Kevlar for the Mind: Bridging the gaps in 'cultural competency'

The concept of cultural competency — the therapist’s ability to understand, acknowledge, and appreciate the differences each person brings to therapy and how it influences the therapeutic process — is an oft-discussed topic among mental health professionals.

It’s usually discussed within the context of race, ethnicity, religion, and even geographical factors such as where you were born and raised. Recently, clinicians who treat military personnel have written about how the military itself is a unique and distinct culture that can impact psychotherapy, especially for therapists not familiar with that culture.

Gaps in cultural understanding can lead to confusion and frustration for both therapist and patient, which can impede progress and possibly lead to the patient dropping out of therapy prematurely. By understanding some of the more common examples of these gaps cited by professionals, you can work with your therapist to ensure they don’t become an obstacle to treatment.

Arguably the biggest difference between the military and civilian worlds is language. The military is fond of acronyms, abbreviations and unique slang words and phrases. This language is adaptive in the combat environment, as it allows large amounts of information to be communicated in a short amount of time.

But for a therapist not familiar with military culture, differences in language may be seen as confusing and unnecessary, leading to miscommunication and frustration on both sides. Here’s an example of language that may sound distinctly “foreign” to a non-military therapist:

“I recently ETS’d from Fort Hood after six years as an NCO, where I worked in the S2 shop. Now, all I seem to be doing is working as an RTO or watching troops PMCS’ing vehicles all day. Hell, I was trained as an 11 Bravo. And wouldn’t you know it, DFAS screwed up my partial DITY and I still haven’t gotten paid since I in-processed.”

Another difference: Troops are taught to be solution-focused rather than problem-oriented. This may conflict with a therapist whose style is more non-directive and tends to spend hour after hour focusing on a patient’s childhood or unconscious motives. Being continuously asked probing questions such as, “How does that make you feel?” can drive a solution-focused person up the wall.

Thirdly, individuality and independence are highly valued traits in American culture. But while they’re also valued in the military, they are less important than “the group.” In fact, individuality and independence are viewed as a potential threat to military unit cohesiveness, morale, and mission effectiveness. A therapist who neglects this distinction will struggle with military patients more than one who understands it.

If at any time you believe issues related to military culture are negatively impacting your relationship with your therapist, discuss it with them sooner rather than later. It was save you both a lot of time and frustration.

Bret A. Moore is a clinical psychologist who served in Iraq. Email kevlarforthemind@militarytimes.com. Names and identifying details will be kept confidential. This column is for informational purposes only. Readers should see a mental health professional or physician for mental health problems.