TAL AFAR, Iraq -- Lt. Maria Kimble, an Army mental-health worker, runs a two-person counseling team out of a small plywood office here. As part of a "combat stress detachment," her job is to help soldiers cope with the horror of the battlefield -- so that they can return to it as soon as possible.

One of her first patients was Sgt. Richard Parkinson, a lanky 27-year-old artillery sergeant from Tulsa, Okla. After Sgt. Parkinson's first tour of Iraq, which ended in the summer of 2004, he suffered nightmares and bursts of anger that grew worse once he came home. Eventually, he sought counseling.

After only four sessions at his base in Fort Polk, La., he was sent back to Iraq. Since returning in May, Sgt. Parkinson has had to respond to two suicide bombings. One image burned into his mind, he says, is that of an Iraqi man, who was missing his arm, begging him for help.

Meeting with Lt. Kimble has allowed him to continue his service, Sgt. Parkinson says. "Without her, I know I would have snapped."

But the recent trauma has also hurt him, he and Lt. Kimble say. "If I had the power, I'd stick him on a plane and send him home," she says.

A combination of repeat deployments, tight troop levels and growing mental strain on soldiers has given a new prominence to Army mental-health workers. The Army has counselors from 10 combat stress detachments in Iraq, part of an unprecedented effort to help soldiers cope with psychological problems and finish their deployments. With the Army struggling to meet recruiting goals, it needs to keep as many soldiers in the fight as it can.

The Pentagon's focus on mental health reflects huge changes to both the Army and combat psychiatry since the Vietnam War. In Vietnam, commanders relied on a draft to provide them with an almost unlimited number of young, inexperienced soldiers. The vast majority of those troops served a required one-year tour of duty and never returned to combat. Today, the all-volunteer military is older, better trained and much tougher to replace.

It is also being asked to do much more. Because today's Army is about half the size it was during Vietnam, soldiers are required to do repeat tours of duty. Even troops who struggle with traumas from a first tour will likely be asked to return to the combat zone for a second or even third round. Often their symptoms grow more acute with repeat exposure, say psychiatrists in Iraq.

To keep soldiers fit for duty, the Army has dramatically increased the number of mental-health workers in Iraq since the war began, to 235. They help the approximately 115,000 soldiers there. "What we have found in the last couple of years is that more is better," says Lt. Gen. Kevin Kiley, the Army's top medical officer.

So far, the counselors' efforts appear to be paying off. In the first 11 months of the Iraq war, an average of 60 soldiers a month were shipped home early because of psychiatric problems. Since then, that number has dropped to 37 a month.

Some Army officials say that helping soldiers finish their deployment could help the troops by sparing them the guilt associated with going home early.

In Iraq, however, mental-health workers say it isn't that simple. Lt. Col. Dale Levandowski, the senior psychiatrist in Lt. Kimble's unit, says that it's impossible to provide troops the full treatment they need to recover as long as they remain in Iraq. A combat zone "is not the place to dig into everything and process every trauma," he says.

Often the best he can do is give soldiers a few days rest and a chance to vent. He teaches them coping techniques. Sometimes he prescribes Ambien to help them sleep or Zoloft to ease their anxiety. The goal, he says, is to "put a lid" on the soldiers' symptoms so that they can function. Then he sends them back to the front lines to face additional violence that recent research suggests could make a full recovery even tougher.

"There are a lot of ethical questions about it," says Col. Levandowski. "The oath I take as a physician is to do no harm," he says. But "ultimately, we are in the business of prosecuting a war."

One of the biggest issues mental-health workers face in Iraq is post-traumatic stress disorder, which is triggered by such experiences as combat, rape, or seeing dead or dying people. The condition can be debilitating, causing people to suffer for years with nightmares, flashbacks, anger, depression and anxiety. Treating post-traumatic stress in the war zone is especially tricky, since soldiers are engulfed in trauma, to varying degrees, almost every day.

As a result, Army psychiatrists have to make tough decisions about how much more trauma soldiers can take. "I do ache for these guys," says Col. Levandowski. "But if you send too many (soldiers) home, the risk is that mental health will be seen as a ticket out of country."

Col. Levandowski's unit, the 85th Medical Detachment arrived in northern Iraq in May. Upon arrival, the detachment's leadership sent a memo to commanders reassuring them that their top priority was to help soldiers finish their tours. (In earlier deployments mental-health workers were sometimes branded by fellow soldiers as the "travel guys," for their ability to send people home.)

Col. Levandowski and a half-dozen others set up a "restoration and fitness program" in Mosul, where soldiers with severe symptoms can come for a few days of rest and a more-complete evaluation. He chose the name because he thought it would sound more "normal and acceptable" than something like "mental health clinic." The program is housed in a cement military building. Sandbags are stacked in front of the windows to protect those inside from flying shrapnel.

The rest of his 39-person unit broke into two- or four-person combat stress control teams and set up shop in smaller operating bases throughout northern Iraq. Most of the day-to-day work with soldiers in the field is done by these counselors.

