Consultation Case Study

Charles Gentzel
25 July 2020

The behavioral health department on Army installation Fort Somewhere, NC has brought

me in to consult related to the different treatment outcomes for female soldiers with PTSD.

Female patients are twice as likely to require a second inpatient hospitalization and are three

times as likely to drop out of treatment early. Female patients are also less engaged during group

therapy and more resistant during individual sessions. General Boyd, the installation commander,

is focused on the issue after a series of articles are published highlighting the treatment

disparities. This negative publicity adds to the already large number of stories involving military

culture’s mistreatment of its female members. The General contracts with me to address the

treatment disparities with the desired result being decreased disparities between genders. Dr.

Guy, the behavioral health department head, and Colonel Manning, head of the post chaplaincy,

as the two consultees.

Given the mental health focus of the problem and that I am being brought in to examine

and improve treatment outcomes for a patient population in a treatment program, I am utilizing a

program-centered administrative mental health approach (Dougherty 2014) that integrates

aspects of feminist consultation, which I see as more a way to approach consultation than a

model. The regimented command structure of the military will make it difficult to live up to the

ideal of nonhierarchical consultation utilized in the feminist model (Hoffman et al 2006), but I

try as much as possible by recommending that meetings between myself and the two

administrators Dr. Guy and Colonel Manning happen in civilian clothes and happen around a

table rather than in a briefing format. My background as a soldier allows me to understand the

hierarchies at work as well as make it easier to enter the system (Dougherty 2014). I understand
 Consultation Case Study
Charles Gentzel
25 July 2020

the acronyms and cultural norms, and I can be seen as one of them because I am one of them

(though for this paper I am imagining I am already retired from active service).

Data collection reveals that outside factors relevant to the client population, such as the

increased rates of sexual harassment and assault, and the negative perceptions male soldiers have

of female achievement (Office of People Analytics 2020). The military also offers two paths for

potential patients. One is going directly to behavioral health for a screening and a referral. This

leads to participation in Dr. Guy’s CBT program that is a mandated mix of individual counseling

and group therapy in a mixed-gendered, but mostly male environment. The second and most

often utilized way is through chaplains. When individual soldiers or their leaders notice an issue,

the chaplain is usually consulted. Certain issues, such as sexual assault or stated suicidal

ideation, have an obligatory response. For most others, marriage problems, nightmares, anxiety,

etc., the chaplain acts a sort of initial screening. Many are trained counselors and will refer

soldiers to behavioral health. Some chaplains are more firmly entrenched in spiritual solutions

and are more likely to steer troubled soldiers towards religious services and faith-based support

groups. My contract involves outcomes from behavioral health, but the chaplaincy is seen as

part of the treatment team and is included as a consultee, though his program and methodology

are outside my contracted scope.

After formal and informal interviews of staff, command teams, and patients, as well as a

review of censing session data, I identify the principle problems as having two layers. The first,

outer layer is the larger military culture’s treatment of women and patriarchal worldview. This is

evident in the often open hostility and harassment that female soldiers experience, the very real

increased threat of sexual assault, and the lack of anyone who will provide credible support for
 Consultation Case Study
Charles Gentzel
25 July 2020

them or investigate their claims (Office of People Analytics 2020). This leads to female patients

not feeling like they can safely open up in mixed-gendered groups or to male counselors and

becoming withdrawn or resistant as a result.

The single model of CBT treatment is the inner layer. There is no one best way to treat

trauma and different patients will have different results depending on the treatment model (Van

der Kolk 2014). This holds true for groups versus individual treatment as well. In a study where

soldiers returning from combat were given CPT therapy in group, individual, or a mixed model

of treatment, it was the individual group that showed the best results (Resick et al 2017). In

contrast, a study focusing on women with trauma from battery found that group treatment

provided better outcomes. The participants found solidarity and gained strength from knowing

other women experienced situations similar to their own (Echeburua, Sasura, and Zubizarreta

2014). Therapy, such as manualized CBT, is also often not enough to effectively treat trauma.

