:11:11.659
He was disowning his aggression.

1432
01:11:11.659 --> 01:11:15.339
He couldn't recognize how
furious he was with her.

1433
01:11:15.339 --> 01:11:16.978
He was sick of having this wife

1434
01:11:16.978 --> 01:11:19.440
who had seemed so unavailable to him

1435
01:11:19.440 --> 01:11:22.540
and he was furious, from his perspective,

1436
01:11:22.540 --> 01:11:24.504
stuck with having to take
care of the three children

1437
01:11:24.504 --> 01:11:26.979
while she was gone and
nobody complimented him

1438
01:11:26.979 --> 01:11:29.104
on what a good job he had done.

1439
01:11:29.104 --> 01:11:33.538
So this period then continued
on with a lot of discussion

1440
01:11:33.538 --> 01:11:38.196
about the rage, his rage,
and his frustration.

1441
01:11:38.196 --> 01:11:39.439
So do you see the unpacking

1442
01:11:39.439 --> 01:11:43.280
and the levels of shared
expression of their feelings

1443
01:11:43.280 --> 01:11:45.415
which are absolutely critical for them

1444
01:11:45.415 --> 01:11:49.808
to be able to move to a more
of a state of reconnection?

1445
01:11:49.808 --> 01:11:53.952
So their attachments were
beginning to rebuilt.

1446
01:11:53.952 --> 01:11:56.537
They began to empathize
more with each other,

1447
01:11:56.537 --> 01:11:59.656
grieve together and one
of the healing rituals

1448
01:11:59.656 --> 01:12:03.325
had to do with her openness to accept.

1449
01:12:03.325 --> 01:12:06.611
She was awarded a medal, a Purple Heart,

1450
01:12:06.611 --> 01:12:09.710
for some of her, said of her heroism.

1451
01:12:09.710 --> 01:12:11.858
She said, "I'm not a hero.

1452
01:12:11.858 --> 01:12:12.916
"Not a hero at all.

1453
01:12:12.916 --> 01:12:15.206
"I don't want it, throw it out."

1454
01:12:15.206 --> 01:12:17.259
So ultimately they had long conversations

1455
01:12:17.259 --> 01:12:19.233
about what that might mean

1456
01:12:19.233 --> 01:12:22.704
and moving along to
another phase of the work

1457
01:12:22.704 --> 01:12:24.491
where her social identity,

1458
01:12:24.491 --> 01:12:29.491
this is where she could
sense that as a veteran,

1459
01:12:29.589 --> 01:12:32.283
that she was going to move
from being the service member

1460
01:12:32.283 --> 01:12:35.952
to veteran, that she would
feel honored by actually

1461
01:12:35.952 --> 01:12:38.066
accepting her award.

1462
01:12:43.546 --> 01:12:45.833
This is something to think about.

1463
01:12:45.833 --> 01:12:46.672
See where we are?

1464
01:12:46.672 --> 01:12:49.365
Maybe all of the above might
be in terms of doing this work.

1465
01:12:52.119 --> 01:12:55.779
But what I would like
to say at the end here,

1466
01:12:55.779 --> 01:12:57.902
to think of this, just thinking of

1467
01:12:57.902 --> 01:13:01.006
why do we focus on this work
and why is it so important?

1468
01:13:02.246 --> 01:13:04.288
It seemed to me that

1469
01:13:04.288 --> 01:13:06.413
as long as we just recognize
that a client is what,

1470
01:13:06.413 --> 01:13:08.157
Winnetka would just say there's
no such thing as a baby,

1471
01:13:08.157 --> 01:13:09.774
that's just a nursing couple.

1472
01:13:09.774 --> 01:13:12.296
There's no such thing as just
a solitary service member.

1473
01:13:13.926 --> 01:13:15.288
There's always, the service member always

1474
01:13:15.288 --> 01:13:17.101
has to be understood in the context to

1475
01:13:17.101 --> 01:13:20.224
whoever his or her family would be

1476
01:13:20.224 --> 01:13:22.298
or people who are important to her.

1477
01:13:24.219 --> 01:13:26.967
The context is absolutely crucial.

