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What Counseling Psychologists Can Do to Help Returning Veterans

The Counseling Psychologist Volume 37 Number 8 November 2009 1076-1089 © 2009 Sage Publications 10.1177/0011000009338303 http://tcp.sagepub.com hosted at http://online.sagepub.com

Steven J. Danish Bradley J. Antonides Virginia Commonwealth University, Richmond

The purpose of this article is to describe the needs of service members and their families who have fought or are fighting in Iraq and Afghanistan and who have sustained psychological and/or physical injuries and how counseling psychologists can help. The focus is twofold: (a) to help the reader better understand those who have served and how what counseling psychologists have to offer may be especially unique and valuable and (b) to describe several programs consistent with the traditions of counseling psychology that those at the Life Skills Center have developed. One program, F.R.E.E. 4 Vets, will be described in some detail. Keywords: prevention/well-being; professional issues; adults In war, there are no unwounded soldiers. Jose Narosky

Introduction and Some Nomenclature The purpose of this article is to describe the needs of service members and their families who have fought or are fighting in Iraq and Afghanistan and who have sustained psychological and/or physical injuries and how counseling psychologists can help. Our focus will be twofold: (a) to help the reader better understand those who have served and how what we have Authors’ Note: The authors would like to thank Lisa Harmon, David McGinnis, John Benesek, Treven Pickett, William Parrish, and LTC Thomas Morgan for their comments, suggestions, and support. Please address correspondence to Steve Danish, Box 842018, Richmond, VA 23284; e-mail: [email protected]. The Division 17 logo denotes that this article has been approved for continuing education credit. To access the CE test, please visit http://per-ce.net/ce/tcp.php. 1076

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to offer may be especially unique and valuable and (b) to describe several programs consistent with the traditions of counseling psychology that we at the Life Skills Center have developed. One program, F.R.E.E. 4 Vets, will be described in some detail. A veteran is an individual who has a history of military service (Army, Navy, Marine, Air Force, and/or Coast Guard). The definition includes active duty service members as well as individuals who have served in the reserves and National Guard who have been deployed. The Army and Air Force National Guard is the state militia (Article I, Section 8 of the U.S. Constitution) whose members serve part-time. They “drill” typically one weekend per month and serve on active duty 2 weeks per year for training. The reserves (Army, Marine, Air Force, Navy, and Coast Guard) are parttime federal troops who also typically “drill” one weekend per month and serve 2 weeks of active duty per year. As of August 2008, some 1.78 million have been deployed (12% of them have been women). Of this number, more than 219,000 reservists and more than 277,000 National Guard soldiers and airmen and women have been mobilized (Tanielian & Jaycox, 2008). Reservists and National Guard soldiers have a different, and often more difficult, set of issues to deal with. Generally, they are responsible for their own quality of life and as such often have houses, mortgages, full-time jobs, and are established within their communities prior to deployment. Therefore, having to deploy may present more of a problem for them than does being in the active forces because they have to extricate themselves practically and psychologically from previous commitments. The Army has a stated goal of giving active duty soldiers 2 years at home between overseas combat tours; the Guard and Reserve soldiers are supposed to have 5 years, but neither standard has been met. Until recently, some Reservists and Guard members as well as active duty soldiers have had as little as 6 months at home (it is referred to as dwell time) between deployments—about the same being experienced for active personnel. This reduced time at home puts pressure on family, stability, work, and community involvement for these Reservists and National Guard members. Reservists and National Guard members have an additional challenge; they are often dispersed in states different from their homes and have limited access to the resources and social support that the active forces have on military posts or bases. There are essentially three sources of psychological help for those who are or have been deployed. Active military members, including Reservists and National Guard members during their deployment, have access to the

