May 12, 2017

Healing from Military Sexual Trauma

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Up to 70% of those in the service experience military sexual trauma. Clinical psychologist Lori S. Katz talks about the evolution of population-based treatments, including her Warrior Renew program.

Omega: Can you define military sexual trauma and discuss its prevalence?

Lori: Military sexual trauma (MST) is defined by the Department of Veterans’ Affairs as “psychological trauma which...resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment that is repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character and occurred while the veteran was serving on active duty or active duty for training.” The definition isn't limited to the geographic location of the trauma, the gender of the victim, or the relationship to the perpetrator.

Rates of MST appear to be alarmingly high for both genders, especially women. A meta-review of 21 studies found MST rates of sexual harassment from 55% to 70% and rates of sexual assault from 11% to 48% among women veterans. However, these numbers are just estimates. Nonetheless, multiple studies suggest the prevalence of MST is very high for both men and women.

Omega: What are some of the factors that contribute to higher rates of sexual trauma in the military?

Lori: Factors like high stress, training in aggression, restricted age range, and living in an isolated community influence the frequency of incidents, as well as the number of service members with pre-military aggression or victimization, and military cultural factors like hyper-masculine values, strict hierarchy, and dominance.

For the victims, MST is a unique trauma because she or he has to continue to work and live with the perpetrator, friends of the perpetrator, and command of the perpetrator. If they “blame the victim,” then she or he may feel traumatized and ostracized by the entire community not just a single perpetrator, and he or she cannot escape.

Omega: How has your work with MST evolved throughout the years?

Lori: In 1992, the Veteran's Administration (VA) issued the first public law authorizing the treatment of MST in the VA system, waiving eligibility restrictions and providing the treatment free of charge. Shortly after, we started a Sexual Trauma Team and we worked on education, awareness, outreach, and later, screening for MST. In 1998, I chaired the team, and in 2000, I became the facility’s MST coordinator.

I was working as a clinician in the Women’s Health Clinic. In 2004, I had the idea of creating a group so that I could treat multiple people for MST at once. I called Diane West, a nurse at US VETS who had just opened a women’s housing community for homeless women veterans, and who was sending me a “flood of consults.” She said, “Funny that you called today. I happen to have a grant proposal on my desk, and it’s due in 5 days!”

Well, somehow, we got the grant! I realized this was a unique opportunity to create something specifically designed for the needs of this population. Apparently there is a new a buzzword for that, called “population-based treatment.” I don’t think that term existed at the time, but I knew there were common issues for those with MST that were not necessarily addressed by treatments targeting certain diagnoses.

Omega: What issues do those with MST have in common?

I believe the top 5 issues for those with MST are:

  1. Feeling isolated and disconnected from others
  2. Feeling vulnerable and fearing reoccurrence
  3. Having a lingering feeling of injustice and lack of closure 
  4. Unrealistic self-blame 
  5. Having difficulty in relationships

In 2005, we started an intensive outpatient program with supportive housing at US VETS. This program included yoga, art therapy, recreational outings, journaling, and classes on trauma, feelings, relationships, addictions, and self-care. The program was very successful (we were covered by PBS and The New York Times). However, in 2013, the Renew program closed. After that, I realized I could write a workbook covering the essential teachings for healing MST. Hence, in 2014 the Warrior Renew book was published.  

Omega: The Warrior Renew program takes a holistic and transformational approach to treatment. How does that differ from other programs?

Lori: First, Warrior Renew is population-based rather than diagnostic-based, which means it addresses common factors for the population regardless of what diagnosis they may have. Other popular treatments target a specific diagnosis, such as PTSD.

Secondly, although Warrior Renew offers skills to manage symptoms, it also targets the cause of the symptoms and helps resolve persistent issues such as resentment, self-blame, and negative emotional beliefs about oneself and others.

Thirdly, this program emphasizes community building and enhances trust, creativity, and empowerment in a way that is not addressed in other treatments.

Omega: Can you talk about some of the simple techniques or exercises you use in your work, such as cleansing breaths?

Lori: Sure.... COPE is one of my favorites. I came up with this strategy to address triggers, intrusive thoughts, and anxiety. The acronym COPE is to help participants remember that they can cope. 

  • Cleansing breath (deep breath in through the nose and out with a sigh)
  • Observation (scanning environment, and observing physical reactions)
  • Positive self-talk (reminding oneself such as: “I can do this. This will pass. I am safe.")
  • Explanation (labeling the experience: “This is only a trigger. This is the fight or flight response. This is anxiety, and it will pass.”)

Omega: What is the biggest challenge today in supporting those who have experienced MST?

Lori: The biggest challenge is letting MST survivors know that there is an effective, compassionate treatment for them. Unfortunately, too many MST survivors feel isolated, not understood, and even blamed. They don’t want to come forward, they don’t want to talk about it (fear of being judged or triggered), and then they don’t get help. I wish every MST survivor knew that he or she is not alone, and there is help.

Omega: How can someone who is inspired by your work get started in their own community or bring this work to their own clinical practice? 

Lori: The workbook is designed so that a facilitator can pick it up and use it to start a Warrior Renew group. It has already been used successfully with women, men, and even in a co-ed group. It’s also been used with veterans, active duty, homeless, and with women in a residential substance abuse treatment program. We have a growing evidence-base for the treatment with several published outcome studies. My hope is that everyone who has had MST, receives the help and support that they deserve.