Healing the Hidden Wounds: Dr. Aaron Banas on Mental Health Support for Veterans and Their Families

Embark on an enlightening journey with me as I sit down with Dr. Aaron Banas from the Steven A. Cohen Military Family Clinic at Easterseals in Silver Spring, MD, for an intimate conversation that promises to reshape your understanding of mental health care for military families. Uncover the deep-seated compassion and dedication that fuels this partnership between the Cohen Veterans Network and Easterseals while providing a beacon of hope to those who've selflessly served our nation. From the silent wounds of trauma to the unspoken struggles of moral injury, Dr. Banas and I navigate the intricacies of support systems designed to heal and fortify the bonds of those who've borne the brunt of service – veterans, active-duty members and their indomitable families.

This heartfelt exchange not only showcases the tailored therapeutic approaches employed by the clinic—from play therapy to individual counseling—but also casts a reverent spotlight on their lifesaving crusade against veteran suicide. Discover the power of community connections and the silent vigil families hold as they become proactive guardians in the battle for mental wellness. Dr. Banas shares the Cohen Clinic's innovative hybrid service model, ensuring no barrier exists between our veterans and the care they deserve. Join us for this moving dialogue that champions the brave, reaffirms the spirit of service, and ignites a call to action within the veteran support network.

To learn more about the Cohen Clinic or schedule an appointment, contact them at info.mfc@eseal.org or call 240-847-7500.

Transcript

Larry Zilliox: 0:15

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 Dr Aaron Banas he is with the Cohen Veterans Clinic there in Silver Maryland, and is on staff there, is part of all of the organizations that we all belong to here in the DC, Virginia, Maryland area.. It's just a wonderful organization and I'm very excited to hear about everything that they do. I know them from being in the veteran space. You guys are just doing such great work. So, doc, welcome to the podcast.

Dr. Banas: 1:02

Thank you so much, larry. It's really a pleasure to be here. I had the good fortune to be a participant at the retreat back in 2020. And when I brought my family, we had a phenomenal time here, and being back here brings a lot of really fond memories, so it's really a pleasure to be here.

Larry Zilliox: 1:25

Well, we're so glad that you're able to come back and talk to us about the Cohen Clinic. If you would just kind of start with sort of the history of the clinic, how it came to be, what its association is with Easterseals, and just give us a kind of brief overview of that.

Dr. Banas: 1:37

Absolutely so. The name is a bit of a mouthful. So we are the Stephen A Cohen Military Family Clinic at Easter Seals. Wow, like that's a full mouth.

Larry Zilliox: 1:49

Yeah, that's why I shortened it, because I knew I was going to get that wrong.

Dr. Banas: 1:53

Right. So the Cohen Clinic is. We're part of two organizations, so the Cohen Veterans Network, which has 22 clinics nationwide that provide services to anybody who is military affiliated. This includes active duty military, their family members, veterans regardless of discharge status and their family members, as well as family members or friends who may not be traditionally covered by the VA or DOD care. So let's say somebody has a grandchild or a grandparent or a cousin, somebody that's been affected by military service, or even a friend.

Larry Zilliox: 2:35

we will see all of those individuals and the services that you provide are mental health services right Correct.

Dr. Banas: 2:41

yes, so we provide mental health services in the form of individual, family, couples and group therapy.

Larry Zilliox: 2:50

The clinic that you work out of is in Silver Spring, so geographically that covers the Virginia Maryland DC area. Yeah, that covers the Virginia Maryland.

Dr. Banas: 2:58

DC area. Yeah, so we currently cover DC Maryland, Virginia, West Virginia and we're also looking to expand into Pennsylvania and part of New Jersey as well With additional clinics in those areas. Sure, so for now it's just going to be our clinic, but we're looking at having potential satellite locations.

Larry Zilliox: 3:19

Okay, it's in-person treatment, but is there also a telehealth aspect to it?

Dr. Banas: 3:25

Absolutely so. We offer hybrid services, pure telehealth, especially for folks who may be more distant to the clinic or who just don't want to have to drive through DC traffic. Yeah, I get that. Yeah, to come and see us. Yeah, there is a clinic in Virginia, by the way, and I just want to mention to drive through DC traffic?

