One of the most important things I do as a clinician is to help veteran students in crisis at San Bernardino Valley College on average once a week. Billy is a 27 year old, 80% disabled Operation Iraqi Freedom veteran who came into the office and asked if he could talk to me. I have known him for quite a while and knew a little about his background but never saw him as a client or in distress. Once he sat down and the door was shut it was evident there was an issue. He was tearful and visibly shaken because he was struggling with issues at home. He feared his PTSD was setting a bad example for his children and pushing his wife away.
Billy was a proud, angry, scared, and venerable young man. It took allot for him to visit me in the center where everyone could see him come in and sit down. Since I am well known to the veteran’s at the college he felt safe to discuss his issues with me. He appeared to be at the end of the rope and needed someone to talk to. Billy is not willing to use the services at the Veterans Administration or the Veterans Center because he don’t trust them. He is paying for a private clinician so ethically I could not continue to see him, my job at that moment was to stabilize the crisis and send him to his private clinician.
Billy was unsure what set off the most recent event. He felt he was a failure because he had no job and his PTSD appeared to be controlling his life. He had been unemployed since he got out and was scared to apply for jobs fearing rejection. As we discussed his situation we got into a deep conversation about what was going on with him. At this point I was just another veteran trying to help him through the crisis not his clinician. I completed a quick suicide assessment on him and found him to not be suicidal. He started telling me some of his stories from deployments and some of the things he had seen and done. I was aware that he was seeing a private psychologist so I had to tread lightly and be sure not to undermine anything his private clinician was doing. I discussed with him the ethical situation of seeing two clinicians and why I could not see him on a continual basis. I asked if he had discussed the issues he disclosed with me to his private clinician. He hadn’t; he didn’t feel the civilian clinician would understand. I advised him that the civilian clinician was perfectly capable of helping him, but he could not put him back together without all of the pieces. I encouraged him to talk to his clinician the same way he talked to me. He agreed to try.
The following week Billy told me that he had taken my advice and was doing allot better. He opened up to his clinician and it appeared to help. Billy told his clinician about our conversation; his clinician told him that he needed to thank me for the advice to open up. Billy is not alone. Many veterans feel they cannot tell civilian clinician things they can tell a veteran. The reality is they can, not all clinicians are a good fit for an individual, finding the right therapist is the key. Civilian clinicians are capable of working with veterans, they just need to know the whole story. Civilian clinician see PTSD frequently, 7.7 million Americans have non-combat PTSD, and the odds of a clinician already treating someone with PTSD is high. The bottom line, it is important for veterans to open up to your civilian clinician and not leave out parts of your puzzle. They can help you more than you know. Billy is doing great now, he is still going to counseling and now has a job. He is still married and helping raise their children, this is a success story that we all like to hear. Sometimes all it takes is someone who is willing to sit with them, listen to their thoughts, and talk to them with empathy.
Recognizing Suicide
Talking to a veteran, family member, or friend about their suicidal thoughts is extremely difficult but necessary. Many times all it takes to prevent a suicide attempt is to ask! You can't make a person suicidal by asking the question and showing that you care. In fact, giving a suicidal person the opportunity to discuss their feelings can provide relief they need and may prevent a suicide attempt.
Common suicide risk factors include:
History of trauma or abuse
Recent loss or stressful life event
Terminal illness or chronic pain
Social isolation and loneliness
Alcoholism or drug abuse
Mental illness
Previous suicide attempts
Family history of suicide
Ways to start a conversation about suicide:
I have been feeling concerned about you lately.
Recently, I have noticed some differences in you and wondered how you are doing.
I wanted to check in with you because you haven’t seemed yourself lately.
Questions you can ask:
When did you begin feeling like this?
Did something happen that made you start feeling this way?
How can I best support you right now?
Have you thought about getting help?
What you can say that helps:
You are not alone in this. I’m here for you.
You may not believe it now, but the way you’re feeling will change.
I may not be able to understand exactly how you feel, but I care about you and want to help.
When you want to give up, tell yourself you will hold off for just one more day, hour, minute—whatever you can manage.
For questions or comments, I can be reached at afterdutyvets@gmail.com or visit our website at marriedtoptsdpro.com and like us on Facebook at Married to PTSD Pro.