1478
01:13:26.967 --> 01:13:30.410
If we can be holding onto complexity

1479
01:13:30.410 --> 01:13:33.071
and thoughtfulness in
working with this population,

1480
01:13:33.071 --> 01:13:36.087
we can recognize the need to have

1481
01:13:38.215 --> 01:13:41.293
the relationship as the
underpinning of the work.

1482
01:13:41.293 --> 01:13:44.614
That allows for us to move
slowly, going back to the idea,

1483
01:13:44.614 --> 01:13:46.099
if we could wait for the client

1484
01:13:46.099 --> 01:13:48.316
to tell us what the clients really need

1485
01:13:48.316 --> 01:13:50.094
and the pacing of the work.

1486
01:13:50.094 --> 01:13:52.261
So that they will then help to define,

1487
01:13:52.261 --> 01:13:53.682
what do they need first?

1488
01:13:53.682 --> 01:13:55.724
It's always self-care, safety,

1489
01:13:55.724 --> 01:13:59.300
stabilization first and then
moving into different layers

1490
01:13:59.300 --> 01:14:02.576
and different levels of
complexity that they can bear.

1491
01:14:02.576 --> 01:14:04.514
So that they can reconnect in ways

1492
01:14:04.514 --> 01:14:07.534
that will really be powerful.

1493
01:14:07.534 --> 01:14:10.160
I would say, I would say
that that's our charge

1494
01:14:10.160 --> 01:14:11.418
with this population

1495
01:14:11.418 --> 01:14:14.299
and I think we will
make quite a difference

1496
01:14:14.299 --> 01:14:18.677
for many success of generations
of children if we do so.

1497
01:14:18.677 --> 01:14:20.452
So, I thank you.

1498
01:14:20.452 --> 01:14:24.405
(applause)

1499
01:14:31.935 --> 01:14:36.935
So are there any comments
or questions or reactions?

1500
01:14:42.246 --> 01:14:43.407
Yeah, Seth?

1501
01:14:43.407 --> 01:14:47.766
(audience member speaking inaudibly)

1502
01:15:26.201 --> 01:15:27.618
Yeah, well I'd be curious and

1503
01:15:27.618 --> 01:15:29.382
if there are ideas from the group as well.

1504
01:15:29.382 --> 01:15:31.230
But my senses, even with this case,

1505
01:15:31.230 --> 01:15:32.136
I didn't highlight that.

1506
01:15:32.136 --> 01:15:34.634
But actually for her, as a reservist,

1507
01:15:34.634 --> 01:15:37.492
she was cut off from the
members of her union.

1508
01:15:37.492 --> 01:15:38.956
Part of that was her detachment.

1509
01:15:38.956 --> 01:15:41.233
She didn't wanna talk with people.

1510
01:15:41.233 --> 01:15:43.495
It was part of her avoidance.

1511
01:15:43.495 --> 01:15:47.645
So a good part of the work
was for her to think about

1512
01:15:47.645 --> 01:15:50.675
how important those people were to her

1513
01:15:50.675 --> 01:15:53.612
during deployment and
she started to reconnect.

1514
01:15:53.612 --> 01:15:54.878
But then, if there are some people

1515
01:15:54.878 --> 01:15:57.157
who are not gonna be
reconnecting with their,

1516
01:15:57.157 --> 01:15:59.476
the people they actually
cared about, but even

1517
01:15:59.476 --> 01:16:04.058
the connection with other
veterans can be so powerful.

1518
01:16:04.058 --> 01:16:06.975
That that's early on.

1519
01:16:06.975 --> 01:16:10.589
People often think that before
people enter into treatment,

1520
01:16:10.589 --> 01:16:13.713
if they need different
types of psychotherapies,

1521
01:16:13.713 --> 01:16:17.009
they often do very well to that.

1522
01:16:17.009 --> 01:16:20.971
Then that often had a
sense of shared experience,

1523
01:16:20.971 --> 01:16:23.968
even if they weren't deployed together.

1524
01:16:23.968 --> 01:16:26.021
But I'm curious, are there
anybody in the audience

1525
01:16:26.021 --> 01:16:27.699
who would speak to that?

1526
01:16:29.748 --> 01:16:30.990
For those of you who have?

