Skills And Sensitivities

Imagine how you might respond if you were the helping professional working with the clients who made the following statements:

  • “How do you know what I feel? Have you ever picked up a weapon?”
  • “Do you know what it is like to kill someone?”
  • “I’m missing two legs. It makes me half a soldier. Don’t you get that?”
  • “My husband is not the same. What happened to him over there? He won’t talk to me anymore. I’m scared.”

As a helping professional, how do you begin to talk to military personnel about their war and combat experience? What approaches, skills, and sensitivities do you need to work with this population?

In Discussion 1, you considered the impact of war and combat on military personnel. In this Discussion, you consider the skills and sensitivities that you, as a helping professional, need to support and work with military personnel. A helping professional’s training is extensive. Most training programs require you to complete a self-assessment of the skills and sensitivities you need to work in the field. Training to work with military personnel is no different.

To prepare for this Discussion, review the media in the resources, and select one interviewee to address. Analyze the interviewee’s war and combat experience and consider the skills and sensitivities you would need if you were the helping professional assigned to treat this service member.


Post explanation of the skills and sensitivities you would need to possess if you were to talk about the personal effects of war and combat with the individual in the interview you selected.

2. Describe one skill or sensitivity you might need to develop or enhance in order to work effectively with military personnel who experienced war or combat.

3. Finally, explain how you might develop these skills. (2-3 pages)

Be sure to support your post with specific references to the resources. If you are using additional articles, be sure to provide full APA-formatted citations for your references.


Required Readings

Blaisure, K. R., Saathoff-Wells, T., Pereira, A., MacDermid Wadsworth, S., & Dombro, A. L. (2016). Serving military families (2nd ed.). New York: NY: Routledge.
Chapter 7, “The Effects of War on Service Members” (pp. 161-179)
Chapter 8, “The Effects of War on Families” (pp. 181-210)

Khamis, V. (2017). Psychological distress of parents in conflict areas: The mediating role of war atrocities, normative stressors and family resources. Journal of Mental Health, 26(2), 104-110.

Schryver, M., eVindevogel, S., Rasmussen, A.E., & Cramer, A.O.J. (2015). Unpacking constructs: A network approach for studying war exposure, daily stressors and Post-Traumatic Stress Disorder. Frontiers in Psychology, 6, 1896.

The Effects of War and Combat

The Effects of War and Combat Program Transcript

CLAUDE BOUSHEY: My name is Claude Boushey, and I work for the Virginia Wounded Warrior program as a veteran peer specialist. My military service started in 1983. I joined the Army when I was 17, and retired in 2010.

STEVEN MATOS: My name is Steven Matos. I served in the United States Marine Corps from ’98 through ’05, and I served in Iraq back in January of ’03 to August ’03.

RICHARD MALMSTROM: My name is Richard Malmstrom. I’m a Lieutenant Commander in the United States Navy.

CLAUDE BOUSHEY: I was nearly killed in a helicopter crash– June 13, 2004– near Taji, Iraq. I was evaced out of Iraq theater into Landstuhl. Broke my back and broke my leg. And they were saying that pretty much a good chance I might be able to walk again, or I might have some issues, or I might not make it through.

I went through four surgeries, one lasting about 16 hours on my spine and my leg. And I got a bunch of hardware in my body now. So my initial goal, for me, was just to recover. The second goal was to get back in the cockpit and fly again. And the third goal, for me, was to get back to Iraq.

RICHARD MALMSTROM: Probably the biggest experience– or the most notable experience– would be when I was assigned to the third battalion 25th Marines. We were assigned to the Sunni Triangle in Iraq, just outside of Al Asad, in 2005. We were at a place called Haditha just along the Euphrates River. But while we were there for seven months, we had 48 Marines who were killed in combat– along with probably several hundred who were wounded in combat as well.

I didn’t want to go out too far into the field. I wanted to get as far as I could without putting myself at undue risk. So I had to remain back a little bit quite often. And as men were being killed and injured, they were often brought back inside the wire. And I would go up with the aid station.

