Therapy for veterans and military families

Check your benefits before you pay me

This is genuinely the first thing to sort out, and it is not in my financial interest to lead with it.

• VA health care. If you are enrolled, VA mental health care is available and in many cases at no cost to you. The VA also runs Vet Centers, which provide counseling to combat veterans and their families, separately from the medical centre and with their own confidentiality rules.
• TRICARE. Coverage, referral requirements and whether a given provider is in network vary by plan and by whether you are active duty, retired, or a family member. Do not assume from a directory listing — call the number on your card and ask specifically.
• Private pay. Some people choose this deliberately, for reasons of privacy or waiting times. That is a legitimate choice made with the facts, not a default.

The exact questions to ask, in the order to ask them.

What tends to be different about military trauma

Not different in kind, but different in shape. It is frequently repeated rather than single-incident. It is bound up with identity and with a group, so leaving it behind can feel like betraying people. And a great deal of what made you effective in service — scanning, controlling emotion, never dropping the load — is exactly what now looks like a symptom at home.

Moral injury deserves naming separately. Some of what people carry is not fear but guilt or shame about something done, witnessed, or not prevented. That responds to different work than a fear-based memory does, and treating it as straightforward PTSD misses it.

ART and military populations

Much of the research on Accelerated Resolution Therapy has been conducted with service members and veterans, which is part of why it interested me. I have used ART with veterans through the Lone Survivor Foundation.

I will also say what I say on the ART page: that evidence base is smaller and newer than the one behind prolonged exposure, cognitive processing therapy and EMDR, which are what the VA/DoD guideline carries. If one of those is the better fit for you, I will tell you, and if the VA can deliver it well and free I will tell you that too.

On clearances and careers

The fear that seeking care will end a career keeps a great many people out of treatment for years. The rules are narrower than the rumours — SF-86 Question 21 has for some time excluded counseling that is strictly related to marital, family, or grief matters, and combat-related mental health treatment. But your situation depends on your service, your position and your command, so verify with your security manager rather than with a web page or a barracks conversation.