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- [Woman] Good evening, everyone.

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- [Audience responds]

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- I am delighted that we
are here for this lecture

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and for Kathryn Basham's giving us a sense

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of the richness of the scholarship

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and commitment she has made.

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This lecture is the result
of a sabbatical year,

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but a long trajectory of
work in the area dealing

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with the needs of service
members 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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Dr. Kathryn Basham engages in
research, writing, clinical

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social work practice, and
education related to the

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effects of deployment and combat
stress on the reintegration

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of service members,
veterans, and their families.

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Dr. Basham earned bother her MSW and Ph.D.

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degrees in Clinical Social Work.

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She has been appointed
to three congressionally

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mandated committees, with
the Institute of Medicine

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at the National Academies
of Science, charged to

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explore issues related to
enhancing the mental health

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treatment of military
and veteran families.

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The current four-year committee that is

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producing two published
texts focuses on the

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evaluation of efficacy
of treatment of PTSD with

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service members, veterans,
and their families.

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In this setting, Dr. 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 and Treatment,"

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"Physiologic, Psychological
and Psychosocial Effects of

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"Deployment-Related Stress with
Gulf War Veterans" in 2008,

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"Provision of Mental Health
Counseling under TRICARE"

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in 2010, and this past year,
"The Assessment of Ongoing

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"Efforts in the Treatment of
Posttraumatic Stress Disorder."

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I think what's important to
note is that, in the work that

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she has been doing, she has
often been the only clinical

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social worker among an
interdisciplinary team.

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She has held the voice of
the field and the expertise

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of the field extraordinarily
well, and is represented

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by the fact that she keeps getting invited

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back to serve on these committees.

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In earlier years, she published
with Dr. Dennis Miehls

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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 intercultural

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practice and pedagogy and diversity.

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She has authored and
co-authored numerous papers on

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these topics and has
presented in both national and

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international forums,
including Walter Reed National

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Medical Center, several
Veterans Administration Medical

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Centers, the Canadian Forces
Social Work Corps, Austen Riggs

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Institute, and various
professional organizations.

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Dr. Basham served on a major
task force of the Council

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for Social Work Education to
design military social work

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competencies, and participated
on the expert panel of

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NASW 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 national

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interdisciplinary organization,
the Alliance for Military

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and Veteran Family
Behavioral Health Providers.

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Dr. Basham has been awarded
a distinguished clinical

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practitioner with the
National Academies of Practice

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and maintains a clinical
practice in Northampton,

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Massachusetts specializing
in clinical social

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work practice with individuals, couples

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and families, supervision
and consultation.

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What I would say about Kathryn
is, as I really worked on

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reinstituting, reengaging
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 on the

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national scene in regards
to the excellence in

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clinical social work education
that we provide here.

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She has represented us
well and has done just an

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extraordinary job for the profession.

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And so, I ask that you join
me in welcoming Dr. Basham

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to speak on Women and the
Military: Rewards and Challenges.

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(audience clapping)

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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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I have this here 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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So I was thinking about this
particular topic and I think

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of the idea that it takes a
village to present a lecture.

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Well, yeah.

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

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who have done a particular
support to me in consultation.

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Dr. Camille Hall, who is
teaching the Beyond Combat

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class 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

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served both in Iraq and
Afghanistan as a clinical

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social worker embedded
with her particular unit.

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Then, I'm also interested
in thanking retired Colonel

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Cameron Ritchie, who's an army
psychiatrist at Walter Reed

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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 I'm
in this field and I only

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figured that out, oh, some
time ago, but it wasn't

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fully evolved until, I'd say 10 years ago.

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I was reared in a family in
New York City, and my father

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had served in World War II
and the Burmese Chinese front.

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He was a newly minted physician

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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 worked in a field hospital,
which consisted of a tent.

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No running water, and
was there for two years

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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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Upon return to life in New York,

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I was the post-deployment baby.

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When we think about what are the effects,

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some of the inter-generational effects,

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both positive and negative.

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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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My early years were certainly
formed by these experiences.

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My father never talked about
it until I harassed him

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at about age 18 and insisted
upon hearing about stories.

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Then he finally relented
and started telling

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various experiences that he had had.

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His basic message to me was, "Don't push!

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"If people do not want to talk

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"about these issues, do not insist."

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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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Upon return, his hope
was to distill some of

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the most positive
experiences during the war.

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So, growing up in New York,
my friends would always

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ask me, "Why does everyone
in your family, whenever

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"we come to visit you, all
of the meals are curry,

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"Indian curry, and Burmese curry

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"and music from the Far East?"

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

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This is when I was little.

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Then I realized that even though I was

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Lithuanian-Hungarian in
background, that we had

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adopted some different
cultural backgrounds.

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This was a way of trying to
distill some of the really

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important features of
the legacies of the war.

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So I just thought that
I would let you know.

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I lived in D.C. for 20 years,
where I worked in practice

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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 can see it,

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but it's and 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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I'm going to be talking
about one of the challenges,

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stressors and rewards for women

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who have 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 on

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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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I was just thinking I will amplify that

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as we go throughout this talk.

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I want to look at, what
are the balance of risk and

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protective factors in coping with

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deployment and traumatic stressors?

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And we're looking at, what are
the psychosocial adjustments

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for women in the military as they

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return home 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 what do we

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need to do in clinical
social work practice?

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Some of the major features
that I've considered in this

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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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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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Here this picture is
depicted in the Civil War.

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Disguised as a man on the right,
Frances Clayton served many

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months in Missouri at
the Missouri artillery

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and cavalry units in the Civil War.

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This was not uncommon.

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When detected, actually they
usually would be banished

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and often punished but, it
was very common for women

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to be serving in combat
positions during that time.

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Then, in 1901, Congress established

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the Army and Nursing Corps.

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Then, several years later,
the Navy Nursing Corps,

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so women have been acknowledged in

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different service roles
throughout decades.

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

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as nurses, clerks, typists
and telephone operators.

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However, when they returned from

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the war, they lost their jobs.

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Mostly they had lost the jobs
that they had previously held.

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They had no benefits.

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There was no equity in terms of

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their rights as service members.

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That was during the time
of where you know we often

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hear the origin of the
school in 1918 where social

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work students were actually
sent to, their internships

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were in Eastern Europe
and Germany at the time.

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It's quite incredible when
you think, those of you who

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are students, 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 and helping

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the actual service
members who were dealing

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with shell shock as well as nursing.

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Let's fast forward.

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In Vietnam, you're all very familiar.

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Again, women were serving in many

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medical roles and nursing roles.

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You also see a major presence
in terms of support positions.

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In the 1990's, that's when
women were actually flying

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airplanes and serving on
ships, driving convoys.

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You hear the increasing degree of combat

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exposure as we have gone
through the decades.

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Clearly, within the last
decade, you see equity

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in terms of their experiences.

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If you can see the comments here.

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"Okay, ladies. You've
been equipped with helmets

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"and body armor as we await orders

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"to break through the glass ceiling."

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Some of you have probably
heard of this news.

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It was just this year,
which is pretty astonishing.

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In January of this year,
women were basically

248
00:13:55,982 --> 00:14:00,094
acknowledged as serving in combat.

249
00:14:00,094 --> 00:14:04,868
The combat-related ban was lifted

250
00:14:04,868 --> 00:14:07,086
when the Pentagon released news.

251
00:14:07,086 --> 00:14:10,943
Basically what they had
to determine was that by

252
00:14:10,943 --> 00:14:15,656
actually allowing women to
be in combat roles, that it

253
00:14:15,656 --> 00:14:18,623
would not undermine the
readiness of the forces.

254
00:14:18,623 --> 00:14:21,773
The claim was this took a while.

255
00:14:21,773 --> 00:14:25,511
If you hear the history
of the women in combat,

256
00:14:25,511 --> 00:14:30,511
this certainly did not
make a lot of sense.

257
00:14:32,716 --> 00:14:36,211
This is a slightly different
scenario because most

258
00:14:36,211 --> 00:14:39,544
women who I've talked with
in the military, they don't

259
00:14:39,544 --> 00:14:43,789
want to be viewed as
vulnerable and different from

260
00:14:43,789 --> 00:14:46,311
their male counterparts
in terms of their jobs.

261
00:14:46,311 --> 00:14:47,855
They don't want to be seen as victimized

262
00:14:47,855 --> 00:14:50,009
or pitiful or somehow less than.

263
00:14:50,009 --> 00:14:54,377
They want to be equal in
terms of rights and pay

264
00:14:54,377 --> 00:14:58,762
and opportunities for advancement.

265
00:14:59,861 --> 00:15:01,508
I just want to talk about
the notion of gender as well.

266
00:15:01,523 --> 00:15:03,462
When you're thinking
about do you want to be

267
00:15:03,462 --> 00:15:06,881
completely equal, then is
there room for difference?

268
00:15:06,881 --> 00:15:09,169
In the military, one of
the most important notions

269
00:15:09,169 --> 00:15:13,066
is that there is a universality of values.

270
00:15:13,066 --> 00:15:15,572
People would often say, why am I

271
00:15:15,572 --> 00:15:16,827
interested in military social work?

272
00:15:16,827 --> 00:15:18,839
Well, if you look at the
values in the military,

273
00:15:18,839 --> 00:15:20,649
they're directly compatible with

274
00:15:20,649 --> 00:15:22,945
the Social Work Code of Ethics.

275
00:15:22,945 --> 00:15:25,668
If you hear the sense of loyalty, pride,

276
00:15:25,668 --> 00:15:28,451
dedication, self-sacrifice, duty, honor,

277
00:15:28,451 --> 00:15:33,451
support of each other, self-determination,

278
00:15:33,693 --> 00:15:38,247
these are parallel with
social work values.

279
00:15:38,247 --> 00:15:41,149
If there's a world of
universality during combat, it is

280
00:15:41,149 --> 00:15:45,822
important for the service
members to pull together,

281
00:15:45,822 --> 00:15:47,407
because they're united, they're defending,

282
00:15:47,407 --> 00:15:48,687
they're protecting each other.

283
00:15:48,687 --> 00:15:51,673
This is not the time for
diversity or differences.

284
00:15:51,673 --> 00:15:54,010
That's when people talk
about in esprit de corps.

285
00:15:54,010 --> 00:15:58,480
In the military, on the one
hand, is their way to assert

286
00:15:58,480 --> 00:16:02,076
the need for advancements in civil rights,

287
00:16:02,076 --> 00:16:04,514
while also recognizing
that there are differences.

288
00:16:04,514 --> 00:16:07,074
Women experience combat and deployment

289
00:16:07,074 --> 00:16:08,496
stressors in a different way.

290
00:16:08,496 --> 00:16:12,525
It's a both/and that I'm
hoping to convey today.

291
00:16:13,346 --> 00:16:16,437
Here, change, yes, as
of January of this year.

292
00:16:16,437 --> 00:16:18,558
This is very important,
that women are acknowledged

293
00:16:18,558 --> 00:16:20,947
in combat, because now
they can have opportunities

294
00:16:20,947 --> 00:16:24,970
for equal pay, advancement and benefits.

295
00:16:24,970 --> 00:16:27,895
That's all been denied, even
up until this past year.

296
00:16:27,895 --> 00:16:29,230
I love this cartoon here.

297
00:16:29,230 --> 00:16:30,069
"Real change.

298
00:16:30,069 --> 00:16:31,065
Women deciding about combat."

299
00:16:31,065 --> 00:16:32,589
Do you see how the pool table has all the

300
00:16:32,589 --> 00:16:37,341
munitions and different activities?

301
00:16:40,184 --> 00:16:42,567
I'll try not to go into too much detail

302
00:16:42,567 --> 00:16:44,173
because it could be mind numbing.

303
00:16:44,173 --> 00:16:46,690
At a quarter to eight,
that's not a good thing.

304
00:16:46,690 --> 00:16:51,690
I think it's important,
I'm always reminded.

305
00:16:52,076 --> 00:16:55,206
I want to look at the
demographics and some of the data

306
00:16:55,206 --> 00:16:59,277
on this population because
it's so compelling when

307
00:16:59,277 --> 00:17:01,909
you hear the number
and also the situation.

308
00:17:01,909 --> 00:17:03,515
Again, think of the both/and.

309
00:17:03,515 --> 00:17:05,465
There's some similarities between

310
00:17:05,465 --> 00:17:06,765
male and female service members.

311
00:17:06,765 --> 00:17:08,675
There are differences.

312
00:17:08,675 --> 00:17:10,321
Total number of all service members.

313
00:17:10,321 --> 00:17:13,063
Over 2.2 million service members

314
00:17:13,063 --> 00:17:15,932
have been deployed since 2001.

315
00:17:15,932 --> 00:17:17,790
820,000 National Guard.

316
00:17:17,790 --> 00:17:19,728
96,000 Reservists.

317
00:17:19,728 --> 00:17:21,568
That's a daunting number.

318
00:17:21,568 --> 00:17:25,331
With women, 15 percent of the current.

319
00:17:25,331 --> 00:17:27,421
OIF stands for Operation Iraqi Freedom.

320
00:17:27,421 --> 00:17:31,361
OEF stands for Operation Enduring Freedom,

321
00:17:31,361 --> 00:17:33,719
which occurred in Afghanistan.

322
00:17:33,719 --> 00:17:36,766
Of the population of
active duty armed forces,

323
00:17:36,766 --> 00:17:40,646
they are 15 percent of the total forces.

324
00:17:40,646 --> 00:17:43,939
That has been an increase in recent years.

325
00:17:45,049 --> 00:17:46,227
Children.

326
00:17:46,227 --> 00:17:49,803
1.3 million dependent
military children have been

327
00:17:49,803 --> 00:17:53,988
affected by deployments
throughout these last 10 years.

328
00:17:53,988 --> 00:17:57,239
Again, I acknowledge the
importance of thinking about

329
00:17:57,239 --> 00:18:01,669
previous era veterans, which
is incredibly significant

330
00:18:01,669 --> 00:18:03,070
in terms of the work that we're doing,

331
00:18:03,070 --> 00:18:05,967
particularly in the VA systems.

332
00:18:05,967 --> 00:18:10,161
I am deliberately focused
on the OIF/OEF active duty.

333
00:18:10,161 --> 00:18:11,576
Then there's the OND.

334
00:18:11,576 --> 00:18:16,576
This is the group that was
in Iraq since 2010, when

335
00:18:16,687 --> 00:18:20,869
troops were withdrawn and
the nature of combat changed.

336
00:18:20,869 --> 00:18:22,595
What do you think of this statistic?

337
00:18:22,595 --> 00:18:24,098
60 million family members have been

338
00:18:24,098 --> 00:18:29,098
affected by deployments
and combat exposure.

339
00:18:29,589 --> 00:18:31,920
57 percent of active duty service members,

340
00:18:31,920 --> 00:18:32,736
so think of this one again.

341
00:18:32,736 --> 00:18:35,679
57 percent of all active
duty service members have

342
00:18:35,679 --> 00:18:38,240
primary family responsibility of a spouse,

343
00:18:38,240 --> 00:18:40,617
children, and/or a dependent.

344
00:18:40,617 --> 00:18:42,979
That's daunting, isn't it?

345
00:18:42,979 --> 00:18:45,147
It's worth noting.

346
00:18:46,776 --> 00:18:49,784
In terms of just the trends
in the field, there's an

347
00:18:49,784 --> 00:18:52,221
increase in Hispanic and new immigrants,

348
00:18:52,221 --> 00:18:55,397
and a decrease in African-American troops.

349
00:18:57,657 --> 00:18:59,851
Listen to some of these
data and just think of the

350
00:18:59,851 --> 00:19:04,479
implications of a voluntary armed forces.

351
00:19:05,024 --> 00:19:07,896
In terms of race, in terms
of the current troops,

352
00:19:07,896 --> 00:19:11,005
70 percent self-define as white,

353
00:19:11,005 --> 00:19:13,467
17 percent as African-American.

354
00:19:13,467 --> 00:19:15,820
That's including Hispanics.

355
00:19:15,820 --> 00:19:18,693
Four percent Asian.

356
00:19:19,724 --> 00:19:21,955
When people are asked to
report their ethnicity,

357
00:19:21,955 --> 00:19:25,105
they actually say 18
percent of Hispanic origin.

