vetcenter

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Biloxi Vet Center
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288 Veterans Ave
Biloxi, MS 39531
(228) 388-9938

http://www1.va.gov/directory/guide/viewMap.cfm

Interventions for PTSD are challenged by the pervasiveness with which they are comingled with additional psychological distress and dysfunctional coping mechanisms such as substance abuse (Kulka, et al., 1990; Meichenbaum, 1994). Veterans often seek treatment for PTSD symptoms--particularly anger and control issues, assistance with relationships, dysfunctional coping skills, and generalized distress. Treatment modalities for PTSD emphasize the growth-enhancing potential of traumatic experiences (Figley, 1993; Herman, 1992; McCann & Pearlman, 1990; Meichenbaum, 1994; Racek, 1985; Tedeschi & Calhoun, 1995 ). Various treatment modalities address the intrusive and recurrent memories of traumatic experiences, emotional numbing, hyperarousal and avoidance of trauma experience symbols, and withdrawal from family, friends, and others.

There are common characteristics among treatment approaches to traumatic experiences (Figley, 1993; Marshall & Dobson, 1995; McCann & Pearlman,1990; Meichenbaum, 1994; Racek, 1985; Tedeschi & Calhoun, 1995). Treatment specifically involves: (a) relationship building with self and others; (b) emotional and cognitive connection with the traumatic experience(s); (c) examination of values; (d) awareness of helplessness and loss of control; (e) engaging in a meaningful interpretation of traumatic experiences; (f) becoming aware of dysfunctional coping mechanisms and replacing them with effective coping responses; and (g) strengthening social skills. Two important features of interventions is the recognition that, in most cases, PTSD is not curable but is treatable (Center for Disease Control, 1988; Kulka, et al., 1990). Consequently, treatment involves the recognition of symptoms, their fluctuations, and counseling support as needed. The second important feature is the normalizing of individual responses to traumatic experiences. Treatment may be provided to individual veterans or individual family members (62%), in groups that may include only veterans, veterans' families, or a combination thereof (34%), and conjoint family therapy (4%) (RCS 1995a; Flora, C. [RCS] personal communication, May 6, 1996).

Individual. Individuals are provided counseling in one hour visits as long as is needed. Counseling addresses the previously described components in the context of their impact on the individuals life, his or her recovery, and focuses on growth (Figley, 1993; McCann & Pearlman,1990; Meichenbaum, 1994; Racek, 1985; Tedeschi & Calhoun, 1995). Positive and productive use of skills learned in the context of the military and war zone is emphasized (Blank, 1993). In addition, regrets over actions and losses are explored in the context of the war zone and resolved. Over time, the veteran tells his or her story, integrating personal experiences, finding meaning in them, and discovering how they relate to the present. The veteran comes to see his or herself as a survivor of traumatic experiences, taking pride in their strengths, their choice of commitment to their country, and in their military service. The process of individual counseling varies among veterans. Some veterans may become involved in long- term therapy and others may have just a few counseling sessions.

Group. Group sessions are also provided and may be part of individual treatment. Groups of four to ten individuals usually meet weekly to discuss progress and issues for which the veteran is seeking support. Groups are a valuable part of follow on for post in-patient treatment and for maintenance of newly learned coping skills. The group also functions as a form of social support for its members. Special attention is given to gender differences in the context of the group. Care is taken to avoid letting female veterans become caregivers to male veterans thus reliving their former roles while leaving their own issues unattended (Price & Knox, 1996).

Family. One of the more important aspects of counseling is attention to significant others and family relationships. Research has documented the negative effect of PTSD in the veterans' lives and those of spouses and children (Hiley-Young et al., 1993; Matsakis, 1988; Motta, 1990; ). Peebles-Kleiger & Kleiger (1994) found in a study of Vietnam veterans that 38% of marriages broke up within six months of coming home. Other studies have documented the contagion of PTSD from veterans to spouses and children (Solomon et al., 1992).

In additon to the impact that the veteran's PTSD may have on his or her family some veterans experience pressure from family, relatives, friends, and other veterans to "forget it," and not talk about their Vietnam experience (Blank, 1993). Others may be pressured to get "fixed" by family members who fail to recognize that they too have been powerfully affected by the veterans experience. When a veteran seeks counseling the growth they experience will likely affect their family. Family members are encouraged to learn about PTSD and recovery.

When necessary, family members may become involved in counseling with the veteran. Family counseling involves increasing information and normalizing the impact of PTSD on the family, identifying dysfunctional coping mechanisms and learning positive coping skills, developing skill in recognizing PTSD symptoms and responding to them, and seeking support when necessary (Figley, 1993).

Normalization of PTSD. Regardless of the treatment modality, an underlying goal is to normalize PTSD as a consequence of war trauma. Vet Center counselors emphasize that within a psychohistorical interpretation and context the development of posttraumatic stress is a normal and expected response (Figley,1993; Meichenbaum, 1994), and that it is the normal consequence of threat appraisal and coping (Lazarus & Folkman, 1984). Thus, PTSD is not to be regarded as pathologic but rather the normal response to traumatic experience(s) that can become manageable through treatment.

Key Staff:
Harry Becnel, Ph.D.
Team Leader
Tanya Griego, MSW
Counselor
Maxine McNeal - No longer works at the vet center
Counselor
William W. Newell II - New vet counselor

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BILOXI VET CENTER

Mississippi