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Closeup of soldier's boots

The top reason psychology students are wary of military careers is a fear of deploying to war zones such as Iraq and Afghanistan.
 
As national training director of the Navy's psychology internship program, Eric Getka, PhD, oversees the training of 10 interns at Navy hospitals in Bethesda, Md., and San Diego. But filling those slots is not easy. To recruit applicants, Getka talks up military service during visits to psychology doctoral programs, staffs a booth at APA's Annual Convention and even makes cold calls to doctoral students.

"I look for people whose interests align with our internship training, and I contact them individually," he says.

His outreach has intensified in recent years in response to psychology students' falling interest in military service, even as demand for psychological services from service members and their families is at an all-time high. Since 2005, applications to the Navy's psychology internship program are down about 30 percent.

Despite that drop, Getka says the Navy's program has consistently met its recruiting goals without compromising on the quality of interns selected.

The Air Force has also struggled: This year, only 28 students cleared the officer selection process and were considered for 25 internship slots. "Either students don't know about these opportunities or there's something so negative to them that students think they're not even worth exploring," says Maj. Ken Furman, PhD, who runs the Wright-Patterson Air Force Base internship program in Dayton, Ohio.

While he would like to see more applications, Furman says the qualifications of those who do apply are strong. In an effort to boost application numbers, Furman works with Air Force recruiters, attends conventions, calls students who've expressed an interest and personally visits doctoral programs.

The personal and professional interests of some students might not match with a military internship, but for those who are open to the idea, he stresses that excellent training is available.

"The whole reason I want to get out there is for people to understand that there's another possibility for internship training," he says.

The Army's training program is doing comparatively better, with internship applications doubling over the past three years from 144 to 287. Maj. John Yeaw, PsyD, psychology training director at Walter Reed Army Medical Center in Washington, D.C., attributes the surge in Army applications to increased public awareness of mental health needs of Iraq and Afghanistan veterans. Students have also been attracted by the Army's option of a residency year that offers training rotations and time to prepare for licensure after the internship year, Yeaw says.

Despite these successes, Army recruiters are intensifying their efforts to bring in psychologists in order to stay ahead of the military's mental health needs.

"We'd like to reach out to different programs that might not have thought of the Army before," Yeaw says.

Benefits and fears

For many psychology students, a military post is financially attractive. Across all three services, interns receive the pay and benefits of an officer at the military's O-3 rank, with salaries at some locations exceeding $70,000 a year. Interns receive a tax-free housing allowance, free medical and dental care, moving expenses, 30 days of paid leave, and commissary and post-exchange privileges.

The Army and Air Force also offer the Health Professions Scholarship Program, which pays for tuition, books and fees for the final two years of a doctoral program, plus a monthly stipend of $1,900 for participating students. In a bid to compete, the Navy starts offering the scholarship next year. In exchange, Navy and Air Force psychologists must serve at least three years on active duty after their internships are complete. For Army psychologists, the three-year commitment starts following licensure.

Nonetheless, military psychologists know that some students simply aren't interested in military service. The top reason psychology students are wary of a military career is a fear of deploying to war zones such as Iraq and Afghanistan, say military training directors. That's the case for Wright State University student Lavonna Connell, who is considering service as an Air Force psychologist. Although she would like to help service members deal with post-traumatic stress disorder and counsel children who are coping with separation from deployed parents, she's not sure she would like to be in Iraq.

"It's the risk of just being in the area," Connell says.

Those risks are real. More than 35,000 service members have been wounded in action in Iraq and Afghanistan, and more than 5,000 have died.

To assuage those fears when he talks to students, Getka points out that psychologists deploy as part of medical teams, and they don't face the same risks as service members trained for combat. According to Getka and Yeaw, no military psychologists have been wounded or killed while deployed to Iraq or Afghanistan.

Family obligations also top many student concerns about deployment. Former Navy electronics technician Alicia Bowman, for example, is considering rejoining the service, but now that she's divorced, she worries about being away from her young sons while on a six-month overseas deployment. Now a clinical psychology student at Indiana University-Purdue University Indianapolis, Bowman would like to help service members—particularly those struggling in basic training—adjust to the demands of military life.

"There are a lot more pros than there are cons, and the only con is my kids," Bowman says.

Yeaw understands that concern. In 2006, when he served for a year with a combat stress control team in southern Baghdad, being away from his family was one of the hardest parts of his job. But he also says that his work with soldiers in Iraq has been the pinnacle of his career.

"It helps you understand what the soldiers are going through, because you're with them," he says.

Capt. Michelle Miller, PsyD, agrees. She completed an Army internship in November 2008, and she regularly talks with psychology students about the realities of working in war zones. "I try to reframe that for them and say, if you do go on a deployment, it'll help you better serve this population," she says.

Surprisingly, one issue that students don't generally ask about is the ongoing controversy over the role of military psychologists in the interrogation of terrorism detainees.

When no one brought up the controversy during a question-and-answer forum at an open house for potential interns at the National Naval Medical Center in Bethesda in January, Getka did, noting that Navy psychologists are not involved in interrogations but are present at sites such as Guantanamo to provide mental health services to detainees and staff.

'Don't ask, don't tell'

Other students say military policies run counter to their beliefs or duties as a psychologist. Chief among them is the prohibition against openly gay men and women from serving in the military. The military's "don't ask, don't tell" policy kept David Guggenheim from applying for a Navy internship in 2007. He said he was fine with the idea of deployment, was impressed by the breadth of training offered at military programs and wanted to serve. But he didn't want to hide the fact that he's gay.

"I considered it, but I didn't want to go back into the closet," says Guggenheim, a clinical psychology doctoral student at Argosy University in Washington, D.C. He finished an internship at a therapeutic day school in Torrance, Calif., in August.

Another tension raised by students is potential conflicts between military orders and psychological ethics, says Lt. Nicholas Guzman, who is completing an internship at National Naval Medical Center in Bethesda, Md. After a presentation he made to students, several wanted to know if, as an officer, he'd be required to report a disclosure of homosexuality made by a patient. Guzman says psychology's ethical code compels him to keep such disclosures confidential. Yeaw emphasizes that military psychologists adhere to their state's licensing regulations and regularly consult with APA's Ethics Office on questions of confidentiality and privacy.

"As a psychologist, you're not put in a position where you have to break someone's confidentiality because of orientation," he says.

Students also ask about other aspects of confidentiality and how military psychologists balance individual patients' needs with the needs of the larger organization. For example, if Yeaw thinks a soldier shouldn't deploy because of post-traumatic stress disorder, he'll make that recommendation to someone within the soldier's chain of command.

Psychologists also point out that the limits of confidentiality are routinely explained to patients, and that even in the civilian world, psychologists must sometimes disclose information, such as a patient expressing homicidal or suicidal intent.

"Conflicts are likely to occur, whether or not you're in the military," Guzman says.

For students who do sign on, making sure that they understand the military's expectations of them is paramount, Yeaw says.

"Some of it's tough. Some of it's challenging. And I want them to know that and be prepared," he says.

By Christopher Munsey