358
00:19:25,105 --> 00:19:29,920
That's a significant number,
and also growing number,

359
00:19:29,920 --> 00:19:32,867
in terms of concentration,
when you think of the forces.

360
00:19:32,867 --> 00:19:37,867
That exists in both enlisted
as well as officer corps.

361
00:19:39,734 --> 00:19:43,931
In terms of marriages,
with active duty men,

362
00:19:43,931 --> 00:19:48,931
59 percent are married
in heterosexual marriage.

363
00:19:49,072 --> 00:19:52,059
46 percent of women are married.

364
00:19:52,059 --> 00:19:53,544
If you switch to the National Guard,

365
00:19:53,544 --> 00:19:55,658
50 percent of men are married.

366
00:19:55,658 --> 00:19:58,441
37% of women, do you hear the drop?

367
00:19:58,441 --> 00:20:00,919
Again, just in terms of
the data, there are more

368
00:20:00,919 --> 00:20:05,450
women who are single in the military.

369
00:20:05,450 --> 00:20:06,994
They are caregivers of children,

370
00:20:06,994 --> 00:20:08,985
parents and other family members.

371
00:20:08,985 --> 00:20:11,444
Then we move on to the rates of divorce.

372
00:20:11,444 --> 00:20:14,614
The rates of divorce
between service members and

373
00:20:14,614 --> 00:20:16,828
general community are
pretty much the same.

374
00:20:16,828 --> 00:20:19,876
However, the rates for women
in the military, two times

375
00:20:19,876 --> 00:20:24,876
the risk of having a divorce
as compared to civilians.

376
00:20:25,584 --> 00:20:29,810
In terms of unemployment, this is

377
00:20:29,810 --> 00:20:33,081
a daunting set of data as well.

378
00:20:33,081 --> 00:20:36,455
12 percent of veterans at this point are

379
00:20:36,455 --> 00:20:41,047
unemployed, compared to
the 7.4 percent rate.

380
00:20:41,047 --> 00:20:44,398
If you look at just the age
range between 18 and 24,

381
00:20:44,398 --> 00:20:45,821
the percentage of veterans who

382
00:20:45,821 --> 00:20:47,914
are umemployed kicks up to 30 percent.

383
00:20:47,914 --> 00:20:50,473
This is really significant,
if you start actually

384
00:20:50,473 --> 00:20:54,414
reviewing the seriousness of these data.

385
00:20:54,414 --> 00:20:55,533
These are unemployment.

386
00:20:55,533 --> 00:20:58,457
These are these service
members returning home,

387
00:20:58,457 --> 00:21:01,484
separated from the
military, looking for work.

388
00:21:01,484 --> 00:21:03,008
Or it may be the Reservists or the Guard

389
00:21:03,008 --> 00:21:05,948
who had their jobs and
have lost their jobs.

390
00:21:06,387 --> 00:21:08,414
Homelessness.

391
00:21:09,370 --> 00:21:11,337
Generally, well the rates of homelessness

392
00:21:11,337 --> 00:21:13,613
are quite dramatic for veterans.

393
00:21:13,613 --> 00:21:16,417
It's 14 percent for men of all veterans,

394
00:21:16,417 --> 00:21:17,473
two percent for women.

395
00:21:17,473 --> 00:21:21,741
So the number of women veterans
who are homeless is lower.

396
00:21:21,741 --> 00:21:23,813
Then I went further.

397
00:21:23,813 --> 00:21:26,047
You can tell it was a little
obsessional exercise here.

398
00:21:26,047 --> 00:21:28,384
I went further with this investigation.

399
00:21:28,384 --> 00:21:33,384
In this last year, 21,800
women were homeless.

400
00:21:33,943 --> 00:21:38,095
These are OIF/OEF veterans,
just in the last few years.

401
00:21:38,095 --> 00:21:40,350
That's a very daunting number.

402
00:21:40,350 --> 00:21:44,191
They are right in our backyard, homeless.

403
00:21:45,578 --> 00:21:48,035
When you think about the U.S. talking

404
00:21:48,035 --> 00:21:50,414
about our role in the military,

405
00:21:50,414 --> 00:21:53,027
sort of at the floating
display of U.S. pride.

406
00:21:53,027 --> 00:21:53,866
Remember that, the Intrepid?

407
00:21:53,866 --> 00:21:58,648
Then the sinking display of
U.S. pride, homeless vets.

408
00:21:59,718 --> 00:22:03,498
So this is another significant
change in the military.

409
00:22:03,498 --> 00:22:04,797
For those of you who know about

410
00:22:04,797 --> 00:22:07,892
the reversal, Don't Ask Don't Tell.

411
00:22:07,892 --> 00:22:12,416
What was missing in my
data analysis there of the

412
00:22:12,416 --> 00:22:15,768
demographics, who knows
how many gay and lesbian

413
00:22:15,768 --> 00:22:19,365
and bisexual service members
or veterans are there?

414
00:22:19,365 --> 00:22:21,722
We have a better counting for
veterans, because they may

415
00:22:21,722 --> 00:22:25,399
feel more open to disclose
their sexual orientation.

416
00:22:25,399 --> 00:22:29,421
Again, in order to go
through with the reversal

417
00:22:29,421 --> 00:22:33,403
of Don't Ask, Don't Tell in April of 2011,

418
00:22:33,403 --> 00:22:36,370
President Obama, the Secretary of Defense

419
00:22:36,370 --> 00:22:39,012
Leon Panetta, and the
Joint Chief of Staff,

420
00:22:39,012 --> 00:22:43,868
retired Admiral Mullen,
certified that the lifting

421
00:22:43,868 --> 00:22:47,060
of the ban would not jeopardize troops.

422
00:22:47,075 --> 00:22:50,957
This is in the writing of the language.

423
00:22:50,957 --> 00:22:52,344
"Hope I'm not a distraction to you boys."

424
00:22:52,344 --> 00:22:53,822
"No Ma'am, we're married."

425
00:22:53,822 --> 00:22:55,427
"To each other."

426
00:22:55,427 --> 00:23:00,161
What we don't know right now
is really the experiences.

427
00:23:00,161 --> 00:23:03,147
You can't sort of track
the experiences for

428
00:23:03,147 --> 00:23:06,175
those service members who are identifying

429
00:23:06,175 --> 00:23:10,441
as a gay, bisexual or
lesbian unless we start

430
00:23:10,441 --> 00:23:15,441
helping them to express their identity.

431
00:23:15,907 --> 00:23:18,225
Even though it's been
two years out into this

432
00:23:18,225 --> 00:23:22,085
new world of supposed
disclosure, there are

433
00:23:22,085 --> 00:23:24,362
still lots of homophobic and other harsh

434
00:23:24,362 --> 00:23:28,164
experiences that people are subjected to.

435
00:23:28,164 --> 00:23:29,176
So why do I have this up here?

436
00:23:29,176 --> 00:23:31,919
The biology of traumatic stress.

437
00:23:31,919 --> 00:23:36,165
I'm going to shift into
talking about different themes

438
00:23:36,165 --> 00:23:40,356
that are particularly pertinent
to women in the military.

439
00:23:41,356 --> 00:23:44,048
I'm not going to go over
the typical reaction

440
00:23:44,048 --> 00:23:45,856
of the traumatic stress response.

441
00:23:45,856 --> 00:23:47,095
Okay, I will a little bit.

442
00:23:47,095 --> 00:23:49,452
I think many of you know this.

443
00:23:49,452 --> 00:23:51,992
I'm going to give you a brief clinical

444
00:23:51,992 --> 00:23:54,735
vignette later in the talk today.

445
00:23:54,735 --> 00:23:58,067
I'll introduce you to Sergeant Sanchez.

446
00:23:58,067 --> 00:24:03,044
She served in Iraq for a year as a medic.

447
00:24:03,044 --> 00:24:07,839
Actually, this is her
brain at this moment.

448
00:24:07,839 --> 00:24:09,078
This is Sergeant Sanchez.

449
00:24:09,078 --> 00:24:13,589
During combat, she actually
witnessed many explosions

450
00:24:13,589 --> 00:24:18,589
and she was directly involved
in an IED blast of a truck

451
00:24:24,476 --> 00:24:29,476
about 100 meters ahead of
her, carrying a number of

452
00:24:30,290 --> 00:24:34,719
her buddies in her unit
and a young man, who was a

453
00:24:34,719 --> 00:24:36,832
private who she had taken under her wing,

454
00:24:36,832 --> 00:24:39,311
only 18 years old, was killed.

455
00:24:39,311 --> 00:24:44,065
At the time, she ran to
the truck, the blazing

456
00:24:44,065 --> 00:24:48,046
truck on fire, and tried to rescue him.

457
00:24:48,046 --> 00:24:50,160
She herself suffered first
and second degree burns

458
00:24:50,160 --> 00:24:54,468
in that effort, and he died in her arms.

459
00:24:54,468 --> 00:24:57,718
This represented a horrific
experience for her.

460
00:24:57,718 --> 00:25:02,718
Remember, when those events
occur, the thalamus receives

461
00:25:03,955 --> 00:25:08,955
stimuli of smells and sounds,
and the feel of the air.

462
00:25:12,411 --> 00:25:17,132
All sorts of visual stimuli
that are disturbing.

463
00:25:17,132 --> 00:25:21,996
At the moment, Sergeant
Sanchez is overwhelmed.

464
00:25:21,996 --> 00:25:26,142
She's not able to really
process the event of the blast,

465
00:25:26,142 --> 00:25:28,174
even though she's running
toward the blast to try to

466
00:25:28,174 --> 00:25:32,053
save him, her body is in
a full state of alert.

467
00:25:32,053 --> 00:25:35,163
Her thalamus is stimulated.

468
00:25:35,163 --> 00:25:38,656
You know the amygdala is the
alarm system that signals

469
00:25:38,656 --> 00:25:43,656
the call for the sympathetic
and parasympathetic systems

470
00:25:44,670 --> 00:25:49,120
to activate both the
enervation and the innervation.

471
00:25:49,120 --> 00:25:54,120
The revving up and the
drawing down at the same time.

472
00:25:54,234 --> 00:25:57,105
For her, the hippocampus was not

473
00:25:57,105 --> 00:25:59,462
recording any memories at the time.

474
00:25:59,462 --> 00:26:01,167
She was just on autopilot.

475
00:26:01,167 --> 00:26:03,483
Just totally in an adrenaline rush,

476
00:26:03,483 --> 00:26:05,733
rushing to save this young man.

477
00:26:05,733 --> 00:26:10,733
We usually think of this as
fight, flight and freeze.

478
00:26:10,898 --> 00:26:12,656
Remember this is the typical phenomenon

479
00:26:12,656 --> 00:26:14,383
we think of with
traumatic stress response.

480
00:26:14,383 --> 00:26:17,837
There's some research that's
been done over the last

481
00:26:17,837 --> 00:26:22,653
number of years at UCLA
with Taylor and colleagues.

482
00:26:22,653 --> 00:26:25,680
What's interesting is there
is a hormone that's released.

483
00:26:25,680 --> 00:26:27,183
There are studies between gender

484
00:26:27,183 --> 00:26:29,621
differences between men and women.

485
00:26:29,621 --> 00:26:34,131
Many women actually produce higher levels

486
00:26:34,131 --> 00:26:37,443
of the hormone, which is called oxytocin.

487
00:26:37,443 --> 00:26:40,653
Oxytocin induces desire for connection,

488
00:26:40,653 --> 00:26:43,985
calm, tenderness, prosocial behavior,

489
00:26:43,985 --> 00:26:48,985
bonding, trust and
reduced fear and anxiety.

490
00:26:49,350 --> 00:26:50,446
That's very interesting, isn't it?

491
00:26:50,446 --> 00:26:52,742
That's different from
fight, flight freeze.

492
00:26:52,742 --> 00:26:57,274
So what was Sergeant
Sanchez doing at that time?

493
00:26:57,274 --> 00:27:00,523
There needs to be more research
to validate those findings,

494
00:27:00,523 --> 00:27:05,359
but it seems pretty evident
that she ran toward that.

495
00:27:05,359 --> 00:27:09,586
She didn't freeze, she didn't
fight, she didn't flee.

496
00:27:09,586 --> 00:27:10,804
Now, again, she's a medic, so you

497
00:27:10,804 --> 00:27:13,015
would say maybe that's her training.

498
00:27:13,015 --> 00:27:16,733
It seemed that it might be
something we should think about.

499
00:27:16,733 --> 00:27:19,212
Are there gender differences?

500
00:27:19,212 --> 00:27:20,532
Again, when we talk about differences,

501
00:27:20,532 --> 00:27:21,915
we always have to be careful.

502
00:27:21,915 --> 00:27:24,271
Let's not be stereotypical.

503
00:27:24,271 --> 00:27:26,038
I'm not suggesting that men would

504
00:27:26,038 --> 00:27:30,185
not have this similar response as well.

505
00:27:30,185 --> 00:27:31,729
I'm just thinking of some of the research

506
00:27:31,729 --> 00:27:35,521
data that supports some
of these differences.

507
00:27:40,304 --> 00:27:44,969
We think about the effects
for many of these families.

508
00:27:44,969 --> 00:27:47,962
There's no such thing as a
deployment cycle any longer.

509
00:27:47,962 --> 00:27:49,953
There's just one deployment cycle.

510
00:27:49,953 --> 00:27:52,472
They're recurrent deployment
cycles, so particularly

511
00:27:52,472 --> 00:27:55,987
many members of the Guard
and Reserve as well as

512
00:27:55,987 --> 00:27:59,705
active duty are all in pre-deployment,

513
00:27:59,705 --> 00:28:01,310
deployment, sustainment, post-deployment.

514
00:28:01,310 --> 00:28:02,652
Just think of how that works.

515
00:28:02,652 --> 00:28:04,886
They may be home for a period of a month

516
00:28:04,886 --> 00:28:09,886
to a year or further, but
then re-deploy, return home.

517
00:28:10,371 --> 00:28:14,049
So the multiple separations,
reunions and strains

518
00:28:14,049 --> 00:28:18,806
are enormous in terms of
adjustments and reintegration.

519
00:28:23,178 --> 00:28:24,458
Some of the effects of combat trauma,

520
00:28:24,458 --> 00:28:26,225
this is more universal.

521
00:28:26,225 --> 00:28:29,619
This is often what people talk
about in terms of some of the

522
00:28:29,619 --> 00:28:34,332
fears and stressors for both
men and women in combat.

523
00:28:34,332 --> 00:28:36,507
An unsafe environment, exposure to combat

524
00:28:36,507 --> 00:28:40,711
and violence, exposure to
dead and mutilated bodies.

525
00:28:40,711 --> 00:28:41,666
This is an important one.

526
00:28:41,666 --> 00:28:43,577
Loss of hope and sense of purpose.

527
00:28:43,577 --> 00:28:45,262
That's crucial because that can determine

528
00:28:45,262 --> 00:28:48,280
effectiveness in all these other areas.

529
00:28:48,280 --> 00:28:49,712
Deprivation.

530
00:28:49,712 --> 00:28:52,353
That is just not having
some of the same comforts

531
00:28:52,353 --> 00:28:55,065
that one would have
normally in one's life.

532
00:28:55,065 --> 00:28:55,801
Separation.

533
00:28:55,801 --> 00:28:57,412
This one is very interesting.

534
00:28:57,412 --> 00:29:01,192
There are a number of reports
that the army does each year.

535
00:29:01,192 --> 00:29:02,898
They actually interview service members

536
00:29:02,898 --> 00:29:06,920
in the field and theater,
and they do focus groups.

537
00:29:06,920 --> 00:29:11,920
The separation from family
and community is as strong

538
00:29:12,001 --> 00:29:15,718
a stressor as the exposure
to combat and violence.

539
00:29:15,718 --> 00:29:17,465
People don't often think that but that's

540
00:29:17,465 --> 00:29:20,394
what they're saying
out there in the field.

541
00:29:20,394 --> 00:29:23,845
Fear and survivor guilt
is often very palpable.

542
00:29:23,845 --> 00:29:25,064
There's another one.

543
00:29:25,064 --> 00:29:28,355
I was just citing some of the data.