Larry Zilliox: 3:39

Yeah, I get that. Yeah, to come and see us? Yeah, there is a clinic in Virginia, by the way, and I just want to mention that it's in the Tidewater area. So if you're listening and you're down in Southern Virginia, that would be the clinic that's closest to you. What are the types of problems that active duty and veterans and family members come to?

Dr. Banas: 3:58

you with. I'd say one of the biggest ones is trauma, whether it be trauma from deployment, trauma related to moral injury. Also relationship concerns, particularly for folks who've had a long career of military service and either they're transitioning out or they're out and now they're with their family or spouse or partner all the time, and this kind of brings up new dynamics and new challenges and also new opportunities. And so we work a lot with couples, a lot with families and a lot with stress and trauma.

Larry Zilliox: 4:35

Is the trauma within the family usually a result of the veteran or the service member having PTS issues? Or when you say trauma, what specifically are you talking about?

Dr. Banas: 4:50

Oftentimes there is this sort of secondary trauma right where it's almost as if so let's say, you have a service member who deploys and experiences trauma in some form or another, whether it be the threat of death, witnessing or learning about other threats to self or others. Mind has to change, it has to adapt to those circumstances, and so you can't behave in the same way in an operational environment as you do back at home. Sure, but the brain as a brain and body change. This requires sort of like a return to baseline. But it's a really challenging thing to do, especially if you get back and there's a lot of stressors waiting for you back at home, whether it be stress from military duties, stress in the family, financial stress, you name it, and that kind of keeps people's nervous system, which is what's affected with PTSD, kind of amped up and there's really this challenge to reintegrate back in and allow your body and mind to come back to a level of pre-deployment.

Dr. Banas: 6:01

And so what ends up happening is, let's say, you have a service member who now may be more vigilant, more aware of their surroundings, more kind of on edge with things, anxious, right Anxious, which again that's an adaptive sort of response. In an operational environment. You have to be on alert in order to accomplish your mission and ensure nothing goes wrong. But now, when family members begin to see this, they begin to take on these traits right, and this isn't absolutely not to blame the service member. This is just kind of the natural progress of things. Families want to support the service member and so as they learn how the service member responds, they start responding similarly as well.

Larry Zilliox: 6:44

So what group do you see the most of? Is it active duty? Is it veterans? Is it family members?

Dr. Banas: 6:51

Which group comes for the most treatment. Sure. So I would say for now it's post. 9-11 veterans is the biggest group that we're seeing right now, especially as a lot of our 9-11 veterans are beginning to retire. We're seeing a significant number there. We also see quite a few active duty service members. We're in a heavily military saturated area. We have quite a few referrals from Fort Meade, walter Reed, fort Belvoir.

Larry Zilliox: 7:23

The veterans and the post-9-11 veterans that you see. Are they opting to come to you and not seek VA treatment? Or is this part of their VA treatment protocol? Or how do you? Are you totally separate? Do you integrate in any way? I'm always curious as to why veterans some veterans just avoid the VA like the plague, which is unfortunate. I think I know they've had some bad experiences, but you know I always say it's a battle to get in. Once you're in, you do get very good care, but I'm curious as to what you find as to why they're coming to you and not so much the VA or the Vet Center or some other offering from the VA certainly some active duty and veterans do come to us if they don't feel comfortable going to their local MTF or to the VA.

Dr. Banas: 8:23

However, I would say the majority are direct referrals from the VA and from the military treatment facilities. We receive these on a pretty consistent basis. We partner very closely with these organizations and typically, I would say one of the biggest reasons that folks come to us is access to care at the VA and DOD can be challenging sometimes, especially for families, which we've seen a significant uptick in recent months, for couples therapy, which oftentimes the VA does not provide, family therapy, which is pretty much it's extremely rare in both the DOD and the VA and we provide that. And also, yeah, we see a lot of folks who they're trying to get in for mental health services but they may have to wait months. This is often for short-term therapy or very limited, and so we end up getting referrals directly from the VA and the DOD for treatment.

