Asking the right questions

Experiencing a hiccup during a study abroad college research project led Rebecca K. Blais, a new associate professor of psychology at Arizona State University, to appreciate the importance of asking the right questions.

At the time, Blais was studying in Greece, and her project focused on risky health behaviors in Greek and American college students. She created a survey that required people to answer questions about their health using a rating scale of 1 to 5. The Greek participants she worked with told her that they did not know how to answer: They did not think about the world in terms of scales. 

“I realized that there is always a cultural context to asking questions,” said Blais, who is a licensed clinical psychologist. “We have to be sensitive to individual experiences in order to make our research and, ultimately, our therapeutic interventions more thoughtful and culturally appropriate.”

The cultural context that Blais now focuses on is the military. She comes from a family of Marines and has dedicated her career to studying how best to support service members who have experienced sexual violence during their military careers. 

“During graduate school, I conducted clinical assessments and provided psychotherapy to veterans with post-traumatic stress disorder (PTSD). I was working with 22-year-old service members who were willing to give their lives for our freedoms, and I decided to leverage my skills as a clinical psychologist to give back to this community,” Blais said.

Military sexual violence ranges from verbal harassment to unwanted physical touching or rape. Because experiencing military sexual violence is associated with suicide, Blais is trying to understand how the two are linked. Possible pathways include PTSD from the sexual trauma itself or from sexual dysfunction that can follow as a result of sexual violence. 

“Sometimes we clinicians aren’t asking the right questions. After a service member experiences an interpersonal trauma like military sexual violence, we should be asking whether he or she feels safe and satisfied in their sexual relationship,” Blais said. “These questions aren’t asked even though research shows sexual dysfunction is a direct risk for suicide. We have to do better and have to ask these questions when meeting with survivors. And as educators, we need to teach emerging clinicians how to broach the topic in treatment, even when the focus is not sexual function.”

Blais now teaches clinical psychology doctoral students how to ask questions about sex and sexual trauma with the goal of normalizing the topic in therapy.  

“If the clinician isn’t comfortable, the client won’t be either. But if we can teach people how to ask sensitive questions in an inviting manner, we are effectively creating a safe space,” she said. “Safe spaces for survivors who experienced military sexual violence are critically important to recovery.”

Another focus of Blais’ research is thinking “outside the box” about how to deliver therapy interventions that are based on the culture of the military. Instead of talking in an office for an hour, Blais has used behavior activation interventions, which are therapy sessions designed to reduce isolation and avoidance in patients while boosting their mood. She has gone skiing in the Rockies with service members and veterans. She has also delivered group therapy by building a motorcycle from the ground up.

“One veteran in the motorcycle group taught me how to weld while we talked about his relationship with his wife. Having him teach me while I counseled him let us engage deeply because our interaction wasn’t seen as a one-way street for the veteran. He felt like he was giving back to me, which I think helped him open up more. If we can set up therapy so that service members are giving back and contributing to the community, we can meet them where they are and where they have value,” Blais said.

For veterans who are struggling, the Veterans Crisis Line offers free, confidential support 24 hours a day, 7 days a week, at 1-800-273-8255 (press 1) or text 838255.