Hello again.  As promised, here are some of the treatment tips I presented in my talk at NICABM last month.  Part one, on values and norms to be aware of was in an update posted a couple of weeks ago.  We got such a strong response, I’m forking over Part 2.

I hasten to remind you that this is based on what I was told by a lot of Service Members who considered themselves Behavioral Health “washouts”. It pains me to say that some of this is stating the obvious and shouldn’t have to be said – they’re just the very basics of good treatment to anyone.  But evidently reminders are needed in some quarters, so here they are- the unexpurgated list of “Do’s” – I may have to leave the “Don’ts” for another time, because this is pretty long for reading at the screen: 


  1. Listen carefully and patiently.

  2. Be respectful.

  3. Be authentic – phonies are quickly spotted and given the old heave-ho.

  4. Make direct eye contact. (Ed. Note: Can you imagine coming home, feeling conflicted, confused and squirrely about some of the things you saw or did that felt “normal” at the time, and facing a therapist who can’t bring him- or herself to look you in the eye?? Oh, puh-lease.)

  5. Lead with questions about physical or behavioral issues rather than feelings or emotions, unless they start there.

  6. Let them tell the story in their own words, without interruption or interpretation or reframing, and use those words back in the conversation.

  7. Rather than the standard “How does that make you feel?” you may want to try something more cognitive, like “What do you make of that?”

  8. Empathic mirroring which works well in other contexts, like “That has to be hard” may be taken as an annoying invitation to whine and wallow.

  9. Be aware that the moral injury warriors suffer when exposed to the worst that humanity has to offer, creates a profound existential crisis, unlike most of what you’ve seen. Treat this gaping wound with profound respect and compassion. Don’t judge. Open your heart and listen.

  10. If you’ve been in the Service yourself, display proof around the office or bring it up in a casual way. This will be received with great relief.

  11. If you haven’t, say that you’re aware that this is a disadvantage to you both; but that you are a pro and you can listen and learn.

  12. Create a comfortable, welcoming, relaxed therapeutic setting – don’t sit (hide) behind the desk.

  13. Engage in back and forth dialogue, respectful sharing and conversation about options, ideas.

  14. Add psycho-educational components on the neuro-physiological nature of traumatic stress – get out of the realm of mental illness.

  15. Don’t be abrupt with “Our time is up” – work a transition.

  16. Dump the “D” in PTSD.  Or call it combat or occupational stress.

  17. Brush up on the concept of PTG or Posttraumatic Growth.

  18. Learn some specific modalities that work for traumatic stress (I discuss this at length in Invisible Heroes but here’s a short list: guided imagery, EMDR, EFT, Somatic Experiencing, Trauma Incident Reduction, mindfulness or MBSR, yoga nidra, massage therapy, Reiki,Therapeutic Touch, biofeedback, neurofeedback, Trauma Releasing Exercises, etc.etc)

OK, hope this is useful.  Let me know.  And please add your own tips as they come to mind, or express your disagreement with some of mine.  This is an important conversation for us to be having.

All best,