Larry Zilliox: 9:24

So it's more of a care in the community aspect than an overflow. Are they just burdened to the point where they're just referring them out?

Dr. Banas: 9:33

to you. Yes, that's correct. Yeah, I recently saw a service member try to get into one of the local MTFs and I think the wait was about four months.

Larry Zilliox: 9:44

That has come about, thankfully, because of the Compact Act, which, for our listeners, if you're not familiar with that if you're a veteran and you're having a mental health emergency, you can seek treatment anywhere in this country. You can seek it from a hospital, a clinic, a private practice, anywhere, and the VA will pay for it. Your guys are no exception. I'm sure that, hopefully, they pay you. Well, let's talk a little bit about the kids. We like to refer to them as the hidden heroes. They are caretakers in their own right, maybe not as much as the primary caretaker, mom or dad, but I sometimes think about them in much like growing up in an alcoholic home, in the sense that they don't have friends over to play. They always go to somebody else's house because they don't, they're not sure if mom or dad is really going to just explode or something somebody does or says is going to trigger something, and and I know, uh, they uh carry a burden and there's this generational trauma that exists. And is that primarily what you're seeing these families and these kids for?

Dr. Banas: 10:59

And is that primarily what you're seeing these families and these kids for Absolutely that and, unfortunately, divorce, oh yeah, which is all mixed into all of that, sure yeah it's kind of a downward spiral, for sure.

Larry Zilliox: 11:16

What is the typical therapy look like in a situation like that? Are we one-on-one with the kids, or is it sort of a family thing with mom and dad? How does that work?

Dr. Banas: 11:24

It really depends on the situation. So oftentimes parents the first approach is parents will say here's my child, we're having difficulty, please fix them Right. But oftentimes it's not the child, it's the family system.

Larry Zilliox: 11:40

Yeah, yeah, it's a dynamic of the environment that they're in, the veteran and their issues with PTSDBI, possibly substance abuse issues I'm sure you see a fair amount of that which aggravates everything. And then the child's just trying to function and survive and go to school and do everything that they need to do in that environment and I know it's got to be really hard and troubling. How long are they in therapy? For a short while, or could they be in for a year? How does it?

Dr. Banas: 12:14

work. Sure, especially with families and children, we try to be as flexible as possible. No-transcript you Well, I'd be able to function and do some of the things I enjoy and so forth. Okay, good, so we would focus over the next few months working on getting that anxiety down to a four for them, whatever that what we call episode of care. We'll sort of reevaluate and see are there any other goals to focus on? So we got your anxiety down, but let's say you're still struggling with sleep. Then we'll do another course of treatment over the next few months targeting that sleep.

Dr. Banas: 13:14

And it's the same thing for children and families. And so oftentimes, as I mentioned, families will come in they'll say fix my child. We may see the child for a few sessions, and if the parent isn't in a place, it isn't in a stage of change where they're like, yes, we need family therapy. We'll first work with the child and we'll have collaborative sessions with the parents to give feedback and recommendations and in that way we'll slowly pull them into the therapy process. And so what that might look like is working with a child for several months, maybe doing something like play therapy, which is a very effective method of getting a child, because how many children and can you sit down with and say, hey, tell me how you're feeling right now? All right, lay down on the couch.

Larry Zilliox: 13:58

Yeah, it just doesn't work. What's the age group primarily? Are these very young kids like six, seven, eight, nine, or are we talking teenagers?

Dr. Banas: 14:06

Yeah, we're seeing kids as young as four. Oh, wow, okay.

Larry Zilliox: 14:09

And then after treatment, is there follow-on maintenance, like yearly or as needed, or how does that work.

Dr. Banas: 14:18

So once one of our clients, whether it be a child or family, whomever even our groups will offer what are called booster sessions. So these are as-needed sessions where again, we're not going to turn anybody away, and these are nice ways to kind of check in with folks, see how they're doing. So, like some of my own clients may come in once a month just for kind of a tune-up. Just like a tune-up hey, this is how things are going, and then we could reassess. Just like a tune-up, hey, this is how things are going, and then we could reassess and if at any point things start to get worse for them, we could bring them in for another regular course of therapy. Right, how does?

