On Aug. 30, the United States withdrew the last of its military troops from Afghanistan. News outlets documented this historic moment with a grainy, green-tinged, night-vision photo of a lone soldier boarding a C-17 cargo plane at the Hamid Karzai International Airport. The man in the photo — Army Maj. Gen. Chris Donahue, commanding general of the 82nd Airborne Division — was the last and final American service member to evacuate from Kabul, Afghanistan, ending a war that began nearly 20 years ago.

This war has claimed the lives of nearly 2,500 American service members and more than 47,000 Afghan civilians, and the United States’ involvement has been debated and discussed for years — and by multiple presidential administrations.

Images and news reports from Afghanistan during the U.S. military withdrawal were chaotic, intense and, for many viewers, heartbreaking. Thousands of people flocked to the Kabul airport, hoping to be included in an evacuation flight out of the country before the Aug. 31 withdrawal deadline set by U.S. President Joe Biden. In the final weeks of August, close to 125,000 people were evacuated on 778 U.S. military and private airplane flights, an estimated 5,500 of whom were American citizens.

The sudden departure has left some to question what could have or should have been done differently — a conversation that will likely continue for years.

And for veterans and military families, it’s all deeply personal. The sudden withdrawal has stirred up difficult and intense emotions for them, and professional counselors who work with the military population are witnessing firsthand the toll it is taking on their clients’ mental health. For practitioners who are veterans themselves, this period has brought an extra layer of difficulty as they’ve needed to work through their own feelings to be able to help clients who are in the midst of similar struggles.

“It [Afghanistan] is definitely coming up in my work with veteran clients,” says Keith Myers, a licensed professional counselor (LPC) who specializes in treating veterans and their families at his private practice in Marietta, Georgia. “The most important thing I’m doing in therapy is acknowledging the events with clients, allowing them a safe space to feel whatever they need to feel and providing them with resources, if needed.”

“I had a former client send me a message a few days ago that went like this: ‘The Afghanistan stuff has been hard to watch. I have been very emotional [during] the few times I watched the news, especially with civilians clinging to that Air Force plane. My heart breaks for the Afghan people that helped the military and now are being left behind’,” says Myers, a core faculty member at Walden University.

Another veteran client recently told Myers, “Alleviating suffering is never in vain, even if the final outcome isn’t permanent. A lot of mistakes were made there, but I don’t want a service member to think that their service and sacrifice there was in vain. Our work should be remembered and honored.”

 

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Counseling Today asked professional counselors who specialize in working with the military population, many of whom are veterans themselves, to offer some suggestions on how best help veteran and military-connected clients who are affected by the U.S.’s withdrawal from Afghanistan.

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The recent events in Afghanistan have affected military and veteran clients significantly. Many of them are experiencing a range of emotions: anger, sadness, frustration and hopelessness. The response can be as varied and unique as the veterans and family members experiencing them and is not just limited to those who served in Afghanistan.

Veterans who served in Iraq are experiencing something similar to what they witnessed in 2013-2014, when portions of Iraq were overrun after the military’s withdrawal from that country. Vietnam veterans, of course, are experiencing distress related to repeated comparisons to their own experiences.

For clinicians who are working with service members, veterans and their families, it might be necessary to help clients find alternative responses to the emotions they are experiencing.

For many veterans, the primary emotion that is being expressed is anger. Angry at the military and government for pulling out of Afghanistan, which can also extend to or rekindle feelings of anger and betrayal at their own leadership while deployed. Anger is the emotion that we experience when something we strongly believe in has been violated in some way. Helping the veteran understand and address the underlying core beliefs that they feel have been violated, such as “we never should have been there in the first place” and “all of the sacrifices were meaningless,” can be beneficial, rather than simply raging at current events.

Many veterans are also experiencing significant sadness, considering the lives lost and damaged during the conflict. This can be exacerbated by memorial moments and anniversary reactions, as we are emerging into the historical fall fighting season. For Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) veterans, the late winter/spring and late summer/autumn months are typically difficult as it was the height of fighting season in both conflicts, and many experienced losses of fellow service members during these months. The upcoming anniversaries of battlefield losses coupled with the current events could exacerbate feelings of sadness and grief.

These current events are ones that can cause grief at the loss of others or grief at the loss of their own capabilities to re-emerge. This “sacrifices were meaningless” self-talk can also demonstrate sadness; however, exploring whether or not the losses were in fact meaningless to the veteran themselves can be helpful in addressing this grief. It can also be beneficial to help the veteran realize how their behavior or outlook changed after the death of their fellow service member: Did they do things differently or convince their chain of command to listen to them?

I am also hearing a lot of confusion, both from clients and from those that I served with, including questions [such as] “Why were we there?” and “What was the point?” These were the same questions that we had while on patrol, sitting in the smoking areas or sitting on a mountainside. The same questions that service members asked while they were deployed. Many service members came to some measure of satisfaction as to why they were serving in combat in that particular time: whether to make life better for the population, to help a country stabilize or to simply take care of those around them.