And primarily, my first priority were those that were either already dead or those that were expected to die very soon. But by the time they got to me, they were usually in pretty bad shape by the time they were there. And I would make sure that they were secure. I would make sure that we put them in the body bags, that we identified them.

I made it a habit of mine to go and put my hand on the remains and say a blessing for them. And I would say it for the benefit of those that were there around us– and for the families because I know it’s important for them. But I

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would say a blessing over the body, or what was left of the body. And soon after putting them into a body bag, we’d put them on a helicopter to send them back home so that they could be interred with the family.

But it was tough because I would go from there, and then have to go take care of the Marines that were left behind. It was a reserve battalion, so many of the men had been friends for years. They weren’t just guys who met a few months ago and then started to deploy. But they were high school buddies and friends from grade school that they now saw blown to pieces– missing heads, missing arms, legs. So, so damaged, that the bone structure just didn’t hold anymore. You could flex the body any way you wanted it to, or any way you wanted it to move, so you could get it into the body bag.

So I’d go right from putting them in the body bags and sending them home, to taking care of their buddies as best I could.

STEVEN MATOS: I was part of the initial push into Baghdad. I don’t think anybody’s really ready for that. It takes that first gunshot to go by your feet for you realize, holy smokes, I’m really getting shot at. And of course, I’m giving you the edited version. A lot of people say before they go, I’m ready to do this, do that. And when that first shot goes over your head or hits in front of your feet, and stuff hits the fan that, OK. I have to get ahead and remember my training, and do what I was trained to do.

I got wounded the first day of war. March 21, 2003, we got caught in a minefield. It was a Iraqi gun position. We went into the position. We took over the guns– they were still hot. Realized there was a bunch of holes in the ground, looked like rat holes, sand rat holes. Realized that something wasn’t right. Within about two hours of us being there, the first one went off. It injured a chaplain’s driver.

During that time, I ran down the field, telling everybody to get back into their vehicles. And about 5 feet from my truck, one of the staff sergeants is pulling out a gurney out of a ambulance to set up a triage for the ones that had just got injured. And he took two steps back, and set one off. And it took is his right leg from the knee down. And it also hurt seven others at the same time, myself. My injuries were treated on the spot.

I was walking around with a limp for a couple days, and so I was smoking heavily. I wouldn’t get out of a vehicle without checking the ground. I was just a little nervous on stepping on something myself. You’ve got a better perspective on what’s going on around you because you’re always looking around. And you’re always trying to make sure that everything is OK.

RICHARD MALMSTROM: The Mobile Assault Platoon, as they call it, they dropped me off down in heat. And they took off to go take care of some other missions. And I was getting myself settled in, getting ready to do some services,

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and I felt a blast. My door actually popped open. I could feel the impact from a blast. And I thought, something just hit right outside my door.

So I grabbed all my gear and went outside. I didn’t see anything immediately, so I went to that battalion aid station. And I could see the plume of smoke from the other side of the Euphrates River, so it was quite a ways away. And again, had to sit and wait for the injured and the KIA to come in. One of my close friends was medevaced out, and waited for weeks to hear of what happened to him.

And in the meantime, they brought back one of the KIA. From the torso down, he was gone. He was hit by a Suicide Vehicle Borne IED. From the waist down, there was nothing left. And they brought him in. He had him in the body bag. I said my blessing.

And what they called the Combat Operational Center called up and said, do we have all the pieces and parts? Or do we need to go looking for everything else? So we open it back up, and started looking through. And we found two left feet and two right feet. We found the feet of the bomber, along with the feet of the Marine who was there.

And we started to have this conversation. Well, what do we do with the feet of the bomber? And the gut reaction of a lot of the people there was to throw them out in the dumpster. Throw them out with the garbage and let the dogs take care of these feet.

And as chaplain, part of my job of being command advisor, it was my task to stand up at that point and say, no, you can’t do that. We have to treat them with respect and dignity. We have to put them in a bag. We have to send it off to Al Asad. And we need to return it to the family, if we can. We need to do whatever we can, for his grieving mother, to return these body parts so they have something. And that was a pretty difficult spot to be in, to have to argue on behalf of the man who just blew up your Marine, who’s lying right there. That was a difficult one.