544
00:29:28,355 --> 00:29:33,152
There's a new phenomenon
that's extremely important.

545
00:29:33,645 --> 00:29:36,688
Very important in terms of
the effects of combat trauma.

546
00:29:36,688 --> 00:29:41,688
It's called moral injury, that
people are often experiencing

547
00:29:42,069 --> 00:29:47,069
in the sense of challenge
to their own code of ethics.

548
00:29:47,371 --> 00:29:49,911
If they have their own sense
of their rules of conduct

549
00:29:49,911 --> 00:29:53,467
and the rules of war, and
either they feel they have

550
00:29:53,467 --> 00:29:56,292
violated in some way,
or if they feel they see

551
00:29:56,292 --> 00:30:01,292
their fellow service
members or command violating

552
00:30:01,329 --> 00:30:04,275
certain codes, they
can suffer a tremendous

553
00:30:04,275 --> 00:30:09,275
sense of despair and
what's called moral injury.

554
00:30:11,489 --> 00:30:13,866
It's very interesting, because
in talking with people,

555
00:30:13,866 --> 00:30:16,689
that seems to be more predominant now

556
00:30:16,689 --> 00:30:20,691
than PTSD, depression, moral injury.

557
00:30:20,691 --> 00:30:22,906
Moral injury, if that is unrelenting,

558
00:30:22,906 --> 00:30:26,297
leads to suicidal thinking.

559
00:30:26,644 --> 00:30:28,777
I didn't want to leave you on that note.

560
00:30:28,777 --> 00:30:31,846
Most service members, I would say,

561
00:30:31,846 --> 00:30:35,706
just want to go back to what we know.

562
00:30:35,706 --> 00:30:40,706
Most service members return without major

563
00:30:40,745 --> 00:30:43,263
mental health outcomes, or problems.

564
00:30:43,263 --> 00:30:44,625
It's very important that we focus

565
00:30:44,625 --> 00:30:47,164
on resilience and protective factors.

566
00:30:47,164 --> 00:30:51,988
So that needs to be the backdrop.

567
00:30:53,517 --> 00:30:55,631
Working this field for so many years,

568
00:30:55,631 --> 00:30:57,255
I'm so struck by people.

569
00:30:57,255 --> 00:30:58,902
One, two, three, four, five deployments.

570
00:30:58,902 --> 00:31:03,069
There are those individuals,
service members and

571
00:31:03,069 --> 00:31:08,069
families who look relatively
unscathed from the events.

572
00:31:08,694 --> 00:31:10,949
Meaning, they are not suffering

573
00:31:10,949 --> 00:31:14,622
some of the mental health impact.

574
00:31:16,109 --> 00:31:18,751
I'm going to focus briefly
on the protective factors.

575
00:31:18,751 --> 00:31:22,133
How do people weather these storms?

576
00:31:22,133 --> 00:31:23,769
Proactive coping.

577
00:31:23,769 --> 00:31:24,805
We know that.

578
00:31:24,805 --> 00:31:25,619
Training and leadership.

579
00:31:25,619 --> 00:31:30,359
This is relevant just
to military and combat.

580
00:31:30,359 --> 00:31:32,383
We know a lot about survivors
of sexual and physical

581
00:31:32,383 --> 00:31:36,081
abuse in childhood, and
domestic violence in adult life.

582
00:31:36,081 --> 00:31:37,687
But this is crucial.

583
00:31:37,687 --> 00:31:42,440
For those units who've had more
cohesive training, and more

584
00:31:42,440 --> 00:31:46,930
of a sense of collaboration and
command that they can really

585
00:31:46,930 --> 00:31:51,165
trust and value, they fare
much better, much much better.

586
00:31:51,165 --> 00:31:53,696
It's common sense.

587
00:31:53,696 --> 00:31:56,663
If they don't trust their
fellow service members,

588
00:31:56,663 --> 00:32:01,072
they're not going to be
in a position of some

589
00:32:01,072 --> 00:32:03,815
safety zone, a psychological safety zone.

590
00:32:03,815 --> 00:32:05,886
Family and social support.

591
00:32:05,886 --> 00:32:08,731
Those are standard resilience factors

592
00:32:08,731 --> 00:32:11,251
that we know about across the board.

593
00:32:11,251 --> 00:32:14,480
This is crucial because I
talk about this topic in

594
00:32:14,480 --> 00:32:16,614
a lot of different
settings, and the focus is

595
00:32:16,614 --> 00:32:20,129
mostly on individual
service members still.

596
00:32:20,129 --> 00:32:22,039
We are a program that
specializes in clinical social

597
00:32:22,039 --> 00:32:26,508
work practice, so I'm
leaning toward talking about

598
00:32:26,508 --> 00:32:30,307
the clients that we're
working with who have some

599
00:32:30,307 --> 00:32:32,847
mental health or psychosocial concerns.

600
00:32:32,847 --> 00:32:34,900
They're issues.

601
00:32:34,900 --> 00:32:39,900
In that realm, the predominant
narrative is individual.

602
00:32:40,182 --> 00:32:40,628
Individual.

603
00:32:40,628 --> 00:32:42,030
Individual.

604
00:32:42,030 --> 00:32:43,554
The family and social support

605
00:32:43,554 --> 00:32:45,504
you have to emphasize regularly.

606
00:32:45,504 --> 00:32:47,638
In the more general
communities, I'm working

607
00:32:47,638 --> 00:32:50,949
on bases or in posts
throughout the country.

608
00:32:50,949 --> 00:32:53,021
There is a huge amount of attention

609
00:32:53,021 --> 00:32:54,445
to family and social support.

610
00:32:54,445 --> 00:32:58,722
More in terms of prevention
than resilience building.

611
00:32:58,722 --> 00:33:01,555
So this is a complex
intersecting social identities.

612
00:33:01,555 --> 00:33:03,078
Another protective factor.

613
00:33:03,078 --> 00:33:06,126
Basically what that means,
is if a service member has

614
00:33:06,126 --> 00:33:10,352
a strong sense of military
identity or veteran identity,

615
00:33:10,352 --> 00:33:14,639
and that is tied in with
whatever their other identities

616
00:33:14,639 --> 00:33:18,905
are in terms of sociocultural
or family identities,

617
00:33:18,905 --> 00:33:23,416
they weather these situations better.

618
00:33:23,416 --> 00:33:24,675
The risk factors you probably know.

619
00:33:24,675 --> 00:33:26,748
They're pretty well-known in

620
00:33:26,748 --> 00:33:29,961
the field in dealing with combat.

621
00:33:31,853 --> 00:33:34,210
The service members who are younger,

622
00:33:34,210 --> 00:33:36,629
lower socioeconomic status, lower ranking,

623
00:33:36,629 --> 00:33:39,878
female gender, and previous
mental health issues

624
00:33:39,878 --> 00:33:44,756
have increased risk for
mental health outcomes.

625
00:33:44,756 --> 00:33:46,928
Again, that doesn't mean
they're going to have them.

626
00:33:46,928 --> 00:33:48,432
It's just a risk factor.

627
00:33:48,432 --> 00:33:51,987
It has to be counterbalanced
with the protective factors.

628
00:33:51,987 --> 00:33:53,694
This is a tricky one.

629
00:33:53,694 --> 00:33:54,710
The previous mental health issues,

630
00:33:54,710 --> 00:33:55,808
we talked about childhood trauma.

631
00:33:55,808 --> 00:33:58,936
There's a lot of talk in
this field, military DOD,

632
00:33:58,936 --> 00:34:01,679
Department of Defense
settings, or VA settings.

633
00:34:01,679 --> 00:34:04,279
Most of the data suggests
if there's childhood

634
00:34:04,279 --> 00:34:06,758
trauma, then that's a big risk factor for

635
00:34:06,758 --> 00:34:09,805
mental health problems in the field.

636
00:34:09,805 --> 00:34:12,589
That's been contradicted by some research.

637
00:34:12,589 --> 00:34:17,589
Rachel Yehuda, she's
working at the Bronx VA now.

638
00:34:20,573 --> 00:34:23,724
She's comparing some of
the service members who've

639
00:34:23,724 --> 00:34:25,897
suffered childhood trauma,
and those who haven't,

640
00:34:25,897 --> 00:34:27,380
and looking at the differences in combat.

641
00:34:27,380 --> 00:34:29,716
The ones who had childhood
trauma who resolved

642
00:34:29,716 --> 00:34:32,826
their issues, and
demonstrated some mastery

643
00:34:32,826 --> 00:34:37,417
and some sense of perspective,
do better in combat.

644
00:34:37,417 --> 00:34:39,753
I think that's a very important finding.

645
00:34:39,753 --> 00:34:42,983
I don't have that right
here, but it's Rachel Yehuda.

646
00:34:42,983 --> 00:34:44,243
This is an important one.

647
00:34:44,243 --> 00:34:44,994
Physical injury.

648
00:34:44,994 --> 00:34:46,335
Any of these service
members who've been injured

649
00:34:46,335 --> 00:34:48,773
in combat, they have three times the risk,

650
00:34:48,773 --> 00:34:52,877
three times the risk, of developing PTSD.

651
00:34:53,444 --> 00:34:57,470
So you must be familiar with
the notion of secondary trauma.

652
00:34:57,470 --> 00:35:00,354
This applies to family members of people

653
00:35:00,354 --> 00:35:03,918
who have been exposed to combat.

654
00:35:05,302 --> 00:35:07,932
It's not just the family members.

655
00:35:07,932 --> 00:35:11,691
Guess who also is going to be
exposed to listening to the

656
00:35:11,691 --> 00:35:15,776
narratives of traumatic events
and working in this field.

657
00:35:15,776 --> 00:35:20,776
Actually, any of us here in
clinical social work are dealing

658
00:35:21,017 --> 00:35:26,017
with exposure to traumatizing
events, hearing about them.

659
00:35:26,279 --> 00:35:30,809
We are susceptible to
developing secondary trauma.

660
00:35:30,809 --> 00:35:33,288
Meaning, that we may develop
some symptoms that are

661
00:35:33,288 --> 00:35:37,900
very similar to what the
person involved is dealing with

662
00:35:37,900 --> 00:35:41,374
in terms of having been
directly traumatized.

663
00:35:41,374 --> 00:35:44,686
So there might be symptoms
of hyper-arousal, agitation,

664
00:35:44,686 --> 00:35:49,686
poor sleep, detachment,
numbing, all of the above.

665
00:35:50,552 --> 00:35:52,772
I remember Jonathan Shay
said a couple of years ago

666
00:35:52,772 --> 00:35:57,772
at the Combat Stress Conference
here in 2008 that he sees it

667
00:36:00,472 --> 00:36:04,536
as an occupational hazard to
actually work in this field.

668
00:36:04,536 --> 00:36:05,775
When you're working with
traumatized clients,

669
00:36:05,775 --> 00:36:10,285
every employer should basically
provide health insurance

670
00:36:10,285 --> 00:36:14,836
that specifically attends to
secondary trauma and plans.

671
00:36:14,836 --> 00:36:17,112
Part of the insurance
plan would be actually

672
00:36:17,112 --> 00:36:20,545
providing for yoga and other regular

673
00:36:20,545 --> 00:36:25,545
massages and other avenues
for reducing stress.

674
00:36:26,051 --> 00:36:27,839
I just thought I would share that.

675
00:36:27,839 --> 00:36:30,115
Actually, in some settings,
I noticed they've done it.

676
00:36:30,115 --> 00:36:33,732
It's been impressive when
you see it in operation.

677
00:36:33,732 --> 00:36:35,458
What does secondary trauma do?

678
00:36:35,458 --> 00:36:38,018
It sets the stage for affecting

679
00:36:38,018 --> 00:36:40,376
children and family members.

680
00:36:40,376 --> 00:36:43,260
There are a lot of data,
unfortunately, to support

681
00:36:43,260 --> 00:36:45,759
that there are higher
rates of marital conflict,

682
00:36:45,759 --> 00:36:50,759
intimate partner violence
and effects on children.

683
00:36:57,718 --> 00:37:00,599
This is an important theme
which I'm at, the caregiving.

684
00:37:03,812 --> 00:37:06,637
Remember that data I was sharing with you?

685
00:37:06,637 --> 00:37:10,762
Like 65 percent of service members are

686
00:37:10,762 --> 00:37:14,012
then caring for a child or family member.

687
00:37:14,012 --> 00:37:16,662
When they're returning home, they're going

688
00:37:16,662 --> 00:37:21,185
to be dealing with that responsibility.

689
00:37:21,185 --> 00:37:24,070
Rather than just assuming
it's caregiving burden.

690
00:37:24,070 --> 00:37:26,263
People often talk about
caregiver burden, which is

691
00:37:26,263 --> 00:37:30,489
important because of the secondary trauma.

692
00:37:30,489 --> 00:37:32,033
There's also caregiving satisfaction.

693
00:37:32,033 --> 00:37:36,626
There's more work in
that area now, looking at

694
00:37:36,626 --> 00:37:39,104
caregiving satisfaction
and post-traumatic growth.

695
00:37:39,104 --> 00:37:42,130
It's not just a sense of
people really suffering

696
00:37:42,130 --> 00:37:46,067
with some of these difficult situations.

697
00:37:47,758 --> 00:37:51,883
What do we know about
some of women in direct

698
00:37:51,883 --> 00:37:56,883
deployment or in combat arenas?

699
00:37:57,021 --> 00:37:58,445
First of all, the environment.

700
00:37:58,445 --> 00:37:59,928
Environmental stressors.

701
00:37:59,928 --> 00:38:04,928
People often talk about, how
about 125, 130 degree heat?

702
00:38:08,929 --> 00:38:11,307
That's insufferable.

703
00:38:11,307 --> 00:38:13,764
Sand, blinding sand.

704
00:38:13,764 --> 00:38:15,411
Insects.

705
00:38:15,411 --> 00:38:18,905
All sorts of toxins that
could be problematic.

706
00:38:18,905 --> 00:38:21,017
These are the physical, environmental

707
00:38:21,017 --> 00:38:23,619
stressors that are very important.

708
00:38:23,619 --> 00:38:25,629
Also, many of the service members coming

709
00:38:25,629 --> 00:38:29,693
back have major sleep problems.

710
00:38:29,693 --> 00:38:31,196
When you think about some of the issues,

711
00:38:31,196 --> 00:38:36,196
one of the major physical
issues is insomnia.

712
00:38:36,438 --> 00:38:39,445
If you have insomnia, you
cannot sleep because you

713
00:38:39,445 --> 00:38:42,025
have been preoccupied with
all of these environmental

714
00:38:42,025 --> 00:38:44,850
stressors and also worried that
you are going to be injured

715
00:38:44,850 --> 00:38:48,851
or killed, or your buddies
would be injured or killed.

716
00:38:48,851 --> 00:38:51,696
Sleep is not an easy phenomenon.

717
00:38:51,696 --> 00:38:55,211
At Walter Reed, that's
what I found fascinating.

718
00:38:55,211 --> 00:38:58,097
The first thing they do
is try to get service

719
00:38:58,097 --> 00:39:00,371
members on a sleep
regimen, to regulate it,

720
00:39:00,371 --> 00:39:03,398
because they cannot cope effectively.

721
00:39:03,398 --> 00:39:05,699
Also, lack of adequate sleep

722
00:39:05,699 --> 00:39:10,393
enhances any mental health problems.

723
00:39:10,393 --> 00:39:11,612
It also can create.

724
00:39:11,612 --> 00:39:15,250
If you don't have adequate
deep sleep and adequate

725
00:39:15,250 --> 00:39:20,250
alpha sleep, it can actually
do some psychotic experiences.

726
00:39:21,446 --> 00:39:23,825
Don't mean to scare people.

727
00:39:23,825 --> 00:39:27,994
It is an important phenomenon.

728
00:39:27,994 --> 00:39:32,994
Many women, the majority are
in their 20's, 30's and 40's.

729
00:39:37,740 --> 00:39:42,597
Dealing with menstruation
can be difficult.

730
00:39:42,597 --> 00:39:43,206
Hygiene.

731
00:39:43,206 --> 00:39:45,295
Limited restrooms.

732
00:39:46,234 --> 00:39:47,270
I found this interesting.