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mental health staff at the nearest, forward operating base. These staff may be psychologists, psychiatrists, social workers, mental health technicians, recreation therapists, and/or physical and occupational therapists. During October and November of 2007, Military Health Assessment Team V (MHAT V; United States Army Medical Department, 2008) personnel surveyed deployed soldiers in Iraq and Afghanistan to assess their mental health status. Soldiers reported significant barriers to accessing and receiving mental health care, and behavioral health personnel reported more difficulties getting to soldiers. In addition, behavioral health personnel reported a shortage of behavioral health assets and higher burnout because of the lack of adequate number of staff. Early in the war, mental health services were generally available for those at the battlefront within 24 hours, although receiving services might require a trip either by air or ground to the nearest combat support hospital. The Army also deployed combat stress casualty (CSC) units within their fighting units to provide emergency and evaluative services closer to the “front.” These units generally employed a psychologist/psychiatrist or master’s level counselor or social worker as well as several mental health technicians. If the injury/illness were severe enough to require admission, the standard practice was evacuation from the combat area. Two problems exist in defining the availability of services. First, in Iraq it was often unclear what constituted the battlefront, as it was not linear. Second, the concept of “mental health problem” was somewhat nebulous. The number of service members experiencing “mental health concerns” far exceeded the number reported due to the stigmatization of admitting to such problem. The culture of “Army Strong” discouraged the appearance of weakness. Probably many service members sought the assistance from chaplains as they acted as de facto mental health counselors (and many had master’s-level credentials in counseling or social work). It was more acceptable to seek help from God, or His representative, than to seek mental health services. Reservists and National Guard members who have been deployed are seen by the Department of Veterans Affairs (VA) once they return to their home base, as are active duty service members once they are discharged. Some states, through their Departments of Veteran Services, offer services as well. Spouses, children, and families may receive limited services if their spouse is in the Guard or Reserves but can receive counseling only with insurance. Presently, the VA offers family therapy only when the veteran is involved. The lack of access to services for families is disappointing because they often become victims as well.1


A Role for Counseling Psychologists Although many counseling psychologists may be unfamiliar with veterans and the services they need, the challenges of working with veterans are not new to our profession. Following the end of World War II, the demand for psychologists to respond to the personal and career problems of returning veterans, including those with injuries suffered during combat, was unprecedented (Whiteley, 1984). The VA was given a mandate to create programs to deal with the rehabilitation, educational, occupational, and emotional needs of these veterans. From this mandate came new positions at VAs that were to be staffed by counseling psychologists (Whiteley, 1984). During the intervening years, and especially as the 20th century ended, the relationship between the VA and psychology, especially counseling psychology, was reduced considerably. However, the human effects of our conflicts in Iraq and Afghanistan have highlighted more than a decade of declining resources being allocated to behavioral health care for veterans. The result is that there were not a sufficient number of VA psychologists available to handle all the psychological and physical injuries experienced by returning veterans, and the recruiting of counseling, clinical, and rehabilitation psychologists has expanded rapidly. One cannot read the “Career Opportunities” section of any Monitor without seeing numerous advertisements for psychologists wanted in the VA. Working with this population seems especially appropriate for counseling psychologists as we pride ourselves in our understanding of, and being sensitive to, other cultures. It is important to recognize that the military has its own culture. It is based on the notion that the sum of all the experiences of the service members has set them apart from the population at large. Outsiders are often seen as having no common experience, and therefore, it would be impossible to articulate to them “what it was like over there.” Consequently, many service members admittedly deny access to these outsiders because they “just don’t get it.” Furthermore, there is a sense felt by some that outsiders ought not to get it. “I paid for it, I have the medals, badges, patches, and injuries to prove it and you don’t; you’re not worthy of understanding my problems.” The result is that many service members mistrust anyone not associated with the military. It is not directed toward mental health professionals per se, but it may affect a veteran’s willingness to access civilian resources. What we lack is an understanding of their culture and why the transition back into their communities is so difficult. The transition out of the military or back from the war is not just a job or location change; it is a culture and