Larry Zilliox: 14:51

somebody get in touch with you to get help?

Dr. Banas: 14:55

Sure, so they could call our clinic let's see if I can remember this off the top of my head 240-847-7500. I will say 99.9% of the time you call that number between our normal business hours, which were open from eight to seven Monday, tuesdays, and from eight to eight Wednesday, thursdays and until 3.30 on Fridays. But you call that number, more likely than not you're going to get a person. One of the things about our clinic that I'm especially proud of is our customer service. We will make sure that either you get a person or you get a call back the same day. I can guarantee that you will receive that. And so our front desk is very they're very on point with making sure that everybody gets contacted. They're very on point with making sure that everybody gets contacted.

Dr. Banas: 15:47

So we have, once somebody contacts our front desk and say, hey, I'd like to speak with somebody or one of our front desk staff members, they know everything that we do, so they would provide a general gist of the treatment From there. They would get them connected with an appointment with our intake team. So, generally, from point of contact in what you call to an intake appointment, which is just kind of understanding your needs, what you're looking for and are we able to meet those needs? That's around no longer than 72 hours. So that's kind of like a first initial appointment. After your intake appointment then you would you from the intake team would then schedule you with one of the clinicians. So this would be sort of a full evaluation, really kind of doing a deep dive into what's bringing you in and how we could help. And getting into that appointment is generally, if it goes longer than two weeks, it's probably more of like a scheduling issue, but in most cases we can get people in the same week, if not within two weeks.

Larry Zilliox: 16:52

And could you substitute like a telehealth appointment, if it's going to be a scheduling issue, just so that they get some sort of initial treatment contact fairly quickly?

Dr. Banas: 17:05

Absolutely, and as long as you are in a private spot. You could be at a park, you could be in your office at work, you could be sitting in your car. As long as you're in a place that's private enough, we could see you wherever you are, okay.

Larry Zilliox: 17:19

The webpage. We'll have a link to the webpage in the show notes as well as the phone number. Is there a contact form on the webpage? Can they go through the webpage to?

Dr. Banas: 17:31

reach you, absolutely. Yeah, the webpage is another great place to contact us through, okay.

Larry Zilliox: 17:36

How big is the clinic? I mean? When we say a clinic, I'm thinking of like a hospital kind of setting, but it's probably just very nice offices and a place where you have a reception area. How many people work there? What's the?

Dr. Banas: 17:51

setup. Yeah, it's very much not like a hospital place, a hospital clinic. When folks come see us for the first time whether it be visitors, it be visitors new students or our clients they talk about how friendly the space is. We have a nice fish tank in our lobby, we have a play area for the kids oh wow. We have books, resources, we have a Keurig, water, snacks, a little library, so we have all kinds of things just to make it as friendly as possible. One of our goals is really to create community and have a community feel for things, and so, yes, it absolutely does not feel like a hospital setting at all. Wow.

Larry Zilliox: 18:36

How many employees are there? How many clinicians? What's the breakdown?

Dr. Banas: 18:41

there, sure. So we have nine full-time clinicians, we have a clinic director, we have a psychiatrist he's an Army veteran and he's fantastic, wow we have a case manager, an outreach coordinator, and we have an intake team of two, and so we have a pretty robust staff.

Larry Zilliox: 19:03

Yeah.

Dr. Banas: 19:03

We currently have two students from the Uniformed Services University an active duty Air Force officer and an active duty Army officer. We have a counseling intern. Next year, we're going to have four students from Uniformed Services University Awesome.

Larry Zilliox: 19:21

That's just great. I'd love to see that where the military medical providers get real world experience, because I think they're going to see things at your clinic that they just won't see in their military practice, especially when it comes to the family dynamics and therapy and that kind of thing. Are there any group therapies for veterans?

Dr. Banas: 19:46

Yes, absolutely so, currently. So we regularly run a couples therapy group. We also are currently I'm actually co-facilitating with one of our counseling fellows, but I forgot to mention we have two of those. We're doing an acceptance and commitment therapy for caregivers. We're doing an acceptance and commitment therapy for caregivers. So this has been a.