1527
01:16:39.376 --> 01:16:40.662
Okay, any other?

1528
01:16:44.254 --> 01:16:48.626
(audience member speaking inaudibly)

1529
01:17:01.600 --> 01:17:02.655
Oh okay, well that part of the

1530
01:17:02.655 --> 01:17:04.844
victim, victimized, or by-stander scenario

1531
01:17:04.844 --> 01:17:07.044
is one to think about because that's,

1532
01:17:07.044 --> 01:17:08.595
that resonates regularly

1533
01:17:08.595 --> 01:17:10.423
with working with traumatized clients.

1534
01:17:12.111 --> 01:17:13.902
Just to give you an example,

1535
01:17:13.902 --> 01:17:16.130
my work, mine was the work as a couple,

1536
01:17:16.130 --> 01:17:19.987
family therapist, and again,
it's disguised in composite

1537
01:17:19.987 --> 01:17:22.130
but it has elements of the actual case.

1538
01:17:23.716 --> 01:17:26.119
So I would reverberate back and forth

1539
01:17:26.119 --> 01:17:28.904
from feeling a sense of helplessness

1540
01:17:28.904 --> 01:17:31.842
in thinking this family
seems so devastated.

1541
01:17:31.842 --> 01:17:35.138
The children were so, they
were suffering so badly,

1542
01:17:35.138 --> 01:17:38.379
that I was glad that I had
listened to the history

1543
01:17:38.379 --> 01:17:40.586
and that's always important,
to get a full history

1544
01:17:40.586 --> 01:17:41.946
because that's what made me realize

1545
01:17:41.946 --> 01:17:43.929
they had tremendous promise.

1546
01:17:43.929 --> 01:17:46.223
So I was struggling with
should I just give up?

1547
01:17:46.223 --> 01:17:51.223
Or I could send this couple
or family to another client,

1548
01:17:51.363 --> 01:17:53.136
send the clients to another clinician.

1549
01:17:53.136 --> 01:17:57.281
That's the typical helplessness
that we can resonate with.

1550
01:17:57.281 --> 01:17:59.685
Then the sense of victimizing.

1551
01:17:59.685 --> 01:18:01.299
Just feeling really frustrated,

1552
01:18:01.299 --> 01:18:03.702
I would get very angry with
her when she would start making

1553
01:18:03.702 --> 01:18:07.894
really, she would curse all
the time really nasty, bigoted,

1554
01:18:07.894 --> 01:18:10.181
offensive remarks and I
would get annoyed with her.

1555
01:18:10.181 --> 01:18:12.499
Then I would think, alright, unpack it.

1556
01:18:12.499 --> 01:18:14.830
You need to pay attention,
what is she really saying?

1557
01:18:14.830 --> 01:18:16.592
What's beneath the vitreal?

1558
01:18:19.637 --> 01:18:21.261
The by-stander, as the social workers,

1559
01:18:21.261 --> 01:18:21.987
we have to be careful.

1560
01:18:21.987 --> 01:18:23.927
We don't just try to
jump in and rescue people

1561
01:18:23.927 --> 01:18:27.527
and try to make nice and
have it all be taken care of.

1562
01:18:27.527 --> 01:18:30.467
So that's a typical
counter-transference response.

1563
01:18:30.467 --> 01:18:33.104
Then the more detached
by-stander is a scary one

1564
01:18:33.104 --> 01:18:36.610
because we can be susceptible
to secondary trauma.

1565
01:18:36.610 --> 01:18:39.887
I talked about so, that
zoning out detachment.

1566
01:18:39.887 --> 01:18:43.824
If you're planning your next vacation

1567
01:18:43.824 --> 01:18:45.928
while you're sitting working
with a family like this,

1568
01:18:45.928 --> 01:18:49.551
that's a clue of
counter-transference enactments.

1569
01:18:49.551 --> 01:18:52.048
So usually enactments have to
have an action component to it

1570
01:18:52.048 --> 01:18:53.502
of doing something.

1571
01:18:53.502 --> 01:18:56.288
Usually if we just sit quietly
and have the experience

1572
01:18:56.288 --> 01:18:57.507
then we could try to catch it.