lifestyle change. Service members make this change alone, without their family transitioning with them. Counseling psychologists have prided themselves in understanding the difficulties experienced by different ethnic groups as they try to adapt to a different culture. Having an awareness of a service member’s level of acculturation as he or she deploys and then returns home, sometimes multiple times, and then leaves the military requires that same level of understanding. It is relevant to note that upon return, surprisingly, some service members express a preference for returning to the combat environment. This sentiment may seem counterintuitive to many, and it illustrates how difficult it might be for those outside the military culture to appreciate their perspective. Perhaps this preference stems from the desire to be with those who they have become so close with and who understand them the best. Members of the active military services and their families then make up a unique subculture within the larger society it serves. It is a closed community with unique customs, cultural norms, diverse membership, and defining rank structure (Harmon, 2007). The military even has its own shorthand lexicon. The closed community typically includes those who have served and their dependent family members (spouses and children). Sometimes nondependent parents and siblings of military personnel are included. The level of military acculturation accelerates among combat veterans and can vary over an individual veteran’s life span. A strong level of military acculturation may sometimes pose a barrier for the veteran or those in the helping role, but it is not unlike other challenges we might face when working with someone from a different cultural background than our own. Through blogs, the Internet, and YouTube videos we can begin to understand the diversity within the military and veteran populations outside of what is presented to us in the mainstream media. So although many of us have the ability to treat individuals with readjustment issues, traumatic brain injuries (TBI), depression, and/or severe posttraumatic stress disorder (PTSD), it will require us to work patiently to gain the trust of returning service members and to attempt to understand what they have experienced during their deployment.

What Veterans and Families Need: The Extent of the Problem There have been a number of reports that have analyzed the needs and problems in services for veterans, and all have found the health care services


available for service members and their families inadequate. For example, an American Psychology Association (APA) task force, the APA Presidential Task Force on Military Deployment Services for Youth, Families and Service Members (2007), identified a number of recommendations for how to better serve our service members and their families. Among these recommendations were Mental health services should be available throughout the deployment cycle and include a focus on prevalent diagnoses/conditions such as adjustment disorder, substance abuse, PTSD, Traumatic Brain Injury (TBI), depression, grief/bereavement, and family violence. Further, mental health services through the deployment cycle should incorporate prevention and intervention strategies designed to help families. (p. 7)

The task force also recommended that members in both military and nonmilitary communities develop outreach programs. To date, most of the emphasis in the literature for the public as well as for the professional has focused on injuries such as PTSD, depression, or TBI. Tanielian and Jaycox (2008) conducted a comprehensive study of the health care needs for returning service members. In their RAND Corporation report, Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, they concluded that approximately 20% of those who have served in either Iraq (Operation Iraqi Freedom; OIF) or Afghanistan (Operation Enduring Freedom; OEF) have experienced PTSD or depression and another approximately 20% have experienced a traumatic brain injury. At the time of their study, 1.64 million troops had been deployed, and the approximate number of service members experiencing these conditions totaled about 620,000. Although the focus of this article is not on PTSD or TBI per se, it is important to understand several things about these injuries. First, TBI has been called the signature injury of these wars. It generally is caused by blasts from improvised explosive devices (IEDs). In previous wars, blasts probably would have caused death, but because of improved armor, survival rates have increased significantly. Second, with regard to PTSD, some researchers and clinicians believe there are differences between war-related PTSD and PTSD caused by a rape or crash stateside. Among the differences hypothesized is that service members with PTSD may have more intrusive thoughts, hypervigilance, and sleep-related problems in part because they have multiple experiences as opposed to a single experience. Third, service members with either injury may have their symptoms disappear or be significantly


