MST: Military Sexual
Myla Haider is a former criminal investigator, counselor, advocate, writer, and survivor of Military Sexual Trauma
(MST). She served in the U.S. Army and deployed to Bosnia, Afghanistan, and Iraq. As an Army CID agent she
worked MST cases involving both male and female victims. She testified against her own offender in 2005 and was
subsequently discharged from the military without benefits after nearly ten years of honorable service. Ms.
Haider spent five years appealing her discharge and was finally medically retired in 2010. Ms. Haider has briefed
members of Congress on systemic investigative deficiencies associated with MST and written articles about MST
investigations published in the journal "Sexual Assault Report." She currently operates a peer counseling program
for MST and combat-related PTSD through Coffee Strong, a G.I. coffee house outside of Fort Lewis, Washington,
and continues to advocate and write about MST and realistic improvements to the DoD system.
Elizabeth Stinson: LMFT licensed in California and Oregon, with a private practice in Portland, OR. Elizabeth has
extensive experience working with survivors of abuse and torture. Elizabeth is a Marriage and Family Therapist who
provides MST trainings and counseling for clinicians throughout the United States. Her extensive clinical work with
trauma and sexual assault survivors includes returning veterans and military members. In her role as an advocate
for human rights, civil liberties and trauma recovery, She established the military trauma committee of the Bay
Military Law Panel of the National Lawyers Guild and is a clinical member of ISTSS, AAMFT & OAMFT. In January of
2011 she was invited to participate in a VA arranged think tank of MST and to present in a veterans administration
workshop in Vancouver, WA on the impact of military sexual trauma on the veteran and their families and
community. firstname.lastname@example.org & 503 327-1772
Military Sexual Trauma (MST)
• Military Sexual Trauma
(MST) is sexual assault
and/or harassment in a
US military setting.
Either the victim or the
perpetrator can be a
member of the military.
Often, both parties are
service members. MST
can occur stateside or
Sexual Trauma is unique in a military setting both during
peacetime and war for several reasons including:
• Survivors of MST commonly live and work with their perpetrators, during and after
• Many survivors are dependent on, or report to their perpetrators. This power
dynamic makes it difficult to report for fear of retribution. Sexual assault by a
superior is commonly called “Command Rape.”
• A survivor, male or female, faces serious stigmas for reporting assault or
harassment. They may not be trusted by their counterparts, and are often accused
of breaking unit cohesion or are harassed by others for sexual favors.
• A survivor’s military career may be extremely affected when they report
harassment and/or assault. The stigmatization that happens after reporting
Command Rape and other forms of MST often lowers the possibility of
advancement in rank. Survivors have been encouraged to remain silent to keep
A Public Health Issue
• Sexual assault and harassment have only been
documented in the Armed Forces since 1988.
• Military sexual trauma has been directly correlated to the
development of PTSD and numerous mental health
concerns such as anxiety, depression and substance
“Violence against women choosing to
serve in the Armed Forces is a public health
concern. Women who are raped or
assaulted while on active duty are more
likely to report chronic health problems,
prescription medication use for emotional
problems, failure to complete college, and
annual incomes of less than $25,000.”
–Christine Hansen (2005)
Military Sexual Trauma
A Spectrum of Trauma Related Problems
The psychological response to MST often includes a
cluster of symptoms that interfere with function.
• The combination of
sexual assault and
greatly heighten the
in veterans of the wars
in Iraq and
MST is a unique form of betrayal
The person who is violated is part of
the same mission as the perpetrator.
Is subject to the same rules under
the UCMJ: Universal Code of
You may be battle buddies
In many cases the perpetrator has a
Needs for Psychosocial
Psychological response to MST can cause
significant impairment in life functioning domains
• Family relationships
• Career & Work Relationship
• Interpersonal and romantic relationships
MST HAS BEEN KNOWN TO SERIOUSLY IMPAIR THE ABILITY TO SELF
REGULATE. CLIENTS REPORT THAT MINOR OBSTACLES AND STRESSORS
ARE OFTEN PERCEIVED AS OVERWHELMING.