1573
01:18:57.507 --> 01:18:58.753
That was part of the self-reflection

1574
01:18:58.753 --> 01:19:00.994
so we don't inflict it on the clients.

1575
01:19:00.994 --> 01:19:02.667
But even when there's an enactment,

1576
01:19:02.667 --> 01:19:03.734
sometimes that can be helpful.

1577
01:19:03.734 --> 01:19:05.438
Because I remember when I was
annoyed with her a few times,

1578
01:19:05.438 --> 01:19:07.872
she said, "Why are you
so judgmental, Kathryn?"

1579
01:19:07.872 --> 01:19:11.710
That's just because I didn't
like her, some of her language.

1580
01:19:11.710 --> 01:19:16.142
So she caught it, she
realized I was acting on my

1581
01:19:16.142 --> 01:19:16.788
counter-transference.

1582
01:19:16.788 --> 01:19:18.805
I wasn't just quietly sitting there.

1583
01:19:18.805 --> 01:19:21.793
So you can use that regularly

1584
01:19:21.793 --> 01:19:23.162
to try to understand the clients better

1585
01:19:23.162 --> 01:19:27.446
and then also when necessary,
repair the rupture.

1586
01:19:27.446 --> 01:19:29.816
I could've lost them
if I didn't figure out.

1587
01:19:29.816 --> 01:19:30.957
I said I was really trying to,

1588
01:19:30.957 --> 01:19:34.718
I did find it hard to listen
to because it was so nasty.

1589
01:19:34.718 --> 01:19:38.899
But I was trying to understand
what it meant to her

1590
01:19:38.899 --> 01:19:40.341
and did she always have those feelings?

1591
01:19:40.341 --> 01:19:41.238
"No, I din't have those feelings.

1592
01:19:41.238 --> 01:19:43.421
"I've only had it since
I was in Iraq and back."

1593
01:19:43.421 --> 01:19:45.233
So that was the clue.

1594
01:19:45.233 --> 01:19:46.595
So does that, thank you for asking that

1595
01:19:46.595 --> 01:19:48.056
because I didn't amplify that.

1596
01:19:49.700 --> 01:19:50.890
Yeah?

1597
01:19:51.638 --> 01:19:55.313
(audience member speaking inaudibly)

1598
01:20:13.683 --> 01:20:14.529
Did everyone hear that?

1599
01:20:14.529 --> 01:20:16.906
Just the question that,

1600
01:20:16.906 --> 01:20:19.673
so this is one family, one
deployment and actually,

1601
01:20:19.673 --> 01:20:21.936
that you see what can happen
sometimes with one deployment.

1602
01:20:21.936 --> 01:20:24.097
But some families, four, five, six

1603
01:20:24.097 --> 01:20:27.094
types of reunions of this
sort, what do you do with that?

1604
01:20:27.094 --> 01:20:30.546
Some of them actually do
not have these difficulties.

1605
01:20:30.546 --> 01:20:32.139
But others do.

1606
01:20:32.139 --> 01:20:34.545
That's something we need to be mindful of

1607
01:20:34.545 --> 01:20:35.611
in doing this work.

1608
01:20:37.240 --> 01:20:42.240
I would say proceed nonetheless
because if the family

1609
01:20:42.662 --> 01:20:45.727
has that history of strength
and desire to be together

1610
01:20:45.727 --> 01:20:48.969
and they've had those
experiences of strong connection,

1611
01:20:48.969 --> 01:20:53.969
then some of these complex
models can be very useful.

1612
01:20:54.146 --> 01:20:55.703
But it raises the question about

1613
01:20:58.168 --> 01:20:59.376
what are we doing in our country

1614
01:20:59.376 --> 01:21:02.732
when we constantly redeploy,
redeploy, redeploy, redeploy,

1615
01:21:02.732 --> 01:21:07.506
when we know the data
suggests that this is harmful.

1616
01:21:07.506 --> 01:21:08.852
If there are enough times of this,

1617
01:21:08.852 --> 01:21:12.745
that it's the people in the minority

1618
01:21:12.745 --> 01:21:15.005
maybe who have no effects,

1619
01:21:16.281 --> 01:21:18.081
who suffer no negative effects.

