“Thank you for your service” is a statement that those currently serving, or who have served, in the U.S. military receive from family, friends, and strangers. Additionally, Thank You For Your Service is the title of a movie that was released in 2017, which depicts U.S. soldiers returning home from Iraq and their struggles to reintegrate into the civilian world, displaying symptoms of PTSD, and their struggles to find mental health resources.
As a therapist who has a passion and desire to help veterans and active duty military, it was difficult to watch these soldiers being turned away or denied help due to a lack of resources available and there being so many veterans needing help. The most disturbing part of this film was the ending, when it was revealed that this was a non-fictional account of U.S. soldiers and their experiences coming back home from Iraq.
While watching this film, I couldn’t help but wonder how this movie would have been different had there been more resources for these soldiers; why was there such a lack of resources and mental health options for them? When observing the different fields of mental health, it is evident that most mental health professionals have an avenue for working with U.S. military members, whether that be through the Department of Veterans Affairs or as civilian contractors. However, there is one particular career option that LMFTs (and LPCs) are not currently offered: we cannot serve on active duty, working with fellow service members, and practicing LMFT in the military. There are no career fields that exist within the U.S. military that are open for LMFTs to enter the military and practice therapy.
As systemic therapists, we are trained and equipped with the abilities to work with a wide variety of populations and issues presented before us, such as depression, marital issues, anxiety, substance abuse, and various mental health struggles or disorders. While LMFTs are doing effective work with U.S. service members, there is always more that we could be doing, if given the opportunities.
The purpose of this article is to bring awareness to the absence of active-duty career fields within the military that are selectively for LMFTs. While there are positions that exist that allow LMFTs to work as civilians with military members, there are no career fields that exist within the U.S. military that allow LMFTs to join the military and serve as therapists alongside our service members.
Benefits of entering the military family
While a clinician is conducting therapy, they have an opportunity to join that system, to see firsthand clients’ presenting problems, and to be an active part of their growth. The idea of the therapist’s role being that of joining the family system while in the therapy room is not uncommon. For those who practice Bowenian therapy, one of the roles of the therapist is to be a part of the family system and remain differentiated and non-anxious. Imagine the work that could be done if a client came to their therapist who is already a member of their military family, who has a strong understanding of their work environment and the stressors that come along with serving in the U.S. military.
A client typically has the opportunity to choose a therapist they believe will be a good fit for them, someone they feel as though they could connect with and have an understanding of their presenting issue. A study conducted in 2018 observing active-duty members and veterans of Operation Iraqi Freedom and/or Operation Enduring Freedom found that 77% of the active-duty participants agreed that they would prefer to work with a psychologist who is a veteran and 18% in partial agreement (Johnson et al., 2018). While there are LMFTs who are veterans and have worked with active-duty military, by opening career fields for LMFTs to enter the military as therapists, there could be more mental health veterans from whom these active duty members and veterans would prefer to seek help.
Statistics within the military
Understanding the system of the US military and its demographics can prove evident to the argument that LMFTs could be of great use as members of the active-duty military. The following statistics are based on the Demographics Profile of the Military Community: 31.4% of military personnel are married with children (29% married to civilians with children, 2.4% dual-military with children), 18.6% married without children (14% married to civilians with no children, 4.6% dual-military with no children), and 3.9% are single with children (OneSource, 2021). A total of 50% of military personnel are married while 4.8% are divorced (OneSource, 2021). In 2022, the Department of Defense recorded 15,479 reported cases of domestic violence to the Family Advocacy Program (Department of Defense, 2023).
It is no secret that there are many veterans who struggle with substance abuse due to the traumas experienced from their service in the military. For active-duty service members, the military has implemented a zero-tolerance policy for any usage of illicit drug usage. According to the 2018 Department of Defense Health Related Behaviors Survey, 34% of active-duty service members reported binge drinking in the last 30 days, with the Marine Corps being the most at 44.9% and the Air Force being the least at 24.1% (Meadows et al., 2018). Within the same study, it was discovered that based on pay grade, O1-O3 (officer pay grade) reported having the highest percentage of binge drinking at 37.1% (Meadows et al., 2018).
When discussing the issue of mental health amongst active-duty military members, one of the most common issues brought up is that of the number of completed suicides. In observing the rate of suicide amongst active-duty members, in 2021, per 100,000 service members, 24.3% (328) active-duty members completed suicide (Department of Defense, 2022).
When examining these statistics, it is important to mention that there are programs both within the U.S. military and outside of the military that are structured to help address these issues, however, opening career fields for LMFTs to enter the military as therapists would help enhance these programs and allow for more resources to our active-duty military members.
