The following is an assignment where we prepared and facilitated an educational group for our peers on the topic of cultural competency with Combat Veterans and their Families. My partner for this assignment was an officer in the US Army with actual combat experience.
Counseling Implications for Combat Veterans and Their Families
David Johnson,
David Powell
University of San Diego
School of Leadership and Education Sciences
COUN525 Group Dynamics in Counseling
May 5, 2011
San Diego has a long history as a military hub; in fact, military and defense represents the second largest sector of the economy (Advameg, Inc. 2011). According to local Veterans Administration figures, nearly 250,000 military veterans, men and women, live in the San Diego area. Students preparing to enter the counseling profession in San Diego will probably encounter combat veterans and/or veteran family members at some point in their professional practice. Unfortunately, counseling students are rarely instructed to think about military culture in the same was as other ethnic or minority cultures. The facilitators have relevant knowledge based on research and personal experience in working with combat veterans and offer this session not only for informational purposes, but also to provide an opportunity to engage in a multicultural experience.
“Counseling Combat Veterans” is designed a single-session group. For this reason, it is important that the group facilitators be explicitly clear regarding the group’s purpose (Jacobs, Masson & Harvill, 2009). This group might be categorized as primarily educational in nature with elements of group discussion and experiential activities included to stimulate participant learning. As noted in the attached Program Outline, the facilitators will explicitly state the purpose of the group within the first 5 minutes. The purpose of this group is to inform student counselors about clinical implications for combat veterans (and their families) and provide experiential learning activities for participants to practice skills based on the information they receive. The learning objectives are to review select clinical implications for working with combat veterans, discuss combat veterans as a unique culture within a multicultural context, and provide an opportunity for counseling skills practice.
The target population for the group is masters-level student counselors at the University of San Diego who provide counseling services to combat veterans or are likely to do so in the near future. This group will be piloted May 5th, 2011 in the Group Dynamics class with students in that class as the initial participants. Participants are selected based on their enrolling in the Group Dynamics class.
The facilitators will operationalize the term “combat veteran” to include current and former members of the United States Armed Forces who served in combat operations in Iraq and Afghanistan. By extension, we will also use the term “veteran families” to refer to the spouses, dependants, and loved ones of combat veterans and those who work or share living space with them. We will reference the Diagnostic and Statistical Manual of Mental Disorders (DSM TR-IV) where appropriate and employ specific terms and models that will be familiar to the participants so they may easily integrate the information presented.
Due to the limited amount of time allotted for the group, the facilitation style of the group is highly leader-directed as described by Jacobs et al (2009, p. 22-23). Not to be confused with an authoritarian leadership style (Capuzzi & Gross, 2002), the leader-directed style is selected because the facilitators have identified a need for knowledge transfer in the target population and are sharing their expertise to help meet said need. Also, since military culture tends to be relatively more leader-directed than mainstream culture, the facilitators will take the opportunity to highlight this contrast between the two cultures. Participants will be expected to accommodate the leaders’ style; however, to prevent boredom or resistance, the group facilitators will provide interactive and visually stimulating elements throughout the session. Any remaining participant discomfort can also be considered as an exercise in capacity-building for empathy for combat veterans who, by virtue of their entrance in military service, are constantly asked to accommodate the leadership style of their superiors.
The session content is divided into two major components, the didactic and the triad.
The didactic contains data, introduces concepts, and defines terms that may be unfamiliar to group participants. A PowerPoint slide show and brief video clips are included for enrichment to help stimulate participants’ interest. The group will provide a basic level of understanding for two particular clinical issues that are especially relevant to combat veterans and their families, Post Traumatic Stress Disorder (PTSD) and suicide. Each facilitator will take turns detailing a clinical issue in terms of important facts, definitions, diagnostic criteria, and treatment implications for combat veterans. Concluding the discussion of each clinical issue will be a client success story. The client success stories will be important to elevate the tone of the group and avoid the group taking on a tone that is too esoteric or overly serious. The facilitators will take responsibility for the tone by balancing the more serious elements of the group session with experiential exercises, upbeat music, and use of props as outlined in the course text (Jacobs, et al, 2009).
The triad will employ the use of props and role-play for the purpose of providing the participants with a counseling skill-building opportunity. Because real life combat veterans have a tendency to “bottle” emotions, this practice exercise will involve a bottle of soda to represent the current stress level of a mock client who is a combat veteran. Sugary candy will represent any additional stress of seeking help from a civilian counselor. If the mock client experiences any additional stress in the course of the role play, a piece of candy will be dropped into the soda bottle, reacting in an overflow of carbonated fizz. The exercise is designed to produce a negative association between messy fizz overflow and any counseling errors (i.e. ineffective questions, lack of understanding of military culture, anything that increases stress of the mock clients).
