Last week I had the pleasure of interviewing Ivan Voronin, a Licensed Clinical Social Worker. Ivan has a deep passion for helping military personnel and veterans. With nine years of experience in various therapy settings, Ivan has gained valuable insights into the unique challenges faced by service members and their families.
Ivan has worked with military personnel in acute crisis response and stabilization, inpatient hospital and residential settings, as well as outpatient therapy in person and virtually. He has also worked extensively with veterans, providing them with the support and resources they need to successfully transition to civilian life.
Can you tell us about your experience working with the military population and how it has influenced your approach to therapy?
My desire to work with service members is what influenced me to go to graduate school. I grew up in a community with a heavy military presence and was fortunate enough to land an internship at a VA hospital during my last year at graduate school. I have continued to work with current and former service members since 2015 in various capacities. Most recently I was employed as a Military Family Life Counselor which gave me the opportunity to board several ships and interact with sailors directly in their work environments. Understanding military culture and dynamics is extremely important when providing services to the military population. In my experience, it has worked out great being a civilian and also have the ability to show understanding of the day to day stressors and dynamics service members experience. Rank and status in the military can carry a lot of weight, so being a civilian often allows me to connect with service members on a more genuine and personal level. Many junior service members see their active duty status as just a job, and often prefer to feel seen for who they are outside of the uniform. We can talk about guns, video games, cars, literature, music, and any other subject of interest to build rapport as two people hanging out together so then it feels easier and more natural to transition to topics of mental health. My experience has been that more often senior service members have become attached to their rank and position and identify more strongly with the military branch they are in. My approach changes slightly depending on the rank as I will typically validate and emphasize the responsibilities and prestige associated with higher ranking members. Talking about military equipment, training exercises, deployments, etc. brings me excitement so I adopt a curious and open mindset to ask a lot of questions about social and professional dynamics within their units or divisions. Even though I am a therapist I still remind my clients of OPSEC and ask them to not share anything I am not supposed to know. After hearing more than 100 stories and individual experiences from service members I can make out certain patterns associated with being in the military which has been helpful in providing validation and understanding for new clients. Military culture and ethics play a big role in the approach as there is a high emphasis on maintaining barring, being capable, competent, and resilient. From my experience service members recoil at sympathy, and it’s not very effective telling them how hard their life must be. I have noticed that having a more neutral tone of voice and empathically reflecting information allows service members to process more effectively and feel more comfortable sharing more. Service members often have high levels of self judgment when it comes to feeling and experiencing negative emotions so it sometimes feels like walking a tightrope between providing an opportunity for exposure and a healing relationship, and risking pushing them away due to their embarrassment and self judgment towards what they are experiencing. At the same time I have learned to not fragilize service members and have seen an incredible capability in my clients to process difficult emotions and follow through with therapeutic recommendations which has resulted in them getting better more quickly. It’s a bit of a dialectic.
What are some of the most common mental health issues you see in military personnel and veterans, and how do you address them in therapy?
The most common issues I have seen are related to allostatic load which is a chronic moderate-high level of physiological and mental stress that includes a perception that they are responsible for things outside of their control, fear of punishment for things outside of their control, and a sense of hopelessness/helplessness with being able to accomplish everything that is tasked. Another common issue I call “emotional constipation” because many of my clients have repressed emotional experiences to the point that they experienced physiological symptoms. On paper it seems like service members struggle with depression, anxiety, substance dependence (alcohol, caffeine, nicotine), other mood disorders, difficulty with attention and concentration, etc. However, looking beneath the surface, most of my service member clients were struggling with real human issues and normal human emotions without knowing healthy ways to express or cope which was causing clinically significant symptoms. Many service members have also endured grueling schedules and dysfunctional work dynamics so environmental stress can play a big role in symptom presentation. Any service member that has to stand duty or work varying shifts will also experience sleep deprivation which greatly affects their mental health. I always tailor my approach to the individual by first understanding mitigating factors and things my clients are enduring in their daily life. I then look for the most obvious patterns and present my clients with a choice: do you need help with problem solving the situation and being more effective? Do we need to work on accepting and processing some things that are going on? Do we need to work on some skills to help you get through this and manage it better? Or, would you prefer to do nothing and potentially make things worse? Depending on their response I will use Dialectical Behavioral Therapy, Gestalt, or Internal Family Systems; whichever seems to be the most effective at the moment. Many service members also have significant trauma histories from their childhoods or from their time in service. Young people often enlist in the military in order to escape a problematic household or communities that experience high levels of violence, drugs, etc. I am typically very careful when it comes to approaching trauma treatment with active duty members due to the high levels of stress they experience on a daily basis, so I typically avoid treating trauma directly while they are active duty so I do not risk them de-compensating.
