Special Considerations for Counseling Military and Veteran Populations

After experiencing combat as a Marine in Operations Desert Shield and Desert Storm, W. Bryce Hagedorn, PhD, NCC, MAC, LMHC, QCS, began considering the possibility of becoming a counselor and helping service members, fellow veterans, and other military-connected individuals when he eventually re-entered civilian life.

“I could see that there was a gap in mental health care there, and I wanted to make a positive impact,” he says.

A person’s military training and experience has a tremendous impact on their worldview and how they respond to counseling, he says, “and although the military has gotten much better at helping service members to identify their needs and build their resilience, there is still a lot of resistance and stigma related to seeking and receiving mental health care among the military population.”

“There is a belief, as there is in other cultural groups, that ‘you can’t help me unless you’ve walked my path,’ and civilian counselors working with military populations are often met with even more resistance unless they have had a personal or vicarious experience with the military.”

Though he typically doesn’t disclose personal details about himself to clients, he does find it beneficial to let new service member and veteran clients know that he has a military background.

“I will share that I’m a former member of the military because of what I perceive as a need to level the playing field,” he says, “and if they’d like, I’ll tell them a little more, just to increase the legitimacy in their eyes that I’m someone who can understand, and I feel like they respond well to that.”

That perceived understanding goes a long way in helping. Many service members and veterans are traumatized by their military experiences, he says.

“Trauma not only affects the brain, such as with PTSD, trauma also affects the soul in terms of ‘moral injury,’ which is the guilt and shame resulting from taking an action or inaction while in combat as result of a direct order, something that is outside of your moral code. Many service members and veterans don’t know how to live with having done these things.”

Often, they suffer in silence because of the stigma associated with seeking and receiving help. Some experience lack of available resources for help, while others may not seek services until their military service has ended, because while on active duty, their command has access to their records, he says.

“Admitting to needing help, particularly from the mental health community, is seen as sign of weakness. ‘Pain is weakness leaving the body’ is one of the sayings the Marine Corps uses, and that’s very much apropos of how the military approaches mental and physical distress.

“A lot of veterans don’t know that they need to advocate for themselves either,” he continues. “They may call the VA and be told they can’t be seen until 6 weeks from now. The people working for the VA are wonderful, they’re just overwhelmed with the need. A veteran in crisis may not know to say, ‘I can’t wait 6 weeks, I need to see someone now.’ Once you voice that, they can introduce you to a care manager who can find local services or someone who can help through telehealth. Even getting in the door can be a barrier to care.”

Dr. Hagedorn highly recommends the 300 or so Vet Centers across the country, which he calls “hidden gems” for service members and veterans.

“Though these are an arm of the VA, they are drop-in counseling locations, and their record system is not tied to the VA,” he says. “Their main focus came out of the Vietnam era, and anyone who’s been in a combat or life-threatening situation can share their experiences and how they are manifesting in their behaviors, whether it be addiction, gambling, sex, and they don’t have to worry about those records being accessed by their command if they’re active duty, or by their employer, or having their ability to own a gun threatened, or the ability for their ex-spouse to use it against them in court. It’s the VA’s best-kept secret that even vets don’t know about.”

Because military culture permeates nearly every aspect of a service member’s life, counselors who have not served and are interested in working with this population can gain credibility by becoming familiar with the nuances of military life—the terminology used, how the branches refer to themselves, the rivalry between them, the differences between the enlisted and officer ranks, and more, he says.

“In terms of better understanding their experiences, there are a lot of good documentaries and books that counselors can educate themselves with, and just being curious and humble about the service member or veteran’s experience can go a long way.”

He offers some advice for counselors interested in working with military-connected clients.

“Be ultra-patient, because it may take a lot longer for them to warm up to the idea of what can happen in counseling. They have the idea that the world is not a safe place, so they tend to be leery about the counselor’s worldview because they’ve seen and done things the general population never has to do.

“It takes some emotional maturity not to personify the client’s reactions to you, and you need to have good self-care in place. It’s tough to hear these stories and not have compassion fatigue set in. Stay connected with other clinicians who are doing this work, because it can feel very isolating and it’s easy to burn out.”

He also recommends developing an “elevator speech” related to your connection (or lack of one) to the military for new clients.

“You’ll be asked right away, ‘Are you former military? Do you understand my story? Can you help me?’ Be able to explain what your connection is to the military, whether you were military, had family who were military, or none of the above, you can still say, ‘I’ve done a lot of training and research, and I know that may not be sufficient, but I think it’s a starting point. Could we work together long enough to see if I can offer the proper help?’”

There are many ways to advocate for these clients, Dr. Hagedorn says.

“Speak with your representatives in government to support different bills that are up for debate,” he says. “NBCC does a great job of alerting people to various legislation, and that’s how you stay connected. Join professional associations that serve veterans and service members to stay updated, and become involved with programs like giveanhour.org, where you can be trained for free and provide an hour of free therapy to a service member, veteran, or spouse. Attending or giving trainings is another way to advocate, perhaps training your community or place of worship. And educating yourself is always a form of advocacy because it opens your eyes.”

Finally, Dr. Hagedorn shared some helpful resources for those interested in this work. For counselors without military connections:

• The Community Provider Toolkit by the Department of Veterans Affairs
• Trainings by the National Child Traumatic Stress Network; enter “veteran” in the search bar for a list of resources
• The Military Culture Course Modules developed by the Uniformed Services University Center for Deployment Psychology

Counselors in search of resources for military-connected clients can share information about the VA’s collection of mobile apps specific to the physical, mental, and relational health of veterans.

NBCC offers trainings and webinars for individuals interested in counseling military populations and continues to work toward opening more military programs to counselors as part of its government and legislative affairs efforts.

After completing his term of service, Dr. Hagedorn earned his master’s degree in counselor education and mental health counseling from the University of Central Florida (UCF) and became a professional counselor in 2000. He then earned his PhD in counseling and counselor education from the University of North Carolina at Greensboro and became the program director of counselor education at Florida International University. Since 2007, he has been a professor and program director of counselor education at UCF.