Welcome Home - A Podcast for Veterans, About Veterans, By Veterans
Welcome Home is a Willing Warriors and the Warrior Retreat at Bull Run project. The program highlights activities at the Warrior Retreat and issues impacting all Veterans. For questions or feedback, please email us at podcast@willingwarriors.org.
Welcome Home - A Podcast for Veterans, About Veterans, By Veterans
A Silent Struggle: Inside the Veteran Experience of Military Sexual Trauma with Dr. Liz Rudisell
Dr. Liz Rudisell from the Lexington, Kentucky VA, brings light to a shadowed corner of the veteran experience, military sexual trauma (MST), during Sexual Assault Awareness and Prevention Month. As we sit with this dedicated Military Sexual Trauma Care Coordinator, we unravel the complex web of MST's effects on our veterans. This episode is a heartfelt journey through the often silent struggles of those who've served, revealing the VA's evolving efforts to support and acknowledge a group that has long grappled with invisible wounds.
Throughout our conversation, Dr. Rudisell offers an insider's perspective on the intricacies of VA services for veterans, discussing everything from eligibility criteria to the array of therapeutic modalities at their disposal. She weaves personal anecdotes with professional insights, painting a vivid picture of the challenges and potent healing that await within the VA's system. For veterans and their loved ones, this episode is a beacon of understanding and a guide to the resources that can start you on the road to recovery.
To learn how to access help for Military Sexual Trauma from the VA, use this link.
Good morning. I'm Larry Zilliox, your host Director of Culinary Services here at the Warrior Retreat at Bull Run, and today our guest is Liz Rudisell. Dr Liz Rudisell, she is the Military Sexual Trauma Care Coordinator at the Lexington, Kentucky VA facility facility and I wanted to have her on to talk about this issue and really give us an idea of what services are available through the VA for helping veterans, both male and female, with this issue and how to deal with it and some of the problems that veterans have in coming forward with this kind of trauma. So, doc, welcome to the podcast. I really appreciate you taking the time to get with us today.
Dr. Liz Rudisell:Yeah, larry, happy to be here and your invite is very timely. This is April. This is Sexual Assault Awareness and Prevention Month is very timely this is April, this is Sexual Assault Awareness and Prevention Month, and so the topic of military sexual trauma is one that we have really been trying to make sure that we're raising awareness about that, especially during this month, so happy to come and talk about it.
Larry Zilliox:Yeah, and if you would tell us a little bit about your background, and you're a psychologist, but what drew you to the VA, instead of say private practice?
Dr. Liz Rudisell:Yeah, so I actually started at the VA as an intern, so I had a little bit of experience previously at a VA, but not a lot. So I had gotten accepted to the Lexington VA specifically to do my internship to complete my doctoral degree and really, really ended up enjoying the work. I liked working with veterans I am married to a veteran so and have lots of them in my family, so it was a very personal kind of mission for me. But also getting into trauma work from from my internship I realized, hey, this might be something that I really want to do, a way that I want to be able to help people, and so VA is awesome for the research and the things that they've put into place to make sure that the trauma treatments that we're offering are evidence-based and the best out there. So I really wanted to learn that as an eager student and continue that work and go on with that.
Larry Zilliox:And have you always been the coordinator for this, or is this a position that you sort of moved into?
Dr. Liz Rudisell:So I was an intern from 2015 to 2016 and got hired on and I took this role in 2019, the very beginning of 2019. In 2019, the very beginning of 2019.
Dr. Liz Rudisell:Before that I was working in the residential PTSD and substance use treatment program at Lexington and was doing trauma treatment there in the residential setting as well, as you know, working with veterans who had experienced military sexual trauma. When this position came open, I was really interested in it because I saw it as a natural extension of my professional growth, but also of my personal goals for wanting to give back to veterans and help them in different ways. Mm-hmm.
Larry Zilliox:So I remember it's only really probably in the last 10 years that this has been something that the military or veteran community has even spoken about. I remember in the early days it was military sexual assault trauma and now it's kind of morphed into military sexual trauma, kind of morphed into military sexual trauma. When you first started in this was it the beginning of the programs that the VA was instituting to recognize this as more of an issue than they had in the past.
Dr. Liz Rudisell:So not necessarily so. Every VA has a military sexual trauma care coordinator and those were implemented a while back, but probably around that same timeline that you're kind of talking about in terms of it really coming to the forefront, really starting to be a conversation that people were willing to have, were asking about or just even putting on the table, and so that was slowly, year by year, we have moved a little bit closer to probably where we need to be to be able to serve veterans who have experienced these things in the military. That you remember?