Anxiety and the accompanying inability to self-regulate
often result in some of the following symptoms and
disorders following an assault and/or prolonged sexual
Within Spectrum of Trauma Related
• Skin Picking-repeated, touching, scratching, picking or rubbing
• It is thought that we are seeing more of these symptoms as a
response to MST than in the civilian sector because of the need to
maintain the anxiety for longer periods of time due to length and
repeated deployments. Most often the anxiety response is seen in
the survivor who has had little relief or support. Body dysmorphic
symptoms correlate with isolation, withdrawal and agoraphobia.
Anxiety Induced Disorders
• Agoraphobia is an anxiety disorder that results in fear of places,
crowds and/or being in places you cannot move easily and quickly
from. People with agoraphobia often struggle with being in a public
or crowded place. There is fear of being in a situation in which you
have less control.
• Your client may have to face the door of your office or be seen in their
home. Public transportation is often an issue, as are family
Disorders that may be related to MST:
BDD- Body Dysmorphic Trichotillomania- (trick-o-til-o-
• False perception of all or • An impulse control
part of ones body, disorder in the family of
causing obsessive body-dysmorphic
response ie: eating disorders causing
disorder, cutting, picking obsessive hair pulling
or hiding (masking) from head, eyebrows or
• Symptom clusters can include:
• aggressive behavior towards self or others
• dissociation and depersonalization
• impairment in capacity to enjoy activities and
intimacies formerly found pleasurable.
VA Materials State: Some Problems
Associated with MST include
• Disturbing memories or nightmares
• Difficulty feeling Safe
• Feelings of depression or numbness
• Problems with alcohol or other drugs
• Feeling isolated from other people
• Problems with anger or irritability
• Problems with sleep & Physical health problems
Impulse Control Symptoms
• MST is also known to stimulate Body Focused
Repetitive Behaviors: BFRB’s are considered both
Impulse control disorders and affect regulation
The International Society of Traumatic
Stress Studies also recommends in
treatment of PTSD that:
“Interventions should be culturally
appropriate, and related to the
local formulation of problems and
ways of coping” (Level- C, pg. 540)
Importance of Presence & Truth
Your client has been trained to be
aware of his/her surroundings and to
maintain a defensive position and
may maintain a highly aroused and
nervous emotional state.
Your client may have had to maintain
this emotional state for far too long.
Your client may need to learn with
you how to relax their symptoms and
experience that relaxation and safety
Things to be Mindful of from a
• Are you a Veteran?
• If not, are you familiar with military culture and terms?
• Note your office décor:
• How personal is it?
• Are there military references?
• Is your office a trigger?
• The Following are Treatment
recommendations based on experience
treating Military Sexual Trauma survivors.
Clients were both male and female who
were either active duty or post-discharge
from the military.
Important Therapeutic Ingredients
• Alliance between client and therapist.
• Your MST client will bring a unique culture and
need to your practice.
• It is very helpful to educate yourself about the
Build Your Therapeutic Alliance
With Great Care
• Begin with a very thorough assessment- many who are treated for
MST have not been properly assessed for PTSD, depression, as well
as TBI ( Traumatic Brain Injury).
It is advised that you do not order tests, evaluations etc without
thoroughly discussing options/procedures and locations with your
client-every step of your process must have the goal of the clients
recognized needs being met willingly.
Clients ability to build trust will parallel building of self
MST is not about sex
MST is an abuse of power
• Explore meaning of safety with your client
• Explore triggers
• Explore clients ability to self-resource
• Involve client in development of treatment plan.
• Establish concrete but broad goals as soon
as possible in union with your client.
• Explore clients awareness of emotional
responses-what helps and what does more
damage than good and why?
• Reinforce with client value of his/her narrative
• Know that your are working with a survivor not a
• Value ALL defense systems.
• Work with client to replace destructive defenses.
Treatment is counterproductive
if retraumatization occurs
• Systematic desensitization and exposure therapy run the
risk of further traumatizing the MST survivor and
should be avoided.
