ReadjustmenttoCollege
forStudentVeterans
Presented by: Laura Jackson, M.A., LPC Intern
May 18, 2012
10:00‐11:30 Session
Texas College Counseling Conference
Texas Counseling Association MakingtheTransitionfrom
SoldiertoStudent
FromSoldiertoStudent
• Homecoming is definitely an ongoing process, not an
event. Returning to a university environment from active
duty is a culture shock.
• It feels awkward to return to school only to discover that
while others are going through their daily routines, and
you are returning from a life altering experience.
• Relationships rapidly change, and many old friends have
graduated or moved in different directions when you
return.
• Readjustment means overcoming obstacles and making
small but important changes. Also, one must allow
himself to relax and be more patient with those around
you.
Adjustment Issues
• Adjusting to college can be challenging for veterans because
they have trouble connecting with traditional college age
students, and they have to balance multiple responsibilities.
• Many veterans will return from an extended period of exposure
to severe emotional or mental trauma, and extremely stressful
working and living conditions.
• Once they return to school, some experience frustration and
difficulty adjusting to the stress and demands of collegiate life.
• Many experience cognitive and emotional impairments that
interfere with their ability to study, and perform academically.
• They also may experience interpersonal or family problems
which affect social functioning; social and personal problems
negatively affect academic performance.
NonTraditionalStudentStatus
• Because of their age and life experiences, veterans are
generally classified as nontraditional students. Jeremiah
Peterson, an Iraq veteran said, “It’s a unique position to be in,
different even from other adults returning to school after time
away. The dropout rate for veterans is extremely high”
(Rocker, 2007, p.1).
• Mental health professionals must begin to understand this
population, how to approach them appropriately and
encouragement is essential for their success.
• College counselors and advisors should talk to their students
and ask them how they are adjusting to academic and civilian
life. Assist in connecting them with appropriate groups on
campus.
SomeActivitiestoConsider
• Create a multi-dimensional mentoring/friendship program, which includes
assigning a current ROTC (Reserve Officers’ Training Corps) student to each
veteran.
• Although most ROTC students haven’t been deployed yet, they will have the
Mentoring
same vocabulary and training in common. The veteran can help the student
Groups
by explaining what to expect in war, and the student can listen with a
sympathetic ear.
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V
Veterans
Club
Veterans
Center
Veteran clubs provide emotional support, and referral information. They help
members by filling a social void, advocating for university policy reforms,
and watching out for those who are struggling with depression or post
traumatic stress disorder. They are coming to each other to help in readjusting
to civilian society and attain college degrees.
• Erect a Veterans Center on universities that functions as a centralized office. It could be
staffed partially by student veterans and could be a storehouse of information to
veterans, i.e. scholarship information, health benefits.
• Veterans can receive assistance in completing various forms from staff members or get
referrals to offices including the counseling department, academic enrichment, or outside
agencies. A central office will create opportunities for veterans to network with each
other and get the necessary social support.
AdministrativeBarriers
• After World War II, there has been a large influx of veterans
who have flocked to college campuses to attain degrees.
Academia has continued to cater that one demographic: 18 and
19 year old freshmen right out of high school. • Many universities have extremely low percentage of veterans
on their campuses, and consequently, administrators haven’t
realized that veterans’ needs can be different from those of a
typical freshman.
• Several service members contact colleges and universities to
inquire about the GI Bill, receiving credits for military
training, and whether there are veterans on campus. Various
student services offices are scrambling to give answers that
they’re not trained to provide along with complex forms and
filing procedures.
• When describing their experiences with peers and professors, many
veterans feel painfully isolated without the camaderie of their
military colleagues and vastly different from those around them.
• The sense of isolation also pertains to being in an unstructured nature
of a civilian institution compared to the highly organized structure of
the military world.
• The ambiguity was extremely frustrating to veterans regarding the
administrative processes. Some felt that no one was there was guide
them through the process of completing GL Bill paperwork,
registering for classes, finding employment, and discussing benefits.
• Veterans described feeling alienated and alone because they
experienced a lack of support from college officials throughout the
administrative process or they didn’t identify with their peers.