The most notable, aside from that, was just a sheer volume that we had. I was very close to our snipers. Their hooch, as we called it– the place where they lived– was just right down the hallway from me at Haditha. And so we got together all the time. I was very close with one of the corpsmen who was attached to them.

And one day, they called me up and they said, well, we just lost two of our sniper teams. So seven of these snipers– their position was compromised, and they were killed. Excuse me. So they asked me to go in and tell the other snipers what had happened. And to make matters worse, one of the younger brothers of the sniper, he was so impressed with his brother. So enamored by his brother that he decided to join the Marines as well.

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So he was in our battalion also. The insurgents had taken his body and we couldn’t find it. And they were doing things to his body. So I had to sit with this young Marine while we waited for his brother to be found. And had to sit and counsel with him, get him calmed down, and try to refocus him on what was now his new task while they were waiting to find his brother.

And then immediately following that, we sent out some Quick Reaction Forces to try to find the men who had done this. And we lost 14 men in– it’s called an AAV, an Amphibious Assault Vehicle. So we lost 21 guys in three days. It was overwhelming. You can’t even imagine what that’s like, to lose so many people in such a short amount of time. And you kind of go through a funk for a while afterwards, until– for several years afterwards. It takes a while to get past something like that.

There were times, too, where I would see the aftermath of an event, and take care of those Marines as they came in. And then, as my corpsmen would come in, they would describe to me all the things that they’d done to try to keep these Marines alive. And they would describe, in detail, everything. The way the scene looked. How the bodies were positioned. The extent that they went through to try to keep these men alive.

I mean, one of them– he was trying to give mouth to mouth resuscitation on one of these Marines. And there were so much internal bleeding that this Marine had vomited blood back up into his mouth as he was trying to resuscitate him. And so we had the smell of blood on his breath, and I could smell that. And having him describe everything that happened, along with seeing the aftermath– it’s another one of those images that gets imprinted on your brain that you can’t escape from.

I was having the flashbacks, the intrusive memories. I can remember probably the worst one I had was as reserve chaplain, I was serving as a school administrator, along with being an associate pastor. And I had set up some training for my teachers. And I set up a room for them to get training on CPR. And when I walked into the room to see the dummies scattered all over the floor– and it’s just the training dummies, it just has the head and the torso. And in my mind’s eye, I was seeing the real thing– not just a training dummy– and having the same visceral reaction to it. The increased heart rate, the sweating, the inability to concentrate– all of those things is just like I was back, seeing these things again.

So I had a lot of the intrusive memories. I had trouble concentrating. I had trouble remembering simple words– my telling my kids to pick up their bowl to put it in the sink. I had to motion to the pick up your, your, you know, your, the, the thing. And my boys would say, you mean the bowl? And I’d, yeah– I couldn’t even think of that.

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I think what really freaked me out was I was sitting at a stoplight one time, and not knowing where I was. I had stopped at a stoplight. And for a good minute or so, I didn’t know if I was going to work or coming home from work, why I was in the car, what time of day it was. I had no clue what I was doing in the car, period, or how I got there. And it shook me quite a bit.

I found myself very short tempered. Could go from 0 to 60 just like that. It took nothing to get me to lose my temper. Didn’t want to even go outside for a fireworks display around Fourth of July. The sounds, the sights, the smells– all of it was too familiar. Even just driving down the road, seeing an animal that had been hit with a car. It would bring back memories, and I would see these things. Even in the church, giving communion, I would see the faces of some of these dead Marines sometimes. It was very difficult. I had a lot of the intrusive memories.

Numbing as well. I had a hard time showing empathy. One of my secretaries, when I returned home, her at her son was murdered on her doorstep, or on his doorstep. He was shot in the head in front of his daughter. And my immediate reaction was well, there’s just one. What’s everybody so upset about? It’s only one– let’s have the funeral and let’s get back to work. And I didn’t see the problem with it.

I was smart enough not to say that out loud, especially talking with the mother. I knew the right thing to say, to say I’m sorry for your loss, and this is awful and terrible. But inside I just couldn’t connect. I just didn’t think that it was that big of a deal. Took a long time to regain some of that empathy.