733
00:39:47,270 --> 00:39:50,377
There's one study that
suggests that 20 percent of the

734
00:39:50,377 --> 00:39:54,787
women who are interviewed,
a very large sample,

735
00:39:54,787 --> 00:39:58,647
reported unintended pregnancies.

736
00:39:58,647 --> 00:40:00,536
Why is that?

737
00:40:00,536 --> 00:40:02,872
Well, sometimes birth
control was not available

738
00:40:02,872 --> 00:40:05,514
in the same way, so it
was more difficult to

739
00:40:05,514 --> 00:40:07,729
take care of oneself and be able to

740
00:40:07,729 --> 00:40:12,729
manage basic gynecological care.

741
00:40:15,604 --> 00:40:17,622
I also talked to one women who was saying,

742
00:40:17,622 --> 00:40:19,390
"Do you know what it's like
to go through menopause

743
00:40:19,390 --> 00:40:24,390
"in 130 degree heat, and
also trying to serve and do

744
00:40:25,160 --> 00:40:28,026
"your job and maintain your fitness

745
00:40:28,026 --> 00:40:30,178
"and do your fitness routine every day?"

746
00:40:30,178 --> 00:40:33,673
No, I don't know, but I can imagine.

747
00:40:33,673 --> 00:40:36,295
Childbirth and nursing.

748
00:40:36,295 --> 00:40:37,636
That's very interesting
because usually when

749
00:40:37,636 --> 00:40:40,012
somebody's pregnant, they're
no longer deployable.

750
00:40:40,012 --> 00:40:43,019
If they're pregnant in
theater, then they have to find

751
00:40:43,019 --> 00:40:45,884
out they're pregnant, and
usually they're sent home.

752
00:40:45,884 --> 00:40:46,879
Sometimes when they're sent home,

753
00:40:46,879 --> 00:40:50,516
then other members in
the unit resent them,

754
00:40:50,516 --> 00:40:54,133
because then somebody
else has to do their job.

755
00:40:54,133 --> 00:40:57,790
If a man and a woman,
a heterosexual couple,

756
00:40:57,790 --> 00:41:00,898
are dealing with a
pregnancy, the man is not

757
00:41:00,898 --> 00:41:03,620
dealing with problems with deployment.

758
00:41:03,620 --> 00:41:05,144
It's the woman in the military

759
00:41:05,144 --> 00:41:10,144
who has negative consequences.

760
00:41:11,665 --> 00:41:14,388
The nursing was very interesting.

761
00:41:14,388 --> 00:41:15,465
This is Colonel Ritchie, who I was

762
00:41:15,465 --> 00:41:16,684
telling you about at Walter Reed.

763
00:41:16,684 --> 00:41:21,684
She was very focused on this
effort in the early 2000's

764
00:41:21,946 --> 00:41:26,253
to make sure that nursing
sailors at the time,

765
00:41:26,253 --> 00:41:30,053
women sailors, would be
able to provide nursing

766
00:41:30,053 --> 00:41:32,837
for their babies when they were on ships.

767
00:41:32,837 --> 00:41:36,371
She set up this elaborate
program, which was very important.

768
00:41:36,371 --> 00:41:38,321
She said that as long as
the command would provide

769
00:41:38,321 --> 00:41:42,588
enough time, and spacing and
support, that would allow

770
00:41:42,588 --> 00:41:45,453
the mother to be able to express milk,

771
00:41:45,453 --> 00:41:47,588
save it, and actually
nurse the baby over time.

772
00:41:47,588 --> 00:41:50,331
This sounds so basic, if you

773
00:41:50,331 --> 00:41:51,916
think of people who are back home.

774
00:41:51,916 --> 00:41:55,187
What happens with a nursing mother who

775
00:41:55,187 --> 00:41:58,681
would have to automatically stop nursing

776
00:41:58,681 --> 00:42:01,588
or not even be with the baby.

777
00:42:01,588 --> 00:42:03,639
In some deployments, the
baby is somewhere else

778
00:42:03,639 --> 00:42:05,448
back home with other family members.

779
00:42:05,448 --> 00:42:10,344
That's a stressor.

780
00:42:10,344 --> 00:42:11,442
Mental health responses.

781
00:42:11,442 --> 00:42:12,741
These are the ones that are familiar

782
00:42:12,741 --> 00:42:15,353
to us who are doing the clinical work.

783
00:42:19,299 --> 00:42:20,682
These committees I'm on, I'm focusing

784
00:42:20,682 --> 00:42:22,570
on post-traumatic stress now, PTSD.

785
00:42:22,570 --> 00:42:24,094
Over and over and over and over.

786
00:42:24,094 --> 00:42:29,094
As I said, the depression,
moral injury, and suicidal

787
00:42:31,145 --> 00:42:36,145
thinking is really as significant as PTSD.

788
00:42:37,307 --> 00:42:38,688
They're both significant.

789
00:42:38,688 --> 00:42:40,923
The scary thing for women
in the military is that

790
00:42:40,923 --> 00:42:44,173
the rates actually are
higher for women than

791
00:42:44,173 --> 00:42:46,022
men in terms of post-traumatic stress.

792
00:42:46,022 --> 00:42:49,394
We have that validated now over years.

793
00:42:49,394 --> 00:42:50,878
With depression and suicidality,

794
00:42:50,878 --> 00:42:52,340
that's not the case though.

795
00:42:52,340 --> 00:42:56,891
Women do not suicide at
the same rates as men.

796
00:42:56,891 --> 00:43:00,442
Service women.

797
00:43:00,934 --> 00:43:03,189
However, when you think
of just the general data,

798
00:43:03,189 --> 00:43:05,973
you might find this important,
because it's rather grim,

799
00:43:05,973 --> 00:43:09,306
compelling some meaning that we

800
00:43:09,306 --> 00:43:11,296
should do something about it.

801
00:43:11,296 --> 00:43:16,296
Last year, there were 349
suicides, just in the army.

802
00:43:17,899 --> 00:43:20,906
There were 295 deaths in combat.

803
00:43:20,906 --> 00:43:23,385
The numbers of suicides
are higher than the

804
00:43:23,385 --> 00:43:28,385
numbers of death, which
is pretty daunting.

805
00:43:28,687 --> 00:43:32,161
When you think any combat era,

806
00:43:32,161 --> 00:43:35,046
there are different
issues that are central.

807
00:43:35,046 --> 00:43:40,044
With the conflicts in Iraq
and Afghanistan, the issues

808
00:43:40,044 --> 00:43:42,831
that have existed are
called signature injuries.

809
00:43:42,831 --> 00:43:44,294
They're a cluster.

810
00:43:44,294 --> 00:43:45,147
They're not just one.

811
00:43:45,147 --> 00:43:48,581
It's not just PTSD or depression.

812
00:43:48,581 --> 00:43:50,105
It's PTSD.

813
00:43:50,105 --> 00:43:51,913
I say post-traumatic stress or PTSD.

814
00:43:51,913 --> 00:43:53,152
Most people coming back are going

815
00:43:53,152 --> 00:43:54,656
to suffer some post traumatic stress.

816
00:43:54,656 --> 00:43:57,114
I would argue that any of us in combat,

817
00:43:57,114 --> 00:43:58,597
we're going to have post traumatic stress.

818
00:43:58,597 --> 00:44:03,169
It's a normal reaction to
abnormal circumstances.

819
00:44:03,169 --> 00:44:08,169
There's symptoms, but
it's not full blown PTSD.

820
00:44:08,939 --> 00:44:11,722
This cluster of post
traumatic stress, depression,

821
00:44:11,722 --> 00:44:14,485
suicidal thinking,
substance abuse, traumatic

822
00:44:14,485 --> 00:44:16,843
brain injury, and
intimate partner violence,

823
00:44:16,843 --> 00:44:18,569
they go hand in hand.

824
00:44:18,569 --> 00:44:21,109
You see the incendiary effect of that.

825
00:44:21,109 --> 00:44:24,583
This is why we, in our
field, need to be mindful

826
00:44:24,583 --> 00:44:26,250
not just of the service member,

827
00:44:26,250 --> 00:44:30,937
but then the impact on the family.

828
00:44:31,389 --> 00:44:34,010
You're familiar probably
with the clusters of

829
00:44:34,010 --> 00:44:36,895
re-experiencing, avoidance
and hyperarousal.

830
00:44:36,895 --> 00:44:40,105
If you think of families, which of these

831
00:44:40,105 --> 00:44:43,458
themes are most difficult for children?

832
00:44:43,458 --> 00:44:44,981
Early on in my work here,
I thought it would be

833
00:44:44,981 --> 00:44:47,115
hyperarousal, because
that's scary when family

834
00:44:47,115 --> 00:44:49,816
members are elevated and augmented and

835
00:44:49,816 --> 00:44:54,673
mad and rage storms, and
a really scary presence.

836
00:44:54,673 --> 00:44:55,445
That's not the case.

837
00:44:55,445 --> 00:44:58,359
Children desperately respond

838
00:44:58,359 --> 00:45:00,878
negatively to the avoidance and numbing.

839
00:45:00,878 --> 00:45:05,774
It has a really powerfully
negative effect.

840
00:45:05,774 --> 00:45:10,259
We'll talk a little about
military sexual trauma.

841
00:45:10,386 --> 00:45:13,515
The Pentagon data of May
of this year, said 26,000

842
00:45:13,515 --> 00:45:15,790
service members were
assaulted in the last year,

843
00:45:15,790 --> 00:45:18,309
compared with 19,000 the year before.

844
00:45:18,309 --> 00:45:22,211
Those of you probably know
that with all the attention

845
00:45:22,211 --> 00:45:26,639
that has been paid in recent
months in the Senate hearings,

846
00:45:26,639 --> 00:45:30,906
the messages are coming
forward and I think

847
00:45:30,906 --> 00:45:32,938
there's much more attention.

848
00:45:32,938 --> 00:45:35,229
People are paying attention.

849
00:45:35,936 --> 00:45:37,489
One in three women in the
military are assaulted,

850
00:45:37,489 --> 00:45:40,211
compared to one in six civilians.

851
00:45:40,426 --> 00:45:44,621
That's sort of a general
number at this point.

852
00:45:44,621 --> 00:45:46,316
Again, that's very daunting.

853
00:45:46,316 --> 00:45:47,992
Which I meant assault, not harassment.

854
00:45:47,992 --> 00:45:51,243
The data on harassment
are like in the range

855
00:45:51,243 --> 00:45:53,486
of something like 70
percent of people in the

856
00:45:53,486 --> 00:45:54,841
military suggest that
they've been harassed.

857
00:45:54,841 --> 00:45:55,933
Both men and women.

858
00:45:56,752 --> 00:46:00,714
It's the assault they're focused on.

859
00:46:00,714 --> 00:46:03,980
in terms of the current
congressional hearings.

860
00:46:05,885 --> 00:46:08,577
The reports in the Department of Defense

861
00:46:08,577 --> 00:46:11,563
are lower than in VA settings,

862
00:46:11,563 --> 00:46:14,936
the Veterans Administrations settings.

863
00:46:14,936 --> 00:46:17,577
If you report, one of the
significant features in

864
00:46:17,577 --> 00:46:20,543
military sexual traumas
is that often the person

865
00:46:20,543 --> 00:46:24,628
who has offended is maybe in your unit,

866
00:46:24,628 --> 00:46:27,045
maybe your superior officer,

867
00:46:27,045 --> 00:46:29,280
maybe your commanding officer.

868
00:46:29,280 --> 00:46:32,063
Many of the women who
are assaulted, and I say

869
00:46:32,063 --> 00:46:33,710
women because men are assaulted as well.

870
00:46:33,710 --> 00:46:34,643
It's not just women.

871
00:46:34,643 --> 00:46:37,631
It's just the focus of this talk is women.

872
00:46:37,631 --> 00:46:42,631
If they are then not separated
from the offending person

873
00:46:42,648 --> 00:46:47,648
who has injured them, they
have to live with that.

874
00:46:48,439 --> 00:46:50,776
Not only is there a deterrent
to reporting because

875
00:46:50,776 --> 00:46:54,290
of safety, there's a deterrent
because it would affect

876
00:46:54,290 --> 00:46:59,290
one's job standing and any
opportunities for promotion.

877
00:47:01,401 --> 00:47:03,229
What we do know, though,
is military sexual

878
00:47:03,229 --> 00:47:07,639
assault is directly associated with PTSD.

879
00:47:07,639 --> 00:47:10,605
Himelfarb conducted a
study a few years ago.

880
00:47:10,605 --> 00:47:12,697
It examined the relations between military

881
00:47:12,697 --> 00:47:17,697
sexual trauma and the
actual outcomes with PTSD.

882
00:47:20,561 --> 00:47:23,851
It's strongly associated
with, rather than thinking

883
00:47:23,851 --> 00:47:27,041
it's associated with
trauma before the military,

884
00:47:27,041 --> 00:47:29,052
or after the military, it's strongly

885
00:47:29,052 --> 00:47:32,120
associated with military sexual assault.

886
00:47:32,120 --> 00:47:33,726
That's one of the major
reasons that you have these

887
00:47:33,726 --> 00:47:38,726
high number of women who
are presenting with PTSD.

888
00:47:42,969 --> 00:47:46,038
I'm not going to go into
much more detail with that,

889
00:47:46,038 --> 00:47:51,038
but Julius St. George has been organizing

890
00:47:53,148 --> 00:47:57,902
a showing which will occur next Wednesday.

891
00:47:57,902 --> 00:47:58,939
Seven o'clock.

892
00:47:58,939 --> 00:48:03,165
Room 106.

893
00:48:03,165 --> 00:48:05,664
Seelye 106.

894
00:48:05,664 --> 00:48:08,203
This is a viewing of "The Invisible War."

895
00:48:08,203 --> 00:48:09,991
For those of you who may or
may not be familiar with that,

896
00:48:09,991 --> 00:48:14,075
it's a documentary that won
a number of awards within the

897
00:48:14,075 --> 00:48:17,447
last two years, documenting
the interviews with women

898
00:48:17,447 --> 00:48:19,296
who have suffered military sexual assault.

899
00:48:19,296 --> 00:48:21,735
It's very powerful.

900
00:48:21,735 --> 00:48:25,249
So powerful that it was shown
to a number of commanding

901
00:48:25,249 --> 00:48:28,094
officers who sat in the
congressional hearings.

902
00:48:28,094 --> 00:48:29,820
What I have found out since from

903
00:48:29,820 --> 00:48:32,380
Deborah Stone, who is a major.

904
00:48:32,380 --> 00:48:34,615
She is a colleague of mine who

905
00:48:34,615 --> 00:48:37,155
is working in Fort Myer in D.C. now.

906
00:48:37,155 --> 00:48:41,889
She has said that the
U.S. Army SHARP training,

907
00:48:41,889 --> 00:48:44,652
that's this training.

908
00:48:44,652 --> 00:48:47,032
This website, you can view.

909
00:48:47,032 --> 00:48:50,263
You can sort of log on
and take a look at it.

910
00:48:50,263 --> 00:48:53,514
They actually have implemented
very elaborate training.

911
00:48:53,514 --> 00:48:57,049
It's about trying to change
the culture in the military.

912
00:48:57,049 --> 00:48:59,406
Some of it's pretty basic.

913
00:48:59,406 --> 00:49:03,388
Both in some basic training
as well as just general

914
00:49:03,388 --> 00:49:07,940
conversation and general
discourse in the military.

915
00:49:07,940 --> 00:49:12,713
People are often using misogynistic,

916
00:49:12,713 --> 00:49:17,713
bigoted, harsh, sexist language.

917
00:49:17,875 --> 00:49:20,251
That does not set the stage for a

918
00:49:20,251 --> 00:49:25,251
respectful, benevolent
environment, shall we say.

919
00:49:25,333 --> 00:49:29,536
This is the challenge
to the cultural typing

920
00:49:29,536 --> 00:49:33,233
that the army has now implemented.

921
00:49:33,233 --> 00:49:35,814
I was looking at some of that today.

922
00:49:35,814 --> 00:49:37,662
They're taking it seriously.

923
00:49:37,662 --> 00:49:40,141
I hope they keep taking it seriously.

924
00:49:40,141 --> 00:49:41,726
What they were saying is
with all that controversy

925
00:49:41,726 --> 00:49:45,505
should they have reporting
outside of the command structure?