SomePointstoConsider
Give Veterans a Voice: The more we listen, the more they will
speak, and the more colleges and universities will learn what does
and doesn’t work for veterans. Establish a roundtable for high level
campus administrators and student veterans. If there are two or more
veterans attending your institution, start a Student Veterans
Association- an excellent resource and sounding board for policy and
practice.
Establish Specific Points of Contact: Student veterans need
knowledgeable points of contact who will support their successful
transition to and through college. From admissions to graduation,
this point person or office can guide them through the administrative
processes and help remove obstacles that may occur.
Build a Strong Web Presence: So many times, colleges and
universities have programs that even their staff, faculty, and students
don’t know about. If you can’t find this information, how can the
returning veteran? Spread the word by developing a welcome page
that is easily accessible for your college’s home page and include
contact information for programs and services.
BalancingMultiple
Responsibilities
• Many veterans return from war and start a family, or they started one
before they went to war. Being a nontraditional student with a family
and a job can make staying focused on school difficult.
• In order for these veterans to efficiently function in their busy
environments, they have to work well with others and form an active
support community.
• Bannerman (2006) confirms that veterans need independence, but
they also need a support network. College counselors and advisers
can play key roles in encouraging students to network on campus,
make new friends, and become engaged in appropriate activities.
• “Interdependence means respecting the autonomy of others and
looking for ways to give and take with an ever-expanding circle of
friends” (Chickering & Reisser, 1993, p. 48).
• Also, it is important to remember that programming activities for
these students will likely need to be different than those designed for
traditional college age students.
• Veterans are often mature and focused, their main objective is
to attain a college degree, become a productive professional in
their field, and care for their families.
• For many traditional aged students, the stereotypical college
experience consists of partying, staying up late and eating
pizza, but these activities won’t appeal to veterans.
• Any social activities must be well planned and tailored to meet
the specific needs of the population. Providing childcare
during these events would be beneficial, even if service
members’ spouses take care of each other’s children.
• It is definitely important to discover veterans’ needs in order to
make social occasions an enjoyable, and productive time as
well.
SocialBarriers
• Veterans are usually ten years older than their classmates and have to
answer such questions such as, “Have you killed any people?”, “How
many people did you kill?” “Why did you join the military?” or “Did
you know anybody who died over there?”
• Many college students and other civilians ask these questions because
they haven’t been exposed to individuals who have served in the
armed forces and received their military education from Hollywood’s
“Tropic Thunder” or “Transformers.”
• Transitioning from the battlefield into civilian life is very challenging
for the returning soldier; one enters into a different culture when
stepping into the role of college student.
• It could be very difficult for veterans to process the effects of this
culture shock.
• Some veterans felt isolated and overwhelmed upon transitioning to
the role of student; they felt alone and experienced difficulty
identifying with peers.
• Many found it especially challenging being the receptacle for
negative public opinion against the war. It was extremely difficult to
deal with the public discontent or apathy toward the war and the
negative perceptions of them as soldiers.
• Some were uncomfortable with the reverence they received from
civilians.
• There are a multitude of other issues that present a challenge to the
transitioning soldier. These include: learning how to function in a
non-structured environment (Mares & Rosenheck, 2004), family
discord (Dekel, Goldblatt & Keider, 2005; Galovski & Lyons, 2004;
Hendrix, Erdmann & Briggs, 1998), difficulties with authority (Lubin
& Johnson, 2000), issues of perceived support (Greenberg et al.
2003), and identity issues both as a result of military service
(Herman, 1997) and as a result of leaving the military (Clewell,
1987).
MentalHealthIssues
• Returning veterans grapple with a unique set of mental health
challenges as they begin the process of transferring from their
soldier role back to their identities as parents, spouses,
employees, and students.
• War has significant effects on the psychological well being of
combat veterans, who frequently return with psychological
disorders, debilitating injuries, and disease (Levy & Sidel,
2009).
• Veterans of wars, including World War II, Vietnam, Persian
Gulf War, and wars in Iraq and Afghanistan, are at high risk for
Post Traumatic Stress Disorder (PTSD), depression, and many
related mood and anxiety disorders (Pietrzak, Johnson,
Goldstein, Malley & Southwick, 2009).
