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**ADVANCE FOR MONDAY OCT. 26** In this photo taken Wednesday, Oct. 21, 2009, Vermont National Guard Maj. Clifford Trott reflects at the armory where soldiers are being screened for deployment in Colchester, Vt. For Trott, an upcoming deployment to Afghanistan means a slightly different way of practicing his specialty. As the unit's psychologist, practicing in a war zone means he can't keep his customary distance with patients. He has to pitch in with guard duty and other missions that have nothing to do with mental health. (AP Photo/Toby Talbot)
Wednesday, April 20, 2011

For psychologist, war zone offers unique challenge

When his war zone patients need to talk to Maj. Clifford Trott, of Colchester, Vt., there’s no couch for them to lie on, no furnished office where they can work out their anxieties with him one-on-one.

They take what they can get: The back of a Humvee, the corner of a mess tent, a barracks cot.

For Trott, a psychologist in the Vermont National Guard, just getting to such a session can be dangerous. In his last deployment, he was in a convoy that drew rocket and mortar fire once, and was occasionally forced into action as a sentinel while making his way across Iraq to get to his soldier-patients.

But he still prefers it to his civilian life job – as a clinical psychologist at a Veterans Administration outpatient clinic.

“My job is inherently rewarding,” he said Wednesday in an interview at Camp Johnson, where he’s preparing for deployment to Afghanistan, along with about 1,500 other Guard members.

“Every day that I was deployed last time, I had some reminder that ‘You are needed here.’ ”

Trott, 44, one of seven psychologists in the Army National Guard, will be embedded with the 3,000 troops of the 86th Infantry Brigade Combat Team (Mountain) as it trains and mentors Afghan security forces on the yearlong mission.

In military terms, he provides “behavioral health support.”

Soft-spoken and earnest, with the brush-cut hair and camouflage fatigues of a rank-and-file soldier, Trott is a Veterans Administration employee in civilian life who doubles as a member of the Guard.

A native of Nantucket, Mass., he’s a former private practitioner who now sees himself as a soldier first, a mental health professional second.

“The reason mental health professionals are important to the military as a whole goes back to war endeavors, all the way back to World War II, when psychologists were put up right in the front line. What they found is that individuals who are taken away from their unit have a lower return-to-duty rate and a worse prognosis for recovery.

“It makes sense for us to be right there. The more embedded we can be, and the more organic, the more benefit we’re going to be to the soldiers’ wellness,” he said.

Along with clinical social worker Col. Jon Coffin, 64, Trott has been busy screening the deploying troops for mental health issues that could get in the way of their service. Each fills out a 27-item questionnaire gauging their feelings about their deployment – whether they feel adequately trained, how their families will cope, whether they’re satisfied with child care arrangements, etc.

The questionnaire also asks whether they’ve lost a loved one recently, been laid off, had a baby, moved or been involved in a pending legal action they feel will affect their service – typical sources of stress.

Have you had any experience that was so horrible or upsetting that, in the past month, you:

 • Have had any nightmares about it or thought about it when you did not want to?

 • Tried not to think about it/went out of your way to avoid situations that remind you of it?

 • Were constantly on guard, watchful or easily startled?

 • Felt numb or detached from others, activities, or your surroundings?

About 25 percent of those filling out the form have checked enough boxes to warrant an in-person “clinical evaluation” by Trott or Coffin before they ship out.

Once they’re deployed, Trott lives and works among his would-be patients, using the familiarity that that breeds to strike up conversations that let them know he’s available if and when they need to talk.

Like the Medevac unit lieutenant who sought him out one night during his 2004-05 stint in Iraq, after the man’s unit had been dispatched to treat victims of an incident involving white phosphorus, an agent used in smoke munitions.

“Three in the morning one night, he came rapping on my door and said ‘I need you,’ very solemn. One of his medics was in a dissociative state. When he was picking up one of the bodies, all of the flesh fell off it. He was in a really bad space. I met with that medic for three or four hours and he bounced back,” said Trott.

In such atmospheres, he has less emotional distance from patients than he does as a civilian practitioner because he lives among them.

“Folks come up and say ‘How you doing, sir?’ ‘Good to see you.’ That makes my day. Because individuals remember my face and also they’re not afraid to come up and talk to me. I feel like I’ve done something right, because there’s a huge stigma in the military on mental health,” he said.

Col. Will Roy, the brigade’s commander, says having a mental health specialist embedded with the unit is important both during the deployment and in its later stages, to help prepare the citizen-soldiers for their return to the states.

“Having a psychologist on staff who’s an asset 24/7, who can circulate through the brigade and meet and talk to soldiers, is tremendous.

“People focus on the worst-case scenario, where we may have a soldier injured or God forbid killed, but given the sheer numbers of soldiers, that’s a lesser focus. It’s dealing with folks with separation anxiety, people who are having issues at home,” Roy said.