Beyond stigma: Understanding the “inclined abstainers” in military behavioral health-care utilization

ABSTRACT

Low treatment utilization in Soldiers with combat-related Posttraumatic Stress Disorder (PTSD) is an ongoing issue. The critical concern is to better understand factors which prohibit a Soldier with PTSD who wants help from seeking treatment (an “inclined abstainer”). A total of 537 Active Duty Soldiers on a US Army post completed a brief survey comprising psychometrically validated measures of stigma, behavioral health treatment beliefs, resilience, PTSD symptoms, and treatment intentions. Health-care records were prospectively tracked for 12 months to determine the relation between survey answers and treatment utilization. Sixty-three percent of those who acknowledged having a mental health-related problem did not seek help within a one-year period. Greater severity of PTSD symptoms was associated with an increased likelihood of behavioral health engagement. Soldiers that were classified as “inclined abstainers” were also more likely to endorse negative beliefs about psychotherapy and report higher levels of resilience as compared to “inclined actors.” These results suggest that a treatment model of PTSD emphasizing self-efficacy and self-reliance, while addressing negative beliefs about psychotherapy, may help promote engagement of behavioral health services among Active Duty Soldiers.     

Can I Touch You Through A Screen? A Discussion of “Video Communication and Transgenerational Shame in the Mother/Daughter Bond”

This discussion elaborates on the complexity that electronically mediated treatment adds to Psychoanalytic work. The author explores the fate of the body in a Skype relationship, with particular attention to dilemmas posed by work with erotic transference when the transgressive excitement of possibility – actual erotic contact between analyst and patient – is absent. Additionally using Goldberg’s understanding of the frame as contact barrier, the author considers Skype as both frame and process and elaborates on limitations posed by Skype in adjusting to the phenomenology of the clinical moment. Ways to vitalize the frame over Skype are suggested. The author’s concerns about Skype treatment with dissociated and traumatized patients are also explored, and unrecognized enactments in Ringel’s work with D are considered, as is the possibility that work over Skype with D may have reified disconnection rather than promoted is intimacy.