In my last column, “Military Culture and the Effective Treatment of Military Personnel: The Hierarchical Class System,” I discussed how status and class were core aspects of the military culture . I also discussed how the hierarchical system within the military impacts clinical care. In this third and final column in my series on military culture, I discuss how language and the solution-focused orientation within the military is relevant for clinical practice.
A Language of Their Own
Each culture has its own unique and distinct language, and the military culture is no different. The language of the military is filled with acronyms, abbreviations, and unique words that are used for the primary purpose of relaying important information in an expedient manner, while minimizing confusion and verbal communication errors.
Moreover, much of the military common language is nonverbal (e.g., hand signals) and subtle (e.g., head nodding). For the clinician unfamiliar with the military language, there can be much confusion and frustration. The case example borrowed from Reger, Etherage, Reger, and Gahm (2008, p. 23) illustrates this point:
Dr. Smith had trained at a VA during graduate school and his father had volunteered for the Army during the Vietnam Conflict. He now wanted to serve those in uniform as a civilian psychologist and accepted a position at an Army MTF.
However, he wondered if he had made a mistake as he listened, confused, to his first patient. Specialist Johnson entered Dr. Smith’s office and stoically explained that his wife encouraged him to come to the clinic due to a variety of stressors associated with his recent arrival at his new assignment.
He alleged that DFAS had cheated him out of some money related to his recent partial DITY and that his new platoon SGT was a “POG” who, he was told, was nothing but a FOBIT on the last deployment. Now in garrison, the platoon SGT was employing his troops in “fulltime PMCS. I never get to do my job.”
Nonetheless, he had gotten into trouble for missing a formation and had just had his first reading for an Article 15. Dr. Smith was caught off guard when the Soldier referred to him constantly as “Sir” and rose formally when Dr. Smith stood. Specialist Johnson hesitated to commit to any treatment plan, saying he wasn’t sure about coming in today and he certainly was not sure he would come back. He joked, “I don’t think I need to be here. Pain is just weakness leaving the body.”
Implications for the Clinician
The clinician unfamiliar with military language who tries to treat a service member faces the same challenges one would face working with clients from any other unfamiliar cultural group. To provide the most effective services possible, a basic understanding of military jargon and idioms is required.
Clinicians lacking this understanding who encounter clients from the military should ask what a particular term or phrase means if he or she doesn’t understand it. An attempt to “fake it” during the therapy by pretending to understand something will be detected by most service members.
In contrast, acknowledging a lack of understanding about a military concept or term allows the service member to educate the clinician, which can strengthen the therapeutic alliance, particularly for the service member who is unsure and hesitant regarding treatment.
In addition to improving the therapeutic alliance, understanding military terminology will help the clinician avoid missing important information regarding the service member’s presenting problem, views about mental health treatment, and overall functioning.
During the initial weeks of recruit training, service members are taught how to be problem solvers. They are required to be solution focused and are taught that every problem can be solved given enough time, thought, resources, and effort.
A common phrase used in the military to highlight this point is “adapt and overcome,” referring to the need to be flexible and to find a solution when one is not immediately apparent. Taken to the extreme, a service member who is not solution oriented but focuses on the problem instead may be seen as inept, unmotivated and lazy, or whining.
Implications for the Clinician
For the therapist who is comfortable being directive and prescriptive, the service member’s solution-focused mind-set can be a tremendous asset in treatment. In concert with the therapist, the service member will generate and implement strategies for change. Moreover, the therapist can be confident that cognitive and behavioral homework assignments will be completed and that attendance at scheduled sessions will be consistent.
For those therapists uncomfortable with a directive and prescriptive approach, effective treatment is still possible. However, the service member may become uncomfortable with a passive and Socratic approach, leading to impatience, resistance, inadequate rapport, and inconsistent attendance.
The military is a unique culture that possesses its own set of norms, values, and customs, as well as its own language and class structure. To be effective, the clinician must be aware of these cultural issues. Not to be will affect individual treatment outcome and potentially have a significant effect on the military unit.
Gaining military cultural awareness is no different from gaining cultural awareness of any other group. It is a matter of taking time, making an effort, and applying what is learned to practice.
Reger, M., Etherage, J., Reger, G., & Gahm, G. (2008). Civilian psychologists in an Army culture: The ethical challenge of cultural competence. Military Psychology, 20(1), 21–35.
**This article was adapted from Dr. Moore’s latest book “Treating PTSD in Military Personnel: A Clinical Handbook-Second Edition” published by Guilford Press.