• It is also not uncommon for combat veterans to experience
interpersonal and relationship difficulties in their transition to
civilian life (Witviliet, Phipps, Feldmen, & Beckham, 2004).
• Veterans frequently do not receive mental health counseling
that facilitates their transition, even when they are suffering
from a serious mental health disorder.
• They don’t have access to counseling or specific support
resources on campus. In addition, veterans often face a stigma
and feelings of weakness as they sit face to face with a
therapist. It is extremely difficult to readjust with this critical
support.
• Hoge et al. (2004) found that only 26% of Iraq and Afghan
soldiers who acknowledged experiencing acute distressing
psychological symptoms actually received mental health care.
• Homecoming and interpersonal functioning is often difficult
for the soldier particularly if he/she was physically wounded
during deployment.
• Younger families may be less prepared to deal with the stress
of recovery, rehabilitation, and adjustment to a chronic
physical disability (National Center for Post Traumatic Stress
Disorder, 2004).
• Several student veterans who return from active duty, have a
wide range of experiences which some military branches
provide little to no mental health to help them ease back into
the academic or civilian world. (DiRamio et al. 2008).
• The veteran’s worldview is living in an unpredictable world
that is undergoing a constant, threatening change. One has seen
so much death, suffering, and has been forced to live with
insecurity that he can no longer feel secure, and has a general
wariness of others.
• Often, the veteran feels like his life has no positive meaning,
no purpose, and no direction, once he has experienced war
(p.88).
• Intense emotions require effective management, and many
veterans need assistance to learn how to do that. Many
veterans have used maladaptive coping mechanisms to deal
with issues of military service including substance abuse.
• College counselors and advisers can serve a pivotal role in the
college community to help students with readjustment issues
by ensuring their mental health needs are met and referring
students to counseling centers.
• They must effectively help veterans communicate the issues
which are most challenging to their success.
SignsthatCounselingMaybe
Helpful
• The nature of the war zones in Iraq and Afghanistan are
breeding grounds for mental health problems, most commonly
experienced by soldiers. Some of the factors may elevate the
risk of psychological problems for returning veterans are:
Greater sense of
unpredictability
and helplessness.
Close quarters,
confusing battle
environments
with no front
lines and no clear
sense of friend or
foe.
The tasks
required for
survival in the
war zone taking
precedence over
acknowledging
and grieving the
loss of friends.
Exposure to
significant
numbers of
civilian
casualties.
The existence of
psychological
problems present
before combat.
Psychological reactions to the extreme stress of the war zone atmosphere often cause a
myriad of symptoms and reactions in returning veterans. These will usually diminish with
time and living in a civilian environment. When these symptoms and reactions persist for
more than a month, it’s time to seek professional help.
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Feelings of helplessness and hopelessness.
Substance and alcohol abuse.
Recurring and intrusive memories and/or combat dreams.
Intense distress in response to cues symbolizing some aspect of
combat; hyper vigilance and being easily startled by noises.
Avoidance of anything associated with war zone experiences.
Diminished interest to participate in important or previously enjoyed
activities; difficulty concentrating.
Suicidal thoughts, feelings, or behavior
Sense of a foreshortened future (not expecting to live to have a
career, marriage, children, or normal life span.)
Being paranoid without any real evidence that others have bad
motives.
Emotionally distant, detached, or estranged from others.
• One who experiences PTSD symptoms realizes they can
exacerbate the transition into student life. Re-experiencing
war trauma, avoidance/numbing and hyperarousal (APA, 2000)
are symptom clusters that potentially affect a student veteran’s
ability to deal with the stress of a college education.
• Physical injuries can be invisible like emotional issues;
veterans may suffer in silence with mild brain injury, hearing
impairment, visual impairment or back injuries that can
negatively impact the ability to succeed in college.
• The veteran student may minimize the actual impact on the
injury, and feel that asking for help is a sign of weakness
(Black, 2007).
SeventeenPTSDSymptoms
• Campus health and counseling officials should have knowledge regarding PTSD
treatment and strategies and have an extensive referral list for veterans. These
symptoms are identified in the 4th edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV).