Dr. Liz Rudisell:that maybe it used to be called military sexual assault trauma. I think probably one of the reasons that that has morphed into just military sexual trauma is because we recognize now that it's not just assault or like unwanted physical contact that someone might have in the realm of assault. In the realm of assault it's actually a longer host of behaviors, kind of like on a spectrum that would be considered military sexual trauma. So anything from like unwanted comments, harassment, cornering or pressuring for sexual attention or sexual activity all the way up into sexual assault. So it's a lot broader than a lot of times people realize and that definition has changed.
Larry Zilliox:Yeah, yeah. Do you think that's a result of just the program kind of expanding and seeing this issue in more and more veterans?
Dr. Liz Rudisell:Absolutely, absolutely. And I think that as the research, the psychology research, has also continued to evolve to say, hey, you know what, even if somebody doesn't experience a sexual assault, these other experiences that can happen, especially in a cumulative perspective, when there's multiple of these incidents that occur, and then even more specifically, in the veteran population, in that specific context of being a service member, that those types of things can actually still have a big impact and a big effect on people psychologically and physically, people psychologically and physically.
Larry Zilliox:So, as that research has progressed, the way that we define it, the way that we look at it and who we want to help right has also evolved. Looking at statistics and getting ready to have this conversation with you, I was kind of shocked to see that the VA reports that one in three female veterans and one in 50 men respond with yes to questions about whether or not they've experienced military sexual trauma Especially. It seems like that's a very high number. Do you know where it is in relationship to the general population?
Dr. Liz Rudisell:So it actually is a little bit higher than the general population and I'd say that, you know, each VA probably has a little bit of slightly different numbers, but on average yes, you're correct One in three female veterans and one in 50 male. When I first took this position back in 2019, that statistic used to be one in 100 male veterans and now they've since updated it and, larry, those are the veterans that will actually acknowledge it and feel safe enough to say, yeah, that happened to me, so the numbers are likely higher. You know if I was going to hypothesize, but I think that the fact that they've updated those statistics doesn't necessarily show like, oh, this is more of a pervasive problem, but maybe people are finally having this conversation with these veterans and then giving them the opportunity to say, yes, that did occur, and they feel okay saying that.
Larry Zilliox:Yeah, I've got to believe that it's a vastly underreported issue for both male and female veterans. But I also probably think that that number is changing because the programs that the VA has set forth here are building enough trust with the veteran that they feel comfortable in coming forward to help them deal with this situation, because I've got to believe that it's just a struggle. I've got to believe that it's just a struggle and of course, I'm guessing that it's usually not just this issue that you see PTS, depression, substance abuse, issues all stemming from this or accompanying this. Would that be a fair assumption?
Dr. Liz Rudisell:Yeah, so we know that people that have had a past history of sexual trauma go on at higher rates to develop certain mental health conditions and certain physical health conditions. And so, when we're speaking specifically about the veteran population, yeah, military sexual trauma predisposes, or kind of you know, ups that ante for going on to be more likely to develop a mental health or physical health condition. Now, a lot of times people hear military sexual trauma and they think, oh, you have to. If you haven't developed PTSD, well then maybe it really hasn't affected you. But that is not the case, right? It people deal with things in lots of different ways.
Dr. Liz Rudisell:People process things or don't process things, um, unfortunately, right, in lots of different ways, maybe because they cannot, and so that can then result in expressing itself in other psychological conditions like depression, like anxiety. Um, it can make certain mental health conditions that were already there could exacerbate them or make them worse. And veterans can still receive treatment, even if they already had a previous diagnosis. If there's a good argument that can be made that that condition was made worse by that experience that they had in the military, then they can still receive treatment for MST. And you know, we know that there's also other ways that people cope with a past history of trauma or sexual trauma, and sometimes that's through substance use or, you know, use of alcohol, and if they then go on to develop a physical health condition because of the way that they were coping, that's considered MST-related as well. Even though it's a physical condition, it's either a direct result of, or made worse by, that experience. They had.
Larry Zilliox:Do you see a higher rate, of instance, amongst veterans from certain branches of the service?
Dr. Liz Rudisell:So I don't really know. I don't have access to actual data that would speak specifically to that. I would point you probably in the direction of some of the DOD research that's come out recently. They've been doing some research and some surveys of current service members and kind of the rates of reporting and those kinds of things.