And eventually, my wife– God bless her– she finally said, well, you need to go get some help. And she was at the point of saying if you don’t get some help, I’m going to leave. So eventually, I said, well, OK, fine. I’ll call the VA. They got me in to see a doctor right away, and started seeing somebody and talking with them.

But that took about three years of working on it. It didn’t happen overnight. Took about three years of talking with the counselor to get through to the other side and finally, get onto an even keel. And then to turn those experiences around and use them for positive experiences, rather than negative.

CLAUDE BOUSHEY: The kind of things I went through through my recovery were both physical, mental, and emotional. Believe it or not, the physical part was a lot easier to recover than the mental and emotional, because physically, you kind of know you’ve got a broken leg and it needs to heal. That bone needs to grow back. You have a crushed spine, so the spine needs to grow back.

Those were easier– dealing with the mental part. I actually lost a buddy in combat during my recovery, so that was pretty hard. I mean, [INAUDIBLE] that portion. Accepting what you are now– walking around, or getting wheeled around

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in a wheelchair, walking with a walker or cane. Having things attached to your body that’s not supposed to be there– to help you recover, of course. But it’s mentally draining because you want your body the way it was before– before June 13, 2004. And once I kind of accepted that– that hey, this is the new you– things got better mentally and emotionally.

It was a lot better on my family as well. I mean, there was a time– rooms like this, I’d sit in the dark and just kind of hang out and relax. And that was my time because I just wanted to reflect on really what happened. And then you go through a phase of woe is me, why me, why did it happened to me, why couldn’t it happen to anybody else, I never did anything wrong, why did it happen to me. So you go through that phase.

And you go through the phase of, oh man, I destroyed a $6 million helicopter. I let my unit down. They’re one less helicopter in the fight in Iraq. So you go through that phase. It’s like, why? I let my unit down. I want to go back. So September of ’05 is when I went back on flying status. And then we started gearing up for the next tour for Iraq, and I volunteered to get on the next boat over, to the next tour with my unit.

So that was a goal that I needed to fulfill because mentally, I felt that I didn’t get the job done the first time because I crashed right in the middle of the tour. So I got sent home, and I wanted to complete a full tour for me, mentally. I was offered other positions. The PCS, the change of duty station so you can go somewhere else and stop deploying. But I elected to stay there and deploy with the unit.

STEVEN MATOS: I got back in August of ’03, and it wasn’t really the best homecoming. I ended up getting divorced. I ended up losing my youngest son. I went home to see my mom and dad, and my brother and grandmother back in New York. And that was nice. But living here in Virginia– I dove into my work. I just did everything that I could to keep busy.

My sleep was horrendous. I wouldn’t fall asleep till 7:00 in the morning the next day. I’d be up all night. Just couldn’t sleep until, finally, body was tired enough that I would just pass out.

Relationship-wise, the smallest things set me off. I don’t care if it was a little bit of spilled milk or just a dumb question– and I’m jumping at the hinges. And that’s when I realized, OK– something’s not right.

And I got in trouble. I had a incident at home, where I got arrested, and I ended up doing time in jail for it. And that’s when I realized, yeah, something’s wrong. I need help because it’s getting to the point that it’s dangerous.

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RICHARD MALMSTROM: I’ve met vets that have tried just taking the medications to make it go away. And I’m a firm believer that that doesn’t work. That may be part of it for some people. It may help them get over the hump. But I think in the long run, just dealing with it, talking about it, getting it out in the open and dealing with it helps in the long run.

CLAUDE BOUSHEY: Your body, mentally and emotionally, go up and down as far as the hardships on the family– and on yourself, as far as what you go through. You need people to talk to you. You need people to encourage you. You need a mentor to kind of look up to and give you that next step, to shoot for.

I didn’t have that. I had my wife looking out for me. I had my friends calling me quite often. So having been down at the bottom, you kind of got to know how it feels to give back a little bit. That way, you can see it in people’s eyes, as far as their recovery. You can tell them what you’ve been through in some cases, and that way they can be encouraged to move forward.

