How is psychological therapy experienced by ex UK armed forces members? An exploration through personal narrative of cross-cultural encounters

The aim of the study was to explore through narrative inquiry the lived experiences of ex-UK armed forces members of psychological therapy, and contribute much needed qualitative findings to a research field currently dominated by quantitative studies. Interview conversations were conducted with ten participants who had served in the UK armed forces and had had weekly psychological therapy over a period of at least a few months since leaving. Narrative inquiry was adopted in analysing the transcripts, and two overarching themes emerged. First, participants revealed a strong identification with, and sense of belonging to the military, often referred to as ‘the family’. Participants implicitly and explicitly retained the values and ideology of the armed forces, such as high standards of personal conduct, structure, order and teamwork. Themes of power and agency also emerged, related to the ‘chain of command’ structure of their previous lives. Second, participants shared the strongly held belief in a significant gulf between military and civilian worlds, a divide that was exacerbated by the lack of a common language and vast differences in everyday professional and personal experiences. Challenges for therapy, particularly with civilian therapists, included how power and control were negotiated and the development of trust. Fear of not being understood or of being judged often led to clients withholding their military experiences in therapy. With military therapists there were different barriers to openness relating to rank and power, stigma, and the fear of personal information going on record and affecting promotion. Successful therapy was facilitated by a friendly, relational style in therapists, and robustness in the face of high emotion. It is recommended that therapists gain at least a rudimentary understanding of military culture, to appreciate the (real and perceived) military/ civilian divide, and to approach working with this client group in terms of cultural difference. Drawing on the ten narratives, twelve specific reflections are offered to enhance practice.