• These 17 symptoms are divided into three separate clusters. The three PTSD symptom
clusters, and the specific symptoms that make up three clusters, are described below
(Keane, 2002).
RE-EXPERIENCING SYMPTOMS
• Frequently having upsetting thoughts or memories about a traumatic event.
• Having recurrent nightmares.
• Acting or feeling as though the traumatic event were happening again, sometimes
called a “flashback.”
• Having very strong feelings of distress when reminded of the traumatic event.
• Being physically responsive, such as experiencing a surge in your heart rate or
sweating, to reminders of the traumatic event.
AVOIDANCE SYMPTOMS
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Making an effort to avoid thoughts, feelings, or conversations about the traumatic event.
Making an effort to avoid places or people that remind you of the traumatic event.
Having a difficult time remembering important parts of the traumatic event.
A loss of interest in important, once positive, activities.
Feeling distant from others.
Experiencing difficulties having positive feelings, such as happiness or love.
Feeling as though your life may be cut short.
HYPERAROUSAL SYMPTOMS
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Having a difficult time falling or staying asleep.
Feeling more irritable or having outbursts of anger.
Having difficulty concentrating.
Feeling constantly “on guard” or like danger is lurking around every corner.
Being “jumpy” or easily startled.
OTHER COMMOM SYMPTOMS of POST-TRAUMATIC STRESS DISORDER
• Anger and irritability
• Guilt, shame or self-blame
• Substance abuse
• Depression and hopelessness
• Suicidal thoughts and feelings
• Feeling alienated and alone
• Feelings of mistrust and betrayal
• Headaches, stomach problems, chest pains
TreatmentOptionsforPTSDandMentalHealth
Issues
• Cognitive therapy: In cognitive therapy, the therapist helps you to understand
and change how you think about your trauma and its aftermath. The goal is to
understand how certain thoughts about your trauma cause you stress and make
your symptoms worse. With the help of your therapist, you will learn to replace
these thoughts with more accurate and less distressing thoughts.
• Exposure therapy: In exposure therapy, the goal is to have less fear about your
memories. By talking about your trauma repeatedly with a therapist, you’ll learn
to get control of your thoughts and feelings about the trauma. You may focus on
memories that are less upsetting before talking about the worse ones.
• EMDR: Eye movement desensitization and reprocessing (EMDR) is a fairly new
therapy for PTSD. While discussing your memories, you’ll focus on distractions
like eye movements, hand taps, and sounds. For example, your therapist will
move his or her hand near your face, and you’ll follow this movement with your
eyes.
• Group therapy: In group therapy, you talk with a group of people who also have
been through a trauma and PTSD. Sharing your story with others may help you
feel more comfortable talking about your trauma. This can help you cope with
your symptoms, memories, and other parts of your life. Group therapy helps you
build relationships with others who understand what you’ve been through.
GroupTherapyandBrief
Therapy
• Group therapy effectively helps combat veterans struggling with mental health
disorders. Murphy, Thompson, Murray, Rainey, and Uddo (2009) found that group
work can be particularly helpful for students in general and particularly combat
veterans.
• Yalom (1995) wrote about the power of groups to provide patients with hope that
group therapy will make a difference in their lives and to allow them to meet others
who have had similar experiences, thoughts, problems, and concerns.
• Groups can help combat veterans learn to appropriately express their emotions and to
understand that they are not isolated in their experiences; many veterans may gain
insight into their style of interpersonal communication, thus improving relationships
outside of the group (Dies, 2003).
• The group facilitator’s role is to build cohesiveness, an essential component in group
therapy, which allows members to show vulnerability, to gain insight, to learn
interpersonal and communication skills, and to create a positive change in their lives
(Yalom, 1995).
• Brief therapy emphasizes the patient and therapist’s efforts to recognize the problems
that incited therapy and to seek an immediate resolution to the patient’s issues (Hoyt,
2003).
• Brief therapy assists in establishing and accomplishing obtainable goals, and
providing help with a specific concern (Hoyt, 2003).
• It advocates getting the most out of every session, focusing on strength,
resources, and healing directly. This form of therapy appears to have a bright
future, because it is effective and is likely to be compatible with the demands
of managed care (Hoyt, 2003).