926
00:49:45,505 --> 00:49:49,040
The conclusion with what
they're doing now is they think

927
00:49:49,040 --> 00:49:52,291
they're trying to change
the culture from the top,

928
00:49:52,291 --> 00:49:56,029
not just from the lower
ranking top-down and mid-range.

929
00:49:56,029 --> 00:49:58,426
So we'll see.

930
00:49:58,503 --> 00:50:01,657
I urge all of you to attend
the viewing next Wednesday if

931
00:50:01,657 --> 00:50:06,657
you'd like to see and hear more
about these issues in depth.

932
00:50:07,183 --> 00:50:08,950
Let's see.

933
00:50:08,950 --> 00:50:10,007
We're going to shift now.

934
00:50:10,007 --> 00:50:14,375
I've given you a lot of
these data about what some

935
00:50:14,375 --> 00:50:16,976
of the issues are that
women are coming back with.

936
00:50:19,206 --> 00:50:23,539
As clinical social
workers, how do we respond?

937
00:50:23,539 --> 00:50:26,423
These are some of the basic
principles that I think are

938
00:50:26,423 --> 00:50:30,305
all familiar to us,
that are critical in any

939
00:50:30,305 --> 00:50:33,554
type of clinical social work encounter.

940
00:50:33,554 --> 00:50:36,561
The value of relationship,
therapeutic alliance,

941
00:50:36,561 --> 00:50:41,561
cultural responsiveness, a
research informed stance,

942
00:50:42,210 --> 00:50:47,195
theoretical grounding, and a
social justice perspective.

943
00:50:47,195 --> 00:50:49,991
Let me just introduce
you to the Sanchez family

944
00:50:49,991 --> 00:50:52,693
a little better, because
then I hope that this will

945
00:50:52,693 --> 00:50:56,756
convey, it's only a clinical
vignette, it's a composite.

946
00:50:56,756 --> 00:50:58,991
I'm hoping that the vignette
will capture some of the

947
00:50:58,991 --> 00:51:01,531
issues that we have just talked about

948
00:51:01,531 --> 00:51:04,948
that are facing many
women in the military.

949
00:51:04,948 --> 00:51:08,727
I'm going to urge us to
think in a very broad sense.

950
00:51:08,727 --> 00:51:11,286
Don't think beyond just symptom relief.

951
00:51:11,286 --> 00:51:16,286
Think of the complexity of
this client's situation.

952
00:51:18,114 --> 00:51:20,937
So first of all, I didn't
ask you who's the client.

953
00:51:20,937 --> 00:51:22,928
I've introduced you to Maria.

954
00:51:22,928 --> 00:51:25,488
I've told you a little
bit about her so far,

955
00:51:25,488 --> 00:51:27,296
but I haven't told you
about the whole family yet.

956
00:51:27,296 --> 00:51:32,296
Maria is 37, was reared
in Puerto Rico in a family

957
00:51:34,590 --> 00:51:36,419
where she was the eldest of four children.

958
00:51:36,419 --> 00:51:37,536
She was reared in poverty in a

959
00:51:37,536 --> 00:51:41,518
very difficult, challenging home life.

960
00:51:41,518 --> 00:51:42,514
Her mother was very physically

961
00:51:42,514 --> 00:51:47,147
ill from her early years onward.

962
00:51:47,147 --> 00:51:49,828
So she was caring for
many of the siblings.

963
00:51:49,828 --> 00:51:51,880
Her mother died when she was only four.

964
00:51:51,880 --> 00:51:54,359
Her mother died from a septic infection.

965
00:51:54,359 --> 00:51:57,365
So Maria was sent at a very early age to

966
00:51:57,365 --> 00:52:01,957
family members in New England to live.

967
00:52:01,957 --> 00:52:04,029
She described herself
as really marginalized

968
00:52:04,029 --> 00:52:06,387
because she was taken in by some distant

969
00:52:06,387 --> 00:52:11,162
relatives and they,
quote, felt sorry for her.

970
00:52:11,162 --> 00:52:13,578
She, in her home life,
had described that she

971
00:52:13,578 --> 00:52:18,069
was beaten by her older brother regularly.

972
00:52:18,069 --> 00:52:20,649
The father was very neglectful and harsh.

973
00:52:20,649 --> 00:52:25,403
She just had an incredibly
difficult early years,

974
00:52:25,403 --> 00:52:30,403
and managed to thrive, we
talked about the nature of

975
00:52:31,478 --> 00:52:34,424
resilience, in her new
setting in New England.

976
00:52:34,424 --> 00:52:36,680
She managed to go to school, get through

977
00:52:36,680 --> 00:52:41,387
high school, and then met Carlos.

978
00:52:41,387 --> 00:52:43,276
Carlos was reared Puerto Rican

979
00:52:43,276 --> 00:52:48,276
ethnicity, oldest of four children.

980
00:52:48,315 --> 00:52:53,315
His family had lived in New
England for about 40 years.

981
00:52:54,817 --> 00:52:59,817
Very educationally oriented,
solid socioeconomically.

982
00:53:01,380 --> 00:53:02,538
Are you hearing the differences in

983
00:53:02,538 --> 00:53:06,845
terms of some of the
sociocultural background?

984
00:53:06,845 --> 00:53:11,845
When they married, they
felt the commonality

985
00:53:12,087 --> 00:53:14,932
in terms of religion,
ethnicity, shared values.

986
00:53:14,932 --> 00:53:16,923
They desperately wanted
to have three children.

987
00:53:16,923 --> 00:53:21,923
Antonio who is now 16, Delia
who's 9, and Anna who's 3.

988
00:53:23,505 --> 00:53:27,630
So they had been married
17 years and Maria

989
00:53:27,630 --> 00:53:30,129
was in the Army Reserves for eight years.

990
00:53:30,129 --> 00:53:31,673
She wanted to join because she wanted to

991
00:53:31,673 --> 00:53:34,497
continue with her schooling
and she had a sense

992
00:53:34,497 --> 00:53:37,544
of pride because some of
the relatives in her family

993
00:53:37,544 --> 00:53:41,323
that adopted her and took her
in had been in the military.

994
00:53:41,323 --> 00:53:42,646
So you hear the sense of identification

995
00:53:42,646 --> 00:53:45,369
that was positive for Maria.

996
00:53:45,369 --> 00:53:50,369
So this family, basically,
you sort of think of where

997
00:53:51,098 --> 00:53:54,349
they were two years before her deployment.

998
00:53:54,349 --> 00:53:57,132
They were basically
functioning quite well.

999
00:53:57,132 --> 00:53:59,631
All three kids were doing what they

1000
00:53:59,631 --> 00:54:03,329
needed to be doing in school, thriving.

1001
00:54:03,329 --> 00:54:05,340
Carlos was an accountant
and Maria was working in

1002
00:54:05,340 --> 00:54:09,180
a nursing home as a nurse's aide.

1003
00:54:09,180 --> 00:54:12,004
Maria's unit's called up,
she's deployed, goes to Iraq.

1004
00:54:12,004 --> 00:54:13,207
This is where you hear the story.

1005
00:54:13,207 --> 00:54:16,498
Then she then had the experience of being

1006
00:54:16,498 --> 00:54:20,297
a medic, and separated from at the time

1007
00:54:20,297 --> 00:54:23,121
a 15 year old, eight
year old, two year old.

1008
00:54:23,121 --> 00:54:24,361
Think of the implications.

1009
00:54:24,361 --> 00:54:27,611
Again, these are the ordinary
stressors of deployment

1010
00:54:27,611 --> 00:54:31,126
but the dramatic difference
between the two and three

1011
00:54:31,126 --> 00:54:32,630
year old, and eight and nine year old,

1012
00:54:32,630 --> 00:54:36,023
and 15 and 16 year old is considerable.

1013
00:54:39,530 --> 00:54:43,579
Let me tell you what happened
upon return from combat.

1014
00:54:43,579 --> 00:54:46,586
Maria was not sleeping.

1015
00:54:46,586 --> 00:54:49,188
She had flashbacks.

1016
00:54:49,188 --> 00:54:51,198
She wanted to be dead.

1017
00:54:51,198 --> 00:54:53,210
She felt that she had
no reason to be living.

1018
00:54:53,210 --> 00:54:58,107
She felt completely
detached from the kids.

1019
00:54:58,107 --> 00:54:59,833
She didn't know how to engage with them,

1020
00:54:59,833 --> 00:55:01,560
because she was getting
reports from school.

1021
00:55:01,560 --> 00:55:04,628
Antonio, the oldest, was
getting into trouble.

1022
00:55:04,628 --> 00:55:06,375
He was beating up other kids.

1023
00:55:06,375 --> 00:55:08,244
Delia was bed-wetting.

1024
00:55:08,244 --> 00:55:11,333
She was wetting her bed every night,

1025
00:55:11,333 --> 00:55:14,075
and very anxious and not able to sleep.

1026
00:55:14,075 --> 00:55:15,904
Anna would shriek every
time her mother would go

1027
00:55:15,904 --> 00:55:18,240
to pick her up, and she
would start screaming.

1028
00:55:18,240 --> 00:55:22,466
So Maria felt like she
had lost everything.

1029
00:55:22,466 --> 00:55:25,311
She was no longer a decent soldier,

1030
00:55:25,311 --> 00:55:27,322
in her perspective, because
she was responsible.

1031
00:55:27,322 --> 00:55:28,318
This is her words.

1032
00:55:28,318 --> 00:55:30,613
She was responsible for the
death of that young man.

1033
00:55:30,613 --> 00:55:33,235
So she was a terrible soldier.

1034
00:55:33,235 --> 00:55:35,124
She wasn't a decent mother.

1035
00:55:35,124 --> 00:55:37,623
She couldn't be a decent mother
to any of these children.

1036
00:55:37,623 --> 00:55:39,350
Then she felt that she failed her husband

1037
00:55:39,350 --> 00:55:43,433
as a wife because they
were fighting constantly.

1038
00:55:43,433 --> 00:55:47,984
She was not only despairing,
but she was not sleeping,

1039
00:55:47,984 --> 00:55:51,215
angry, irritable, yelling,
yelling at the kids.

1040
00:55:51,215 --> 00:55:53,043
He was distant.

1041
00:55:53,043 --> 00:55:54,059
He tried to spend as much time

1042
00:55:54,059 --> 00:55:55,664
away from the home as possible.

1043
00:55:58,464 --> 00:56:00,418
We have enough of at least some

1044
00:56:00,418 --> 00:56:02,166
of the cameo of the vignette.

1045
00:56:02,166 --> 00:56:02,958
So what do you do?

1046
00:56:02,958 --> 00:56:05,051
Who's the client?

1047
00:56:05,051 --> 00:56:05,802
Some of you are familiar with this.

1048
00:56:05,802 --> 00:56:09,317
This is my model that I try to use.

1049
00:56:09,317 --> 00:56:11,369
This is the client.

1050
00:56:11,369 --> 00:56:11,938
So who's the client?

1051
00:56:11,938 --> 00:56:13,177
Is it just Maria?

1052
00:56:13,177 --> 00:56:14,214
Or what about Carlos?

1053
00:56:14,214 --> 00:56:16,083
What about the whole family?

1054
00:56:16,083 --> 00:56:17,566
It could be an individual as a client.

1055
00:56:17,566 --> 00:56:18,419
It could be the couple.

1056
00:56:18,419 --> 00:56:20,024
It could be the family.

1057
00:56:20,024 --> 00:56:21,629
I would argue that it was the

1058
00:56:21,629 --> 00:56:24,583
whole family that was my client.

1059
00:56:24,583 --> 00:56:27,095
With every given client,
we need to pay attention to

1060
00:56:27,095 --> 00:56:32,095
diversity, health trauma
and addictions, basic

1061
00:56:35,913 --> 00:56:39,651
developmental themes,
family and community, social

1062
00:56:39,651 --> 00:56:43,023
policy and research,
sociopolitical context and ethics.

1063
00:56:43,023 --> 00:56:45,279
Does that make sense?

1064
00:56:45,279 --> 00:56:48,123
With every single client,
we need to be mindful of

1065
00:56:48,123 --> 00:56:51,678
these things as well as, guess what,

1066
00:56:51,678 --> 00:56:54,177
the client is interacting with us.

1067
00:56:54,177 --> 00:56:57,956
As clinicians, we're influencing this

1068
00:56:57,956 --> 00:57:00,191
therapeutic alliance at any given moment.

1069
00:57:00,191 --> 00:57:04,478
We need to be mindful of all
of these factors as well.

1070
00:57:04,478 --> 00:57:09,171
Going back to the case, if
you were thinking of what

1071
00:57:09,171 --> 00:57:11,569
would you do, how would
you assess, and what

1072
00:57:11,569 --> 00:57:13,905
theory models would you draw from?

1073
00:57:13,905 --> 00:57:18,905
Did you hear in the description
with Maria, with her

1074
00:57:20,122 --> 00:57:25,122
nightmares, her flashbacks,
her hopelessness,

1075
00:57:27,985 --> 00:57:30,342
her irritability, her hyperarousal?

1076
00:57:30,342 --> 00:57:33,267
Are you hearing poles for trauma theory?

1077
00:57:33,267 --> 00:57:34,690
Poles for trauma theory.

1078
00:57:34,690 --> 00:57:36,640
Are you hearing the incredible
relationship disruptions

1079
00:57:36,640 --> 00:57:39,464
and the sense of estrangement and

1080
00:57:39,464 --> 00:57:41,800
the poles for attachment theory?

1081
00:57:41,800 --> 00:57:44,848
You're hearing the alienation they

1082
00:57:44,848 --> 00:57:49,848
have again with families of origin.

1083
00:57:50,435 --> 00:57:52,285
They're no longer talking to them.

1084
00:57:52,285 --> 00:57:56,144
The family theory comes to mind.

1085
00:57:56,144 --> 00:57:59,354
When you think of how we try to use the

1086
00:57:59,354 --> 00:58:01,841
multiplicity of theory
models, it's not random.

1087
00:58:01,841 --> 00:58:05,226
It's actually based on what
are the presenting issues,

1088
00:58:05,226 --> 00:58:10,226
and then pulling from the
different theory models.

1089
00:58:10,325 --> 00:58:11,524
So why do we care about
psychodynamic theory?

1090
00:58:11,524 --> 00:58:15,303
Well at least in this line
of work, if we really believe

1091
00:58:15,303 --> 00:58:17,294
that there are certain
patterns that are established

1092
00:58:17,294 --> 00:58:19,895
in childhood, that they're
going to influence both

1093
00:58:19,895 --> 00:58:22,637
strengths and vulnerabilities
in later life,

1094
00:58:22,637 --> 00:58:26,030
then that will affect
how our female service

1095
00:58:26,030 --> 00:58:29,261
members are going to
navigate these stressors.

1096
00:58:29,261 --> 00:58:31,070
Power of the unconscious.

1097
00:58:31,070 --> 00:58:32,837
This is very important.

1098
00:58:32,837 --> 00:58:35,132
This unique meaning of a
narrative of an individual.

1099
00:58:35,132 --> 00:58:37,103
Rather than assuming, in many, settings,

1100
00:58:37,103 --> 00:58:40,923
the treatment programs
are symptom related.

1101
00:58:40,923 --> 00:58:45,169
So if a client has a
symptom picture of PTSD,

1102
00:58:45,169 --> 00:58:50,169
then they may be
recommended to a particular

1103
00:58:52,362 --> 00:58:55,145
protocol that focuses on PTSD.

1104
00:58:55,145 --> 00:58:56,932
So it might be cognitive
processing treatment.

1105
00:58:56,932 --> 00:59:00,034
It might be CDT, which would
be fine except you need to find

1106
00:59:00,354 --> 00:59:03,632
out the unique meaning of the
experience for the individual,

1107
00:59:03,671 --> 00:59:07,819
rather than just focusing
on symptom picture.

1108
00:59:07,819 --> 00:59:08,855
Who is the individual?

1109
00:59:08,855 --> 00:59:10,074
Transference, countertransference,

1110
00:59:10,074 --> 00:59:14,361
is pivotal because it tells us how we are

1111
00:59:14,361 --> 00:59:18,628
reflecting on the work and
what role it has in the work.

