Don't Worry, this isn't the ASVAB

What if I told you there's a quiz that almost every veteran scores high on, and it's not the ASVAB (yes, this is a joke, since I enjoy sarcasm in session and out of session).

During my time working with Veterans, there's a theme I often see that not many people are aware of. That theme is Veterans and childhood trauma, which ties into that quiz I mentioned above: ACEs.

ACEs stands for Adverse Childhood Experiences, which is basically a way of gauging the amount of childhood trauma you experienced before the age of 18.

During my traineeship in graduate school to become a therapist, I worked at an elementary school with little kids, and that's where I first learned about ACEs scores. To skip all the boring history of how it came to be. Essentially, a health insurance company accidentally discovered a connection between childhood trauma (emotional abuse, physical abuse, sexual abuse, emotional neglect, domestic violence, alcohol/drug abuse by parents, incarceration of parents, divorce, mentally ill parents, etc.) and health impacts, including mental health, physical health, and risk of addiction. The higher the score, the more trauma that child experienced, and the more likely they were to be at risk of negative impacts on their physical and mental health.

You might be wondering how this ties into Veterans. Typically, I ask all my clients to complete various assessment questionnaires. If you've been in therapy, or even had a regular annual check-up, you might recognize these. Some of them include the PHQ-9 (depression), the GAD (anxiety), and the PCL-5 (PTSD), and I personally always request an ACEs assessment (childhood trauma). I explain to all my clients that these scores give me an overall insight, a snapshot into themes and patterns that I then look for while we're in session and talking.

It was to my surprise that once I began working with Veterans, I noticed a very distinct theme: all my Veterans, combat or not, had high ACEs scores. Now, to clarify, not every veteran will have a high ACEs score, and not every veteran has experienced a high amount of trauma. There are always outliers in every population of people. However, in the work I've done with my clients, they have all had high ACEs scores.

Another theme that's prevalent in the veteran community is under-reporting. A significant number of Veterans seem to under-report the trauma and abuse they've experienced, whether it's because it was normalized behavior, they've blocked it out, or they simply don't recognize it for what it is. This is to be expected, and it's normal.

The reason ACEs are so important is that there are a couple of different schools of thought in the therapy world about where sessions should focus:

• Future-focused: Only look ahead, since that's where we're going. Set new goals, focus on growth, work on solutions.

• Present-and-future-focused: Fix what isn't working now, leave alone what isn't broken, and work toward new goals.

• Past-focused: Understand, heal, and process the past. Understanding why we do the things we do helps us address what's currently going on, which helps us in the present day and with building toward the future.

As I'm sure you can guess, I'm the latter. As a therapist, I believe that understanding why we do things, why we feel things, and the impact of the experiences we've lived, follows us. The patterns, behaviors, coping mechanisms, maladaptive coping (coping in an unhealthy way), and outcomes are all tied to our past: our childhood and our parents.

To be clear, I'm not the therapist who sits there and says, "Let's blame your parents, it's okay that you do XYZ, it's your mom's or dad's fault, not yours." But I am the therapist who says, "I wonder where you got this behavior from. This thought you have, where did it originate? That coping style, how did it form?" I'm a curious therapist, and in my time working with Veterans, that curiosity gives us insight, and that insight gives us the space to work through, heal, and ultimately move forward.

ACEs aren't just about the amount of trauma you experienced as a child. It's a roadmap to understanding my Veterans' pasts and connecting them to their present. As I so often explain to my clients: Veterans and childhood trauma go hand in hand. As Veterans, you are protectors and providers. Protect your legacy. Healing these things in session with me, recalling and revisiting those memories, sitting with them and allowing yourself to feel them, allows you to heal them. And if you can heal them, it's very likely your kids won't be in therapy 20 years from now working on this same trauma, and your grandkids won't be the next generation trying to fix something they didn't create. If you do this trauma work, you are protecting them. If you'd like to take the ACE's test, go here My name is Beth, I am an LMFT (Licensed Marriage and Family Therapist) in California and my Masters degree is in Clinical Psychology. But, I am also just a person who grew up with extensive trauma and abuse in my childhood, teen years, and young adulthood. Academics and school just made sense to me and were an escape from home life which was what led me to going to college and I took one psychology class in college and never stopped, it led me to becoming a therapist. 

I started working with the Veteran population in early 2023. I found that I loved working with Combat Veterans/Veterans and also their spouses because of things like the fact that dark humor didn't phase me (it was a familiar language that I also spoke), being able to still have my own personality and joke in sessions eased tension, creating a bond with my clients from a place of not being the expert, but a human with a difficult past helped my Veteran clients grow to trust me and begin to share more and heal.