Participants will be randomly assigned into triads each consisting of a counselor, client, or observer. The facilitators will provide general verbal instructions as well as specific written instructions to each participant. “Counselors” will be instructed to meet with the client for a very short session, about 6 minutes. Counselors will attempt to determine whether the client meets diagnostic criteria for either PTSD or suicide by asking only open-ended questions. “Clients” will be supplied with a presenting issue (either PTSD or suicide) as well as other complicating issues that are frequently experienced by combat veterans. Clients will be instructed to specifically avoid disclosing certain pertinent information unless specifically asked by the counselors. “Observers” will monitor the time of the exercise by setting a timer and ending the session when the timer goes off. In addition, observers will visually represent the success/failure of the counselor as by adding candy to the soda if they determine the clients have been placed under additional stress.
Following the exercise, the facilitators will utilize a round to ask the participants to highlight their experiences, describe what they learned, and/or ask any questions they may have. Facilitators will praise participants for making appropriate clinical decisions, discussing their observations, and/or developing their capacity for serving combat veterans.
The group session will conclude with mention of information and referral resources for participants. Facilitators will thank the attendees for their active participation. A feedback session will be then facilitated by the Group Dynamics instructor.
Program Outline (50 Minutes)
I. Introductions, etc. (5 minutes)
A. Presenters identify themselves and share their area of expertise
B. Purpose of the group
a. The purpose of this group is to inform student counselors about clinical implications for combat veterans (and their families) and provide experiential learning activities for participants to practice skills based on the information they receive.
b. The learning objectives are to review select clinical implications for working with combat veterans, discuss combat veterans as a “culture” within a multicultural context, and provide an opportunity for counseling skills practice.
C. Overview of the session and expectations
a. Session is divided into two units: Informative presentation and Skills building exercise.
b. Presentation may include imagery which may be unsuitable for sensitive individuals; such individuals should excuse themselves now if they do not want to participate.
c. Housekeeping items: Bathrooms, cell phones, emergency exits, who is certified in first aid?, how will questions be handled?, evaluation period after.
II. Clinical Issues: PTSD and Suicide PowerPoint Presentation with Videos
A. PTSD – David J (12 Minutes)
a. PTSD Facts: How many cases? How is PTSD defined? What causes it?
b. How to recognize PTSD: Symptoms? How might PTSD manifest in combat veterans?
c. Success story
B. Suicide – David P (12 Minutes)
a. Suicide Facts: How many cases? How is suicide defined? What causes it?
b. How to recognize suicide: Symptoms? How might suicide manifest in combat veterans?
c. Success story
III. Transition (1 minute)
IV. Counseling Skills Practice (15 Minutes)
A. Role Play: Reconfigure into triads. Instructions will be given.
B. Clients present their symptoms, counselors assess for risk and apply diagnostic criteria, and observers visually represent the counselor’s degree of success/failure using candy and soda. Timers will be set for 7 minutes.
C. Observations: what did you learn?
V. Information and Referral Resources (3 Minutes)
VI. Conclusions, affirmations, acknowledgements (2 Minutes)
References
Advameg, Inc., "San Diego: Economy." CityData.com. Available from http://www.city-
data.com/us-cities/The-West/San-Diego-Economy.html. Internet; accessed 14 April 2011.
Capuzzi, D. & Gross, D. R. (2002). Introduction to group counseling (3rd ed.). Denver, CO:
Love Publishing Company.
Jacobs, E. E., Masson, R.L. & Harvill, R. L. (2009). Group counseling: Strategies and skills. (6th
ed.) Belmont, CA: Brooks/Cole, Cengage Learning.
U. S. Department of Veterans Affairs, "VA San Diego Health Care System." United States
Department of Veterans Affairs. Available from http://www.sandiego.va.gov/about/. Internet; accessed 14 April 2011.
These slips will be distributed randomly to group participants for the role play:
Counselor: You may ask only open-ended questions.
You are a clinical mental health intern who recently graduated from USD with your master’s degree in counseling. Your studies prepared you for working with diverse cultures, and you are confident in your clinical skills. You are a full time counselor working for a family counseling agency under the supervision of a Marriage and Family Therapist. Use whatever real-life knowledge you have about combat, military culture, and veteran service.
Counselor: You may ask only open-ended questions.
You are an intern who recently graduated from USD with your master’s degree in counseling. Your studies prepared you for working with diverse cultures, and you are confident in your clinical skills. You are a full time counselor working for a family counseling agency under the supervision of a Marriage and Family Therapist. Use whatever real-life knowledge you have about combat, military culture, and veteran service.
Counselor: You may ask only open-ended questions.
You are a school counselor who recently graduated from USD with your master’s degree in counseling. Your studies prepared you for working with diverse cultures, and you are confident in your clinical skills. You work at an alternative middle school for kids with behavior problems. One of your “favorite” ADD/ADHD kids has become so increasingly violent this semester, that placement into a more restrictive school is being considered. The school psychologist has recommended you to meet with the child’s parent, a combat veteran, for an informal conference before next week’s IEP meeting. Use whatever real-life knowledge you have about combat, military culture, and veteran service.
