counselors in the military

Counseling in the Military

Mental health professionals may provide services to military populations as either active duty commissioned military officers or civilian professionals stationed with military units—sometimes at very remote locations. In either case, counselors working with military service members find themselves in daily multiple relationships with clients. Quite often these multiple roles are entirely unavoidable and are even a necessary ingredient in effective mental health care. At other times, these multiple relationships are uncomfortable or even distressing for client and counselor alike.

A Contributor’s Perspective

W. Brad Johnson, a former Navy psychologist and now a colleague and consultant to many military mental health providers, highlights the reasons multiple relationships are an unavoidable ingredient in the daily lives of those working in the military and how military counselors can work to minimize harm to their clients in this environment.

Multiple Relationships in Military Mental Health Counseling

W. Brad Johnson

Multiple Roles in Embedded Military Environments

When a mental health professional is “embedded” or deployed with a military unit (e.g., an Army brigade, a Navy aircraft carrier, an Air Force squadron), that professional is typically a commissioned military officer who also happens to be a mental health counselor, social worker, psychologist, or psychiatrist. Here are some of the distinctive elements of mental health practice in embedded environments. Each of these factors clearly increases the risk of multiple relationships with clients.

· When a counselor is also a commissioned officer, he or she will have a legally binding senior–subordinate or subordinate–senior relationship with everyone in the population to whom he or she will provide mental health services. In this rank-conscious culture, it can be difficult to fulfill multiple roles such as empathic counselor and superior officer, or mental health expert and direct subordinate.

· Counselors in embedded or isolated duty stations cannot choose to enter or exit counseling relationships. Although civilian counselors might enjoy the luxury of being able to refer a client with whom they have or may have a problematic multiple relationship, military providers often cannot refer. Because the military counselor may be the only available provider in the deployed unit or at an isolated base, he or she must generally accept every referral and see every service member with a mental health need, regardless of whether the counselor is a close personal friend, a direct supervisor, or a coworker to that client. In fact, one should assume from the start that every member of the military unit is a potential client, including colleagues and close friends (Johnson, Ralph, & Johnson, 2005).

· At times, roles with clients might shift suddenly and with little opportunity to carefully inform clients. In embedded or isolated duty stations, a mental health professional might be directed to perform a fitness-for-duty or security clearance evaluation on a service member who is also a current, perhaps even a long-term, client. The sudden addition of a forensic or evaluative role with a client can cause confusion and distress. If the counselor determines that the service member is not fit for deployment or not a good risk for a security clearance, this outcome might naturally sour the counseling relationship if the client feels blindsided and betrayed.

· In contrast to civilian settings, counselors practicing in the military wield considerable power over military service members. The military is a traditional and hierarchical culture. In this context, commanding officers often defer to the judgment and expertise of mental health professionals when there are questions about a service member’s mental health, fitness for continued service in the military, ability to deploy to a combat zone, and risk to self or others. These are high-stakes assessments with profound consequences for the service member’s career. For this reason, counselors must remain sensitive to their degree of power over the lives and livelihood of clients.

· Finally, in military contexts, frequent and close personal contact with clients is nearly guaranteed. Deployed military units and small military bases are isolated and close-knit communities. Like counselors in rural communities, military counselors will find themselves in extra-counseling contact with most clients on a routine basis. When deployed with a unit, the counselor will find him- or herself eating, sleeping, and carrying out all the mundane tasks of life while (literally!) shoulder to shoulder with clients. For this reason, effective counselors need to develop a high comfort level with frequent boundary crossings.

Case Illustrations: Counseling o