Understanding Veteran Culture to Provide Effective Treatment

February 18, 2021

Written by Ross Cole, LCSW, Primary Therapist - Veterans Program

What is Veteran Culture?

In 2018, while completing his psychiatry residency, Dr. Gregory Burek authored an article on Veteran culture that was published in the Resident’s Journal of The American Journal of Psychiatry. Himself a Marine Corps Veteran, Burek stated the purpose of his piece was to “provid[e] clinicians with useful information to consider when treating active-duty service members and veterans.” Providing culturally competent care to Veterans, he says, requires understanding the common experiences and values that shape Veterans’ lives.

Dr. Gregory Burek identifies the following concepts and important principles as foundational to military service:

• Honor
• Courage
• Duty
• Self-sacrifice
• Discipline
• Teamwork
• Never giving up
• Holding oneself to higher standard
• Being part of something greater

These guiding values and principles are instilled in service members from the moment they enter Basic Training, and for most Vets, they endure in some form for the rest of their lives.

Common Issues Facing Veterans with PTSD

When reading over these guiding values and principles, one can’t help but see them as virtues. Lived out, they comprise an approach to life that can bring about success for the individual and significant benefit for the community and society. At the same time, as a trauma therapist who has spent years helping Veterans recover from Post-traumatic Stress Disorder (PTSD),

I have observed that those same values can present obstacles for Veterans struggling to make sense of what they have been through and what it says about them.

Examples of PTSD Stressor Statements

For the Soldier who saw children harmed, intentionally or not, as a result of her role in combat, how can she look back and see herself as honorable, or worthy of caring for her own children? When the Sailor who was trapped in a helpless situation, where a horrific death seemed inescapable, naturally felt overwhelming terror, did that mean he was not truly strong or courageous? And how can the Marine who was taught to “never leave anyone behind” move forward with his life when his best friend’s life was cut short? These types of questions can arise when the sacred values and principles of military life are distorted by experiences of war, violence, and loss. And these questions are often at the heart of PTSD.

Military Culture

In addition to the lofty values and traits named above, Burek also notes facets of military and Veteran culture that are less commendable but no less common. For instance, Veterans often have an outlook on life--and a corresponding sense of humor--that is dark, morbid, pessimistic, and/or cynical. Also, military and Veteran culture tends to promote denial and suppression as the most acceptable approaches to dealing with physical and emotional pain. Similarly, there is often reluctance to seek professional help among the Veteran population, particularly for mental health concerns. It is important to note, I think, that these cultural patterns are understandable, given the duties with which our Service Members are tasked, the stressors they often face, and the possible consequences for their lives if they acknowledge their struggles.

Why Veterans Are Reluctant to Receive Mental Health Treatment

Nonetheless, these aspects of Veteran culture can also hinder recovery from trauma. Veterans may deny their struggles, or simply refuse professional help. Dark humor and a jaded outlook may mask grief, fear, or other vulnerable emotions, obstructing natural emotional processes that bring about recovery. Veterans may believe that allowing themselves to feel strong emotions associated with traumatic memories will cause them to “go crazy,” lose control of themselves, or would mean that they are “weak.” It is an unfortunate (yet understandable) reality of military and Veteran culture that natural human emotions are often viewed with some degree of trepidation and/or disdain.

Despite the various complications that military and Veteran culture may present, the good news for Veterans struggling with PTSD is that recovery and growth after trauma are still possible.

Veterans Mental Health Recovery

As decades of research has indicated, and my first-hand experience has validated, there are treatments available that can help trauma survivors reclaim meaningful, healthy, and fulfilling lives, no matter how long they have suffered from PTSD.

Three specific treatments come with the highest recommendation from the Departments of Defense (DoD) and Veteran Affairs (VA), and from other authoritative professional organizations:

• Prolonged Exposure Therapy

Prolonged Exposure (PE) teaches you to gradually approach trauma-related memories, feelings, and situations that you have been avoiding. By confronting these challenges, you can decrease your PTSD symptoms.

• Cognitive Processing Therapy

Cognitive Processing Therapy (CPT) teaches you how to evaluate and change the upsetting thoughts you have had since your trauma. By changing your thoughts, you can change how you feel.

• ​Eye Movement Desensitization Reprocessing

Eye Movement Desensitization & Reprocessing (EMDR) helps you process upsetting memories, thoughts, feelings, and sensations to put the trauma in the past.

Through the course of these therapies, patients can diffuse the grief, fear, and pain that have kept them stuck, and develop new relationships with their own emotions. They can find more accurate, helpful, and compassionate answers to the questions that have plagued them, facilitating healing and recovery.

These therapies are unequivocally difficult; they require patients to purposefully revisit their most horrific experiences, to face the memories and feel the emotions they wish would go away.

But as I have found, the same values of duty, courage, and persistence that enabled them to earn their status as Service Members, to hold up under incredible stress, and to survive unspeakable trauma—those values can sustain them through their “new mission” of treatment and bring about successful recovery.

Veterans Mental Health Services

In closing, I will highlight two of the most unique and exciting aspects of HopeWay’s Veterans Program.

Veteran-led Program 

First off, we are a program that is Veteran-led (Justin Johnson, MD; USAR) and the non-Veteran on the staff (yours truly) is well-versed in Veteran culture, having served Veterans exclusively since 2015. Thus, serving Veterans and understanding their culture is squarely in our wheelhouse.

Most Effective PTSD Treatments

Second, while there are many excellent organizations and providers that offer PE, CPT, or EMDR to patients suffering from PTSD, HopeWay is proud to offer all three of the highest-recommended PTSD treatments to Veterans entering our program.

Personalized Admissions Process

Veterans will decide collaboratively with HopeWay’s clinical staff which treatment is most appropriate, and will complete trauma work in individual therapy format, multiple sessions per week. This feature, along with our intensive and flexible treatment timeframe (2 to 6 weeks), allows us to tailor Veterans’ trauma treatment to their individual needs. There are few programs in the US, if any, that offer this level of clinical flexibility. In fact, combined with the integrative group therapies that distinguish the HopeWay model, I believe our Veterans Program stands alone.

Ross Cole, LCSW

Ross Cole is a Licensed Clinical Social Worker and serves as a Primary Therapist in HopeWay’s Veterans Program. His mental health career includes work with children, adolescents, adults, couples, and families in a variety of settings. Prior to joining HopeWay, Ross  worked specifically with military Veterans at the Salisbury VA Medical Center providing specialized treatment for PTSD. He completed VA-credentialed training in evidence-based treatments for PTSD, including Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing Therapy (EMDR), Cognitive Behavioral Conjoint Therapy, Written Exposure Therapy, and STAIR (Skills Training in Affective & Interpersonal Regulation). Ross completed both his bachelor’s and master’s degrees at UNC Chapel Hill.