It can be helpful to allow the veteran to explore how they rationalized their service while in country and to re-engage that rationalization now. The end does not invalidate what has gone before, so the reasons they gave themselves then can be helpful now. And one of the most powerful things that I have seen in the discussion lately is the simple fact of “we were there for each other.” In the middle of the suck, nothing matters but the people to the left and right of you — and that’s who and what we were fighting for, and no amount of current events can take that away from us.

— Duane France is a retired U.S. Army noncommissioned officer and combat veteran who practices as an LPC in Colorado Springs, Colorado. He is the director of veteran service for the Family Care Center, a private outpatient mental health clinic specializing in service members, veterans and their families, and the executive director of the Colorado Veterans Health and Wellness Agency, a nonprofit that is affiliated with the Family Care Center. He writes and speaks about veteran mental health on his blog and podcast and is the author of the “From Combat to Counseling” column series at CT Online.

 

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I will sum up my reaction to recent Afghanistan events in two words: complex and jarring. While this subject is nothing new for many veterans who lived and experienced Afghanistan, the abrupt and dramatic details, images and public interests elicit a flurry of emotions and a surreal, isolated overtone.

Veterans’ minds and emotions are intense when watching petrified faces of people we actually knew, the Hindu Kush we saw on the horizon daily, the vehicles we traveled in, and the places we walked and lived. If you are speaking with a U.S. veteran about Afghanistan, here are some ideas and insights to help facilitate a meaningful interaction that may very well be the only one they have. These encompass every reaction I’ve directly heard from veterans (friends and clients) as well as my own.

• Avoidance, anger and the need for peace: Avoidance and anger are great defense tactics that veterans lean on. It’s easier to have an angry rant or to avoid the subject altogether than to go deeper and search for meaning and healing. Counselors are often the only people to spur that journey to peace, so definitely open up the conversation and work your magic.
• Complexity: People new to this subject don’t seem to grasp the complexity of the sociopolitical aspects of Afghanistan. There is no simple, clear, truly known explanation or answer to so many questions about what has gone on or is now going on. This makes it difficult to feel, think, articulate and resolve for veterans too.
• Betrayal, confusion, frustration and embarrassment: Due to explicit language, I can’t share direct quotes, but to combine several, “We all wanted out of there but could it have maybe just been a little bit less of a giant ‘F you’ to everyone?” Veterans (and Afghans) are well aware that their lives are the pieces played on geopolitical chessboards, but it is even more upsetting when their individual experiences are completely ignored and/or erroneously lumped into strong opinions about governmental follies and intentions by friends, family and fellow citizens.
• Deep compassion, concern, guilt, and helplessness: If you are watching media coverage and feeling deeply for people you’ve never met, just imagine if you knew them by name; laughed at their jokes; shared lamb kabobs their wife made for you; watched young girls boss the boys around; enjoyed broken language conversations and eye contact between burka adornments; placed money into a businesswoman’s hand; [and] listened to stories of “before the Taliban came” and fears of what will come again when the U.S. inevitably leaves.

The haunting possibilities, realities and unknowns leave many of us feeling helpless, angry, confused, misunderstood and isolated in our experiences and feelings. The unique and powerful thing counselors can offer is a strategic space to sort through the complexities and ensure the vital step of dispelling the “it was all for nothing” lie, which is often the sticking point for veterans.

— Natosha Monroe is an Army veteran and LPC who specializes in treating clients with trauma and anxiety.

 

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The human spirit and soul are at stake for veterans across all wars who have been deployed in support of combat operations, engaged in warfighting and mobilized for humanitarian missions. The stench of death in field hospitals, tent cities and on the battlefield reminds us of how fragile human life can be for service members, veterans and military families. Healing during phases of a pandemic virus also complicates mental health issues. Providing military mental health requires that we restore the fragmented self, as we place the “in session” sign on our metaphoric exterior door. Thus, as a profession we should be mindful of counselor self-care and be in a mission-forward environment providing competent clinical military counseling services.

The military withdrawal from Afghanistan highlights the perfect storm that reflects a mental health tipping point in military mental health. This is reflected by Magellan’s Federal Military and Family Life Counselors (MFLAC) program which is recruiting for an immediate surge of mental health professionals to provide services on U.S. military bases. This is also seen in longer-than-normal wait times at VA clinics and with private Tricare providers.

The visual media played in real time has created a retraumatization for those who have experienced warfighting in hostile regions of the globe. Many in the military community have pre-existing political ideologies, a cultural belief system, [and] mental health and behavioral practices that help or hinder their coping and resiliency resources. Clients who enlisted after the terrorist attacks of Sept. 11th stated they wanted to “defend their homeland.” Thus, this cultivated some meaning and purpose to their chosen military career. However, many veterans I have worked with are jaded by their military service. As they transition to civilian life, their head is always on a swivel. They train to aggress not stress in the face of adversity because the life and safety of other unit members were dependent upon their quick and decisive actions and reactions. Consequently, current issues of mood regulation expressed as frustration, anger, anxiety, hypervigilance, substance use and other symptoms of an unhealthy nature have created a unique type of complex posttraumatic stress disorder (PTSD). Edward Tick, in his book Warrior’s Return: Restoring the Soul After War, eloquently describes complex PTSD as a moral injury that requires a transformative approach to healing, as opposed to “treating” the symptoms of PTSD and co-occurring mental health conditions.

