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Peer counseling: another dimension of warrior recovery.

February 12-15 marked the beginning of a pilot program for peer counseling at Fort Irwin, California. Dr. Richard Long, a professor in the Department of Counseling, Educational Leadership, and Professional Studies at Columbus State University, Columbus, Georgia, and I conducted 23 hours of training to prepare 24 NCOs and company grade officers to function in the role of peer counselors. Units throughout the 11th Armored Cavalry Regiment, the Support Brigade, and U.S. Army Medical Department Activity, including the Wounded Warrior Transition Unit, selected Soldiers to participate in the peer counselor training. The commands who allowed their service members to attend the training demonstrated their commitment to their Soldiers and families, and those who completed the initial training program deserve recognition.

[ILLUSTRATION OMITTED]

The training began with an evening on the theme "From Ground Zero" in which the participants examined a number of real-life scenarios from Soldiers who had returned from Iraq and were facing serious issues involving post-traumatic stress and other factors. The group had to work through the case studies and discuss how to handle each situation. At the end of the training, each small group again revisited the case studies, employing the new skill sets that they had acquired over the course of the training. The skill sets came alive as another means for looking at ways to assist Soldiers in need and/or in crisis during the training. The participants themselves recognized the enrichment of their own skills that had occurred as they made use of the new skill sets that they had acquired during the week.

At the closing ceremony, Chaplain (COL) David E. Bates, the command chaplain for NTC and Fort Irwin, underscored what the participants were discovering for themselves.

"One of the things that attracted me to this course was the potential benefit for a ripple effect in the community when Soldiers use the skills taught with their spouses, family, and friends," he said.

What is a peer counselor?

The peer counseling concept is in some ways analogous to the combat lifesaver program in wide use among all Army units today. The combat lifesaver provides emergency care to Soldiers in forward units in order to stabilize them until they can be treated by trained medical personnel. Approximately 90 percent of combat deaths are due to loss of blood, lung collapse, or blockage of the airway, and combat lifesavers learn to intervene and treat those conditions and others. Likewise, a peer counselor is not a professional mental health care provider or a chaplain--nor is he intended to be a substitute for them. A peer counselor is an individual who has had at least 20 hours of training in some of the basic counseling skill sets such as a perspective on effective counseling, counseling as a process, building the counseling relationship, active listening and interpersonal skills for in-depth exploration, the nature of change and commitment to action, and termination and referral issues. The peer counselor is a resource for short-term and basic counseling at a peer level, and in this capacity he works in cooperation and in consultation with the Family Life Chaplain and other helping services. Peer counselors themselves are also a network for peer counseling resources and a conduit for other more formal/professional helping resources.

What type of person should be selected to be a peer counselor?

A candidate should have a commitment to help others and the ability to interact with individuals from a wide range of backgrounds and situations. He must be willing to accept professional and ethical standards of conduct to include protecting confidential information and maintaining an empathic and genuine stance of respect for the client. The counselor must never become an advice giver but must always honor the abilities of the client to make his own decisions. The counselor candidate must be willing to work within a community of other counselors, their supervisors, and professional caregivers. They must never work outside the philosophy and goals of the program or as an independent entity. The candidate must at all times keep in mind that he is "to do no harm" as per the American Association of Marriage and Family Therapists (AAMFT) Code of Ethics.

What are some of the competency skills that a peer counselor should have and how is that trained on a compressed timeline?

Of the 20 hours plus of training that our counselors complete, the students are immediately thrust into real-life scenarios about issues faced by Soldiers returning from extended deployments as well as scenarios from their own lives. The structure of the training is based on an adult learning model. Each skill set is taught in the following cycle:

* A period of theoretical instruction is followed by a live demonstration of the skill set by the instructors with observations, questions, and discussion following by the entire group.

* The students then break out into groups of three where a rotation of three roles--counselor, client, and observer--is performed by each participant using the skill set.

* The instructors move from group to group to observe and ensure that the groups are remaining on task and to offer suggestions. For example, group members practice active listening skills to create empathy and to build the professional relationship such as summarizing, nonverbal acknowledgment, reframing, restructuring, clarifying, open questions, role playing, and selective reflecting.

Other important areas covered throughout the course include crisis intervention, potential conflicts of interest and how to handle them, scope of practice, assessment for referrals, and so forth. By the end of the training, peer counselor students are able to use the basic elements of one of the brief therapeutic theories as a framework to assist potential clients in bringing their issues to resolution. Participants also discuss their firsthand experiences of the impact of the interventions that they are learning in a very positive and powerful manner.

