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 Earlier concepts of the unconscious that are outdated have been rejected by modern psychodynamics that has recognized its underlying, enduring contributions to our understanding and ability to treat mental illness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
587 C OMBAT V ETERANS AT R ISK FOR S 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.
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- Winter '15
- United States Department of Veterans Affairs, Posttraumatic stress disorder