Opportunities for mental health professionals within the U.S. military
Currently, the primary mental health professions that are available for individuals who desire to join the military as a service member are as follows: clinical psychology, research psychology, psychiatric/behavioral health nurse practitioner, psychiatry and social work. These positions require advanced degrees in psychology, psychiatry, or social work. For those wishing to enlist (any rank below that of a commissioned officer), they have the opportunity to be a behavioral health specialist/specialist. When observing the job descriptions between the branches of the military, both the clinical psychology and social work jobs discuss providing help for not only the servicemembers, but their families as well.
Outside of the mental health professions mentioned previously, the military does have a position called Military Family Life Chaplain. These Military Family Life Chaplains function as trainers in family life skills, as well as provide training to chaplains in pastoral counseling and relationship education skills and programs (U.S. Department of the Army, 2015). To become a Military Family Life Chaplain, the Chaplain must complete the U.S. Army FLC Training Program or an equivalent program. In order for an individual to be a Family Life Chaplain Supervisor, they must complete the Family Life Chaplain Program (or an equivalent program) as well as meet professional credentialing requirements, which are determined by AAMFT. The work that these Military Family Life Chaplains conduct is important and invaluable for our service members and their families. Knowing that the Military Family Life Chaplains’ professional credentialing requirements are established by AAMFT shows that the U.S. military values MFTs’ approach to therapy.
LMFTs’ current work with active-duty military
Currently, there are multiple options of employment for LMFTs wanting to work with the military. The first is as a civilian contractor. The civilian contractors are LMFTs who work with active-duty members while not being a member of the U.S. military. Specifically, the U.S. Navy and Marine Corps have positions available for LMFTs to work as child counselors, clinical counselors, deployed resiliency counselors, substance abuse clinical counselors, and other similar career options.
As of 2004, LMFTs also have the option to be a Military and Family Life Counselor (MFLC). Per the Military OneSource website, MFLCs provide non-medical counseling for service members as well as support for service members’ families and survivors. Additionally, MFLCs provide group support with briefings as well as specific presentations on and off installations.
Final thoughts
It is evident that the mental health of our service members is important and valued by the U.S. military. While the work that current mental health professionals who are active-duty do is beneficial and impactful for the U.S. military, opening opportunities for LMFTs to join among those ranks could help support not only the service members and families needing help, but also the active-duty mental health professionals, as well. Adding LMFT as a career choice for AAMFT credentialed personnel would open those opportunities. To the fellow LMFTs who want to serve in the U.S. military: continue to do the work we can to help our current active-duty members, while continuing to bring awareness that we could do more for our active-duty members by becoming an active-duty member. To the Department of Defense: LMFTs are here, we want to help, we want to serve in the U.S. military alongside those who serve and dedicate their lives to our freedoms. Let us serve with those who serve.
Learn more about working with military families with resources from AAMFT:
>Competencies for Family Therapists Working with Service Members, Veterans, and their Families
>Competency-Based Family Therapy with Military Service Members
>Military Couples: Physical Health and Relational Well-being
>Responding to Uncommon Valor: MFTs Serving Military Families
Sean Surber, PhD, LMFT, LPC, is an AAMFT Professional member holding the Clinical Fellow and Approved Supervisor designations. He currently works as a counselor at Lighthouse Recovery Texas located in Dallas, TX, focusing on helping individuals and families struggling with substance abuse and addiction recovery.
Department of Defense. (2022). Department of Defense annual report on suicide in the military: Calendar year 2021. Retrieved from https://www.dspo.mil/Portals/113/Documents/2022%20ASR/Annual%20Report%20on%20Suicide%20in%20the%20Military%20CY%202021%20with%20CY21%20DoDSER%20(1).pdf?ver=tat8FRrUhH2IlndFrCGbsA%3d%3d
Department of Defense. (2023). Report on child abuse and neglect and domestic abuse in the military for fiscal year 2022 [PDF file]. Retrieved from https://www.dspo.mil/Portals/113/Documents/2022%20ASR/Annual%20Report%20on%20Suicide%20in%20the%20Military%20CY%202021%20with%20CY21%20DoDSER%20(1).pdf?ver=tat8FRrUhH2IlndFrCGbsA%3d%3d
Johnson, T. S., Ganz, A., Berger, S., Ganguly, A., & Koritzky, G. (2018). Service members prefer a psychotherapist who is a veteran. Frontiers in Psychology, 9, 1068. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034519/
Meadows, S. O., Engel, C. C., Collins, R. L., Beckman, R. L., Cefalu, M., Hawes-Dawson, J., … & Williams, K. M. (2018). 2015 Department of Defense health related behaviors survey (HRBS). Rand Health Quarterly, 8(2). Retrieved from https://apps.dtic.mil/sti/pdfs/AD1129973.pdf
OneSource, M. (2021). 2021 demographics: Profile of the military community. Retrieved from https://download.militaryonesource.mil/12038/MOS/Reports/2021-demographics-report.pdf
U.S. Department of the Army. (2015). Army chaplain corps activities: Army regulation 165-1. Retrieved from https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/r165_1.pdf
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