How did the concept of peer counselors come about?

Peer counseling is a concept which began in the 1960's and 1970's in educational settings and was used to a greater extent in the 1980's when educational budgets were beginning to be cut. Peer counselors became a means to enhance the services of the professional counselors and to take counseling services to a grass roots level. In the case of Fort Irwin in 2008, the helping services are stretched beyond the limits because of the needs of service members and their families, especially with ever higher percentages of service members experiencing prolonged and multiple deployments.

I attended the Cape Cod Institute in August 2007. The subject of the continuing education training which Dr. Long, our facilitator for the week, and I attended was Emotionally Focused Therapy, one of the latest therapy theories which has been proven to be effective in the treatment of Post-Traumatic Stress Disorder (PTSD) both for the individual and the couple who are experiencing the disorder. As part of that training Dr. Susan Johnson, Professor of Clinical Psychology at the University of Ottawa and director of the Center for Emotionally Focused Therapy, talked about her work with the firemen in New York City and the trauma many of them faced after 9/11. Even as one group among numerous care providers, Dr. Johnson knew that she and her staff could not sustain long term therapy for these firemen from the geographical distance of her work in Ottawa, nor could they sustain the volume of care giving required. So, she worked with the firemen to develop a peer counselor program which proved to be very effective. Professional firefighters, as peer counselors who as insiders understood the needs of their peers, were enabled to convey a message of help and support in a very profound manner simply by acquiring training in very basic counseling skills.

As we have been looking for means to maximize helping services on Fort Irwin for our service members and their families, the concept of the peer counselor resonated with me. Who better to know the life of a Soldier than a Soldier peer or a leader who is often the first point of contact? What better way to take care giving to a more readily available level? Thus began a dialogue between myself and Dr. Long which has resulted in the pilot program for which we initiated the training of 24 first contact leaders. We are about making better leaders, better human beings, better husbands/wives, and better parents of already great leaders and of passing that legacy on so that no Soldier is left behind whether on the battlefield of conflict or on the battlefield of life. This is what Soldiers helping Soldiers is all about.

What is the way forward?

What is the vision for the peer counselor program at Fort Irwin? COL Joseph K. Wallace, the chief of staff for NTC and Fort Irwin, summed up the way forward in his remarks at the closing ceremony as, "What we are interested in is having you notice those patterns of behavior or thinking that may get a trooper or Soldier into trouble, and interrupting the pattern before the trooper becomes a problem. Because, when it gets to my level, it's a PROBLEM."

The vision of the Family Life Center for the peer counselor program is that many service members and their family members will find assistance and solutions to their problems at a much earlier stage in the problem, and that issues will be resolved long before professional care giving services are required. Early intervention will give us healthier and more effective Soldiers as well as healthier and more effective families. I will be providing on-going monthly training and consultation for those who graduated from our Peer Counselor Training Program. As part of the discussions that came out of the training, we will be in dialogue with the commands, other helping services, and the peer counselors as we continue to develop and implement the program. If you would like to talk to a peer counselor or if you would like more information about peer counseling, please contact the Fort Irwin Family Life Center at (760) 380-4664 or DSN 470-4664.

[FIGURE 3 OMITTED]

Peer Counseling. Training

I was one of the few people invited to participate in the pilot training program for peer counselors. As peer counselors, we are the first line or could be the middle man between the Soldier and trained mental health professionals or for Chaplains trained in counseling.

Shortly after the training, I had to put my training to the test. I wondered, "Did I learn enough?" Well, my first day back to work I was going to find out how much I had really learned. I had to counsel a Soldier who probably could not wait until the end of the month to see his regular counselor. I went into the office and started by asking him questions about his situation. I began by asking round about questions to get started. I did not want him to know that I was counseling him. But that did not work. One member of our team came into the office and asked us, "What are you all doing?" The Soldier replied, "I am being counseled." After he said that, I laughed because I had not realized how much he knew. I felt that I was getting closer and closer to the root issue to determine if I should have his regular appointment date moved up, and I started using the different techniques and questions I learned in school. Some of these were: Using a scale of 1 to 10, how would you rate your day? And, what would make your today better than yesterday? Or, If you were to go to sleep and wake up tomorrow and you noticed that everything was perfect, what would make you know that everything was corrected? Just statements like that would get you to the point where you can start asking all sorts of questions. The one thing is that you first have to gain Soldiers' trust so they will feel comfortable with you and telling you their problems.