Dr. Banas: 20:07

We've done two sessions so far and this is our first time running this particular group, and I should caveat that we really look to the needs of the community as we're designing groups. We don't just say, hey, we're going to do this group and throw it out there and hope somebody shows up Right. We really look at what the needs are, what we're seeing, what are a lot of the concerns and, like with a couples group, we saw a huge need for couples therapy. So we said, well, hey, let's get together and do this couples group and it's been successful. We do a parenting support group. We're doing a LGBT group later in the summer. We're doing a LGBT group later in the summer. We're doing a parenting support group for ADHD later on in the summer as well. So we always have some form of group or another going on, Right.

Larry Zilliox: 20:54

And go back to the first one that you talked about, the acceptance and what was that, sure.

Dr. Banas: 20:59

So acceptance and commitment therapy for caregivers? So what is that? I've never heard of that. And commitment therapy for caregivers so what is that? I've never heard of that. So acceptance and commitment therapy sort of the metaphor that this sort of treatment uses is imagine to solve a problem. You have a shovel and it's to dig a hole, and so you keep digging and you keep digging and before you know it, you now dug this deep hole that you're now stuck in, and so you have no other tools with you. And so what do you end up? Keep doing? You just start digging again and you get deeper and deeper in that hole. And so with acceptance and commitment therapy, it's just being able to say, hey, this is where I am right now.

Dr. Banas: 21:38

If I, just if I try to do or change things or try to control, then it actually can make things worse for me. And so really really revolves around control and how control affects anxiety. Because when somebody is experiencing anxiety, they try to control it Only if I do this or if I do this or if I change this. But the irony there is, the more you try to control that anxiety, the more you're feeding into it. So the goal is there is practicing mindfulness techniques, so helping to calm your body down when you get into a state of stress, but also allowing yourself to feel what you need to feel and then make committed action with willingness rather than control.

Larry Zilliox: 22:19

Mm-hmm, how much if you have a sense of it, because I know that there are a lot of veterans that are just not forthcoming at all about suicide. But what's your sense of how many veterans out there are at risk for veteran suicide? It's considerable, yeah it.

Dr. Banas: 22:44

It's considerable.

Larry Zilliox: 22:45

Yeah.

Dr. Banas: 22:46

It's very considerable. I think one of the big reasons is isolation.

Larry Zilliox: 22:51

Mm-hmm.

Dr. Banas: 22:51

Yeah, when there's a lack of connection with the community, with your family, with others, with feeling that you're alone and other people don't understand you or your experience, then it can take you to a really dark place.

Larry Zilliox: 23:05

Mm-hmm.

Larry Zilliox: 23:05

That's why I think programs like the American Legion's Be the One or Buddy Checks or that kind of thing are huge, because anytime you can get the veteran involved in just about anything will help with that.

Larry Zilliox: 23:23

I almost think, too, that if you're a listener who has a family member who's a veteran that seems to be pulling back and more and more isolation in their in their life, that getting them to reach out to you all, even through telehealth, would would really benefit them, because you know, okay, they don't have to leave the house, but certainly they got that computer there and they know how to work. Zoom, yeah, I think that would be a great thing to do, just to get them in touch with you. And, kenneth, how does that work if a family member has concerns? Now I know the family member should call you for their own therapy sake, because dealing with a loved one who's a veteran, who has PTS, maybe TBI, employment issues, financial issues, maybe stressors because of a recent divorce, substance abuse, issues, which I'd like to talk a little bit about that as well but they really could use the therapy to help them navigate that whole situation. But can they reach out to you and try to find help in finding a way to get their loved one in touch with you.

Dr. Banas: 24:43

Absolutely. One of the things that I do on a regular basis is provide consultations. So this means that, so, let's say, a family member calls into the clinic with concerns, our front desk would connect them with me. They don't need an appointment, we just have to find a time to speak. You don't have to register. You don't have to do anything. I'll provide, I will listen, I will hear you and I will provide guidance. And even if that means speaking to the veteran or service member myself to say, hey, what's, what's going on? How can we help you, so it's sort of like a informal consultation. That's one of the things I'm more than happy to do, wow.