Grounding techniques and mindfulness that help reduce the constant stress response of the

trauma brain and set conditions that make therapeutic interventions more successful. Rhythmic

breathing and body awareness techniques such as those found in yoga, tai chi, and therapeutic

touch are especially helpful to incorporate into therapy programs (Van der Kolk 2014).

My interim recommendations were to create an option for female-only therapy groups,

and to making group participation optional. This was written up recommending a five-year plan

where patients are allowed choose their individual counselors not based on which clinics they

were assigned to, but on a counselors gender, training, and theoretic orientation. This serves the

dual purpose of providing a safer space for female patients and giving patients of both genders

more control over their therapy. Keeping in line with the nonhierarchical approach of the
 Consultation Case Study
Charles Gentzel
25 July 2020

feminist model, it also encouraged staff members to explore therapeutic options and

interventions outside of the manualized regiment of CBT sessions. Staff members were sent to

outside training in several different models and began to incorporate EMDR, yoga, animal

therapy, narrative exposure therapy, and free writing into treatment. All of which are

interventions that have proven effective at treating PTSD (Van der Kolk 2014). Chaplains were

also provided with screening tools and trained in greater detail on the symptoms of PTSD, as

well as comorbid conditions. The larger patriarchal worldview and the systemic treatment of

female soldiers were addressed through recommendations that sexual assaults be investigated by

outside agencies, a mentorship program that connects female soldiers with female senior leaders

be established, budget increases for Sexual Harassment/Assault Response and Prevention

(SHARP) and Equal Opportunity (EO) programs, as well as inclusion of feminist works in

Commander’s reading lists. These recommendations were not adopted. I set yearly

appointments to check in on the implementation of the program.

The treatment recommendations were refined throughout the five year period. Staff

members collaborated on cases and recommended patients to different treatment models based

on perceived needs. Exit surveys from both genders revealed better treatment outcomes across

the board. Female patients overwhelmingly chose to be treated in female-only groups and by

female therapists. Participants in female-only treatment not only decreased drop-out rates, they

surpassed male patients in the number who completed treatment programs. Before termination, I

once more recommended the systemic changes included in the initial report and included

possible further areas of exploration including more potential treatment interventions based on

the most recent research.

 Consultation Case Study
Charles Gentzel
25 July 2020

References

Dougherty, A. M. (2014). Psychological Consultation and Collaboration in School and

Community Settings (6th edition). Belmont, CA: Brooks/Cole. ISBN: 978-1285098562

Echeburúa, E., Sarasua, B., & Zubizarreta, I. (2014). Individual versus individual and group
therapy regarding a cognitive-behavioral treatment for battered women in a community
setting. Journal of Interpersonal Violence, 29(10), 1783-1801.
doi:10.1177/0886260513511703

Hoffman, M. A., Phillips, E. L., Noumair, D. A., Shullman, S., Geisler, C., Gray, J., . . . Ziegler,
D. (2006). Toward a feminist and multicultural model of consultation and advocacy.
Journal of Multicultural Counseling and Development, 34(2), 116-128.
doi:10.1002/j.2161-1912.2006.tb00032.x

Office of People Analytics. (2020). 2019 Military Service Gender Relations Focus Groups:
Active Duty retrieved from
https://www.sapr.mil/sites/default/files/Appendix_G_OPA_2019_Service_Academy
%20_Gender_Relations_Focus_Groups-Overview_Report.pdf

Resick, P. A., Wachen, J. S., Dondanville, K. A., Pruiksma, K. E., Yarvis, J. S., Peterson, A. L., .
. . and the STRONG STAR Consortium. (2017). Effect of group vs individual cognitive
processing therapy in active-duty military seeking treatment for posttraumatic stress
disorder: A randomized clinical trial. JAMA Psychiatry (Chicago, Ill.), 74(1), 28-36.
doi:10.1001/jamapsychiatry.2016.2729

Van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of
Trauma. New York: Viking.
Consultation Case Study
Charles Gentzel
25 July 2020