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International Society of Schema Therapy
In This Issue
In this April issue - Schema Therapy with Marginalized Populations
Treat the Soldier & unlock the Healthy Adult
Generally, when a person with a military background comes for psychological treatment they have been unwell, with clinically significant symptoms for at least 12 months. There is a significantly higher 12-month prevalence of all mental illnesses compared to the general Australian population. For example, the prevalence of major depression (MDD) was 6.4% compared to 3.1% in general population (1). Generally military personnel will present for treatment with more than one of the following problems; trauma, unstable mood, anxiety, alienation, hyperarousal or substance use including alcohol. When working with people who have been in any kind of military, it can be very difficult to soothe maladapted modes and release the Healthy Adult. For the purposes of this article we shall discuss people who have been in the Army when they developed their psychological problems, however the general concepts can apply to other arms of a Defence Force. We shall aim to conceptualise the schema presented in terms of what draws people to join a Defence Force which can give clues to early maladapted schemas; how the training to be a soldier causes and strengthens maladapted coping modes and how these coping modes are not conducive with a healthy civilian adult. The final stage shall be a case study by one author (MF) to illustrate some of our ideas.
People are attracted to the army for many reasons, however they all have to become defenders of the land. The army is a fighting force of people that are primarily land based and it functions as a complex system based on hierarchy, rules, group cohesion and limits on all emotional experiences. There are certainly many who are seeking the safe attachment and sense of competence the army will provide. The rules and regulations provide a set of predictable limits far more containing than those of the civilian society, as they are based on survival while protecting the life of others. There is little play or spontaneity in the army and hence people with basic schemas within the domain of hypervigilance and inhibition are able to surrender without necessarily being victimised. Disconnection, rejection and failure schemas can be overcompensated for and will be rewarded with early promotions. Those with impaired autonomy and achievement may also find the support and structure from the army containing and helpful; at least until it becomes clear that it is an organisation and not a family.
Throughout a career in the army, many early maladapted schemas can be soothed or maladapted coping modes supported, but at risk is the absence of an environment conducive to the development of the Healthy Adult. The soldier is not allowed to express emotions in an uncontained or free manner nor may he feel certain emotions especially while in the theatre of war. This has significant consequences following a soldier’s career.
There are many people who seek out the army as it provides an environment that is opposite to their dysfunctional childhood. There are clear rules and expectations. If you work hard and follow them there is a predictable career progression and you are immediately part of a lifelong culture. The system of the army acts both as a demanding parent and a detached protector – not worrying about you individually but allowing those that surrender to the structure to be promoted, kept safe and working within a group of people with singular goals. Thus, the very nature of creating a soldier from basic training, where people are subjected to controlled bullying thereby causing a group of basic trainees to form a common defence against a common enemy, to the end of a soldiers career, they are encouraged to develop or strengthen maladapted coping modes including:
1.Detached protector to prevent any emotions occurring being felt and at times not even acknowledged.
2.Demanding parent who is the “screaming sergeant or corporal” from basic training making you keep going even when both your core biological & psychological needs are not being met.
3.Punitive critic who is the internalised advisor providing the rules and regulations why you did or did not get your promotion.
4.Detached self-soother who is active in the gym, or the bar pushing the soldier to go further and harder.
The experience of war and acting in the roles that the soldier has been trained for can cement some of these maladapted coping modes and cause others to develop once they return home. This process can be the beginning of a serious mental illness, where the woman who can no longer bathe her children as she sees the dead child from Timor, or the man who cannot have BBQs any more due to the burning smell in Vietnam. Then when the soldier discharges from the Army to become a civilian all the coping modes that he or she had developed for survival are now life interfering. The Healthy Adult mode will often try to assist by intellectualising & minimising the problem while the relationships around them deteriorate.
Treatment of the soldier needs to begin with a clear conceptualisation, where the maladapted coping modes are given a clear origin initially in the Army. If there are clear childhood triggers for schemas then of course linking helps, however it is often more useful to start with these modes coming from army experiences of core needs not being met and then with increasing therapeutic alliance and the person becoming adapted to the way of schema therapy starting to link back to key childhood experiences. Rescripting an event can be traumatising if tried too early in treatment and often using letters or linking the bodily sensations to a thought can build the person’s resilience for therapy.
Ryan* is 44 years of age. He joined the Army at 26 years due to being bored and seeking stability and a challenge. Prior to the Army he had a lot of casual jobs and an undeveloped sense of self. The military provided Ryan with a stable base, structure, a family, a purpose, boundaries and an identity… a soldier. These core needs had been largely absent from his life prior to the military. Ryan thrived in the military for 14 years and completed eight operational deployments, most of which were to Afghanistan. Ryan loved his job as it made him feel happy, worthwhile and like he was achieving something.
Ryan has attended numerous services, in Australia and even overseas to get treatment for his PTSD, depression and alcohol misuse. He has had individual treatment, inpatient treatment on a number of occasions, and regular management by his GP, Clinical Psychologist and Psychiatrist. He has attended a range of personal and professional development activities, including retraining (e.g. Diploma in Business and Management), attending wounded soldier activities (e.g. trekking the Kokoda trail) and skills training (e.g. meditation). He even has a veteran companion dog. Despite years of therapy (approximately four to five to date), the reduction in his trauma symptoms, and the development of a Healthy Adult, Ryan still today struggles with his Compliant Surrender and Over Controller modes, both of which originate in the military.
Ryan’s Compliant Surrender and Over Controller modes were developed in the military to serve the organisation and to do the job expected of him. Ryan’s identity still remains enmeshed with being a soldier as he seeks the same purpose, stimulation and value as he did when he was a functioning soldier. These modes play out in his current day-to-day interactions and relationships causing ongoing issues. Understanding the development and implications of these modes and strengthening his Healthy Adult, will require him to finally relinquish the soldier within him, which he is still not ready to do. Hence therapy will continue to challenge these maladaptive modes and further strengthen and develop his individuation as a person and Healthy Adult.
1.Department of Defence, Mental Health in the Australian Defence Force: 2010 ADF Mental Health Prevalence and Wellbeing Study Report, p. xix.
* Name changed to protect identity
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