reduced in a relatively short period. Milliken, Auchterlonie, and Hoge (2007) reported that as many as half of the service members experiencing PTSD at postdeployment have their symptoms disappear within 3 months. Hoge et al. (2004) found that many service members who have mTBI (mild TBI, commonly referred to as a concussion) also seem to have many of their symptoms disappear within 4 to 12 weeks. The symptoms for PTSD include insomnia, memory deficits, poor concentration, depressed mood, anxiety, irritability, intrusive thoughts, emotional numbing, hyperarousal, and avoidance behavior. For postconcussion syndrome (PCS) following mTBI, the symptoms are insomnia, memory deficits, poor concentration, depressed mood, anxiety, irritability, headaches, dizziness, fatigue, and noise/light intolerance. Note that there are several symptoms that are found in both PTSD and mTBI, namely, deficits in attention, anxiety, memory, irritability, and sleep disturbances, that make it hard for providers to always differentiate the two. As of August 2008, one third of those deployed have served at least two tours in a combat zone, more than 70,000 have been deployed three times, and more than 20,000 have been deployed at least five times. With increased deployments, the likelihood of greater levels of PTSD, depression, and TBI increases. Thus, the needs of these injured service members, if all chose to be treated, would totally overwhelm the health care system. For example, as of May 2008, more than 850,000 OIF and OEF service members have been eligible for VA services, yet only about 40% have sought care or other VA entitlements, including education and vocational training, for one reason or another (DoD, 2008). Whereas the numbers of deployed service members experiencing PTSD, depression, and TBI are significant, they represent only part of the number requiring help. As many as 50% of the remaining service members are or have experienced difficulties reintegrating into their families, workplaces, and communities. They have difficulties including but not restricted to family or relationship issues and interactions, work/employment difficulties, and a sense of a lack of focus or purpose in adjusting to their return home (Henderson, 2006). Many of these difficulties are the result of combat stress injuries (Figley & Nash, 2007). Moreover, focusing only on the needs of the service members totally ignores the needs of family members (spouses, children, parents) who may experience secondary traumatization as a result of the deployment of their spouse or family member. Marital problems increase. The yearly divorce rate in the U.S. Army nearly doubled for enlisted personnel and tripled for officers between 2001 and 2004. More than 40% of those deployed have


children, and 72% of the children are younger than 12 years old (APA Presidential Task Force on Military Deployment Services for Youth, Families and Service Members, 2007). Having a primary caretaker deployed to a war zone is stressful for both the family member who is at home as well as for the children. The remaining parent has to deal with his or her stress, and having to deal with children’s emotional needs as well may be too much. Gibbs et al. (2007) found that levels of child maltreatment were higher when a parent was deployed than when neither parent was deployed. In addition, levels of child neglect were nearly twice as high during a deployment. Among female civilian spouses, rates of maltreatment, physical abuse, and neglect were especially elevated during the deployment of the other spouse. What is evident from this description is (a) a large number of service members have been deployed, many for multiple times; (b) psychological and physical injuries experienced by the service members deployed have been extensive and varied and may be well beyond what has been reported in the media; (c) the effects of the wars have been felt not only by the service members who have deployed but also by the families of these service members; and (d) the help available for the service members and their families is terribly insufficient in comparison to their needs in most locations.

Resilience-Based Interventions for Veterans and Their Families APA and other groups have set up programs to encourage psychologists and other helping professionals to volunteer 1 hour per week to provide services to veterans. Given the orientation of the first author, perhaps best described in Danish and Forneris (2008), we have chosen to pursue a more resilience-based format for several reasons. First, the unmet needs of the service members and their families are significant and pressing. As noted earlier, the numbers needing help are overloading the system, and choosing to work individually with veterans and/or their families seemed relatively inconsequential in meeting these needs and was being addressed by other groups. Second, from all we spoke with, we consistently received the message that facilitating resiliency was the ultimate goal. As the Life Skills Center focuses on health promotion and enhancing personal development, we felt a more programmatic approach was needed to supplement the efforts of the VA and Department of Defense. The major program we have developed is F.R.E.E. 4 Vets (Danish, 2008),2 which stands for family, relationships, education, and employment. The program is a psychoeducational, skill-based program rather than one