1112
00:59:18,628 --> 00:59:20,985
I use attachment theory
regularly with this population

1113
00:59:20,985 --> 00:59:22,793
because it doesn't make
sense that with all the

1114
00:59:22,793 --> 00:59:26,064
separations and reunions
and disengagements and

1115
00:59:26,064 --> 00:59:28,685
reattachments that under
the best of circumstances,

1116
00:59:28,685 --> 00:59:33,195
this couple had a secure attachment.

1117
00:59:33,195 --> 00:59:34,800
It was earned security.

1118
00:59:34,800 --> 00:59:37,523
Maria had more of a
disorganized attachment.

1119
00:59:37,523 --> 00:59:40,448
I'm going to move through
this pretty quickly.

1120
00:59:40,448 --> 00:59:44,207
Those of you who are somewhat familiar

1121
00:59:44,207 --> 00:59:46,990
with attachment theory,
you realize that there are

1122
00:59:46,990 --> 00:59:51,013
either secure or insecure
internal attachment models.

1123
00:59:51,013 --> 00:59:54,020
Disorganized and disoriented is what

1124
00:59:54,020 --> 00:59:55,911
Maria was dealing with as a child.

1125
00:59:55,911 --> 00:59:58,348
She had a relatively
secure attachment with

1126
00:59:58,348 --> 01:00:02,473
Carlos by the time she
went off to deployment.

1127
01:00:02,473 --> 01:00:07,473
Their attachment systems
were disregulated based on

1128
01:00:07,633 --> 01:00:11,960
the numbers of stressors
that bombarded them.

1129
01:00:11,960 --> 01:00:15,373
This is an important construct.

1130
01:00:15,373 --> 01:00:19,860
The interference with mentalization.

1131
01:00:20,087 --> 01:00:21,672
A part of attachment
theory that's a capacity to

1132
01:00:21,672 --> 01:00:24,700
actually be aware of one's
feeling and reflect upon

1133
01:00:24,700 --> 01:00:27,076
them, and be able to
attune to the feelings of

1134
01:00:27,076 --> 01:00:31,972
other people, and also reflect
upon them so that there's

1135
01:00:31,972 --> 01:00:35,507
a capacity to make sense
of it and, meaning-making.

1136
01:00:35,507 --> 01:00:39,104
When enough combat and
deployment stressors,

1137
01:00:39,104 --> 01:00:42,598
this process, mentalization,
breaks down as well.

1138
01:00:42,598 --> 01:00:44,345
And think, again, this is what gets

1139
01:00:44,345 --> 01:00:48,185
interrupted when you have enough stress.

1140
01:00:48,185 --> 01:00:51,436
the care seeking of
attachment breaks down.

1141
01:00:51,436 --> 01:00:53,143
People don't always seek care.

1142
01:00:53,143 --> 01:00:56,007
Remember with Carlos, he
wasn't seeking any care.

1143
01:00:56,007 --> 01:00:58,872
She wasn't seeking any
care, from each other.

1144
01:00:58,872 --> 01:01:00,315
They're not offering a
safe haven to each other.

1145
01:01:00,315 --> 01:01:02,611
There's no curiosity.

1146
01:01:02,611 --> 01:01:04,663
This is a crucial one.

1147
01:01:04,663 --> 01:01:05,922
The circle of security is broken.

1148
01:01:05,922 --> 01:01:10,493
That sense of connecting
back to the person,

1149
01:01:10,493 --> 01:01:14,536
or people, who are most
important in terms of

1150
01:01:14,536 --> 01:01:17,998
providing comfort and security.

1151
01:01:17,998 --> 01:01:20,306
So, how about another model for a moment?

1152
01:01:20,306 --> 01:01:22,927
Why do we care about Winnicott?

1153
01:01:22,927 --> 01:01:24,512
First of all, Donald and Claire Winnicott

1154
01:01:24,512 --> 01:01:29,408
focused their entire
careers in World War II

1155
01:01:29,408 --> 01:01:31,725
in helping children survive the Blitz.

1156
01:01:31,725 --> 01:01:36,052
They took them to homes
outside in the countryside.

1157
01:01:36,052 --> 01:01:37,495
One would think, well were
these children traumatized

1158
01:01:37,495 --> 01:01:39,120
because they're taken
away from their families?

1159
01:01:39,120 --> 01:01:40,136
No.

1160
01:01:40,136 --> 01:01:42,391
They provided homes that had a good enough

1161
01:01:42,391 --> 01:01:45,195
holding environment, and
good enough mothering,

1162
01:01:45,195 --> 01:01:49,218
concepts from his model,
that helped to sustain them.

1163
01:01:49,218 --> 01:01:51,555
When reunited with their
families back in London,

1164
01:01:51,555 --> 01:01:56,555
they navigated those
separations quite well.

1165
01:01:59,033 --> 01:02:01,225
Victim-victimizer-bystander.

1166
01:02:01,225 --> 01:02:03,724
Why is this relevant?

1167
01:02:03,724 --> 01:02:06,020
Anyone who has suffered trauma will

1168
01:02:06,020 --> 01:02:07,890
know what it's like to be a victim.

1169
01:02:07,890 --> 01:02:10,571
You've had somebody who's
offended you, and there's

1170
01:02:10,571 --> 01:02:13,639
usually a bystander who
hasn't done much of anything.

1171
01:02:13,639 --> 01:02:16,483
Why is that important?

1172
01:02:16,483 --> 01:02:21,483
Because in families,
if you think of Carlos

1173
01:02:22,659 --> 01:02:24,955
the husband, he felt
like a helpless victim.

1174
01:02:24,955 --> 01:02:29,466
He felt victimized by his partner.

1175
01:02:29,466 --> 01:02:33,529
She felt victimized as well.

1176
01:02:33,529 --> 01:02:35,601
Neither of them were really
recognizing that they

1177
01:02:35,601 --> 01:02:38,872
were aggressive and
victimizing each other.

1178
01:02:38,872 --> 01:02:43,467
These themes are important in
families as well as for us.

1179
01:02:45,151 --> 01:02:46,248
As long as we reflect, we have a

1180
01:02:46,248 --> 01:02:49,969
better chance of helping our clients.

1181
01:02:49,969 --> 01:02:51,449
Back to the practice approaches.

1182
01:02:51,449 --> 01:02:53,419
Those of you that work in
the Department of Defense,

1183
01:02:53,419 --> 01:02:55,959
in VA settings, these are
probably familiar to you.

1184
01:02:55,959 --> 01:02:58,519
These are considered the
gold standard treatments

1185
01:02:58,519 --> 01:03:03,519
for PTSD and depression,
cognitive-behavioral work,

1186
01:03:03,557 --> 01:03:05,813
cognitive processing
treatment, prolonged exposure.

1187
01:03:05,813 --> 01:03:07,133
They're all CDT models.

1188
01:03:07,133 --> 01:03:12,133
They all have very strong validity.

1189
01:03:12,375 --> 01:03:17,375
However, imagine with Carlos
and Maria, can you imagine

1190
01:03:19,141 --> 01:03:23,163
them focusing exclusively on
these models without paying

1191
01:03:23,163 --> 01:03:27,832
attention to couple and family
therapy and other methods?

1192
01:03:28,547 --> 01:03:31,575
What I want to, let me go
back to this for a moment,

1193
01:03:31,575 --> 01:03:34,216
just propose, why would we
want to work with families?

1194
01:03:34,216 --> 01:03:37,954
Because I'm arguing with
this need for actually

1195
01:03:37,954 --> 01:03:39,783
working with this entire family.

1196
01:03:39,783 --> 01:03:42,160
It's to promote secure attachments.

1197
01:03:42,160 --> 01:03:45,045
We help them reconnect,
reduce mental health

1198
01:03:45,045 --> 01:03:49,088
symptomatology, minimize
secondary trauma, help

1199
01:03:49,088 --> 01:03:51,302
them with learning more,
and then restoring a sense

1200
01:03:51,302 --> 01:03:55,163
of re-connection and social vindication.

1201
01:03:55,163 --> 01:03:57,662
This is a trauma-informed
model that I've been working

1202
01:03:57,662 --> 01:04:02,662
on that's geared to military
and veteran families.

1203
01:04:03,269 --> 01:04:04,773
It's similar to a lot of
trauma-informed models,

1204
01:04:04,773 --> 01:04:07,658
where the first phase is
safety, stabilization.

1205
01:04:07,658 --> 01:04:09,649
Second, a reflection on
the trauma narrative.

1206
01:04:09,649 --> 01:04:12,940
Third, consolidation of new perspectives.

1207
01:04:12,940 --> 01:04:14,951
What I'm going to
emphasize is the attachment

1208
01:04:14,951 --> 01:04:19,787
piece, because, getting
back to the case of

1209
01:04:19,787 --> 01:04:24,277
Carlos and Maria, they
needed to have a sense that

1210
01:04:24,277 --> 01:04:25,984
there was a safe environment at home.

1211
01:04:25,984 --> 01:04:27,568
You hear the volatility.

1212
01:04:27,568 --> 01:04:28,584
It wasn't clear to me if there was

1213
01:04:28,584 --> 01:04:30,413
intimate partner violence or not.

1214
01:04:30,413 --> 01:04:33,988
How to do a risk assessment
to establish safety.

1215
01:04:33,988 --> 01:04:37,767
The whole realm of self-care was crucial.

1216
01:04:37,767 --> 01:04:40,918
The affect regulation was just thrown off.

1217
01:04:40,918 --> 01:04:42,583
Not only for Maria, who is the

1218
01:04:42,583 --> 01:04:45,346
combat veteran, but for her husband.

1219
01:04:45,346 --> 01:04:46,565
Does that make sense?

1220
01:04:46,565 --> 01:04:49,003
In their years where
they had more stability,

1221
01:04:49,003 --> 01:04:51,889
they were able to relate
in really harmonious

1222
01:04:51,889 --> 01:04:55,545
ways and to be able to
self-soothe, and to be able

1223
01:04:55,545 --> 01:04:57,942
to manage their emotions
without having these

1224
01:04:57,942 --> 01:04:59,792
incredible ups and downs, rage storms.

1225
01:04:59,792 --> 01:05:02,453
This feature was absolutely critical.

1226
01:05:02,453 --> 01:05:07,453
The biobehavioral strategies
for stress reduction.

1227
01:05:07,837 --> 01:05:09,767
That's repeated there.

1228
01:05:09,767 --> 01:05:13,342
I guess I'm trying to make the point.

1229
01:05:13,342 --> 01:05:16,390
Stress reduction, self-soothing,
affect regulation.

1230
01:05:16,390 --> 01:05:18,726
This couple was completely disregulated.

1231
01:05:18,726 --> 01:05:23,726
This was the major focus of the self-care.

1232
01:05:24,212 --> 01:05:26,366
In addition, in this
early phase of the work,

1233
01:05:26,366 --> 01:05:28,580
remember the physical health?

1234
01:05:28,580 --> 01:05:30,084
Neither of them were sleeping.

1235
01:05:30,084 --> 01:05:31,445
Not just Maria.

1236
01:05:31,445 --> 01:05:34,270
Carlos wasn't sleeping,
and the little one,

1237
01:05:34,270 --> 01:05:36,280
Anna, wasn't sleeping.

1238
01:05:36,280 --> 01:05:38,679
Delia was wetting her bed.

1239
01:05:38,679 --> 01:05:40,425
The only one sleeping was Antonio.

1240
01:05:40,425 --> 01:05:42,680
So the whole household had
problems with physical health.

1241
01:05:42,680 --> 01:05:44,265
Mental health.

1242
01:05:44,265 --> 01:05:45,850
You heard the issues.

1243
01:05:45,850 --> 01:05:48,714
Maria needed to have a
referral to a psychiatrist

1244
01:05:48,714 --> 01:05:51,498
to see if she needed help
with sleep, depression,

1245
01:05:51,498 --> 01:05:55,744
check out any possible suicidality.

1246
01:05:55,744 --> 01:05:57,816
She was also drinking
several glasses of wine,

1247
01:05:57,816 --> 01:06:00,559
two or three or four
glasses of wine a night.

1248
01:06:00,559 --> 01:06:04,074
She had to be checked.

1249
01:06:04,074 --> 01:06:06,451
This is where you can pull in.

1250
01:06:06,451 --> 01:06:09,661
If you are the clinician
who's actually providing

1251
01:06:09,661 --> 01:06:14,661
the support, at the
moment you're providing a

1252
01:06:14,740 --> 01:06:16,467
supportive psychotherapy role.

1253
01:06:16,467 --> 01:06:18,114
You're doing an extended assessment

1254
01:06:18,114 --> 01:06:20,917
and building a therapeutic alliance,

1255
01:06:20,917 --> 01:06:23,131
connecting with this
whole cast of characters.

1256
01:06:23,131 --> 01:06:25,671
The psychiatrists,
physicians, nutritionists,

1257
01:06:25,671 --> 01:06:27,460
other clinicians who are working.

1258
01:06:27,460 --> 01:06:30,974
The school counselors who are dealing

1259
01:06:30,974 --> 01:06:35,357
with the children who are suffering.

1260
01:06:37,883 --> 01:06:40,746
Psychoeducation regarding post-deployment.

1261
01:06:40,746 --> 01:06:42,107
This is also a piece of this.

1262
01:06:42,107 --> 01:06:47,107
For many couples, the
partners need a basic

1263
01:06:47,593 --> 01:06:49,178
understanding of some of these stressors

1264
01:06:49,178 --> 01:06:52,977
that they may have been dealing with.

1265
01:06:52,977 --> 01:06:55,456
Once again, it's understanding, safety

1266
01:06:55,456 --> 01:06:59,499
and developingt in attachment theory line.

1267
01:06:59,499 --> 01:07:01,899
What they were doing is developing secure

1268
01:07:01,899 --> 01:07:05,271
attachments and re-connections once again,

1269
01:07:05,271 --> 01:07:07,323
so they're able to move on.

1270
01:07:07,323 --> 01:07:11,163
Moving on means actually trying to address

1271
01:07:11,163 --> 01:07:14,292
some of the traumatic experiences.

1272
01:07:14,292 --> 01:07:18,741
At that point, Maria is ready for entering

1273
01:07:18,741 --> 01:07:20,346
cognitive process and treatment.

1274
01:07:20,346 --> 01:07:22,500
She's in a position
where she's stable enough

1275
01:07:22,500 --> 01:07:25,791
to be able to withstand recalling the

1276
01:07:25,791 --> 01:07:29,022
content of the horrific, traumatic events.

1277
01:07:29,022 --> 01:07:32,049
Maria gets her own individual therapist.

1278
01:07:32,049 --> 01:07:35,340
But what do we do in couples therapy?

1279
01:07:35,340 --> 01:07:37,697
She starts to talk about
how devastated she was

1280
01:07:37,697 --> 01:07:40,705
of being lost, and not having any role

1281
01:07:40,705 --> 01:07:43,000
in her family, losing her husband,

1282
01:07:43,000 --> 01:07:45,053
losing her children, losing her sense of

1283
01:07:45,053 --> 01:07:48,690
being a soldier, wanting to be dead.

1284
01:07:48,690 --> 01:07:53,690
He then becomes, Carlos,
much more compassionate.

1285
01:07:54,113 --> 01:07:56,330
Because at this point, they
are starting to talk to

1286
01:07:56,330 --> 01:07:58,223
each other and talk
about how they've missed

1287
01:07:58,223 --> 01:08:00,457
each other, how they've lost each other.

1288
01:08:00,457 --> 01:08:01,575
The grieving.

1289
01:08:01,575 --> 01:08:05,252
This is a phase of grieving.

1290
01:08:05,252 --> 01:08:06,938
It's not just sharing of trauma events.

1291
01:08:06,938 --> 01:08:09,214
It's the grieving of those experiences

1292
01:08:09,214 --> 01:08:10,534
and the grieving of whatever was lost

1293
01:08:10,534 --> 01:08:13,114
during the deployment.

1294
01:08:13,114 --> 01:08:16,732
The lost years with these children.

1295
01:08:16,732 --> 01:08:19,392
This couple was actually
able to go from a sense of

1296
01:08:19,392 --> 01:08:22,399
bitter estrangement to really connecting

1297
01:08:22,399 --> 01:08:24,355
with each other in a powerful way.

