Counseling with Care and Courage
The Impact of Ambivalence on Wounded Warriors

by Katie Evans, PhD, CADC III, NCAC II

Katie Evans, PhD, CADC III, NCAC II
Drug & Alcohol Counselor and PTSD Specialist

As the conflicts in Iraq and Afghanistan continue, clinicians will find themselves facing more and more clients who are coping with Post Traumatic Stress Disorder (PTSD). A key symptom linked to PTSD is ambivalence - a split of two extreme feelings so opposed that if the condition remains unresolved it can leads to a disassociative state. Ambivalence is common in those entering recovery and the condition can often interfere with treatment. Successful counseling requires the resolution of ambivalence, particularly with addicted soldiers suffering from PTSD. The reduction or resolution of ambivalence is critical in assisting the wounded warrior to achieve safety and sobriety.

We live in a world where spouses and families desire instant access to loved ones in the military. However, this constant connection can interfere with the focus that our military men and women need to stay alert. Hyper-vigilance is required to be ready for unknown.

Soldiers must balance the demands of loved ones with the duties they have to fulfill as members of the armed forces. These conflicting demands can lead to a split of raw emotion: rage, guilt and/or fear. These emotions can be devastating, eroding trust and clear thinking. This split can also cause dissociation and fragment the soldier’s psychological world. The soldier can become lost in a trance, caught somewhere between Bagdad and home, and unable to focus on either situation.

Ambivalence can lead to or increase survivor’s guilt. Members of the armed services suffer conflicts between their role as spouse and soldier. They lived when others died. And these feelings can carry over to the family: domestic violence is higher in newly reunited couples after serving in active duty.(1) In addition, the increasing rate of homicide and suicide amongst returning soldiers is shocking. The March, April, May and June 2008 issues of the Army Times all feature front-page stories related to these issues. The Army Times also reports that self-injury or injuries to others quadrupled between 2006 and 2007.

Neither the soldier nor his or her family member is ready for a return home without interventions and information about PTSD and addiction. The soldier is forever changed by what he or she saw and during time overseas. Anger, flashbacks and trauma are common – side effects of the adrenaline needed by soldiers to remain alive and cope with the stresses they faced. While a soldier may have returned home, he or she may be living with recollections of war in his or her brain, which can lead to the need for psychic numbing. If they cannot forget their experiences, alcohol or drugs may be sought to escape from their memories.

The loved ones who waited so long for the soldier to return now realize the impact of the war on their spouse. The trauma is now a vicarious one now shared by spouse and family members. They too are confused and ambivalent about the hero’s return home. “Who am I” and “where do I fit in” are normal questions asked in an abnormal situation.

To help resolve these issues, clinicians need to learn more about the symptoms of PTSD and teach others how to recognize these symptoms. How the abuse of alcohol to numb the pain and turn down the war can lead to an increase of flashbacks and dissociative states.

Redefining a new identity and learning emotional regulation skills can help prevent violence to oneself and others. Sobriety, taught with integrated PTSD treatment, can begin healing ambivalence, dissociation and untreated grief and loss features of addiction and coexisting military trauma. Safety and sobriety are the first steps needed in a treatment plan.

In my workshop on Counseling with Care and Courage, I will demonstrate how to assist the addicted soldier in finding safety and sobriety. Treating ambivalence and fragmentation is a key to healing. It is my hope that this article, workshop and upcoming publications will be of help and service to your professional growth. Your reading this article demonstrates your desire to be of service to those whose service to our country caused them the symptoms you will treat.

1 Domestic Violence in Veterans With Post-Traumatic Stress Disorder Who Seek Couples Therapy, Journal of Marital and Family Therapy, Oct 2006 by Michelle D. Sherman, Fred Sautter, M. Hope Jackson, Judy A. Lyons and Han, Xiaotong

Dr Evans has a PhD in Clinical Psychology and is both a state and nationally certified alcohol and drug counselor with a specialization on dual diagnosis, military and other Post Traumatic Stress Disorders (PTSD). Dr. Evans will be presenting Counseling with Care and Courage at NAADAC’s Recovery for a Lifetime conference. She is an author and her home study courses are NAADAC approved. For more information on Dr. Evans’ publications, national trainings and home study courses, please visit her Web site at www.drkatieevans.com. To contact her directly or to be added to her personal mailing list e-mail drkatieevans@verizon.net.