Throughout history, cultures have struggled to find the most effective ways to redress the destructive psychological impact of warfare and military duty upon those who have been called to serve. In the US, the Veterans Administration Health Care System has been entrusted with the responsibility to provide mental health care after military corpsmen and military hospitals have delivered first line emergency care.
Over the past century and one half, the VA has developed numerous innovative programs to meet the special needs of veterans and, to a lesser extent, to their families. Prominent problems of combat exposure and extended military service have been targeted through programs to cope with post-traumatic stress disorder, substance abuse, family disruptions, and other emotional sequelae common to veterans.
Psychotherapy with former soldiers requires that therapists have deep understanding of the phenomenology of veterans, as well as appreciation of the special interventions that have been developed to meet their unique needs. But this is not enough. Over Dr. Brooks' many years of work within the VA Health Care System, he has come to fervently believe that therapeutic interventions with veterans are most effective when these interventions are enriched by recognition of the new insights of "men and masculinity" research—what Levant and Pollack (1995) refer to as "the new psychology of men."
Of all contexts for psychological intervention, none is more "male" than the military or the VA. Women, of course, are increasing their role and influence within these settings and women veterans have made enormous contributions to all US combat operations. Nevertheless, it is Brooks' contention that the military and the VA remain dominated by values inherent in male socialization and the male social role. Therefore, the most efficacious psychotherapy interventions are those that integrate awareness of the military experience with the "male experience."
Over the past three decades, the psychotherapy field has moved radically from its former acceptance of "one-size-fits all" therapy models to demand that theorists recognize cultural diversity. One important aspect of this movement has been the attention granted to "gender" as a fundamental organizing variable in clients' lives. A common thread among feminist critiques of mental health and psychotherapy practices has been the concern that they have failed to comprehend how traditional socialization sometimes contributes to over-diagnosing, over-medicating, and over-treating girls and women. Ironically, a case can be made that similar failures in the mental health communities have contributed to the underdiagnosing and undertreating of boys and men.
Over the past 30 years, evidence has accumulated indicating that men are far less likely than women to seek professional help in general, and psychotherapy in particular. Even when men appear in counselors' offices, there can be no assumption than these men are enthusiastic about being there, since some have argued that many men see therapy as a last resort (or go only when under some form of coercion).
Much of this gender discrepancy in utilization of mental health services can be attributed to male socialization, with its emphasis on emotional stoicism and self-reliance. To some extent, however, this unfortunate disconnection between men and mental health services might be attributable to laxity in recognizing the special needs of men and their impediments to functioning as "ideal" therapy clients.
One of the first tenets of all multicultural counseling paradigms (Sue & Sue, 2003) is that effective and ethical multicultural work requires that practitioners must have considerable knowledge about the unique challenges and issues of the population with which they work. For military veterans, these issues can be conceptualized as the product of socialization into a hyper-masculine culture that requires allegiance to the code of "warrior masculinity." To survive, the soldier must be emotionally stoic, violent, hypervigilant of threat and danger, and intensely loyal to comrades (to the point of sacrificing life when necessary). Historically, military culture has featured problematic patterns of distrust of women and over reliance on alcohol for recreation and escape. In brief, the "warrior" is an exaggeration of the most traditional male and is subject to many of the psychological problems more common among men.
Dr. Brooks' approach to work with men (and military veterans) can be captured by the acronym "MASTERY." First, the therapist should be keenly aware of personal feelings about this population and should carefully Monitor his/her reactivity. Second, the therapist should look behind men's facades of self-sufficiency and problem-denial and Assume that most all men have some of conflict and gender role strain. Third, the therapist should be able to view the male client's presenting problems in context, or See the "maleness" of his problems. Fourth, the therapist will do well by conveying understanding of a man's pain by Transmitting empathy and gender sensitivity. Fifth, the therapist should go beyond emotional support and Empower the man to move into new ways of relating to his male role and embrace broader definitions of masculinity. Finally, the therapist will need to Respect a man's resistance and Yield to limitations rooted in his situational context.
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