As already discussed, post-traumatic stress disorders result in widely varying degrees of impairment. When a single veteran (whether bachelor or divorced) with the disorder requests help, I refer him to a group of other combat veterans. The reasons are twofold. First, the veteran is usually quite isolated and has lost many of his social skills. He has few contacts with other human beings. The group provides a microcosm in which he can again learn how to interact with other people. It also helps remove the fear, prevalent among these veterans, that each individual veteran is the only individual with these symptoms. In addition, many of the veterans form close support groups of their own outside the therapy sessions; they telephone each other and help each other through particularly problematic episodes.
Second, the most basic rationale for group treatment of these veterans is that it finally provides the veteran with that "long boat ride home" with other veterans who have had similar experiences. It provides a forum in which veterans troubled by their combat experiences can work their feelings through with other veterans who have had similar conflicts. In addition, the present symptoms of the disorder are all quite similar, and there is more reinforcement in working through these symptoms with one's peers than in doing it alone.
The group situation is appropriate for most degrees of the symptoms presented. The especially isolated individuals will often be quite frightened of the initial group session. When challenged by questioning the strength that brought them to the initial interview, however, they will usually respond by following through with the group. Those with severely homicidal or suicidal symptoms are best handled in a more crisis-oriented, one-to-one setting until the crisis is resolved. I refer thee veterans to an appropriate emergency team, with the expectation directly shared with the veteran that he will join the group as soon as the crisis is abated.
Veterans who are presently married or living with a partner present a somewhat different picture. Their relationships with their partners are almost invariably problematic. Frequently, a violent, explosive episode at home created the crisis that brought the veteran in for counseling in the first place. When such is the case or there is a history of battering of the partner, it is extremely important to refer the veteran and his partner to a family disturbance counseling center. The consequences of this continued behavior are obvious. In addition, a referral for the veteran to a group with other combat veterans is appropriate. The partner of the veteran may find some understanding of her plight and additional support from a woman's group created specifically for partners of Vietnam combat veterans.
Other veterans who are married or living with a partner may not be experiencing so serious a problem. However, the partners are often detached from one another; they just seem to live under the same roof, period. Referral of the veteran to a combat veterans group and referral of the partner to a partners of Vietnam veterans group is important.
Some veterans and their partners will jointly attend the screening session. Both are troubled by what has been happening and often want to enter marital therapy together immediately. In my experience, the veteran finds it extremely difficult in the beginning of therapy to deal with interactional aspects with his partner when other past interactions with traumatic overtones overshadow the present. When these traumatic experiences do surface, the partner is often unable to relate. Therefore, it is much more beneficial, in my opinion, to allow the veteran time with other combat veterans in a group. In the meantime, suggest a woman's support group for partners of Vietnam veterans for the spouse. Here she would receive additional support as well as an understanding of post-traumatic stress disorders. Sometime thereafter, marital therapy, couples group therapy or family therapy may be appropriate.
Many veterans with post-traumatic stress disorders, in addition to the symptoms already described, also have significant problems due to multiple substance abuse. In my experience, those veterans who have habitually medicated themselves have compounded the problem. Not only do they experience many of the symptoms already described, but the additional symptoms of chronic multiple substance abuse and alcoholism may mask the underlying reasons for self-medication as well. Therefore, these chronic syndromes, which perpetuate themselves through addictive behavior, must be dealt with first. Then a more accurate picture of the underlying problem will result, and an appropriate referral can be made.
Except for some help with an immediate crisis upon being first interviewed during the screening session, the combat veteran struggling with the symptoms of post-traumatic stress disorder, chronic and/or delayed, benefits most from group interaction with his combat peers. Throughout this paper I have emphasized the individual, solitary aspect of the war for each veteran. The aftermath of the war has followed in kind. Now, with help from the DAV Vietnam Veterans Outreach Program and the Vet Center Program, models have been established for reintegrating troubled Vietnam veterans with themselves and their society. Helping the community to recognize the problem and directing the veteran to the specialized services of the community have given the veteran struggling with this disorder a means of "coming home".
It has also been found to be helpful with the older vet, those from Korea and World War Two and more of them are seaking help and support too.
PTSD Support Service
P.O. Box 5574
Woodland Park, CO 80866
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