Dr. Liz Rudisell:So that would probably be a good place to look for that kind of data. But I'll tell you, it occurs all across branches of services, all across backgrounds and you know, nobody is necessarily quote unquote, you know, immune from potentially having this type of experience.
Larry Zilliox:So when you look at the varying degrees of military sexual trauma, starting with being pressured into sexual activities, threats of negative treatment, all the way to rape when do you find most of the victims landing? What category is it? Is it that superiors have used the power of their position for unwanted contact? I think a lot of people think, oh, it's all about rape and violence. But with this expanded definition, where do most of your patients land?
Dr. Liz Rudisell:patient's land. So again, that's kind of hard to necessarily generalize because it really is all across that spectrum. Now I would say that, statistically, because of most people's understanding or misunderstanding of what military sexual trauma is, they tend to think that it is the assault piece only, and so just due to that, you know, there's likely more instances reported that definitely fall to that side of the spectrum. But as we continue to raise awareness, as we continue to talk about hey, you might qualify for MST-related care that is free for these conditions, and here's these other experiences that also count, you know, as we continue to try to put that message out there, I think that it's starting to really capture that other end of the spectrum as well. But just saying, like you know, probably it is heavier towards the other side.
Larry Zilliox:Yeah, yeah. So let's talk a little bit about the treatment aspect. As you said, every VA medical facility has a military sexual trauma coordinator. Is that the point of contact that a veteran should seek out if they believe they have issues related to this?
Dr. Liz Rudisell:So, yeah, so I am my position's called care coordinator because I'm an advocate and a support and a source of information for them. I am a good point person for them to come to and say, hey, I want to know what I'm eligible for Like, do I fall within what is captured by MST-related care and what does that look like and what are my options. And I also have just a very informed conversation with them and process where are you right now? You have all of these things available to you and where do you feel ready to actually begin? Or you know, do you want to sit on this? Do you want to just think about what your options are and then maybe come back? Do you want to just think about what your options are and then maybe come back?
Dr. Liz Rudisell:Everybody's different and there's no one correct answer for every single veteran, and so that's one thing I always try to keep in my mind some coping, skill building and to really equip themselves to with being able to process that very traumatic event. And some people say I never want to talk about it. I'm going to tell you and I would like you know to be able to receive free treatment for my mental health conditions and my physical health conditions that are MST related, but I don't ever want to process all the details of what had happened because I don't think that I can or I don't think that's right for me and that is 100% an okay answer too, right. Sure.
Dr. Liz Rudisell:They have the power and the choice to be able to do that. So I that's one thing that I always want to say like I'm a great door and avenue to help you kind of figure out where you're going to go and what's available, and you don't always have to say that you know exactly what the answer is right now.
Larry Zilliox:So does a veteran need to have a service-connected disability rating to get services to deal with this issue?
Dr. Liz Rudisell:So no, that's a very common question. A lot of times people will kind of think that as well and make that assumption. But you do not have to have a service connection to be seen. Now there are a couple of caveats right for former service members about how they will qualify. So first question is kind of like does that instance that they experienced count as MST?
Dr. Liz Rudisell:If that's a yes, then did that former service member serve on service Like? So were they federally activated for service full time? And if that is yes, did they have a qualifying discharge? And the discharge is either honorable or other than honorable. And if that is a yes, then we look at like what types of care can be provided. So sometimes if somebody has an other than honorable discharge, they can still be seen for MST related care only, but and they can have a character of discharge, file a character of discharge to see if they can be eligible for VA purposes, and so there are other ways that if they don't have that, haven't met that 24 month eligibility to meet certain requirements for VA, then they can sometimes still be seen MST related care only. There are a couple of different caveats there but generally have to meet veteran status. So if it's someone you know who is in the National Guard and they have never been federally activated, unfortunately that kind of falls outside of that eligibility.
Larry Zilliox:Sure. So as a veteran, I'm dealing with this issue and I decide that I want to get treatment from the VA and I come to see you and we have that initial conversation and I qualify and I say I want help. What does it look like? Is it like a weekly counseling session or what does the therapy in general look like?
Dr. Liz Rudisell:Yeah. So you mean, if somebody says, hey, I want to, I want to engage in mental health treatment, is that you're kind of asking like, what does that look like?
Larry Zilliox:Yeah, what is? Is it the same as if they came to you for PTS or so they, we, I'll give them a range of options, right?