1298
01:08:25,494 --> 01:08:27,194
Why does this matter?

1299
01:08:27,194 --> 01:08:29,226
The pattern of
victim-victimizer-bystander?

1300
01:08:29,226 --> 01:08:34,021
Well, they were each blaming the other.

1301
01:08:34,021 --> 01:08:36,520
She kept saying to him
that he seems so passive

1302
01:08:36,520 --> 01:08:38,795
and hopeless and helpless,
and she couldn't stand him.

1303
01:08:38,795 --> 01:08:40,278
He kept saying she was so agitated and

1304
01:08:40,278 --> 01:08:42,513
angry and furious and hard to be around.

1305
01:08:42,513 --> 01:08:44,586
He couldn't stand it.

1306
01:08:44,586 --> 01:08:49,238
So they were unable to
tolerate the others' qualities.

1307
01:08:49,238 --> 01:08:51,006
They were victimizing
each other constantly.

1308
01:08:51,006 --> 01:08:54,277
Back and forth, back and
forth, back and forth.

1309
01:08:54,277 --> 01:08:56,247
Ultimately, as they were
talking about what they

1310
01:08:56,247 --> 01:08:59,823
had lost, what they felt they had grieved,

1311
01:08:59,823 --> 01:09:02,647
they were able to then actually establish

1312
01:09:02,647 --> 01:09:04,395
more of a connection.

1313
01:09:04,395 --> 01:09:06,894
He said to her that he
hated her bitterness,

1314
01:09:06,894 --> 01:09:08,438
that she had become a bitter old woman.

1315
01:09:08,438 --> 01:09:09,230
Old?

1316
01:09:09,230 --> 01:09:10,246
She was like 38.

1317
01:09:10,246 --> 01:09:12,257
Bitter old woman who he couldn't

1318
01:09:12,257 --> 01:09:14,025
stand being around anymore.

1319
01:09:14,025 --> 01:09:16,585
Another part of this that
happens with a lot of

1320
01:09:16,585 --> 01:09:19,104
combat veterans, and I
think it's an important

1321
01:09:19,104 --> 01:09:24,104
phenomenon, she hadn't
sounded so racist and

1322
01:09:24,183 --> 01:09:28,776
bigoted before, but she
certainly did after combat.

1323
01:09:28,776 --> 01:09:31,701
She only had vicious
things to say about anybody

1324
01:09:31,701 --> 01:09:33,205
who looked as if they had Middle Eastern

1325
01:09:33,205 --> 01:09:38,205
ancestry, ethnicity, family background.

1326
01:09:38,304 --> 01:09:42,144
She would hurl all these nasty comments

1327
01:09:42,144 --> 01:09:45,638
and really sounded quite vicious.

1328
01:09:45,638 --> 01:09:47,446
He said he couldn't live with

1329
01:09:47,446 --> 01:09:51,713
somebody so vile and so hateful.

1330
01:09:51,713 --> 01:09:54,760
As she kept talking about
what happened when she

1331
01:09:54,760 --> 01:09:58,275
saw this young man killed
and holding her hand

1332
01:09:58,275 --> 01:10:00,287
in her arms, she said,
"I hate all of them.

1333
01:10:00,287 --> 01:10:00,856
"I hate them.

1334
01:10:00,856 --> 01:10:02,359
"I hate them."

1335
01:10:02,359 --> 01:10:05,914
Then he said to her, "Why
are you hating an entire

1336
01:10:05,914 --> 01:10:10,465
"group of people when one person killed?

1337
01:10:10,465 --> 01:10:14,549
"And even that one person was fighting

1338
01:10:14,549 --> 01:10:17,171
"just the way you were fighting."

1339
01:10:17,171 --> 01:10:21,660
She then sank into a state
of tremendous sadness and

1340
01:10:21,660 --> 01:10:26,516
helplessness and powerlessness
and fear and anxiety.

1341
01:10:26,516 --> 01:10:29,868
She re-owned what had
been projected onto him

1342
01:10:29,868 --> 01:10:34,868
as being helpless and
frightened and insecure.

1343
01:10:35,029 --> 01:10:39,925
Do you hear the unpacking
of racialized hatred?

1344
01:10:39,925 --> 01:10:43,440
If people are trained to see
the enemy as bad and evil and

1345
01:10:43,440 --> 01:10:47,260
good and bad, and you kill the
enemy, you don't expect that

1346
01:10:47,260 --> 01:10:52,260
to change necessarily
automatically upon homecoming.

1347
01:10:52,318 --> 01:10:57,318
Some of those deep-seated
beliefs can really settle in.

1348
01:10:57,520 --> 01:11:00,933
Fortunately, her's was
not that deep-seated.

1349
01:11:00,933 --> 01:11:03,168
Unpacking the hatred was tying in with her

1350
01:11:03,168 --> 01:11:07,434
inability to stick with her powerlessness.

1351
01:11:07,434 --> 01:11:08,999
For him, what was interesting,
what was he disowning?

1352
01:11:08,999 --> 01:11:11,498
He was disowning his aggression.

1353
01:11:11,498 --> 01:11:15,358
He couldn't recognize how
furious he was with her.

1354
01:11:15,358 --> 01:11:16,882
He was sick of having this wife

1355
01:11:16,882 --> 01:11:19,625
who was so unavailable to him.

1356
01:11:19,625 --> 01:11:23,139
He was furious, from his
perspective, stuck with

1357
01:11:23,139 --> 01:11:24,683
having to take care of
the three children while

1358
01:11:24,683 --> 01:11:26,959
she was gone, and nobody complimented him

1359
01:11:26,959 --> 01:11:29,722
on what a good job he had done.

1360
01:11:29,722 --> 01:11:32,993
This period then
continued on with a lot of

1361
01:11:32,993 --> 01:11:37,993
discussion about his
rage and his frustration.

1362
01:11:38,357 --> 01:11:39,860
Do you see the unpacking and the levels of

1363
01:11:39,860 --> 01:11:43,639
shared expression of
their feelings, which are

1364
01:11:43,639 --> 01:11:45,671
absolutely critical for them to be able to

1365
01:11:45,671 --> 01:11:50,059
move to more of a state of reconnection.

1366
01:11:50,059 --> 01:11:54,082
Their attachments were
beginning to rebuild.

1367
01:11:54,082 --> 01:11:55,687
They began to empathize
more with each other.

1368
01:11:55,687 --> 01:11:58,603
Grieve together.

1369
01:11:58,634 --> 01:12:00,299
One of the healing
rituals had to do with her

1370
01:12:00,299 --> 01:12:05,299
openness to accept, she
was rewarded a medal,

1371
01:12:05,907 --> 01:12:09,909
a Purple Heart, for some of her heroism.

1372
01:12:09,909 --> 01:12:11,921
She said, "I'm not a hero.

1373
01:12:11,921 --> 01:12:13,119
"I'm not a hero at all.

1374
01:12:13,119 --> 01:12:13,688
"I don't want it.

1375
01:12:13,688 --> 01:12:15,537
"Throw it out."

1376
01:12:15,537 --> 01:12:17,081
So ultimately they had long conversations

1377
01:12:17,081 --> 01:12:19,539
about what that might mean.

1378
01:12:19,539 --> 01:12:22,932
Moving along to another
phase of the work where

1379
01:12:22,932 --> 01:12:27,260
her social identity, this
is where she could sense

1380
01:12:27,260 --> 01:12:30,734
that as a veteran, that
she was going to move

1381
01:12:30,734 --> 01:12:33,538
from being a service
member to veteran, that she

1382
01:12:33,538 --> 01:12:37,825
would feel honored by
actually accepting her award.

1383
01:12:42,994 --> 01:12:45,509
This is something to think about.

1384
01:12:45,509 --> 01:12:46,854
See where we are.

1385
01:12:46,996 --> 01:12:48,134
Maybe all of the above might

1386
01:12:48,134 --> 01:12:52,238
be in terms of doing this work.

1387
01:12:52,238 --> 01:12:56,038
What I would like to say at the end here,

1388
01:12:56,038 --> 01:12:59,816
is why do we focus on this work

1389
01:12:59,816 --> 01:13:02,315
and why is it so important?

1390
01:13:02,315 --> 01:13:05,099
What seemed to me that as long as we just

1391
01:13:05,099 --> 01:13:07,070
recognize that a client is
what Winnicott would say

1392
01:13:07,070 --> 01:13:08,350
there's no such thing as a baby.

1393
01:13:08,350 --> 01:13:09,995
There's just a nursing couple.

1394
01:13:09,995 --> 01:13:13,348
There's no such thing as
a solitary service member.

1395
01:13:13,348 --> 01:13:15,948
The service member always
has to be understood

1396
01:13:15,948 --> 01:13:18,975
in the context of
whoever his or her family

1397
01:13:18,975 --> 01:13:23,975
would be or people who
are important to her.

1398
01:13:24,339 --> 01:13:26,777
The context is absolutely crucial.

1399
01:13:26,777 --> 01:13:30,597
Also, if we can be holding
onto complexity and

1400
01:13:30,597 --> 01:13:32,872
thoughtfulness, in working
with this population,

1401
01:13:32,872 --> 01:13:35,879
we can recognize the need to have the

1402
01:13:35,879 --> 01:13:40,879
relationship as the
underpinning of the work.

1403
01:13:41,508 --> 01:13:44,047
That allows for us to
move slowly, going back

1404
01:13:44,047 --> 01:13:46,627
to the idea of wait for
the client to tell us

1405
01:13:46,627 --> 01:13:49,268
what the clients really
need and the pacing of

1406
01:13:49,268 --> 01:13:51,625
the work so that then
they will help to define

1407
01:13:51,625 --> 01:13:53,880
what do they need first?

1408
01:13:53,880 --> 01:13:57,679
It's always self-care,
safety, stabilization first.

1409
01:13:57,679 --> 01:14:00,442
Then, moving into different
layers and levels of

1410
01:14:00,442 --> 01:14:03,165
complexity that they can
bear so that they can

1411
01:14:03,165 --> 01:14:07,655
reconnect in different ways
that will really be powerful.

1412
01:14:07,655 --> 01:14:11,515
I would say that that's our
charge with this population.

1413
01:14:11,515 --> 01:14:14,075
I think we will make
quite a difference for

1414
01:14:14,075 --> 01:14:18,118
many successive generations
of children if we do so.

1415
01:14:18,118 --> 01:14:20,373
So, I thank you.

1416
01:14:20,373 --> 01:14:25,307
(audience clapping)

1417
01:14:32,462 --> 01:14:33,986
Are there any comments or questions?

1418
01:14:33,986 --> 01:14:38,986
Reactions?

1419
01:14:42,317 --> 01:14:44,165
Yes?

1420
01:14:44,165 --> 01:14:46,881
- [Man] How do we help
returning veterans who are

1421
01:14:46,881 --> 01:14:49,752
very fond of keeping their identity?

1422
01:14:49,752 --> 01:14:50,861
I've done some work in the military.

1423
01:14:50,861 --> 01:14:53,103
(inaudible)

1424
01:14:53,103 --> 01:14:55,774
They really get tight.

1425
01:14:55,774 --> 01:14:56,680
They feel like family.

1426
01:14:56,680 --> 01:14:58,285
So that's really important (inaudible).

1427
01:14:58,285 --> 01:15:01,562
Then when they come back
to the United States

1428
01:15:02,134 --> 01:15:06,894
(inaudible)

1429
01:15:26,617 --> 01:15:29,465
I'd be curious in their
ideas from the group as well,

1430
01:15:29,465 --> 01:15:32,025
but my sense is with this
case, I didn't highlight that,

1431
01:15:32,025 --> 01:15:35,662
but actually for her, as a
reservist, she was cut off

1432
01:15:35,662 --> 01:15:37,836
from other members of her unit.

1433
01:15:37,836 --> 01:15:39,075
Part of that was her detachment.

1434
01:15:39,075 --> 01:15:40,883
She didn't want to talk with people.

1435
01:15:40,883 --> 01:15:42,915
It was part of her avoidance.

1436
01:15:42,915 --> 01:15:46,918
A good part of the work
was for her to think about

1437
01:15:46,918 --> 01:15:51,918
how important those people
were to her during deployment.

1438
01:15:52,180 --> 01:15:53,724
She started to reconnect.

1439
01:15:53,724 --> 01:15:55,208
But then, if there are
some people who are not

1440
01:15:55,208 --> 01:15:57,604
going to be reconnecting
with the people they

1441
01:15:57,604 --> 01:16:00,672
actually cared about,
but even the connection

1442
01:16:00,672 --> 01:16:05,672
with other veterans can be so powerful.

1443
01:16:05,934 --> 01:16:08,982
Early on, people often
think of that before

1444
01:16:08,982 --> 01:16:10,831
people enter into treatment.

1445
01:16:10,831 --> 01:16:13,309
If they need different
types of psychotherapies,

1446
01:16:13,309 --> 01:16:18,309
they often do very well,
vet-to-vet, often have a sense of

1447
01:16:20,359 --> 01:16:24,138
shared experience, even if
they weren't deployed together.

1448
01:16:24,138 --> 01:16:25,642
I'm curious, is there anybody in

1449
01:16:25,642 --> 01:16:29,660
the audience who would speak to that?

1450
01:16:29,847 --> 01:16:34,847
Or those of you have...?

1451
01:16:39,702 --> 01:16:44,374
Okay, any other...?

1452
01:16:44,374 --> 01:16:46,629
(audience member asks question)

1453
01:17:01,765 --> 01:17:04,305
Okay, well, part of the
victimizer-bystander

1454
01:17:04,305 --> 01:17:06,540
scenario is one to think
about because that's

1455
01:17:06,540 --> 01:17:09,079
one that resonates regularly with working

1456
01:17:09,079 --> 01:17:11,640
with traumatized clients.

1457
01:17:11,640 --> 01:17:15,418
Just to give you an example, mine was that

1458
01:17:15,418 --> 01:17:17,247
work as a couple family therapist.

1459
01:17:17,247 --> 01:17:20,152
Again, it's disguised and composite,

1460
01:17:20,152 --> 01:17:22,245
but it has elements of the actual case.

1461
01:17:22,245 --> 01:17:27,019
I would reverberate back
and forth from feeling a

1462
01:17:27,019 --> 01:17:30,636
sense of helplessness, of
thinking this family seems

1463
01:17:30,636 --> 01:17:35,410
so devastated, the children
are suffering so badly,

1464
01:17:35,410 --> 01:17:38,417
that I was glad that I had
listened to the history.

1465
01:17:38,417 --> 01:17:40,672
That's always important,
to get a full history.

1466
01:17:40,672 --> 01:17:44,431
That's what made me realize
they had tremendous promise.

1467
01:17:44,431 --> 01:17:45,975
I was struggling with,
should I just give up,

1468
01:17:45,975 --> 01:17:50,975
could I send the clients
to another clinician?

1469
01:17:53,492 --> 01:17:57,596
That's a typical helplessness
that we can resonate with.

1470
01:17:57,596 --> 01:17:59,892
And then the sense of victimizing.

1471
01:17:59,892 --> 01:18:01,436
Just feeling really frustrated.

1472
01:18:01,436 --> 01:18:02,980
I would get very angry with her.

1473
01:18:02,980 --> 01:18:06,739
She would curse all the
time, really nasty, bigoted

1474
01:18:06,739 --> 01:18:10,030
offensive remarks, and I
would get annoyed with her.

1475
01:18:10,030 --> 01:18:12,529
Then I would think, "All right, unpack it.

1476
01:18:12,529 --> 01:18:13,830
"You need to pay attention.

1477
01:18:13,830 --> 01:18:15,089
"What is she really saying?

1478
01:18:15,089 --> 01:18:18,225
"What's beneath the vitriol?"

1479
01:18:18,889 --> 01:18:22,180
As social workers, we have
to be careful we don't

1480
01:18:22,180 --> 01:18:24,435
just try to jump in and
rescue people and try to

1481
01:18:24,435 --> 01:18:27,991
make nice and have it
all be taken care of.

1482
01:18:27,991 --> 01:18:31,059
That's a typical
countertransference response.

