More Than a Diagnosis: Why Military Knowledge and Cultural Competency Matter When Treating Veterans
June is PTSD Awareness Month — a time to shine a light on one of the most prevalent and most misunderstood mental health conditions affecting veterans and civilians alike. At Upward Behavioral Health, we are using this month to share something we think matters: what it means to provide high-quality, evidence-based mental health care to veterans and service members and why having clinicians with deep roots in VA-based care makes a meaningful difference.
The Military Is Its Own Culture
One of the most important things a clinician can understand about working with veterans is this: the military is not just a job. It is a culture — one with its own values, language, and way of seeing the world. And that culture is worth understanding deeply, not as a barrier to overcome, but as a framework that has shaped who your client is.
Military culture is built on collectivism — the understanding that the group comes before the individual, that cohesion and mutual reliance are not just valued but essential. Service members are also trained in stoicism: the ability to endure hardship without showing emotion, which in many military contexts is both a professional expectation and a genuine survival skill. These are not character flaws. They are adaptive traits forged in demanding environments.
In a clinical setting, however, a therapist unfamiliar with military culture may misread stoicism as resistance, or interpret a veteran's solution-focused, action-oriented approach to problems as impatience with the therapeutic process. Understanding the culture means knowing what you are seeing — and being able to work with it rather than around it.
Military language, rank structure, deployment experiences, and the specific stressors associated with different service eras and occupational specialties all shape how a veteran understands their own history. Clinicians with substantive VA experience do not need a translation guide. That familiarity is built in.
One area where cultural competency matters most is stigma. Research consistently identifies stigma as the greatest barrier to veterans seeking mental health care. In a culture that prizes strength, reliability, and service to others, seeking help can feel deeply at odds with one's identity as a soldier, sailor, airman, or Marine — not because the military has failed these individuals, but because the very qualities that make an effective service member can make vulnerability feel unacceptable. Clinicians who understand that dynamic — and know how to address it directly — are better positioned to build the kind of therapeutic alliance that leads to engagement and change.
PTSD in Veterans: A Complex Clinical Picture
PTSD is among the most well-documented mental health conditions in veteran populations, and treating it effectively requires more than familiarity with the diagnosis. Research suggests that up to 80% of individuals with PTSD have at least one co-occurring mental health condition. The most common include depression, generalized anxiety disorder, panic disorder, and substance use disorders — and this is particularly relevant in veteran populations, where co-occurring PTSD and substance use disorders have been documented at especially high rates.
This level of complexity has real clinical implications. A clinician delivering PTSD treatment needs to understand not just the core diagnosis, but how these co-occurring conditions interact with one another. Does the substance use function as avoidance of trauma-related distress? Is depression maintaining hopeless cognitions that need to be addressed as part of trauma-focused work? Is insomnia — one of the most persistent and undertreated symptoms in this population — interfering with treatment engagement and recovery? Accurate, thorough assessment is the foundation. But knowing how to sequence and integrate treatment for a complex clinical presentation is what separates competent care from genuinely expert care.
Our Team's Background: Built Inside the VA
Two of our clinicians — Dr. Megan Keyes and Dr. Misti Norton — spent a combined 42 years working within the VA system before joining Upward. That depth of experience shapes every aspect of how we approach care with this population.
Dr. Keyes completed her post-doctoral fellowship in Behavioral Medicine and PTSD at the VA Medical Center in New Orleans. Over her 26-year career with the VA — spanning clinical, research, training, and consultation roles — she served for 16 years as an expert consultant with the VA National Center for PTSD's Prolonged Exposure (PE) Therapy program. In that role, she provided clinical guidance and oversight to hundreds of VA therapists learning to deliver PE, one of the two first-line, evidence-based psychotherapies for PTSD recommended by both the VA and the Department of Defense. She is also certified in Cognitive Processing Therapy (CPT), the other gold-standard PTSD treatment. PTSD and its clinical complexities remain at the core of her work.
Dr. Norton spent 16 years at the Birmingham VA Medical Center where she provided care on the PTSD Clinical Team, served as an expert consultant within the VA's national training initiative for Cognitive Behavioral Therapy for Insomnia (CBT-I), and founded the Behavioral Sleep Medicine Service. She holds certifications in individual and group CBT-I, CBT for Nightmares, PE, and CPT. Dr. Norton achieved Diplomate status in Behavioral Sleep Medicine in 2024 — a credential held by a relatively small number of psychologists in the country. She also specializes in evidence-based treatment of OCD using Exposure and Response Prevention (ERP), one of the most effective and most underutilized treatments in outpatient mental health care.
A Range of Evidence-Based Treatments Under One Roof
Because PTSD rarely presents in isolation, effective care for veterans often means having access to expertise across multiple evidence-based treatments — not just for PTSD itself, but for the conditions most likely to accompany it. At Upward, our clinical team offers a range of empirically supported therapies that directly address the most common co-occurring conditions in this population.
These include Prolonged Exposure Therapy (PE), Cognitive Processing Therapy (CPT), and Written Exposure Therapy (WET) for PTSD; Cognitive Behavioral Therapy for insomnia (CBT-I) and nightmares (CBT-N) for sleep-related disorders; Exposure and Response Prevention (ERP) for OCD; evidence-based treatments for depression and anxiety disorders; and executive functioning coaching for ADHD. Moreover, we offer psychological evaluations for a range of issues including autism, ADHD, cognitive functioning, and dementia. Our team members have advanced training and specialized experience in providing the leading, effective therapies for a range of mental health issues many service members and veterans experience.
Accessible Care, Wherever You Are
Upward Behavioral Health offers in-person appointments in Birmingham, Alabama as well as telehealth appointments on our HIPAA-secure, easy-to-use telehealth platform to clients across the country in PSYPACT-participating states. For veterans in rural or underserved areas — where distance to VA facilities can be substantial and transportation is often limited — telehealth is not just a convenience. It is frequently the most realistic path to accessing quality care. We are committed to making that access real.
For Veterans, Service Members, and Their Families
This PTSD Awareness Month, if you are a veteran, an active-duty service member, or a family member trying to navigate a loved one’s care, we want you to know that expert, evidence-based care is available — care delivered by clinicians who understand not just the diagnosis, but the culture, the experience, and the full complexity of what you may be carrying. If you are interested in services, please contact us to schedule a free 15-minute consultation. We would welcome the opportunity to talk with you. You can reach us at (205) 983-4063 or visit us at www.upwardbehavioralhealth.com.