• The purpose of systematic desensitization is to
demonstrate the irrationality of a fear.
• Your clients fear response is rational, although exploring
their emotions around their fear response when
they are feeling safe can help to defuse a
destructive emotional response.
Self Mastery = Self Regulation
• Client will have to repeatedly reprocess trauma, how and
when must be up to them.
• The ability to process unexpected stimulus of traumatic
memory is one of the primary goals of therapy for the
military sexual assault survivor
• Increase in these strengths will support client increased
ability to self-regulate.
Imagine a Three Legged Table
• Imagine your client is the surface
(what happens if a 3 legged table is missing a leg?)
• One of these legs is their ability to self-
• The second leg is their family and friends
• The third leg is their community resource
& that includes you.
• ACT is new to the psychology field and based in the belief
that ongoing attempts to get rid of symptoms may create
more stress as well as clinical disorders.
• ACT is a mindfulness-based behavior therapy, shown to
be quite effective in working with survivors of trauma.
• The Traumatized client often struggles with states of
hyper-arousal that interfere with executive function.
Why Mindfulness as Treatment
The timing and location of neural activation directly
correlates with the timing and characteristics of
There is an interconnection between brain, mind and
relationship that stimulates neural firing patterns in
By practicing mindful, cognitive awareness with your
client you support their growing self-management.
In essence you help support “their” management of
“their” neural firing.
What is Mindfulness?
• Mindfulness is a state of “being aware”---
• It is a process of observation and attention in the flow of
changing stimuli and perceptions.
• Mindfulness is ‘in the moment’, present, engaged awareness.
• An important characteristic of a mindful state is that it is free
of judgment. Also, mindfulness is not a passive state; we apply
intention when we are mindful.
Building Safety in Non-Reactivity
• We know that outcome and process cannot be predicted with
the use of mindfulness, because mindfulness “is” the process.
• By supporting your clients ability to be “present” in the
moment of now with safety as their center and its “impact on
their nervous system” is the needed outcome.
• One of the benefits of mindfulness is the growing ability to
self-regulate. This practice supports your clients ability and
sense of self-mastery.
How to Practice Mindfulness in
• There are a number of ways to practice mindfulness in the
• One way is to focus on breathing-
• Ask your client to sit quietly with you and focus on their breathing
• As things come to mind, ask them to name them, “simply” and
then to “lay them down” with the next exhale-- psychologically
putting them down and returning to focused breathing.
Supporting Building of Client Self-Control
• Reinforce with client the power of focus and benefit of
relaxation as they slowly gain control over their thoughts and
• Following breathing exercise--examine with client somatic
• Do a body scan- what is client feeling and where
• “Pick up” or discuss what client is ready to examine that had
been consciously laid down–
• Honor range of feelings
Mindful Breathing Exercise
• Practice with them-begin by devoting 5 minutes a session to
• Process with your client their inner struggle to “set thoughts
down”—support their growing sense of “controlled self”—the
controlled self can be returned to often within session to
demonstrate value of self control as mindfulness develops.
• Work with your client to cultivate their own sense of well-
being as they want it to develop.
Expect Emotional Reactivity
Often, when working with survivors of Abuse and Sexual
harassment there is a lot of emotional reactivity to the
concept and practice of “setting down” fears and pain that
• Your client has been spending a lot psychological energy
defending themselves and has adopted a “structure”—
• Initial relaxation of the structure also involves relaxation of
some of the constructed defenses. In processing this-expect
emotional reactivity. This is good---they are feeling something
new and it is frightening--- it is the undefended self they can
access to begin healing.—
Mindfulness & Resilience
• The work of Dr. Daniel Siegel on Mindfulness and the brain,
teaches us that neuroscience studies and subjective
experience of mindfulness, together demonstrate that non-
reactivity and emotional balance go hand-in-hand with the fact
of labeling and describing internal states.
• “We learn that what before felt like an unchangeable and
distressful feeling can now be observed and noted and we can
come back to equilibrium more readily. This is the essence of a
resilient affective style.”