--SGT James W. Stephens, Jr.

68S Preventive Medicine

Chaplain (Major) Tammie Crews holds a Bachelor of Arts degree (summa cum laude) in Religious Studies from Trevecca Nazarene University in Nashville, Tennessee; a Master of Divinity degree (magna cum laude) in Biblical Studies and Theology from Nazarene Theological Seminary in Kansas City, Missouri; and a Master of Science degree in Community Counseling, specializing in Family Counseling, from Columbus State University in Columbus, Georgia. She has done work toward a doctorate in Theology from the University of Sheffield, England. She has served as the battalion chaplain for the 189th Command Support Battalion at Fort Bragg, the 485th Corps Support Battalion in Hanau, Germany, and as a battalion chaplain in the 1-501st Aviation in support of Operation Iraqi Freedom. She is currently the Family Life Chaplain at Fort Irwin, California.
Figure 1

PEER COUNSELING TRAINING AGENDA.

February 12:

1900-2100--Opening Evening Session, Introduction, and
Opening Remarks *

Skill Building: From Ground Zero--From Iraq to Home: In
Search of What to Say

February 13:

0900--Skill Building: Initial Discussion, Attending to the
Soldier *

0930--Skill Building: Attending to the Soldier and the
Role of the Peer Counselor *

1000--Live Demonstration and Discussion

1030--Round Robin Skills Practice and Group Feedback

1200--Lunch

1300--Skill Building: Initial Disclosure, Emphatic
Understanding *

1330--Skill Building: Empathy Role Play *

1400--Live Demonstration and Discussion

1430--Round Robin Skills Practice and Group Feedback

1630--Discussion of the Day's Lessons Learned

February 14:

0900--Skill Building: In-depth Exploration, Advanced
Empathy *

0930--Skill Building: Advanced Empathy Role Play *

1000--Live Demonstration and Discussion

1030--Round Robin Skills Practice and Group Feedback

1200--Lunch

1300--Skill Building: In-Depth Exploration,
Confrontation *

1330--Skill Building: In-Depth Exploration,
Confrontation *

1400--Live Demonstration and Discussion

1430--Round Robin Skills Practice and Group Feedback

1630--Discussion of the Day's Lessons Learned

February 15:

0900--Skill Building: Taking Action *

0930--Skill Building: Taking Action, Application of Skills
Taught *

1000--Live Demonstration and Discussion

1030--Round Robin Skills Practice and Group Feedback

1200--Lunch

1300--Skill Building: Making a Referral *

1330--Skill Building: Making a Referral *

1400--Live Demonstration and Discussion

1430--Round Robin Skills Practice and Group Feedback

1630--A Vision for the Future: Role of Embedded
Training in Health Care Delivery

* Power Point Presentation

Figure 2

PEER COUNSELOR
(Initial contact)
Identify the Problem

 Problem is solved in dialogue
 with the peer counselor

 REFERRALS

 CHAPLAIN FAMILY LIFE COMMUNITY
 CHAPLAIN MENTAL HEALTH

 Informal/Formal Formal Formal
 Pastoral Counseling Therapy Clinical Therapy/
(Individual/Conjoint) (Individual/Conjoint/ Treatment (Individual/
 Family) Conjoint/Family)

 No Diagnosis/Treatment Diagnosis/Treatment
 Treatment Plan Plan
 Plan/Diagnosis Formal Assessment

 Confidentiality Confidentiality with Confidentiality with
 Absolute Exceptions Exceptions

 No No Limited
 Command Access Command Access Command Access

 No Records Formal Records Formal Records
 or Informal (HIPPA) (HIPPA)
 Records Locally Stored Systems Stored

 Short Short/Long Long
 Term Term Term

 Individual(s) is referred to appropriate sources without
 being abandoned

 REFERRALS

 ASAP ARMY COMMUNITY COMMUNITY
 (WITH CMH) SERVICES RESOURCES

 Treatment Information
 Education

 Formal No
 Assessment Treatment Plan/
 Diagnosis

 Confidentiality Confidentiality
 with Exceptions

 Limited Limited No
 Command Command Access Command
 Access Access

 Formal Records Formal Records
 (HIPPA) (Non-Clinical)
 Systems Stored Locally Stored

 Long Very shout
 Term Terra
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Author:Crews, Tammie
Publication:Infantry Magazine
Date:Mar 1, 2008
Words:2499
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