1483
01:18:31,059 --> 01:18:33,578
The more detached bystander
is a scary one because

1484
01:18:33,578 --> 01:18:38,216
we can be susceptible to secondary trauma.

1485
01:18:38,278 --> 01:18:40,729
That zoning out detachment,
if you're planning

1486
01:18:40,729 --> 01:18:45,000
your next vacation
while you're sitting and

1487
01:18:45,000 --> 01:18:46,073
working with the family like this.

1488
01:18:46,073 --> 01:18:49,831
That's a clue of
countertransference enactment.

1489
01:18:49,831 --> 01:18:51,214
Usually the enactments
have to have an action

1490
01:18:51,214 --> 01:18:53,631
component to it, of doing something.

1491
01:18:53,631 --> 01:18:55,134
Usually if we just sit quietly and have

1492
01:18:55,134 --> 01:18:57,450
the experience, and we try to catch it.

1493
01:18:57,450 --> 01:18:58,791
That was part of the self-reflection.

1494
01:18:58,791 --> 01:19:00,640
So we don't inflict it on the clients.

1495
01:19:00,640 --> 01:19:02,652
Even when there's an enactment,

1496
01:19:02,652 --> 01:19:03,708
sometimes it can be helpful.

1497
01:19:03,708 --> 01:19:05,476
I remember when I was
annoyed with her a few times,

1498
01:19:05,476 --> 01:19:08,239
she said, "Why are you
so judgmental Kathryn?"

1499
01:19:08,239 --> 01:19:11,042
That's just because I didn't
like some of her language.

1500
01:19:11,042 --> 01:19:14,049
So she caught it.

1501
01:19:14,049 --> 01:19:16,894
She realized I was acting
on my countertransference.

1502
01:19:16,894 --> 01:19:18,986
I wasn't just quietly sitting there.

1503
01:19:18,986 --> 01:19:22,054
So you can use that regularly to try to

1504
01:19:22,054 --> 01:19:23,619
understand the clients better and also

1505
01:19:23,619 --> 01:19:27,601
when necessary, repair the rupture.

1506
01:19:27,601 --> 01:19:29,998
I could have lost them
if I didn't figure out...

1507
01:19:29,998 --> 01:19:32,639
I said I did find it hard to listen to,

1508
01:19:32,639 --> 01:19:34,143
because it was so nasty.

1509
01:19:34,143 --> 01:19:38,735
But I was trying to understand
what it meant to her.

1510
01:19:38,735 --> 01:19:40,360
Did she always have those feelings?

1511
01:19:40,360 --> 01:19:41,376
"No, I didn't have those feelings.

1512
01:19:41,376 --> 01:19:43,448
"I've only had it since
I was in Iraq and back."

1513
01:19:43,448 --> 01:19:45,297
So that was the clue.

1514
01:19:45,297 --> 01:19:49,747
Thank you for asking that
because I didn't amplify that.

1515
01:19:49,747 --> 01:19:51,128
Yeah?

1516
01:19:51,128 --> 01:19:56,128
(audience member asks question)

1517
01:20:13,944 --> 01:20:15,975
Did everyone hear that?

1518
01:20:16,360 --> 01:20:18,332
So this is one family.

1519
01:20:18,332 --> 01:20:19,653
This is one deployment.

1520
01:20:19,653 --> 01:20:22,700
See what happens with one deployment.

1521
01:20:22,700 --> 01:20:24,692
Some families, four, five, six types

1522
01:20:24,692 --> 01:20:26,581
of reunions of this sort.

1523
01:20:26,581 --> 01:20:27,333
What do you do with that?

1524
01:20:27,333 --> 01:20:30,441
Some of them actually do
not have these difficulties.

1525
01:20:30,441 --> 01:20:33,082
Others do and that's something we need

1526
01:20:33,082 --> 01:20:36,719
to be mindful of in doing this work.

1527
01:20:36,719 --> 01:20:41,719
I would say proceed nonetheless,
because if the family

1528
01:20:42,510 --> 01:20:45,903
has the history of strength
and the desire to be together,

1529
01:20:45,903 --> 01:20:49,133
and they've had those experiences
and strong connections,

1530
01:20:49,133 --> 01:20:54,133
then some of these complex
models can be very useful.

1531
01:20:54,679 --> 01:20:58,987
It raises the question about
what are we doing in our

1532
01:20:58,987 --> 01:21:03,009
country when we constantly,
redeploy, redeploy, redeploy?

1533
01:21:03,009 --> 01:21:05,590
When we know the data suggests that this

1534
01:21:05,590 --> 01:21:09,369
is harmful if there are
enough times of this.

1535
01:21:09,369 --> 01:21:14,369
It's the people in the
minority who have no effects,

1536
01:21:14,712 --> 01:21:18,207
who suffer no negative effects.

1537
01:21:18,207 --> 01:21:22,737
(audience member asks question)

1538
01:21:22,737 --> 01:21:24,054
Yeah.

1539
01:21:35,131 --> 01:21:37,934
A service member might
not have difficulties in

1540
01:21:37,934 --> 01:21:41,571
reintegration, but the
families sometimes can.

1541
01:21:41,571 --> 01:21:43,847
I would hope that we,
particularly in our field,

1542
01:21:43,847 --> 01:21:47,971
that's why I primarily talk
and work with the families.

1543
01:21:47,971 --> 01:21:50,328
I mean, I'm focusing on
the women in the military.

1544
01:21:50,328 --> 01:21:54,127
It's an area that I'm
interested in nowadays as well,

1545
01:21:54,127 --> 01:21:57,682
but the families are pivotal
as sources of support,

1546
01:21:57,682 --> 01:22:01,482
and also they need our assistance
when they're suffering.

1547
01:22:07,475 --> 01:22:12,475
(audience member asks question)

1548
01:22:12,895 --> 01:22:14,983
The moral injury?

1549
01:22:15,907 --> 01:22:19,036
It usually occurs around
some event where the service

1550
01:22:19,036 --> 01:22:22,835
member has experienced
something that they felt

1551
01:22:22,835 --> 01:22:27,835
that they betrayed their
own sense of ethics.

1552
01:22:28,666 --> 01:22:30,230
What's interesting is, even though,

1553
01:22:30,230 --> 01:22:32,039
for her, this was very clear cut.

1554
01:22:32,039 --> 01:22:33,095
She felt that she should have

1555
01:22:33,095 --> 01:22:35,106
been able to save this young man.

1556
01:22:35,106 --> 01:22:37,707
So she felt that she let herself down

1557
01:22:37,707 --> 01:22:40,755
and was just completely morally corrupt.

1558
01:22:40,755 --> 01:22:42,238
But that was her view of it.

1559
01:22:42,238 --> 01:22:44,148
Sometimes other people can actually

1560
01:22:44,148 --> 01:22:47,256
observe something they consider egregious.

1561
01:22:47,256 --> 01:22:52,256
Often the killings of
children, whether deliberate,

1562
01:22:53,331 --> 01:22:57,374
or the so-called noncombatants who

1563
01:22:57,374 --> 01:23:01,011
get killed in the process of war.

1564
01:23:01,011 --> 01:23:03,245
That can feel horrific.

1565
01:23:03,245 --> 01:23:06,638
That's the bystander who's watching.

1566
01:23:06,638 --> 01:23:09,259
Sometimes the moral injury can be almost

1567
01:23:09,259 --> 01:23:13,038
as profound as having
done something oneself.

1568
01:23:13,038 --> 01:23:16,594
Inviting that conversation,
I think, is what's important.

1569
01:23:16,594 --> 01:23:20,332
Usually the timing, the
pacing is so crucial.

1570
01:23:20,332 --> 01:23:22,364
The site of such delicate territory.

1571
01:23:22,364 --> 01:23:25,452
That people have to be ready to do that.

1572
01:23:25,452 --> 01:23:26,996
If you notice, with this
couple, I was trying to

1573
01:23:26,996 --> 01:23:29,049
deliberately convey, you
have to work with that

1574
01:23:29,049 --> 01:23:33,558
first phase, which is
really both the restraints.

1575
01:23:33,558 --> 01:23:37,073
Helping them reconnect,
reestablish attachments.

1576
01:23:37,073 --> 01:23:40,365
And then, each of them
had a sturdier base.

1577
01:23:40,365 --> 01:23:43,108
They could also regulate
their moods better.

1578
01:23:43,108 --> 01:23:44,469
Each of them.

1579
01:23:44,469 --> 01:23:48,310
So they could withstand
the discussion, because it

1580
01:23:48,310 --> 01:23:50,604
brings up such shame and guilt.

1581
01:23:50,604 --> 01:23:53,359
Not just guilt, shame.

1582
01:23:54,221 --> 01:23:56,212
For her, she was able to
get to a point where she

1583
01:23:56,212 --> 01:24:01,108
could then see that she
was human and mortal

1584
01:24:01,108 --> 01:24:04,095
and humble and she could not do it.

1585
01:24:04,095 --> 01:24:06,614
She just had tremendous fallibility.

1586
01:24:06,614 --> 01:24:07,650
She hated that.

1587
01:24:07,650 --> 01:24:12,251
That's different from a
so-called ethical defect.

1588
01:24:12,913 --> 01:24:17,913
(audience member asking question)

1589
01:24:25,347 --> 01:24:28,896
How long to get to stabilization?

1590
01:24:28,896 --> 01:24:30,969
With this particular family?

1591
01:24:30,969 --> 01:24:33,224
Just a couple of months.

1592
01:24:33,224 --> 01:24:37,003
If that's your goal, if your
goal is to pay attention

1593
01:24:37,003 --> 01:24:41,026
to what the pressing issues
are, it's interdisciplinary.

1594
01:24:41,026 --> 01:24:44,297
You're coordinating with
this cast of characters.

1595
01:24:44,297 --> 01:24:48,055
You're the anchor trying
to then provide the

1596
01:24:48,055 --> 01:24:50,290
clinical clinical case management.

1597
01:24:50,290 --> 01:24:51,834
It's best, I think, with Winnicott

1598
01:24:51,834 --> 01:24:54,252
and clinical case management.

1599
01:24:54,252 --> 01:24:57,523
We can be in touch with
a whole range of people.

1600
01:24:57,523 --> 01:25:02,155
So you're creating this
circle of security.

1601
01:25:02,155 --> 01:25:03,415
It's not just the partners.

1602
01:25:03,415 --> 01:25:04,431
It's the children.

1603
01:25:04,431 --> 01:25:05,447
It's the school.

1604
01:25:05,447 --> 01:25:08,982
It's all the cast of
characters and professionals

1605
01:25:08,982 --> 01:25:13,982
at work that need to be included as well.

1606
01:25:15,219 --> 01:25:17,312
Go ahead.

1607
01:25:17,312 --> 01:25:22,312
(audience member asks question)

1608
01:25:34,114 --> 01:25:35,638
It's mostly military sexual trauma.

1609
01:25:35,638 --> 01:25:36,410
That's what they're saying.

1610
01:25:36,410 --> 01:25:38,766
And that's a direct
association with why those

1611
01:25:38,766 --> 01:25:42,403
rates are significantly higher for women.

1612
01:25:42,403 --> 01:25:46,690
Otherwise they're re-exposed
then to some of the

1613
01:25:46,690 --> 01:25:50,286
same combat stressors as
men, the male counterparts.

1614
01:25:50,286 --> 01:25:52,562
It's not as if they're...

1615
01:25:52,562 --> 01:25:55,873
Any thoughts about that?

1616
01:25:55,873 --> 01:25:58,393
Anybody have thoughts about why

1617
01:25:58,393 --> 01:26:01,542
women would have more risk factors?

1618
01:26:01,542 --> 01:26:02,923
One thing is that if people are

1619
01:26:02,923 --> 01:26:05,971
then deployed with different
units, they haven't

1620
01:26:05,971 --> 01:26:07,942
trained with a different unit.

1621
01:26:07,942 --> 01:26:09,588
And if there's a sense of
insecurity, then with the

1622
01:26:09,588 --> 01:26:12,025
other service members or the command,

1623
01:26:12,025 --> 01:26:16,312
that's not necessarily
going to cause PTSD.

1624
01:26:16,312 --> 01:26:17,553
You have to look at the risk

1625
01:26:17,553 --> 01:26:18,913
factors and the protective factors.

1626
01:26:18,913 --> 01:26:21,412
That's the balance of the two.

1627
01:26:21,412 --> 01:26:22,204
Yeah?

1628
01:26:22,204 --> 01:26:27,035
(audience member asks question)

1629
01:26:41,729 --> 01:26:46,219
So just at the continuation
of the masculinized culture?

1630
01:26:46,219 --> 01:26:48,918
I didn't hear the last...

1631
01:27:04,992 --> 01:27:07,856
So you're hearing pockets of misogyny.

1632
01:27:07,856 --> 01:27:09,441
That's what I think some of

1633
01:27:09,441 --> 01:27:11,148
the brass we're talking about now.

1634
01:27:11,148 --> 01:27:14,886
There's certainly going
to be ongoing misogynistic

1635
01:27:14,886 --> 01:27:18,685
attitudes, but now there's
some effort to tell people,

1636
01:27:18,685 --> 01:27:20,067
"You don't talk that way.

1637
01:27:20,067 --> 01:27:21,733
"This is what harassment is.

1638
01:27:21,733 --> 01:27:22,749
"This is rape.

1639
01:27:22,749 --> 01:27:23,379
"This is assault.

1640
01:27:23,379 --> 01:27:26,061
"This is abusive talk."

1641
01:27:26,061 --> 01:27:29,839
It seems like that persists.

1642
01:27:29,839 --> 01:27:32,481
Maybe just one more comment and
then we're going to wrap up.

1643
01:27:32,481 --> 01:27:33,904
- [Woman] I was just going
to say that maybe one

1644
01:27:33,904 --> 01:27:36,686
of the reasons why Maria
was using that kind of

1645
01:27:36,686 --> 01:27:39,714
language is that as well
in the military it's

1646
01:27:39,714 --> 01:27:44,315
very, very, common for
soldiers to go away (inaudible)

1647
01:27:45,545 --> 01:27:49,556
Even men, my husband
included, he never talked

1648
01:27:49,556 --> 01:27:52,340
that way before he went on a deployment.

1649
01:27:52,340 --> 01:27:55,651
When he came back, they get used to

1650
01:27:55,651 --> 01:27:57,643
using certain language over there.

1651
01:27:57,643 --> 01:27:59,735
It's all understood between the soldiers,

1652
01:27:59,735 --> 01:28:01,361
but when they come back it does not...

1653
01:28:01,361 --> 01:28:03,900
That's a very good point.

1654
01:28:03,900 --> 01:28:05,546
Because sometimes it's
become part of the training.

1655
01:28:05,546 --> 01:28:06,745
You've heard about some
of the basic training.

1656
01:28:06,745 --> 01:28:10,078
It's nasty stuff.

1657
01:28:10,078 --> 01:28:11,356
It's misogynistic.

1658
01:28:11,356 --> 01:28:12,129
It's racist.

1659
01:28:12,129 --> 01:28:13,104
It's bigoted.

1660
01:28:13,104 --> 01:28:14,221
It's all of the above.

1661
01:28:14,221 --> 01:28:16,883
It's what we might think
of as abusive language,

1662
01:28:16,883 --> 01:28:20,052
but they are suggesting
that one of the high rates

1663
01:28:20,052 --> 01:28:22,185
of the military sexual
assault has something to do

1664
01:28:22,185 --> 01:28:24,745
with that generalized acceptance.

1665
01:28:24,745 --> 01:28:28,159
That the language can then
be translated into behavior.

1666
01:28:28,159 --> 01:28:32,446
Words become the behavior.

1667
01:28:32,446 --> 01:28:37,446
That type of harsh treatment,
you have to set the limit

1668
01:28:38,317 --> 01:28:42,511
between the boundary and the word's

1669
01:28:42,527 --> 01:28:43,965
behavior and adjust the language.

1670
01:28:43,965 --> 01:28:46,261
No easy feat here.

1671
01:28:46,261 --> 01:28:49,532
I wish us all the best in
working with this population.

1672
01:28:49,532 --> 01:28:51,157
Thank you very much.

1673
01:28:51,157 --> 01:28:56,157
(clapping)