Clinician's Digest - Page 2

What drew the group together was Hendrix's initial idea that global conflicts are rooted in dysfunctional family dynamics, and that beginning to enhance empathy and connection within couples might have larger ripple effects around the world. Hendrix started the weekend with an emotional plea to the group to help create "a new marital narrative" that would address what he termed "the core human tragedy—the loss of connection." He proposed that the group brainstorm about ways to make the tools and relational awareness that are the hallmarks of couples therapy more visible and accessible to the wider culture.

By the weekend's conclusion, two ideas emerged as organizing principles. The first was that the nature of effective social movements has been transformed by the digital revolution, so whatever the organizing tactics of the successful movements of the past, those methods need to be rethought in light of the power of the Internet as a low-cost, high-impact way of galvanizing large numbers of people today. The other was that, as the Networker pointed out in its last issue, the digital revolution has become a "relationship revolution." In the age of Web 2.0, we've learned that the Internet is a vital lifeline, not only of information, but also of connection and conversation with others. However, bombarded with messages of all kinds every moment of the day, we've become exquisitely attuned to attempts to engage us in genuine conversation, as opposed to being proselytized or sold to. The group agreed that, whatever path its efforts might take, the goal was not to "sell" anybody on a particular idea or model of relationship, but to provide a forum where science-based information and a range of illuminating conversations about the challenges of contemporary relationships could be made available to a much wider population than will ever see the inside of a therapist's office.

Dubbing itself the Couples Education Think Tank (CETT), the group reached few concrete conclusions, other than that they'd continue to meet, and try to involve other prominent therapists and therapy organizations in their ongoing discussions about practical means to achieve their lofty goals. What may be most important for other therapists about CETT isn't any official pronouncements it might make or concrete actions it might take, but the example of professionals entering into collaborations and taking the time and trouble to go beyond their individual self-interest to find ways to address the larger issues of the day. There are no shortcuts to making a difference in the wider world, but the key is certainly a willingness to transcend the sense of powerlessness and of the disheartening immensity of the task. As Hendrix put it at the conclusion of the weekend, "The best thing we can do for the world is to help couples understand that the best thing that they can do for the world is to have a great relationship. That means starting from where we are, wherever we may be."

Preventing Combat Trauma

While much of this issue is devoted to the ways the mental health professions can best serve the needs of the troops serving in Iraq and Afghanistan, the focus is almost entirely on what can be done after a soldier has been traumatized. But during the last year, the Army has made a huge investment in trying to lower the rate of traumatization among troops by using the old community psychology principle of primary prevention. Alarmed by a RAND Corporation study finding that one in five veterans serving in the war zones of Iraq and Afghanistan were suffering from PTSD or major depression, as well as an epidemic of suicides among military personnel around the country, the Army has implemented the Comprehensive Soldier Fitness Program (CSF), a $117 million project to teach emotional resiliency to prevent traumatization. CSF marks the first time the Army has attempted to address and track the mental fitness of its soldiers from training through postdeployment.

Spearheaded by former American Psychological Association president Martin Seligman, and drawing from the principles of Positive Psychology, the program is based on the premise that psychological resilience, taught ahead of time, can help immunize people from disorders arising from stress and trauma. All new Army recruits already take the Global Assessment Tool (GAT), which evaluates their strengths in physical, social, emotional, spiritual, and family domains, but CSF calls for them to retake the GAT throughout their military careers. In addition, all soldiers will receive resilience training in the GAT domains, with a focus on teaching soldiers "cognitive skills that increase core competencies including optimism, mental agility, self-regulation, self-awareness, character strengths, and connection." More than 1,323 trainers are now in place.

Unprecedented in its scope and application of psychological principles to military training, the program, not surprisingly, has drawn criticism. Seligman and other proponents of CSF argue that it's largely adapted from Battlemind, a debriefing program administered to soldiers after exposure to trauma, which has been shown to reduce traumatization and depression in combat troops. Seligman has pointed to the successful resilience programs that he's developed for suburban Philadelphia schoolchildren, but psychologist James Coyne, from the University of Pennsylvania's School of Medicine, has challenged the generalizability of some of Seligman's research findings. "Marty stayed away from studying whether those ideas would work with inner-city kids who are actually exposed to trauma," he says.

Trauma expert Richard Gist, who trains and studies emergency-response teams around the world, points out that the less individualized prevention programs are, the less effective they seem to be. Although each soldier takes the GAT annually, he contends that the functions it assesses and the resilience-training modules of CSF are too broad to do much good. "To treat trauma, you have to know each individual's system of belief, and how they normally face challenges to them," he contends.

Others argue that if CSF helps even a small percentage of soldiers to avoid postdeployment PTSD, depression, homicides, suicides, and substance abuse, it's worth the money and effort. "When critics have some positive efficacy results using something else, I'll be happy to read it," says Brigadier General Rhonda Cornum, director of the CSF program. Gist believes there's a potential danger to CSF, however. "Good intentions can lead to harmful results," he says, recalling the days when Critical Incident Debriefing teams rushed into trauma scenes, providing immediate counseling to everyone: eventually, they learned that the presence of such teams was associated with an increase in PTSD. "The most likely way you can do harm with psychological interventions," cautions Gist, "is to believe there's no possibility of doing harm."

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