Tools To Explore
With Your Client
• Narrative Therapy: Working with the survivor’s
narrative can be very effective in reframing responses to
experiences when a goal is set of not feeling “defined” by
• EMDR: Eye Movement Desensitization and Reprocessing
(EMDR) is effective treatment for many in reducing the
“charge” felt when triggered by traumatic recall.
• You may hear stories about how the
victim is often investigated-not the
• Until the protocol for investigating
MST is changed-this will remain an
obstacle for survivors.
• Your client may be unwilling to bring charges against their
• In military sexual trauma cases, you as the clinician
cannot make any guarantees about how your client will
be treated, either by the military or by either a military or
civilian judicial process.
Examine whether or not:
• You, as their clinician can support
them through their process
whether they choose to report the
abuse or not-
Reporting Options as per DoD SAPR
• A confidential reporting method • When a victim reports an
that allows a Service Member incident of sexual assault, the
disclose to specified officials that matter is referred for
he or she has been the victim of a investigation and victim‘s rights
sexual assault. apply.
• Victim receives access to medical • Victims may receive health
care, counseling, and advocacy, care, counseling, & advocacy
without requiring officials to services. However, details of
automatically report to law the incident are reportable to
enforcement or initiate an official command and law
When working with Military clients, please
keep in mind:
• Communications between sexual assault victims and Victim
Advocates are afforded no privilege under military law and VA’s
can be expected to testify at trials.
• In contrast, thirty-five states provide a privilege for
communications between a victim and a Victim Advocate.
• The absence of a privilege can limit the effectiveness of Victim
Advocates in the military community.
• In addition, privilege does not exist between medical personnel
and the Chain of Command
When the assaulted person is a
member of a “reserve unit”
local law enforcement
authorities can and should be
Sexual Assault Response Coordinators
• There is not privilege
between a SARC and a
• It is the role of the SARC to
advocate on behalf of the
victim; however often this
position is a collateral duty
• DSARC in CAI: Combat
Areas of Interest
Client Is a Member of a System
• A client emotionally supported is less likely
to self-medicate destructively.
• Help your client assess their family, social
and work relationships.
• You may want to explore client’s function
level prior to service in order to establish
appropriate therapeutic goals.
The Power of Resiliency
• Your clinical awareness of their experience coupled with
their understanding their response to their experience
can help them examine their “self expectations”.
• Celebrate the fact that they are resilient enough to be in
front of you. They could have made different choices in
their response and they may have considered many more
destructive ones. You can help them recognize the power
of their own responses and how healthy choices support
their healing and resiliency.
Expectation –vs-- Reality
• Psychological distress is often the result of the experience
when expectation does not match reality.
• Often your client will feel defeated by the lack of
understanding of their experience by friends, family and
• Support their exploration of their expectations vs. reality
• By doing this often you are supporting their ability to be
mindful of where they are in the “present moment.”
• MST survivors often describe experiencing ―involuntary
flooding‖ -- described as a sense of overwhelm with traumatic
memories accompanied by what may feel like disabling
• If flooding occurs in session– move into it, not away from it.
• Be mindful of what the clients experience is—use guided
imagery and breathing to bring your client into the present
safety of the session.
• Your traumatized client experiences involuntary flooding with or
Your Client and Medication
• Often MST survivors are in need of medication in
order to manage symptoms.
• Know what medications your client has had and
• Support the transition to different medications
Importance of Presence and Truth
• Your client has been trained to be aware of his/her
surroundings and to maintain a defensive position and
may maintain a highly aroused and nervous emotional
• Your client may have had to maintain this emotional state
for far too long.
• Your client may need to learn with you how to relax their
symptoms and experience that relaxation and safety with
Importance of Trust & Safety
• Being a therapist does not bring automatic trust.
The military is an environment in which seeking
mental health is often viewed as weakness.
• Pay attention to clients emotional response.
• Do not pretend you know what they mean if it does
not make sense to you. Ask a lot of questions. Your
clients ability to answer, even the very difficult
questions can help defuse the trauma.