based on disseminating information. Information tells you what to do but not how to do it. Skills teach how to and are taught in the same way as you learn to drive a car, throw a ball, and/or shoot a weapon—each component of the skill must be explicitly described, demonstrated, and practiced until it can be used consistently and effectively. Therefore, for the F.R.E.E. 4 Vets Program to be effective, practice is necessary. At the program’s core is understanding that service members had to learn how to exist in a lifethreatening environment and now must adapt these skills to learn how to live and succeed in their home environment. A war veteran is not just who they are. Intuitively, they may understand this. In many cases, their experiences have changed them in profound and sometimes overwhelming ways. Many may want to incorporate the changes taught in the program into their identity but lack the skills to separate the practical from the impractical, the healthy from the maladaptive. The program helps them toward this end. F.R.E.E. 4 Vets is intended to be implemented in one of two ways: (a) selfdirected via the Web or CD with toll-free access for issues and/or questions or (b) taught via virtual or real chat rooms led by a trained peer veteran. Information about the availability of the program would first be given to veterans when they return from deployment and go through the mandatory postdeployment health assessment (PDHA) that is done within the first 30 days of their return or the mandatory postdeployment health reassessment (PDHRA) done within 90 days of their return. In addition, information about the program would be given to organizations providing support to veterans and their families such as American Legion Posts, the Iraq and Afghanistan Veterans Association (IAVA), the National Veterans Foundation (NVF), and Military One Source. F.R.E.E. 4 Vets has three parts: (a) assessing whether one has a combat stress–related injury, and if so, how to overcome the injury; (b) helping one to move forward on his or her goals and life plans; and (c) helping one to develop career and job plans. Each component includes several workshops. In the first part, there are specific skill-based workshops that focus on teaching veterans how to (a) assess their combat stress injuries, PTSD, and/or TBI; (b) understand why they are different following the injury and their combat experience; (c) overcome their injuries by learning how to control stress through aerobic exercise, deep breathing, using a mantra, and/or muscle relaxation; (d) develop better sleep habits; (e) deal with interpersonal or relationship stress by repairing and enhancing relationships through more effective communication skills; and (f) understand that how they think can cause stress and how to reframe some of their thoughts. In the second part, veterans are taught how to (a) put their past behind them and move forward


by developing dreams for their future; (b) turn their dreams into goals; (c) understand and overcome roadblocks to be able to reach their goals; (d) make effective decisions; (e) develop social support networks; (f) assess and take risks to reach their goals, when appropriate; and (g) assess their progress. In the third part, the focus of the workshops is to learn (a) more about their career interests, (b) how to identify and transfer skills learned in the war zone to careers at home, and (c) how to find a job they want and write a resume. To date, 22 veterans have gone through the program informally and have been very positive. A formal evaluation is now being planned. A second program, H.E.L.P.4Families (standing for health, education, lifestyles, parenting; Danish, 2009) is in the process of being developed. It parallels F.R.E.E. 4 Vets in that it is designed to help spouses, parents, and other family members (a) better understand the difficulties that veterans are having throughout the deployment cycle, especially in the reintegration process; (b) recognize and assess some of the difficulties, such as secondary traumatization, that they are experiencing as a result of what the veteran has and is experiencing (this includes being sensitive to differences that occur during different parts of the deployment cycles); (c) understand how to identify sources of help within their community for the deployed veteran, themselves, and their families; and (d) learn the skills that will help them cope and succeed during the deployment cycle as well as facilitate the effectiveness of their veteran family member prior to and during deployment and enhance his or her resilience during the reintegration process. A third program developed at our center is designed for school counselors and school psychologists. PACCD (Cohen, Wood, & Danish, 2008) is a program for promoting adjustment for children of caregivers/parents who are deployed or will soon be deploying. The program provides (a) an overview of the deployment cycle students and parents/caregivers of the deployed service member experience; (b) an understanding of how students of different ages are affected by the deployment and/or the return from deployment, both positively and negatively, and the impact the students have on schools; (c) “warning signs” of student problems at these different times; (d) information and skills about making referrals when needed; (e) information and skills to provide to teachers about how to identify problems, both school problems for students and problems parents are experiencing, and how to talk with parents about these problems; (f) a means of discussing and brainstorming ways to help students who have (or have had) a deployed parent/caregiver; and (g) experiential activities for working with students and parents. These are some of the ways we at the Life Skills Center are seeking to help service members and their families. Here are some things you can do.


