The Role of Talk Therapy in the Treatment of Service Members (Part 1)

Harold Kudler, chair of the SVI, offered the following discussion on the members list a few months ago on the interplay between talk therapy and biological treatments especially as it applies to service members and veterans. His discussion has broader implications for psychoanalysts. His discussion is worth reading again and preserving.

"Speaking as Chair of APsaA's Service Members and Veterans Initiative (as well as a leader in the development of the VA/DoD's Clinical Practice Guideline for the Management of PTSD), I fully agree with Jane's comments. [Jane Hall had commented on the value of combining biological treatments with talk therapy and the role analysts can play in researching and promoting this approach]

Freud (who spent a great deal of his time thinking about the problems faced by WWI Veterans and the range of treatments that had been used to address these) recognized the importance of balancing biological and psychological views of the same phenomenon. Eric Kandel has been one of the most articulate modern contributors to an understanding that every discipline (like psychoanalysis) actually NEEDS and anti-discipline (like neuroscience) as a spur to greater understanding but that you cannot succeed in reducing a discipline to its anti-discipline without losing the essential richness and value of that understanding.

Talk therapy is an essential tool that needs to be available to every Service Member, Veteran and family member. Not everyone will choose talk therapy and not everyone may be able to use talk therapy. As a VA clinician for 30 years, I can witness that there are many Veterans who could not approach talk therapy UNTIL they obtained enough relief from meds (mostly SSRIs) that they could effectively "sit in the room" with their own traumatic narrative. The conversation and the interpersonal closeness necessary to do talk therapy was simply overwhelming for them until the biological alarms that are stuck in the "on position" as part of PTSD are at least muffled if not turned off (and I don't mean sedated/tranquilized - I mean specifically decreased through a discrete if still to be fully understood biological intervention). Once you've seen clear clinical evidence that medication therapy can actually facilitate talk therapy, you become less excited about getting up on top of your own tower (biological or psychological) and shouting at people standing on their own towers. Reductionism is reductionism whichever tower you like to look down from.

And, certainly, psychodynamic psychotherapy is one of the most important talk therapies which modern clinical science has to offer. 

I'd also like to call your attention to the great work being done by Drs. Judith Broder and Carol Tanenbaum in their psychoanalytic program, The Soldier's Project. 

 

Prudy Gourguechon, M.D.