Cultural Competence in Mental Health Treatment: What do You Call a Military Patient?

What do You Call a Military Patient?
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By Navy Capt. (Dr.) Carrie Kennedy, Director, Deployment Health Clinical Center
May 22, 2017

Are you seeing a service member as a patient? What do you call him or her? It seems like such a simple question, but it’s not as easy as it sounds. Should you address the service member by first name? Last name? Rank? Job title? Call sign?

In examining the question, we have to ask what rank denotes. To most service members, military service in general is a large bulk of their personal identity, earned through hard work, a characterization of who they are, and in many respects, rank is akin to a first name.

Okay – but shouldn’t things be relaxed in therapy so the provider can build rapport and get patients to take a step out of the military momentarily? Maybe and maybe not. For active-duty, reserve or Guard members, using rank propagates patient confidence in your belief and expectation in their recovery and your recognition of their service. It sends a strong message that you have confidence in their ability to heal, cope and return to or improve upon prior levels of functioning. Rank represents military identity and maintains their association with their military unit. Maintaining association to the military unit in turn fosters recovery, particularly in arduous and deployed scenarios. Thus, your default should be to call military patients by their rank. However…

At times, service members are referred to by other seemingly unusual terms, such as their job title, a changed form of their rank or a call sign. You could find yourself providing care to the OpsO (operations officer), a Master Guns (master gunnery sergeant), or Scooby, Cool Breeze, Cheetoh, or Zeus (call signs), and at times use of these names may be the most appropriate to foster rapport, enable therapy and still maintain association with their military identity and unit.

What about when someone is leaving the service or is already out? Even when a service member is not able to remain in military service because of a medical problem, legal problem or simply when their military service is finished, rank or another military-related name may still be appropriate, and the issue is worthy of a conversation with the patient.

When working with service members, one essential competency is to understand the military rank structure and to be able to identify rank insignia. The Center for Deployment Psychology provides this excellent Military Rank Charts resource.


The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.


Comments

  • This article seems to be common sense for anyone trained in psychotherapy. How to address them being worthy of part of the conversation is obviously the first step in establishing the relationship. In most all therapies there is a transference set up fairly soon in treatment, meaning a transfer of unconscious feelings pertaining to the clients early relationships with parents and later with teachers, drill sgts., commanders, and others in authority over the soldier/vet. transferred to the therapist. And if the therapist is on active duty and an officer outranking that of the client, it is even a bigger issue in the transference. How this manifests in therapy is that the client may try too hard to please, or do the right thing for the therapist, or be overly resistant to working enough in therapy.

    • Very interesting comment! I think you will find next week's blog very interesting as it addresses dealing with issues of rank in psychotherapy.

  • At Army hospitals, they have gone back and forth on this issue for a variety of reasons. Once I was in a trauma room with a Veteran who had been injured seriously in auto accident. He was incoherent and not cooperative, until I came alongside him and called him by the rank he had held 30+ years earlier - "Sergeant" Suddenly he seemed to call on inner reserves to calm himself, become more aware and cooperative. Later on he told me that he hadn't been that scared of dying since Vietnam.

    • The power associated with one's military identification is amazing and lifelong. Thank you so much for this story. It is a great depiction of this concept.

      -- CAPT Carrie Kennedy

  • Too true. And, there may be a difference between the effectiveness of using rank for a medical/psychological clinician vs. a chaplain. Chaplains have tacit permission to "cross" rank boundaries in building care relationships ... one of the reasons Army and Air Force chaplains aren't addressed by rank, but only as "Chaplain". Therefore a chaplain addressing someone by first name (in counseling) may create a sense of a close and trusted relationship, while using rank (outside of counseling) shows respect for the counselee's military identity and also creates clear boundaries that make counseling time special, distinctive, even sacred time. ...But one size doesn't fit all. Sometimes you would want to use the counselee's rank (or rank-and-last-name) in counseling to add emphasis, or tacitly remind the counselee of a boundary.
    Military services also have distinctive body language that you have to be culturally competent to interpret correctly.

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