1620
01:21:19.119 --> 01:21:21.719
(audience member speaking inaudibly)

1621
01:21:21.719 --> 01:21:22.950
Yeah, mhmm.

1622
01:21:22.950 --> 01:21:26.939
(audience member speaking inaudibly)

1623
01:21:33.688 --> 01:21:34.942
So you're saying that the service member

1624
01:21:34.942 --> 01:21:37.740
might not actually have some difficulties

1625
01:21:37.740 --> 01:21:41.038
in the integration, but
the families sometimes can.

1626
01:21:41.038 --> 01:21:43.441
I would hope that we,
particularly in our field,

1627
01:21:43.441 --> 01:21:48.058
that's why I primarily talk
and work with the families.

1628
01:21:48.058 --> 01:21:50.959
I'm focusing on the women
in the military because

1629
01:21:50.959 --> 01:21:54.041
that's an area that I'm
interested in nowadays as well.

1630
01:21:54.041 --> 01:21:57.522
But the families are pivotal
as sources of support

1631
01:21:57.522 --> 01:22:00.576
and also they need
assistance, our assistance,

1632
01:22:00.576 --> 01:22:01.806
when they're suffering.

1633
01:22:02.981 --> 01:22:06.684
So, we just have. Yeah.
Take you there first.

1634
01:22:06.684 --> 01:22:10.975
(audience member speaking inaudibly)

1635
01:22:12.699 --> 01:22:13.808
The moral injury?

1636
01:22:15.635 --> 01:22:17.722
Well it usually occurs around some event

1637
01:22:17.722 --> 01:22:20.040
where the service member has experienced

1638
01:22:21.880 --> 01:22:23.145
something that they had felt,

1639
01:22:23.145 --> 01:22:26.588
that their sense of ethics,

1640
01:22:26.588 --> 01:22:28.091
they've betrayed their
own sense of ethics.

1641
01:22:28.091 --> 01:22:30.755
What's interesting is even though for her,

1642
01:22:30.755 --> 01:22:31.893
this was very clear cut.

1643
01:22:31.893 --> 01:22:35.032
She felt that she should've
been able to save this young man

1644
01:22:35.032 --> 01:22:37.992
and so she felt that she let herself down

1645
01:22:37.992 --> 01:22:40.702
and it was just completely
morally corrupt.

1646
01:22:40.702 --> 01:22:42.158
But that was her view of it.

1647
01:22:42.158 --> 01:22:44.283
Sometimes people, other
people can actually

1648
01:22:44.283 --> 01:22:47.154
observe something they consider egregious.

1649
01:22:48.520 --> 01:22:51.159
Often the killings of children or

1650
01:22:52.358 --> 01:22:55.528
whether deliberate or instead of

1651
01:22:55.528 --> 01:22:58.006
the so-called non-combatants
who get killed

1652
01:22:58.006 --> 01:23:01.274
in the process of war.

1653
01:23:01.274 --> 01:23:03.055
That can feel horrific.

1654
01:23:03.055 --> 01:23:06.577
Just as being a bystander who's watching.

1655
01:23:06.577 --> 01:23:08.539
Sometimes the feeling of moral injury

1656
01:23:08.539 --> 01:23:09.701
can be almost as profound

1657
01:23:09.701 --> 01:23:11.545
as having done something one-self.

1658
01:23:12.510 --> 01:23:15.439
So inviting that type,
that conversation I think

1659
01:23:15.439 --> 01:23:17.876
is what's important but usually again,

1660
01:23:17.876 --> 01:23:20.113
the timing, the pacing is so crucial

1661
01:23:20.113 --> 01:23:21.817
because that is such delicate territory.

1662
01:23:23.666 --> 01:23:25.410
People have to be ready to do that.

1663
01:23:25.410 --> 01:23:26.593
If you noticed with this couple,

1664
01:23:26.593 --> 01:23:27.955
I was deliberately trying to convey

1665
01:23:27.955 --> 01:23:30.898
you have to work with that first phase.