Always give them something to move forward for. It’s pretty much like being on first base. You want to get to second base. They circle first base forever. They can’t never get to home. So that’s the analogy I use, is give them a resource or a service for them to move forward, or goal.

STEVEN MATOS: If you’re looking for help for your PTSD, always know that you’re not alone. That’s the biggest thing that we all look for, is for being able to connect with someone that’s either been there and done that, or has done the same thing as you and is looking for a helping hand. Never, ever, think that hey, I might have done something that, deep inside, is killing me– but someone else has done the same thing if not something just as bad, or maybe even worse. And there’s always somebody on the other side who would like to help you.

Most Marines don’t want to admit that they have PTSD because it makes you look weak. You don’t want to tell a leader, hey, I think my head’s mixed up. They’re going to tell hey, go home and sleep it off and come back tomorrow, and you should be OK. So you just learn to put in the back burner for as long as you can. And that’s the bad thing. I got back home in ’03, and I didn’t have my first incident until ’06. And when it happened, it was just a explosion of emotions that were put away for so many years, and which is why I got in trouble.

CLAUDE BOUSHEY: I got involved in the Wounded Warrior program when I was injured and doing my recovery. I knew how it was to recover from almost nearly getting killed– coming back, recovering, recuperating, rehabbing, going through with that whole experience. Hit rock bottom, pretty much. And being able to come back and help other veterans– to help them with the issues that I faced, and help them with other issues that are facing most veterans today– was my driving force for helping other veterans when I retired from the Army.

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RICHARD MALMSTROM: I encourage all the service members I come across to join things like the American Legion or the VFW so they can find some of these kindred spirits to swap war stories. And it’s more than just braggadocio. It’s more than just that. You’re not just bragging about what you’ve done, but it’s more of sharing those combat experiences and lightening that load just a little bit.

CLAUDE BOUSHEY: I do a lot of outreach. I try to bring combat veterans to the group because once they come to the group, they can connect and get with other veterans instant camaraderie. It’s a peer to peer approach that we use, nothing clinical. There’s no doctors, there’s no clinicians, therapists, or anything. It’s pretty much a combat veteran talking to another combat veteran. It’s a approach. It’s not the best method. It’s a method– acceptable method.

So that’s the approach that we use here at the Virginia Wounded Warrior program. What works for veteran A may not work for Veteran B, so you got to use a different approach. And having a peer mentor– or a peer veteran specialist that we do here at the program– definitely will help someone guide through those hurdles and issues so we can get them to the right resource.

STEVEN MATOS: The Wounded Warrior program is awesome because you’ve got guys from almost every service. You got your Marines, you got your Army, you got your Navy, you got your Air Force, you’ve got your reservists. And you get to see from every single perspective you might imagine of, OK– Marines do this, Army does that. And you get to kind of understand what their job really is. You get to see what somebody else has gone through. I’ve met a couple guys that were in Iraq the same time that I was, doing a complete different mission. And I didn’t know about that. That’s pretty cool. I wish I was there for that.

So you get that perspective, and you also get that camaraderie and that family feeling. I look forward to Tuesdays because it’s like going to see a cousin or a aunt because it’s just that feeling of family. I could go ahead, go in, and speak about my problems. And I know somebody’s going to help me out that day.

And we could go to a daily check-in to see how your week was from last week, see if you have any issues at home that you’d like to talk about, see if anything is bothering you. It might be the anniversary of the date that you got hurt, or a date that you had to put somebody down, and that always weighs heavy on folks. And then we might find a topic. If somebody says something during their check-in that we could all talk about, we’ll all talk about it.

RICHARD MALMSTROM: So talking about is probably step number one. Or I should say recognizing that it’s going to happen, that you’re not immune to it, is step number one. Step number two would be to talk about it. Talk about what you saw. Find a counselor– somebody that you trust, so you’re not breaking any confidences– and talk about those things with that other person, along with how they’re affecting you. How those images in your mind are sticking with you.

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I could tell you hundreds of things that have stuck in my mind over the years, of just things that people have described to me. And they become real to us as well. So they can really affect us the same way that it affects somebody else.

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