Becoming a culturally competent clinical military counselor is difficult because training and development is sparse. The current literature in military psychology and counseling recognizes that the military is not one homogeneous group labeled as “the military culture.” Today’s military comprises men and women that identify with various racial and ethnic groups: Hispanic/Latinx, African American, Native American, Asian American, the LGBT community, as well as many other cultural groups. The military culture also reflects within-group differences through branch of service, enlisted versus officer rank, and the distinct military occupational specialties (e.g., infantry, special forces/operations, truck mechanic, logistics and embarkation specialists, communications officer, counterintelligence).

Overall, it is critical as professionals that we understand the unique cultural differences between military and civilian mental health assessment, diagnosis and treatment practices. Restoring the mind, body and spirit after warfighting requires a vision of optimal wellness, guided by transition services, that transforms the wounded warrior’s level of meaning and purpose relating to their military service.

— Mark A. Stebnicki is a licensed clinical mental health counselor (LCMHC), professor emeritus at East Carolina University and author of the ACA-published book Clinical Military Counseling: Guidelines for Practice. He is the developer and instructor of the Clinical Military Counseling Certificate (CMCC) program through the Telehealth Certificate Institute. He is an active teacher, trainer, researcher and practitioner with extensive experience in military mental health, posttraumatic stress, chronic illness and disability.

 

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As a military spouse, mother, counselor educator and supervisor, and clinician, these recent times stress the importance of ethical self-awareness and boundaries at a whole new level.

As a military spouse, I understand the stress the coming and going of your service member can put on your relationship as well as your family dynamic. I can empathize with the military couple and family who does everything in their power to prepare to maximize quality time prior to your Marine/sailor/soldier’s departure, but despite all your efforts, you are still running around helping them pack last-minute items. In many movies, the actual stressors of these moments are not emphasized. I can understand the constant worry you have for your loved one when you are apart, whether it is a training or deployment.

Today, I think of the spouse who never wanted their Marine/soldier/sailor to leave but helped them pack. Today, I feel for the children who said, “See you later daddy/mommy,” and never will.

In recent research I have conducted with a colleague [soon to be published in the Journal of Multicultural Counseling and Development], we found that many mental health providers interested in servicing the military-connected population were or are currently military-connected themselves. With that being said, during this time, counselors working with this population are strongly encouraged to take some extra time and reflect upon the recent events. Awareness is key to ensuring best practices are offered to their clients. It is important for counselors to remember that they, too, are human. We need to check in with ourselves and be able to process the events of the world and their professional as well as personal impact on us.

For those of us who are military-connected, these recent events can be very personal as it affects us, our loved ones and our lifestyle. We need to be able to process the [withdrawal] event to ensure we do not create an environment supportive of countertransference. Remembering that counseling is a place which is intended to support our clients’ well-being first and foremost may be difficult when clients present with thoughts and beliefs that are contrary to our own. Ensuring we are at a place where we do not allow for our values and beliefs to impose upon our clients is imperative.

Furthermore, we may have clients that seek us out because we are military-connected. We, as counselors, need to remember this is a counseling relationship. Despite our personal need and desire for support and community at this time, we need to ensure we are at a point to keep our professional boundaries to ensure the well-being of our clients. If in the event, we are unable to do so, this is where we need to seek supervision and consultation. We need to ensure that our clients have continuity of care if we are unable to be fully present with them at this time.

Remember, we are human; the world impacts us too! We need to take a moment, process and find the support we need in this time in order to provide clients with the best care possible.

— Nicole M. Arcuri Sanders is an LPC in New Jersey and Texas, LCMHC in North Carolina, licensed professional clinical counselor (LPCC) in California, a counselor supervisor and a core faculty member in counselor education and clinical mental health counseling at Capella University. Her area of clinical focus and research is the military-connected population; she has also presented at local, regional and national conferences to advocate for effective clinical services to meet this population’s needs. She has previously worked as a Department of Defense Education Activity district military liaison counselor, substance awareness counselor, school counselor, psychiatric assessment counselor, anti-bullying specialist and teacher.

 

 

Additional resources

• The Military and Government Counseling Association (MGCA), a division of the American Counseling Association
• ACA competencies: “Exemplary Practices for Military Populations”
• ACA-published book Clinical Military Counseling: Guidelines for Practice
• Information about joining ACA’s Veterans Interest Network: org/aca-community/aca-connect/interest-networks

Counseling Today articles:

• “Counseling in the trenches”
• “Advice for counselors who want to work with military clients”
• “Suicide prevention strategies with the military-affiliated population”
• “Using reality therapy to help military families”
• “From Combat to Counseling” column

Related reading:

• From The Lancet Psychiatry, “The effect of the withdrawal from Afghanistan on military personnel’s mental health“

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.