Veteran and the therapist can be used to enable the

veteran and the therapist can be used to
enable the veterans to give up selfdestructive
behavior.
Earlier concepts of the unconscious that
are outdated have been rejected by modern
psychodynamics that has recognized its
underlying, enduring contributions to our
understanding and ability to treat mental
illness and, in particular, the role of the
unconscious in influencing behavior, the value
of dreams in that process, and the nature of
the relationship with therapists doing the
treatment. The concept that human behavior
can be understood without reference to
unconscious processes runs counter to
advances in neuroscience that see the mind as
operating largely by unconscious processes
taking place in the brain (Kandel, 2013).
Clinicians are often trained in one form
of therapy and practice that with minimal
variation with all of their patients. Many
clinical researchers believe that a multifaceted
approach is more effective, but since
demonstrating its effectiveness is more
challenging and harder to fund, it reinforces
the tendency to specialize in and utilize only
one particular approach. Granting agencies are

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ETERANS AT
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ISK FOR
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UICIDE
beginning to recognize this and to fund
“integrative projects.”
A less constrictive approach has been
incorporated in a short-term psychodynamic
therapy (12 sessions) that also utilizes
techniques of established behavioral
psychotherapies. There is reason to believe
that these therapies would improve their
ability to treat combat veterans with PTSD at
risk for suicide if the therapists employing
them received training in some basic
psychodynamic principles. For clinicians
wanting to incorporate the psychodynamic
approach into their clinical practices, there are
many ways to get this training.
In a research project, the situation is
more complicated. The didactic training of
both therapists and supervisors is carried out
by an expert and involves use of a guideline
describing the treatment protocol; case
examples; weekly supervision of the first cases
treated; less frequent subsequent supervision
throughout the treatment; the use of an
adherence protocol to be completed by the
supervisor; and the employment of an
adequate control group with which to compare
the results.
COMBAT DIFFERENCES
There is a difference in the population
that served in the Vietnam War and the wars
in Iraq and Afghanistan. The veterans of the
wars in Vietnam were drafted, their average
age was 20, and they rarely had a history of
suicidal behavior prior to the war. Veterans of
the wars in Iraq and Afghanistan were
volunteers, their average age was 28, and they
frequently had histories of precombat mental
illness including suicidal behavior prior to
combat (Leardmann et al., 2013). In cases we
have seen, their enlistment was often a way of
trying to provide structure to their lives which
left them vulnerable when it did not work.