Cover Story

As a recent Pentagon report finds (see "Transforming Military Mental Health"), psychologists' expertise is being recognized-and sought-more than ever before to train service members, help them cope with their duties, and treat those with post-traumatic stress disorder, traumatic brain injuries and other mental health concerns.

To give APA members a glimpse of the varied, intense, and sometimes dangerous work of psychologists serving in the military, the Monitor interviewed five who are now serving. Here are their stories.

On the ground in Baghdad

As an Army psychologist in Iraq, Army Capt. Jill Breitbach, PsyD, regularly ventured out across Taji to be available for the soldiers doing the dangerous work of patrolling and running convoys in the violent region north of Baghdad.

Breitbach, who deployed with the 3rd Infantry Division in 2005-06, oversaw four mental health clinics staffed by about 10 soldiers, responsible for treating all soldiers serving in and around Baghdad.

"If you're not with the soldiers you support through their day-to-day activities, then you're not one of them," says Breitbach.

She earned her doctorate from Pacific University in 2002, where her dissertation focused on the ways resilience can prevent trauma. That interest in resilience, combined with meeting her future husband, a soldier with the Army's 3rd Special Forces Group, piqued her interest in becoming a military psychologist.

She applied for an Army internship and interned at Eisenhower Army Medical Center, then completed the Officer Basic Course (OBC) at Fort Sam Houston in Texas. After OBC, she was assigned for one year with the 82nd Airborne Division at Fort Bragg, N.C., where soldiers redeployed home from Iraq were suffering from depression, substance abuse and suicide in the aftermath of combat experience.

"I did a lot of work with deployment and redeployment issues, and a lot, a lot, a lot of work with PTSD," Breitbach says.

Today, she is with the 1st Special Warfare Training Group at Fort Bragg, teaching physical and mentaladaptability skills to soldiers in Special Forces training. "The classes are very similar to the entry-level basic counseling skills most psychologists get in training-how to recognize emotions, empathize, asking the right questions to elicit more information and being aware of your own buttons," she says.

Being an Army psychologist means that whenever she catches up withfriends from graduate school, she's calling from someplace new.

"I've deployed, I've seen the world, I have a well-rounded experience," she says. "Serving as a psychologist in the Army, you get such a variety of experiences. It's worth it."

Keeping soldiers 'shored up'

Based in Baghdad, Navy Lt. Cmdr. Shannon Johnson, PhD, says she never knows the challenge each day will bring, but she does know she'll have a chance to make a difference in keeping soldiers functioning in a brutal environment.

A Navy psychologist, Johnson serves with the Army's 113th Medical Company, Combat Stress Control, a mental health unit covering Baghdad, Ramadi, Taji, the province of Diyala and much of southern Iraq.

Johnson and her colleagues work with soldiers from the 2nd Infantry Division, deployed to Iraq since June 2006, and the 10th Mountain Division, deployed since August 2006. She arrived in February.

"Every day I feel like I'm having an impact, and a very important impact for groups of people that are...really suffering," she says.

The men and women she works with have lost many fellow soldiers. Earlier this year, they got the news that they'd be serving in Iraq three months longer then planned. And as part of the surge strategy, many soldiers are moving from large Forward Operating Bases (FOBs) into smaller outposts called Joint Security Stations with local Iraqi forces. Besides being less secure from attacks by insurgents, the stations don't have the hot meals and showers of the FOBs.

Some soldiers are on their third deployment, and they are still struggling with combat stress from previous experiences in Iraq and Afghanistan. For many soldiers, getting decent sleep is impossible. And while many appreciate the connection of e-mail, it also brings with it the troubles of spouses and misbehaving children back home, she says.

She and her colleagues also work with unit leadership, providing tipsfor spotting soldiers in trouble. For some soldiers who need respite, the unit arranges for a restoration break of three to seven days, a chance to get some sleep, hot showers, cooked meals and classes on coping skills.

A patient base of 12,000

Being a Navy psychologist aboard an aircraft carrier is a balancing act in several ways. For one, the people you're there to help are the same people you live and work with-and are sometimes friends with-says Lt. Justin D'Arienzo, PsyD.

Since September 2006, D'Arienzo has served as psychologist for the ship'scompany of the U.S.S. Kitty Hawk and its 3,000 members, home-ported in Yokosuka, Japan.

When the ship, which is the Navy's only permanently forward deployed aircraft carrier, leaves port for months-long deployments throughout the Pacific, D'Arienzo is also on call for all the sailors and officers of the accompanying air wing, ships and submarines, which can boost his patient base past 12,000.

A Navy psychologist since 2003, D'Arienzo works with the ship's leadership on personnel issues, for instance helping sailors who aren't adjusting to shipboard life or not keeping up with their work. That's a recurring problem for the Kitty Hawk, where most sailors face long days of hard work and little sleep. Most sailors are up before 6 a.m. standing watches, running drills and getting training, and most don't hit the rack until sometime after midnight.

In working with the senior enlisted sailors and officers supervising the younger, more junior sailors, he tries to stick to the bottom line of how best a sailor can be helped, whether it's changing a work assignment, or sometimes in a few extreme cases, recommending administrative separation from the Navy.

"You really need to give explanations to people, so they understand why somebody needs to be out of the Navy, or why the environment needs to change so we can help a sailor," he says.