Dr. Liz Rudisell:So if they say you know what, I don't think I'm ready to do trauma intensive therapy yet, then typically I'll have them look at the our general mental health clinic. So I kind of give them the analogy that you know our general mental health clinic. You come in and they can treat you for pretty much any type of disorder that you've been diagnosed with Anxiety, depression, bipolar disorder, PTSD as well, or just current stressors, grief, those types of things. Kind of like your primary care doctor. Right, you go in you say I've got a headache, I've got a stomach ache, and then I've got this really bad foot injury. And they say, well, I can treat you for the headache and the stomach ache. Now that foot injury might need a specialist. Right, our PTSD clinical team and across the different VA's that call it different things my facility, we call it the PTSD clinical team they all they do day in, day out, is trauma treatment mm-hmm and so that's kind of like our our version of a specialist.
Dr. Liz Rudisell:Right, you have a foot injury. You might want the podiatrist looking at it. Right, if you have PTSD or a past trauma, it doesn't even have to be a full diagnosis of PTSD, it could just be the acknowledgement that this traumatic event happened. Those same evidence-based psychotherapies work well for those experiences as well. Now they're going to do what I've been referring to as that trauma intensive treatment, and there are a handful to choose from. So you make another choice right about which of those do I think is good for me. So if they go the route of the PTSD clinical team, they'll do an evidence-based treatment related to PTSD or to trauma, and that's typically once a week for 12 to 15 weeks, and that you know that's that's kind of it's. Another reason we call it intensive is because it is every week. You have things that you do at home. Part of the reason is because we want those things that you're working on to generalize to your real life right the general mental health clinic.
Dr. Liz Rudisell:You're probably depending upon if you are doing an evidence-based psychotherapy for depression or anxiety, your visits might be, you know, a little bit more spread out every couple weeks and also depending upon your availability and those types of things, we can really tailor it to the veteran. We know that people have lots of other things going on in their lives as they're working on themselves, but then they can also do medication management. Some people say I only want to do medication management and see a psychiatrist or a prescriber instead of maybe jumping right into therapy. For folks who think, you know, I want to do the evidence-based treatment but I don't know if I am going to be, you know, have the coping skills that I need or I'm going to need more support or I want a more intensive experience, sometimes residential treatment is a really good option for them, typically 45 days and they the residential program that come and they stay on VA campus for that period of time.
Dr. Liz Rudisell:They have groups during the day. They have their individual therapists there that they see twice a week. They do those same evidence-based psychotherapies but they're kind of like accelerated right. One of the reasons I really liked our residential Larry is because you got to see progress in veterans so like so quickly, right From when they came in and they were asking for help and having all of these issues and symptoms and the intensity of those symptoms and then by the time they were walking out the door. It's just it was one of those things that I think one of the reasons that people in healthcare do what they do, right, sure so, and so those are some of the options.
Dr. Liz Rudisell:Some people really like groups we offer groups. Some people want couples therapy or family therapy because their past MST experience has impacted the way that they are in their relationships with their spouse, with their kids, and how they parent Right. So we try to think of all of those different things and how they might impact. If they need substance use treatment right, if they're still coping or trying to cope right Maladaptively with that past history of MST, then we can offer the substance use, get them stabilized there first so that they can then move on to other things Employment difficulties. We can help address that Spirituality or issues or crisis of faith. I know that you had somebody from a whole health program on a while back.
Dr. Liz Rudisell:Whole health is also another great avenue for helping people kind of figure out what's really important to them and working on themselves. Psychotherapies are awesome. They work. We want them to do that, and we want people to take care of themselves and figure out their purpose and what really matters to them at the end of the day too. So they work great in conjunction together.
Larry Zilliox:Yeah Well, I would encourage our listeners to really take advantage of these services that are available to the VA. Even in, there's just so much that is left on the table and I see so many veterans that are struggling and they don't need to be. I know that there are a lot of issues with qualifying for a rating and a lot of paperwork and a lot of delay, but my experience has always been once you overcome that and you're in the system, the level of care that you receive is second to none, and I think Dr Rudisal is a good example of that. You really have laid it out for us. I really appreciate that. I think that our listeners are much more informed about this issue and just the counseling available in general to help veterans deal with PTS, with depression, substance abuse, with all the things that they've struggled with and trying to cope with this issue or something else. But I really appreciate you coming on today and really thanks so much for all this information and for everything that you do for all the veterans, of course.
Dr. Liz Rudisell:I really appreciate you having me on Larry.
Larry Zilliox:So, for our listeners, we will have another episode next Monday morning at 0500. If you have any questions or suggestions, you can reach us at podcast at willingwarriorsorg. Until then, thanks for listening.
