Preparing for High Stress Tour of Duty Providing Military Mental Health Services Abroad

Dear Belleruth,
I’ll be leaving soon for Landstuhl Regional Medical Center, where I will be providing psychological treatment to our military personnel and their families. . .

I have had my own private practice for the past 8 years. Your book, Invisible Heroes, and your audio programs have been invaluable to my work on nearly a daily basis. My question is this:

Do you have any advice for me as I begin this assignment?

Warm Regards,



Dear Paul,

My opening advice is to pay careful attention to your first impressions after you arrive - of the people you'll be serving, your new colleagues, and the hospital culture as a whole.  It’s altogether possible that ‘beginner's mind’ will be your best teacher here, because you'll never have such clear eyes about what patients are needing and what they’re not getting.

If at all possible, see if you can write down your impressions, because in under 6 weeks, you'll be part of the system and won't notice this stuff any more - and it's important to let it inform the quality of care you are giving.

Also, if you can:

•    Identify some trustworthy colleagues from back home, who can help you with their expertise now and then while you’re overseas – maybe a really good couples’ or family therapist; or a chemical dependency counselor; or someone familiar with EMDR, Cognitive Behavioral Therapy, or some other specialized approaches. Ask if they wouldn’t mind your calling occasionally with a question when you need a savvy sounding board with no axe to grind.   
•    Keep a journal so you can talk to yourself, too.
•    See to your own self-care, including exercise, meditation and/or guided imagery, to deal with the vicarious suffering you’ll be experiencing.
•    Hand-pick a sympatico work buddy (and hopefully there will be more than one) with whom to debrief on a regular, semi-structured basis.) You can use somebody who’s been there a while who can show you the ropes and serve as a mentor.
•    Meet with colleagues, if possible, once a week, for solution-oriented discussions about clients or programs (as opposed to gripe sessions, which are ultimately demoralizing)
•    Keep your heart open, but with good, behavioral boundaries. Contrary to popular belief, it's a closed heart that leads to burnout, not an open one.
•    Remember that you’re new – you’re not supposed to know everything, and it’s okay to ask for help.

Thank you for doing this work. I salute your adventurous spirit!

All best,

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