1666
01:23:30.898 --> 01:23:33.382
Which is really both strings strengths

1667
01:23:33.382 --> 01:23:37.039
helping them reconnect,
re-establish attachments

1668
01:23:37.039 --> 01:23:40.499
and then each of them had a sturdier base.

1669
01:23:40.499 --> 01:23:44.335
They could also regulate their
moods better, each of them,

1670
01:23:44.335 --> 01:23:46.762
so they could withstand the discussion of,

1671
01:23:48.114 --> 01:23:50.519
because it brings up such shame and guilt.

1672
01:23:50.519 --> 01:23:52.111
Not just guilt, shame.

1673
01:23:54.100 --> 01:23:56.055
For her, she was able to get to a point

1674
01:23:56.055 --> 01:23:58.755
where she could then see that

1675
01:23:58.755 --> 01:24:02.443
she was human and mortal and humble

1676
01:24:02.443 --> 01:24:03.918
and she could not do it.

1677
01:24:03.918 --> 01:24:07.423
She just had tremendous
valability and she hated that.

1678
01:24:07.423 --> 01:24:11.277
But that's different from
so-called ethical defect.

1679
01:24:13.802 --> 01:24:15.281
Yeah, Ruth, did you?

1680
01:24:16.309 --> 01:24:19.994
(audience member speaking inaudibly)

1681
01:24:25.124 --> 01:24:27.061
How long to get to stabilization?

1682
01:24:28.827 --> 01:24:31.641
For this particular family,
just a couple of months.

1683
01:24:32.983 --> 01:24:35.133
Because I think if that's your goal,

1684
01:24:35.133 --> 01:24:37.042
if your goal is to pay attention

1685
01:24:37.042 --> 01:24:38.765
to what the pressing issues are,

1686
01:24:38.765 --> 01:24:41.427
and then work, it's
interdisciplinary work though,

1687
01:24:41.427 --> 01:24:44.648
you're coordinating with
this cast of characters.

1688
01:24:44.648 --> 01:24:48.139
You are the anchor trying to then provide

1689
01:24:48.139 --> 01:24:50.586
its clinical case management that's best

1690
01:24:50.586 --> 01:24:53.847
with old Winnetka and
clinical case management.

1691
01:24:53.847 --> 01:24:57.273
Where we can be in touch
with a whole range of people

1692
01:24:57.273 --> 01:25:02.113
and so you're creating
this circle of security.

1693
01:25:02.113 --> 01:25:03.534
It's not just the partners.

1694
01:25:03.534 --> 01:25:05.137
It's the children, it's the school.

1695
01:25:05.137 --> 01:25:09.289
It's all the cast of characters
in the professional network

1696
01:25:09.289 --> 01:25:12.364
that need to be included as well.

1697
01:25:15.218 --> 01:25:16.932
So, go ahead.

1698
01:25:17.726 --> 01:25:22.005
(audience member speaking inaudibly)

1699
01:25:33.572 --> 01:25:35.504
It's mostly military sexual trauma.

1700
01:25:35.504 --> 01:25:36.148
That's what they're saying.

1701
01:25:36.148 --> 01:25:38.579
That that's a direct association with why

1702
01:25:38.579 --> 01:25:40.959
those rates are significantly
higher for women.

1703
01:25:42.401 --> 01:25:45.920
Because otherwise they're exposed then

1704
01:25:45.920 --> 01:25:49.350
to some of the same
combat stressors as men,

1705
01:25:49.350 --> 01:25:50.987
the male counterparts.

1706
01:25:50.987 --> 01:25:52.372
So it's not as if they're...

1707
01:25:54.332 --> 01:25:56.109
Yeah, any thoughts about that?

1708
01:25:56.109 --> 01:25:57.312
Anybody have thoughts about that?

1709
01:25:57.312 --> 01:26:01.546
Of why they would, women
would have more risk factors?

1710
01:26:01.546 --> 01:26:03.742
One thing is that if
people are then deployed

1711
01:26:03.742 --> 01:26:07.137
with different units, they
haven't trained with the unit,

1712
01:26:07.137 --> 01:26:09.831
and if there's a sense of insecurity then

1713
01:26:09.831 --> 01:26:11.977
with the other service
members or the command.

1714
01:26:11.977 --> 01:26:16.069
That's a very, that's not
necessarily gonna cause PTSD.