At the most basic level, whenever you are interacting with a service members either as clients or just happen to get behind them in line at the grocery store, shake their hand and simply say “Thank you for serving” before anything else. It may be awkward. You may not even get a response, but you’ll be remembered as someone who cared enough to make the gesture. It is a simple thing that really goes a long way. If you work at a university either in a counseling center or in an academic department, find out who is in charge of veteran services and whether you have a Student Veteran’s Association. Meet with these groups both to offer your services and to learn more about the culture of the military. If you work in the community, contact your nearest VA or Vet Center or maybe your state’s National Guard to see if they can use your help. Do not assume they will welcome you with open arms. They are not always as open to outsiders as they should be, but with persistence and a willingness to volunteer some of your time, you can find a way to help. In these new settings, think of yourself as being in a new environment and needing to learn how these individuals think and act differently than the individuals with whom you are most familiar. As with any other new group, listening will be important, as will being willing to admit your ignorance and ask questions to better understand. The Web also contains hundreds of sites with valuable information. Finally, the Uniformed Services University of the Health Sciences located in Maryland has continual training opportunity available for psychologists wanting to work with veterans. As difficult as it is to establish yourself as someone who is willing to provide services to returning veterans and their family members, conducting research may even be more difficult. Although there a number of grants available, access to the veterans or their families is difficult. It is best to collaborate with someone who already has access. That said, many of the community-based research studies in which counseling psychologists are or have been involved serve as a model for the kind of research that would be valuable. Finally, one area in which there are a number of opportunities is training our doctoral students to work with service members and their families. As mentioned earlier, the number of positions available at the VA for psychologists is expanding, as are the internship opportunities. However, without some experience with veterans, these opportunities will be difficult to obtain. To offset this problem, our Psychology Department is initiating a course jointly with the VA in Richmond. The course is titled The Psychological Needs of Service Members and Their Families Across the Deployment Cycle. The course description is


With over 1.65 million having served in either Iraq or Afghanistan, the needs of Service Members and their families are complex and growing. The course provides opportunities to understand the psychological needs of both Service Members and their families from pre-deployment through post-deployment. Additionally, the impact of physical injuries on psychological well-being will be considered from their perspectives. Various interventions, both psychological and physical, will be surveyed as well as the different sources of help available for returning Service Members and their families with special emphasis on Veterans Administration Medical Centers.

The classes will be taught partly at the VA and partly on our university campus. We expect a number of VA trainees as well as our doctoral students will take the course. Psychologists and other professionals from the VA will teach about PTSD, TBI, and other injuries, both physical and/or psychological, as well as effective intervention strategies. Other professionals who are familiar with family programs, issues faced by spouses, the process of preparing for deployment, the experience of being deployed, the special needs of rural veterans and families will also be presented. We hope those enrolled in this course will develop a better understanding of the needs of veterans and their families and effective strategies to work with them as well as the organizations that provide services to these underserved groups.

Concluding Comment The future of these two wars may change with the change in administration. Regardless, there are well over 500,000 veterans and untold numbers of family members who may require services. The need is now, and opportunities exist in all the areas where we work. For example, as of August 2009, a new GI Bill will begin. Veterans who have served in these two wars will become eligible for free college tuition to the most expensive public institution in each state and a stipend. The last GI Bill in 1944 resulted in 8 million veterans returning to school. The numbers eligible as a result of this new bill are not nearly as large, but the influx seeking additional education will be considerable. Counseling psychologists who work at university counseling centers or teach in institutions of higher education as well as those who work in businesses, health facilities, private practice, and at other sites face a new challenge. That challenge is to understand a new culture and how we can best apply what we know to facilitate the successful reintegration of these veterans and their families.