Working with veterans is a bit different than working with active duty because they are no longer in that environment, but may continue to experience the same type of symptoms and patterns as if they were still in. Veterans with many years of service sometimes struggle with letting go of that part of their identities and integrating back into civilian life. Some veterans also hold negative and pessimistic attitudes towards civilians due to a difference in ethics and values which has been described as feeling like you’re constantly have to bite your tongue and grit your teeth when you cannot correct rude behavior at the grocery store, or people getting in your way in public because they are walking mindlessly. I have worked with many clients on accepting the differences between civilian and military life and helping them let go of putting military-like standards on civilian behavior.
How do you help clients navigate the transition from military to civilian life and address any mental health challenges that may arise during this process?
First, it is important to start with a checklist of everything they have done or have yet to do related to their transition. I encourage service members to get every possible medical related thing documented prior to their EOS date, whether they are seeking VA benefits or not. Service members should register with the VA as soon as possible even if they do not plan on using VA services because it’s a great back up option in the case of medical emergencies. It’s important to talk about their plans for work and where they will be moving to after their final permanent change of station so they feel a sense of stability. I have noticed that individuals retiring from the military sometimes struggle the most due to experiencing such a dramatic change after living 20+ years with a certain routine and expectations, and also having a large part of their identity connected with the military. I have noticed that many juniors feel a sense of relief associated with the end of their last contract, but just like seniors are liable to experience adjustment issues and an influx of mental health issues they may have been avoiding during their time in service. Receiving mental health help still carries a big stigma in the military so my service members avoid, white knuckle it, or distract continuously until their service has ended or their issues simply become too prominent to ignore. I would encourage every service member leaving the military to attend psychotherapy for a few sessions to talk through their transition, process their experience, and at the very least create a better association with receiving mental health help if they might need it in the future. I believe that if mental health treatment was treated the same as a routine out processing appointment it could help remove many barriers in the long run.
How do you work with clients who may be resistant to seeking mental health treatment, particularly in a military culture that often stigmatizes mental health issues?
I work on normalizing human experiences as much as possible especially when their feelings and reactions are valid for the context they are in. I have also found it helpful to create clear definitions for my role as a therapist and provide education on the mechanisms of action in therapy. As a therapist my role is to be non-judgmental, to seek understanding, to provide a compassionate presence and facilitate a space where spontaneous healing may occur. I let my clients know that therapy is often not about giving advice and that they are the experts on themselves. My role is often focused on bringing attention and awareness to things they may be avoiding in their minds or in their bodies, helping them confront those things with a healing intention, and to let my clients use me as a sounding board so their brains can make spontaneous adaptive connections as they talk through experiences out loud. I empower my clients by letting them know that they are in control of the process and have the power to stop, redirect, and comment on the treatment itself as necessary as long as they communicate openly. It is important for my clients to know that I have no intention of changing who they are as people and that receiving mental health treatment is not a reflection of their ability or inability to perform as a service member. I explicitly discuss my documentation process and that I write down only the necessary information relating to the visit (If documentation is required). I have found it helpful to use specific examples and hypothetical situations when explaining the limits of confidentiality to help them feel more comfortable with sharing their experience without the fear that I may document or report something that may harm their career. I also reassure active duty service members that they have rights when it comes to being questioned about services they receive and can respond that they have a “medical appointment” if questioned by leadership.
How can people learn more about you and contact you?
You can check out my PsychologyToday profile by typing in Ivan Voronin, LCSW/Vestra Psychotherapy. There you will find my contact information if you would like to get in touch. You can also reach me through email at ivan@vestrapsychotherapy.com. My personal website is in the works!