D'Arienzo reaches out to sailors in several ways. He writes a column on psychological issues called "MindGames" for the ship's newspaper, which often gives people an excuse to talk to him. He restarted an Alcoholics Anonymous group and later this year will teach introductory psychology for college credit.

D'Arienzo always knew he wanted to serve in the military. He earned a PsyD in clinical psychology from Nova Southeastern University in 2003, and following Officer Indoctrination School in Newport, R.I., completed an internship at Portsmouth Naval Hospital in Virginia.

He was drawn to the Navy by the prospect of responsibility, the varying job assignments and the internship pay of $52,000, far above what he could make at a civilian facility.

In working with the sailors, D'Arienzo follows a brief, solution-based therapy that stresses the importance of staying committed to the ship's mission and, by overcoming adversity, achieving personal growth.

"If you can make it through a tour on Kitty Hawk, you can make it through any tour," he says.

Bronze Star service

When it came time to apply for an internship, Air Force Maj. Mark Staal, PhD, knew he wanted four things-autonomy, responsibility, variety and opportunity.

Although he was interested in a program at Stanford University, the Air Force offered a competitive salary, a postdoctoral fellowship, a guaranteed job for several years, and the chance to gain experience and get licensed.

"For me, it was a no-brainer," Staal says.

Following an internship at Wilford Hall at Lackland Air Force Base in San Antonio, Texas, in 1996, Staal spent three years in Albuquerque, N.M., at Kirtland Air Force Base, where, assigned to the chief of mental health, he was responsible for mental health care for 10,000 people and their families.

"I had gone from essentially supervising myself to supervising 25 professional staff," he says.

Staal got a chance to teach leadership and psychology at the Air Force Academy and to provide clinical services in the academy's cadet counseling center. At the academy, he helped cadets deal with the issues other college students face: stress over academic performance, relationship difficulties, adjustment issues and depression.

"I think military service academy cadets have it tougher then their collegiate peers, since they are asked to balance these typical anxieties along with military and officer candidate expectations," he says.

Taking up an opportunity for a postdoctoral fellowship at NASA's Ames Research Center, Staal's specialty changed from clinical psychology to aviation psychology. At Ames, Staal studied the impact stress has on decision-making.

Staal has also deployed to Iraq and Afghanistan four times from 2004 to 2006 for months at a time, helping the Iraqis plan the country's elections in July 2005. He also received the Bronze Star for contributions to Operation Iraqi Freedom while working with Air Force Special Operations personnel.

In his current assignment as an operational psychologist with the 1st Special Operations Group, Staal assists Air Force personnel going through Special Operations training.

He describes his role as focusing on education, consultation and training, for instance, helping Air Force students learn resistance strategies during the Survival, Evasion, Resistance and Escape course.

He also works with air crew who may be anxious about operating in new environments, such as those who will be flying aboard different types of aircraft or learning how to scuba dive.

"There's no secret formula to it. It's a lot of cognitive behavioral types of strategies that one might use to overcome any type of anxiety, applied to an operational context," he says.

Staal says he's got the "best job" in the Air Force. "In many ways, there's no other experience like it, going downrange and deploying in support of your country," he says.

A performance-enhancement psychologist

As an Army operational psychologist Maj. Kristin Woolley, PhD, is often out in the field with her fellow soldiers-and experiencing, at least during training, some of the same fears they experience-she admits.

It means earning her Army parachutist badge and going through the Army's Survival, Evasion, Resistance and Escape course, which teaches service members how to survive in enemy territory, and resist interrogation if captured.

Going through such emotionally and physically intense training puts her in a better position to assess soldiers going through Special Operations training, Woolley says.

"If you don't understand what fears those people encounter doing those kinds of things, then you can't really assess that in the people you're training," she says.

Woolley serves as the command psychologist at the U.S. Army's JFK Special Warfare Center and School in Fort Bragg, N.C. The school is a training center for the Army's Special Operations command. The students are soldiers, all of whom go through mentally and physically rigorous qualification courses to join the Army's Special Forces, PsyOps and Civil Affairs communities. Most will be deployed to Iraq or Afghanistan.

In her role as command psychologist, Woolley answers questions from the command's leadership about how to best select the soldiers for the elite, highly specialized communities and how to assess their performance during qualification courses and training.

"My primary goal is more of a performance enhancement psychologist, where I try to get the right kind of training environment, or the right kind of soldier in that position, so that the training goes well and we're actually getting the right product," Woolley says.

To do her job, Woolley spends much of her time observing training of the students. By combining what she observes about their performance with results from different psychological tests, Woolley talks to them about their strengths and weaknesses, and ways they can improve.

What she's looking for are the qualities that are sought in soldiers selected for the Special Operations community-the adaptability and flexibility needed to operate alone or in small groups without much guidance. She also wants to see that they can control their emotions when physically and mentally exhausted and be culturally savvy when interacting with people from different backgrounds, Woolley says.

At the start of her Army career as a Signal Corps officer, Woolley found that she had to be on the watch for interpersonal problems. For instance, one of her soldiers struggled with family problems: His spouse was back home and involved with, and writing letters to, a fellow soldier from his unit. "I remember thinking, 'I have to figure this out. They have weapons, and they're on my watch, and I've got to solve this problem,'" Woolley says.

Woolley also recruits psychologists interested in operational psychology and working with Special Operations forces into new openings for psychologists. "When commanders see that I'm making their job easier, or their programs more complete, they want me and everyone I can get my hands on," she says.