Larry Zilliox: 25:20

Yeah, that's huge because definitely isolation is really a real, real problem. Substance abuse issues I don't think you these days see veterans who aren't self-medicating and don't have issues where it's not aggravating their PTS or TBI, where it's not aggravating their PTS or TBI, and is that all incorporated into the therapy and the process of trying to get them?

Dr. Banas: 25:51

straight? Absolutely, because with substance use the irony there is that it helps reduce symptoms in the moment, but what it ends up contributing to is avoidance, and avoidance will perpetuate both anxiety and post-traumatic stress symptoms, and so you will never actually fully work through the problem. You're just kind of kicking it down the road to later and then it hits you again and then you have to go back to whatever the substance is, and so we certainly incorporate that in our treatment. In fact, several of our staff members are substance use counselors, so we have capacity to do that.

Dr. Banas: 26:33

That is not always our number one treatment, just because if somebody comes in with serious substance use, we'll need to get them to the level of care where they would most benefit. So if somebody, let's say, is using drugs or alcohol on a daily basis, we're probably not the right level. And let's say they can't hold a job, their family's falling apart, we're probably not the right level of care for them. But we don't just turn them away. What we'll do is we'll get them to work with our case manager, who will help connect them with the best mode of treatment, whether that be a residential treatment or partial hospitalization or intensive outpatient program. But we would continue to see the service member or veteran until they're in that program, right? So we don't leave them hanging.

Larry Zilliox: 27:22

Yeah, Talk about the relationship with the clinic and Easterseals. I'm really. I see it's part of the name, but I'm not sure how that works Absolutely.

Dr. Banas: 27:31

So each of the 22 clinics nationwide their part. They sort of had two parent organizations, one being the Cohen Veterans Network and the other being an affiliate site Like for. So for us Easter Seals is our affiliate. So Easter Seals, they've been around forever. Yeah, I think it comes around since around like 1916 or 1918. They've been around for quite some time. And so Easter Seals itself as an organization has different locations. So we're within the DC, maryland, virginia, west Virginia region, and so Easter Seals offers a range of services. They have the Veteran Staffing Network, which provides employment resources for veterans. They have the Homeless Veteran Reintegration Program. They also have adult day services. They have child care, development centers, head Starts, so a wide range of programs. So as a part of Easter Seals, so we're housed in an Easter Seals facility, so you co-locate with them. Exactly, I see, yeah, so we're part of their organization network, but we're also part of the Cohen Veterans Network as well.

Larry Zilliox: 28:41

And the funding comes from the Cohen Veterans Network or Easter Shields, it's split evenly. Oh, okay, wow, that's great. Well, it's good to know because I've always heard the name and always wondered what the association is there. As we kind of wrap up here, what's the one thing, the most important thing you'd want our listeners to know about the Coen Clinic?

Dr. Banas: 29:05

One of our most important, I would say, goals is community. We want to be here to support you, to support our community, and we're here. It doesn't have to be this. You know mental health. It can be scary, thinking like, oh no, I need to go and get my head shrunk. We're a pretty down to earth bunch. We'll kind of get a sense of what's going on and help you however we can, whether that's with us or getting you connected with resources in the community. We're here for you and it doesn't have to be. I have to schedule an appointment. You're welcome to consult with me and, Larry, I can give you my information to put out there. Folks are more than welcome to reach out to me individually. I always welcome those calls and those messages, and so we're here for you. If you're struggling, it doesn't have to be alone. If we can't help you, we will find somebody in the community who will be able to Great.

Larry Zilliox: 29:55

Well, listen, doc, thanks so much for coming out and sitting down with us and telling us all about the clinic. Telling us all about the clinic Just amazing resources that you all provide and the help that you provide for not only active duty but veterans and family members. Especially, as you mentioned, the resources out there for family members are much more limited than they are for veterans and active duty, so that aspect of the work I think is just wonderful and amazing. So thank you very much for coming out and joining us. Thanks so much, larry, for our listeners. We'll have another episode next Monday morning at 5 am. If you have any questions or suggestions, you can reach us at podcast at willingwarriorsorg. Until then. Thanks for listening.