Group Plan
Session 1: Introduction to the Group
• Introduce yourself to the group and provide members with information about
your professional training.
• Discuss ethical expectations and guidelines for group participation.
• Ask participants to introduce themselves to the group and identify a goal for
group therapy.
• Use the Miracle Question (“If you woke up tomorrow and your problems
about the war were all gone, how would life be different?”) to help elicit
goals.
• Ask the members to rate on a scale of 1 to 10 how close they are to achieving this
goal.
• Ask the group members to provide an overview of their military background.
Session 2: Unique Problems of College Student Veterans
• Prior to the group meeting, familiarize yourself with institutional services
specifically for veterans and be aware of other resources available on campus,
such as career counseling, individual counseling, and academic help.
• Allow group members to discuss their experiences with and the quality of help
resources offered by their particular branch of service before returning to the
United States.
• Ask the group members to discuss what kind of personal challenges they have
faced since transitioning to college.
• Ask the group members to discuss academic difficulties they have or may have
experienced upon returning to college.
• Allow the group members to discuss the often frustrating bureaucratic barriers
they may have experienced since returning to school.
• Encourage them to discuss their feelings about returning to college with
traditional-age college students without a military background.
Session 3: Combat Stress and PTSD
• Provide group members with psychoeducation using Handout 21.1 regarding the signs and
symptoms of PTSD as well as current treatment modalities, especially the importance of
talking about the traumatic event(s).
• Ask the group members to discuss their reactions to the description of PTSD.
• Ask group members to discuss how combat related-stress and PTSD have negatively
affected their daily lives.
• Ask group members to describe their coping style when they experience PTSD symptoms.
• Track progress by asking members to compare their ratings on a scale of 1 to 10 (how close
to their goal) with ratings from Session 1. What accounted for any changes.
Session 4: Combat Stress and PTSD (Continued)
• Ask group members to recall particularly traumatic combat experiences.
• Encourage group members to explore their emotional reactions to the trauma in as much
detail as possible.
• Allow members to identify and discuss intrusive thoughts and flashbacks, and ask what they
have done in the past to help cope with these.
• Encourage group members to seek out individual counseling when needed, and encourage
them to be open to recalling traumatic events.
Session 5: Stress Management
• Have group members identify recurring or common stressors in their lives.
• Have group members share with one another how they cope with stress.
• Demonstrate and train group members to use effective means of coping with
stressors, such as deep breathing and muscle relaxation.
• Provide instruction about relaxation techniques.
Session 6: Anger Management
• Encourage group members to describe and identify targets, situations, and
triggers that typically create angry outbursts.
• Have group members discuss the negative ways in which anger has affected
their personal lives.
• Explain the difference between assertiveness and anger/aggression, and
discuss examples of assertiveness and aggression management.
• Encourage group members to identify how they would like to manage angry
outbursts in the future.
Session 7: Interpersonal Issues and Relationships
• Ask the group members to acknowledge and discuss any current relationship
difficulties with spouses, significant others, children, parents, or others.
• Encourage group members to discuss positive aspects of their relationships
as well.
• Ask group members to discuss a behavior that they would like to change that
may improve the relationship.
• Use more group time to educate group members about family counseling and
couples counseling and how the members may benefit from those therapeutic
modalities.
• Make the group members aware of family and couples counseling resources
on campus.
Session 8: Group Wrap-Up and Termination, and Identification of Community
Resources
• Ask group members to identify something that they learned about themselves
and about managing psychological issues on campus.
• Use the rating scale again to rate progress toward the goal. Discuss and
share coping mechanisms and what specific changes got them closer.
• Ask group members to discuss what was helpful about the group and how
they will use what they learned from the group experience.
• Ask for feedback regarding how to make the group more effective in the
future.
• Ask group members to identify university-based support resources they plan
to use, such as housing, counseling, financial aid, and advising.
• Provide the group members with a list of university and community
resources.
ReferralsforVeterans
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United States Department of Veterans Affairs: The homepage for the VA is http://www.va.gov/. The following sites are parts of the Veterans Affairs main site that may be of special interest to returning veterans.
