When the Patient Remains in Danger: Psychotherapy in U.S. Combat Zones

Much of the literature on the psychological treatment of victims of violence focuses on demographic populations that do not represent the majority of victims. Part of the origin of this problem is that the prototypical victim and the prototypical perpetrator are often the same. Young, poor, minority males often constitute both the victim and the perpetrator class in America. As a group, these individuals, while disproportionately thought of as suitable for incarceration, are not thought of as good candidates for psychological treatment. However, their suffering is real, unrelenting and often not addressed. Therapists face significant barriers, in the patient, in society and in themselves, in trying to help these individuals. This article examines the issues of racism, drugs, ongoing danger, class inequalities, misogyny and the blended victim/perpetrator, all of which complicate engagement and understanding between therapist and patient.