1715
01:26:16.069 --> 01:26:17.723
But you have to look at the risk factors

1716
01:26:17.723 --> 01:26:18.744
and the protective factors.

1717
01:26:18.744 --> 01:26:20.112
That's the balance of the two.

1718
01:26:21.189 --> 01:26:21.759
Yeah.

1719
01:26:22.441 --> 01:26:26.235
(audience member speaking inaudibly)

1720
01:26:41.279 --> 01:26:42.974
You're just talking about the continuation

1721
01:26:42.974 --> 01:26:45.009
of the mass analyzed culture?

1722
01:26:46.257 --> 01:26:47.323
I didn't hear the last...

1723
01:26:48.196 --> 01:26:52.051
(audience member speaking inaudibly)

1724
01:26:56.324 --> 01:26:57.559
Oh okay, yeah.

1725
01:26:58.474 --> 01:27:02.544
(audience member speaking inaudibly)

1726
01:27:04.326 --> 01:27:07.720
So you're saying, so you're
hearing pockets of mysogyny?

1727
01:27:07.720 --> 01:27:11.186
That's what I think some of the
brass are talking about now.

1728
01:27:11.186 --> 01:27:13.515
That there's certainly going to be

1729
01:27:13.515 --> 01:27:15.136
ongoing misogynistic attitudes.

1730
01:27:15.136 --> 01:27:18.538
But now there's some effort to tell people

1731
01:27:18.538 --> 01:27:19.888
you don't talk that way.

1732
01:27:19.888 --> 01:27:21.844
This is what harassment is.

1733
01:27:21.844 --> 01:27:22.469
This is rape.

1734
01:27:22.469 --> 01:27:23.574
This is assault.

1735
01:27:23.574 --> 01:27:25.073
This is abusive talk.

1736
01:27:26.176 --> 01:27:29.623
But, yeah, it seems like that persists.

1737
01:27:29.623 --> 01:27:31.259
Maybe just one more comment
and then we're gonna wrap up.

1738
01:27:31.259 --> 01:27:31.877
Yeah, go ahead.

1739
01:27:31.877 --> 01:27:36.125
(audience member speaking inaudibly)

1740
01:27:38.174 --> 01:27:39.584
Mhmm, yeah.

1741
01:27:40.879 --> 01:27:44.959
(audience member speaking inaudibly)

1742
01:28:01.229 --> 01:28:03.481
Yeah, that's a very good point

1743
01:28:03.481 --> 01:28:05.163
that sometimes that's
become part of the training

1744
01:28:05.163 --> 01:28:07.315
if you've heard about
some of the basic training

1745
01:28:07.315 --> 01:28:09.754
and it's yeah, that's nasty stuff.

1746
01:28:09.754 --> 01:28:12.918
It's misogynistic, it's
racist, it's bigoted.

1747
01:28:12.918 --> 01:28:13.979
It's all the above.

1748
01:28:13.979 --> 01:28:17.205
But it's what we might think
of as abusive language.

1749
01:28:17.205 --> 01:28:19.981
But they are suggesting
that one of the high rates

1750
01:28:19.981 --> 01:28:22.581
of military sexual assault
has something to do with that

1751
01:28:22.581 --> 01:28:24.632
sort of that generalized acceptance.

1752
01:28:24.632 --> 01:28:27.294
That the language then can
translate into behavior.

1753
01:28:28.789 --> 01:28:32.081
That's sort of like it becomes,
words become the behavior

1754
01:28:32.081 --> 01:28:37.081
so that type of harsh treatment doesn't,

1755
01:28:37.325 --> 01:28:39.185
you have to set the limit and the boundary

1756
01:28:39.185 --> 01:28:40.932
between the words and behavior

1757
01:28:40.932 --> 01:28:43.532
and then also adjust the language.

1758
01:28:43.532 --> 01:28:45.952
No easy feat here, but..

1759
01:28:45.952 --> 01:28:49.691
So I wish us all the best in
working with this population.

1760
01:28:49.691 --> 01:28:51.037
So thank you very much.

1761
01:28:51.037 --> 01:28:55.327
(applause)