Iraq War Clinician Guide: This guide was developed to provide mental health professionals with information about the war‐zone experience of soldiers and the stresses and challenges associated with combat. http://www.ncptsd.va.gov/ncmain/ncdocs/manuals/nc_manual_iwcguide.html
However, this site also contains many resources for readjustment to civilian life:
Transition Assistance Information for Enduring Freedom and Iraqi Freedom Veterans http://www.ncptsd.va.gov/ncmain/ncdocs/handouts/iraq_clinician_guide_app_j1.pdf
• Warzone‐Related Stress Reactions: What Veterans Need to Know http://www.ncptsd.va.gov/ncmain/ncdocs/handouts/iraq_clinician_guide_app_j2.pdf
• Depression
http://www.ncptsd.va.gov/ncmain/ncdocs/handouts/iraq_clinician_guide_app_j3.pdf
• Stress, Trauma, and Alcohol and Drug Use http://www.ncptsd.va.gov/ncmain/ncdocs/handouts/iraq_clinician_guide_app_j4.pdf
• What if I Have Sleep Problems? http://www.ncptsd.va.gov/ncmain/ncdocs/handouts/iraq_clinician_guide_app_j5.pdf
• Coping with Traumatic Stress Reactions http://www.ncptsd.va.gov/ncmain/ncdocs/handouts/iraq_clinician_guide_app_j6.pdf
• Warzone‐Related Stress Reactions: What Families Need to Know http://www.ncptsd.va.gov/ncmain/ncdocs/handouts/iraq_clinician_guide_app_j7.pdf
• Families in the Military http://www.ncptsd.va.gov/ncmain/ncdocs/handouts/iraq_clinician_guide_app_j8.pdf
• Homecoming after Deployment: Dealing with Changes and Expectations http://www.ncptsd.va.gov/ncmain/ncdocs/handouts/iraq_clinician_guide_app_j9.pdf
• Homecoming after Deployment: Tips for Reunion http://www.ncptsd.va.gov/ncmain/ncdocs/handouts/iraq_clinician_guide_app_j10.pdf
Seamless Transition Home:
http://www.seamlesstransition.va.gov/
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Transition Assistance Information for Enduring Freedom and Iraqi Freedom Veterans: http://www.seamlesstransition.va.gov/transition.asp
National Center for PTSD (NCPTSD): Affiliated with the VA, the NCPTSD aims to advance the clinical care and social welfare of
veterans through research, education and training on PTSD and stress‐related disorders. However, this site also contains many resources for readjustment to civilian life. http://www.ncptsd.va.gov/ncmain/index.jsp
Readjustment Counseling Services: This Veterans Administration site provides tools to locate nearby veterans centers and service providers. http://www.vetcenter.va.gov/
http://www.studentveterans.org/resourcelibrary/documents/campuskitforstudentveterans.pdf
http://www.studentveterans.org/resourcelibrary/documents/veteran_resource_guide.pdf
http://www.studentveterans.org/resourcelibrary/documents/fromcombattocampus.pdf
http://www.uoregon.edu/~vfsa/
Battlemind Training: Transitioning from Combat Discusses how attitudes and skills developed in combat can be altered to achieve success and happiness in civilian life. http://usachppm.apgea.army.mil/hio_public/images/dhpw/brochures/Battlemind_Training_I.pdf
The Road to Resilience: This article from the American Psychological Association describes resilience and some factors that affect how people deal with hardship. Much of the brochure focuses on developing and using a personal strategy for enhancing resilience. http://apahelpcenter.org/featuredtopics/feature.php?id=6
Post‐Traumatic Stress Disorder (PTSD) Resources:
American Psychiatric Association: A discussion of PTSD symptoms, treatments, and resources. http://www.healthyminds.org/multimedia/ptsd.pdf •
National Institute of Mental Health: A discussion of PTSD symptoms, treatments, and resources. http://www.nimh.nih.gov/health/topics/post‐traumatic‐stress‐disorder‐ptsd/index.shtml
Books of Interest:
"Down Range: To Iraq and Back" by Bridgett Cantrell and Chuck Dean (http://www.namvetbook.com/downrange.htm)
"Courage After Fire" by Keith Armstrong, Suzanne Best, and Paula Domenici http://www.courageafterfire.com/