Notes 1. At the time this article was prepared, the armed services has a policy of “Don’t ask, don’t tell.” Furthermore, heterosexual partners have no standing in the armed services. As such, researchers have not considered partners in their studies. For these reasons, we have used the term spouse rather than partner throughout. 2. For additional information about the program, please contact the author.

References APA Presidential Task Force on Military Deployment Services for Youth, Families and Service Members. (2007). The psychological needs of U.S. military service members and their families: A preliminary report. Washington, DC: American Psychological Association. Cohen, J., Wood, B., & Danish, S. (2008). Program for promoting adjustment for children of caregivers/parents who are deployed. Richmond: Life Skills Center, Virginia Commonwealth University. Danish, S. (2008). F.R.E.E. 4 Vets. Richmond: Life Skills Center, Virginia Commonwealth University. Danish, S., & Forneris, T. (2008). Promoting positive development and competency across the lifespan. In S. Brown & R. Lent (Eds.), Handbook of counseling psychology (4th ed., pp. 500-516). Thousand Oaks, CA: Sage. Figley, C., & Nash, W. (2007). Combat stress injury: Theory, research, and management. New York: Routledge. Gibbs, D., Martin, S., Johnson, R., Rentz, E., Clinton-Sherrod, M., & Hardison, J. (2007). Child maltreatment and substance abuse among U.S. Army soldiers. Child Maltreatment, 13, 259-268. Harmon, L. (2007). A descriptive study of military family needs following a polytrauma. Unpublished dissertation, Virginia Commonwealth University, Richmond. Henderson, K. (2006). While they’re at war. Boston: Houghton Mifflin Hoge, C., Castro, C., Messer, S., McGurk, D., Cotting, D., & Koffman, R. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351, 13-22. Milliken, C., Auchterlonie, J., & Hoge, C. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq War. Journal of the American Medical Association, 298, 2141-2148. Tanielian, T., & Jaycox, L. (Eds.). (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences and services to assist recovery. Santa Monica, CA: RAND. United States Army Medical Department, Office of the Surgeon General. (2008, February 14). Mental Health Advisory Team (MHAT) V Operation Iraqi Freedom 06-08: Iraq Operation Enduring Freedom 8: Afghanistan. Retrieved April 3, 2009, from http://www .armymedicine.army.mil/reports/mhat/mhat_v/mhat-v.cfm Whiteley, J. (1984). A historical perspective on the development of counseling psychology as a profession In S. Brown & R. Lent (Eds.), Handbook of counseling psychology (pp. 3-55). Newbury Park, CA: Sage.

Danish, Antonides / Helping Returning Veterans 1089 Steven J. Danish is Director of the Life Skills Center and F.R.E.E. 4 Vets Program as well as Professor of Psychology and Social and Behavioral at Virginia Commonwealth University. He previously served as Chair of the Department of Psychology. He received his doctorate in Counseling Psychology from Michigan State University. Dr. Danish is a licensed psychologist, a Diplomate in Counseling Psychology, a fellow of three divisions (17, 27, and 47) of the American Psychological Association and a registered sport psychologist of the Sports Medicine Division of the United States Olympic Committee. His research interests include developing and evaluating life skills programs for returning veterans and their families as well as for youth. Bradley J. Antonides is a first year doctoral student in counseling psychology at Virginia Commonwealth University. His research interests include the psychological needs of returning service members and their families and developing a leadership model for psychological health in military service organizations. He is a veteran of Operation Iraqi Freedom (2003, 2005) and has served as an enlisted member and officer in the U.S. Army Medical Department since 1992. He serves presently as a Captain in the Reserve Medical Service Corps Branch, U.S. Army Hospital, Richmond, VA.