Expanding the Diagnosis &
• “…over the years, it has become clear that in clinical
settings the majority of traumatized treatment seeking
patients suffer from a variety of psychological problems
that are not included in the diagnosis of PTSD”…
Bessel Van Der Kolk-The Assessment & Treatment of Complex PTSD
by Judith Herman-Trauma & Recovery
• The main difference between • In addition to the PTSD criteria,
PTSD and Complex PTSD isn’t the ‘Complex PTSD’ features many
length of time the sufferer has had (but not always all) of the
or symptoms, but rather the following –
duration of the trauma and the
difference in symptoms and their • Alterations in Affect-including:
severity due to the prolonged persistent dysphoria (chronic low
trauma. mood), chronic suicidal pre-
occupation, self-injury, explosive
• Those with Complex PTSD have or extremely inhibited anger (may
usually experienced a trauma over alternate).
a long term period, rather than
one event or one period of time.
Traumatic Spectrum Symptoms
Seen In MST Survivors
• Alterations in consciousness, such • Alterations in perception of
as forgetting traumatic events, perpetrator, including:
reliving traumatic events, or preoccupation with relationship
having episodes in which one feels with perpetrator (includes
detached from one's mental preoccupation with revenge)
processes or body unrealistic attribution of total
power to perpetrator
Alterations in self-perception,
which may include a sense of • Caution: Victims assessment of
helplessness, shame, guilt, stigma, power realities may be more
and a sense of being completely realistic than clinician’s
different than other human beings
In MST Survivors
• Alterations in relations • Repeated failures of self-
with others, including: protection
isolation and withdrawal,
disruption in intimate • Alterations in systems of
relationships, repeated meaning:
search for rescuer (can • Loss of faith
alternate with isolation
and withdrawal) • Sense of hopelessness &
• Persistent distrust
DoD SAPRO Program
Department of Defense Sexual Assault Prevention & Response Office
• Founded in 2005 by Congressional Mandate
• Reporting options and advocates were issued to bases stateside and in CAI
along with guidelines and procedures for sexual assault (SA) and sexual
• The Department of Defense tracks the numbers of sexual assaults reported
and prosecuted each year and issues them in FY SAPR reports
• The individual services vary on their SAPRO implementation
• SAPRO has two main websites with two distinctly different missions:
www.sapr.mil and www.myduty.mil
Breakdown of Victims and Subjects
In Unrestricted Reports 07-09
Among treatment recommendations:
Ensure service members who report they were
sexually assaulted are afforded the assistance of a
nationally certified victim advocate.
Ensure victims understand their rights, including the
opportunity to consult with legal counsel to minimize
victim confusion during the investigative process.
Improve medical care for victims of sexual assault,
particularly those in deployed areas.
Ensure gender-appropriate care for male victims.
Inform victims and service members of disciplinary
actions related to sexual assault.
• Organization for Military Accountability:
• Use the SAPRO pages for DoD reporting options and
guidelines as well as to reference published reports
• SWAN has a helpline!
• For up to date policy papers on MST, consult Swords to
Plowshares and Iraq and Afghanistan Veterans of America
• Veterans For Common Sense-Advocacy & Policy:
• For a complete list of rape crisis centers near military
bases, check out Veterans For America’s link:
• Several community organizations have free retreats for
Service Members and Veterans: check out :Vets4Vets,
The Coming Home Project, and Outward Bound
Care of the Advocate or Clinician
Recognizing Secondary Trauma
• Secondary Trauma is a reality. A good therapist cannot hear
MST survivor stories without empathically feeling a great deal.
• You are working with very difficult and hard to process issues.
Be sure that as you take on more of this work, you also
balance it with your own self-care.
• Seek council when needed
• Exercise, eat well, stay rested and please use what restorative
measures you need to keep yourself replenished.
• Those of you who are working with survivors of military
sexual trauma are helping to strengthen and bring
compassion to the country's system of psychosocial
counseling, promoting much needed individual and,
perhaps, national healing from this shared trauma that
impacts us all.
• And we thank you for your efforts.