Counselor: You may ask only open-ended questions.
You are a school counselor who recently graduated from USD with your master’s degree in counseling. Your studies prepared you for working with diverse cultures, and you are confident in your clinical skills. You work at an alternative middle school for kids with behavior problems. One of your “favorite” ADD/ADHD kids has become so increasingly violent this semester, that placement into a more restrictive school is being considered. The school psychologist has recommended you to meet with the child’s parent, a combat veteran, for an informal conference before next week’s IEP meeting. Use whatever real-life knowledge you have about combat, military culture, and veteran service.
Client: Your primary goal is to make the counselor believe there is nothing seriously wrong with you. However, you also realize that you have persistent suicidal thoughts which is totally freaking you out. Do NOT tell the counselor about your suicidal thoughts unless you are specifically asked to do so.
You returned from Afghanistan 3 years ago to discover you could no longer relate to your spouse and child. You’re separated, but haven’t had the money to go through the whole divorce thing yet. Finding jobs has been easy for you, but you have a hard time putting up with other people’s drama and stupid crap from bosses, so you usually quit before giving them the satisfaction of firing you. Since you have no strong family connections in any particular place, you recently decided to move to a new city to look for a better job. You feel like a failure most of the time except when you’re high.
Client: Your primary goal is to make the counselor believe there is nothing seriously wrong with you. However, you also realize that you have extremely violent dreams that prevent you from ever getting a full 8 hours sleep. Several times a month you experience vivid memories of Iraq when you’re awake, and sometimes it takes a moment to figure out where you are. Do NOT tell the counselor about your drug use unless specifically asked to do so.
You returned from Iraq 3 years ago to discover you could no longer relate to your spouse and child. You’re separated, but haven’t had the money to go through the whole divorce thing yet. Finding jobs has been easy for you, but you have a hard time putting up with other people’s drama and stupid crap from bosses, so you usually quit before giving them the satisfaction of firing you. Since you have no strong family connections in any particular place, you recently decided to move to a new city to look for a better job. You feel like a failure most of the time except when you’re high.
Client: Your primary goal is to make the counselor believe there is nothing seriously wrong with you. However, you also realize that you have persistent suicidal thoughts which is totally freaking you out. Do NOT tell the counselor about your suicidal thoughts unless you are specifically asked to do so.
You returned from Afghanistan 3 years ago to discover you could no longer relate to your spouse and child. You’re separated, but haven’t had the money to go through the whole divorce thing yet. Finding jobs has been easy for you, but you have a hard time putting up with other people’s drama and stupid crap from bosses, so you usually quit before giving them the satisfaction of firing you. Since you have no strong family connections in any particular place, you recently decided to move to a new city to look for a better job. You feel like a failure most of the time except when you’re high.
Client: Your primary goal is to make the counselor believe there is nothing seriously wrong with you. However, you also realize that you have extremely violent dreams that prevent you from ever getting a full 8 hours sleep. Several times a month you experience vivid memories of Iraq when you’re awake, and sometimes it takes a moment to figure out where you are. Do NOT tell the counselor about your drug use unless specifically asked to do so.
You returned from Iraq 3 years ago to discover you could no longer relate to your spouse and child. You’re separated, but haven’t had the money to go through the whole divorce thing yet. Finding jobs has been easy for you, but you have a hard time putting up with other people’s drama and stupid crap from bosses, so you usually quit before giving them the satisfaction of firing you. Since you have no strong family connections in any particular place, you recently decided to move to a new city to look for a better job. You feel like a failure most of the time except when you’re high.
Observer: Your role is to monitor the client’s response to the counselor for any signs of stress. Specifically look for repeated questions or answers, eye contact, body position, etc.
You will hold the soda, representing the client, and the candy, representing the stress of speaking with the counselor. If the client mentions drug use or suicidal thoughts, drop 4 candies in the soda.
Observer: Your role is to monitor the client’s response to the counselor for any signs of stress. Specifically look for repeated questions or answers, eye contact, body position, etc.
You will hold the soda, representing the client, and the candy, representing the stress of speaking with the counselor. At the 5th minute, regardless of how well the counselor and client may be getting along, begin dropping candies into the soda one at a time.
Observer: Your role is to monitor the client’s response to the counselor for any signs of stress. Specifically look for repeated questions or answers, eye contact, body position, etc.
You will hold the soda, representing the client, and the candy, representing the stress of speaking with the counselor. If the client mentions drug use or suicidal thoughts, drop 4 candies in the soda.
Observer: Your role is to monitor the client’s response to the counselor for any signs of stress. Specifically look for repeated questions or answers, eye contact, body position, etc.
You will hold the soda, representing the client, and the candy, representing the stress of speaking with the counselor. At the 5th minute, regardless of how well the counselor and client may be getting along, begin dropping candies into the soda one at a time.
Posts