One of those is Lt. Kimble, a 33-year-old who has a master's degree in social work. Back home in Texas, she worked with Vietnam and Iraq war vets who were suffering from post-traumatic stress disorder at a Veterans Affairs hospital. She also spent about $2,000 of her own money to attend a six-day Defense Department conference on combat stress at Camp Pendleton, Calif. "I'm single and this is my thing," she says.

None of it really prepared her for her first weeks in Iraq, she says.

Shortly after she arrived in Tal Afar, a soldier was shot in the head by an insurgent sniper. Lt. Kimble quietly watched as the fallen soldier's colleagues stoically carried his body into the base's small makeshift hospital.

The next day, she held what the Army calls a "Critical Event Debriefing" for the 12 soldiers who witnessed the shooting. Such debriefings were initially developed for police and firemen. The Army uses them to encourage troops to talk about what they experienced in a supportive group environment. The sessions, say proponents, can help prevent long-term psychological problems such as post-traumatic stress disorder.

Before the session began, she worried that the soldiers wouldn't want to talk. Instead they recounted the incident in detail, describing how their colleague's head snapped when it was hit by the bullet and how his brain matter had splattered. "I was amazed people would say the exact same thing," she says. "One person would describe what had happened in very graphic detail and then the next person would repeat it."

At the time, she wondered if reliving the incident so explicitly somehow comforted the soldiers involved. After she had heard the incident described a dozen times, she couldn't get it out of her head.

"I'd close my eyes to go to sleep at night and see it all over again," she says.

The military regularly conducts debriefings for units that lose troops in Iraq. But senior military psychiatrists in the Army and Air Force say their services are slowly beginning to move away from mandatory group sessions. Recent research has raised questions about whether such group debriefing sessions work. For some people, it may just be too painful to relive the event.

Several officers involved in the group sessions led by Lt. Kimble say discussing events such as the sniper attack is important. The shared impressions allow soldiers to impose order on a chaotic situation. "It helps soldiers realize that they did the best they could," says Capt. Noah Hanners, a platoon leader in Tal Afar.

Before she arrived in Iraq, Lt. Kimble asked recently returned soldiers what they liked about the combat stress control teams. The biggest complaint she heard was that the counselors didn't get out to the more isolated combat outposts. "In my head, my goal was to come as far forward as possible," she says.

The base where she is located is a dusty and barren outpost about 30 miles from the larger camps in Mosul. To build rapport with combat troops, she tags along with them to the rifle range with her M-16. She and her colleague in Tal Afar, Sgt. Frank Padilla, spend a couple of days each week riding resupply convoys to visit soldiers at even more remote bases where there are no chaplains or mental-health counselors. Often she is the only woman at these facilities.

In the seven months she has been in Iraq she has attended memorial services for 13 soldiers killed in the area she covers -- a region about twice the size of Connecticut.

The more time she spent on the road visiting with the troops, the more they sought her out for counseling. Lt. Kimble figures that she and Sgt. Padilla have met with about 400 soldiers out of a population of about 3,500 in their area.

One of those was Sgt. Parkinson. After returning home after his first tour last year, he experienced nightmares and had trouble controlling his anger. He tried to deal with it on his own. One night he woke from a nightmare and, thinking he was under attack, accidentally struck his wife in the face. Days later, Sgt. Parkinson's wife forced him to get counseling on his base. WSJ(11/28) Therapists Take On Soldiers' Trauma In -2-

He completed four sessions. Then he got orders to change units and go back to Iraq. In Iraq, his nightmares increased. Often he only got one or two hours of sleep a night. He regularly fell asleep on duty. He was short-tempered. "I'd snap at my soldiers for almost no reason and make them feel like crap," he says.

Eventually, his section chief ordered him to see Lt. Kimble. Sgt. Parkinson says he wasn't opposed to getting help, but initially thought he could handle his problems on his own. "I guess I am hard headed," he says.

In one of his first sessions with the lieutenant he mentioned that he was haunted by images from a terrorist bombing his unit had been called to during his first deployment. Lt. Kimble gently prodded him to share more details.

"Did you see dead bodies or dead children?" she recalls asking.

"I don't really want to talk about it," Sgt. Parkinson replied.

After the session, Lt. Kimble says she kicked herself for pushing her new patient too hard. Back in the U.S. she regularly asked veterans struggling with post-traumatic stress disorder such questions. Usually they didn't have a problem talking about old events.

Working with patients in Iraq, however, demanded a different approach. "I learned this is not an environment to try to dig deep into old emotions. It's too hard. These guys know they are going to have to go right back out there the next day and face the same sorts of things again," Lt. Kimble says.

Slowly, Lt. Kimble built up a rapport with Sgt. Parkinson. Typically she'd begin by asking him simple questions like, "What brings you by?" Often he'd talk about his wife or his soldiers. Sometimes he'd blow off steam by griping about his chain of command, he says.

Last July, Lt. Kimble arranged for him to go to Mosul for three days to attend Col. Levandowski's program. The Army psychiatrist prescribed him some medication to help him sleep. He takes the pills on those nights when he knows his unit won't get called out on missions. He also sat in some classes on controlling his anger.

Talking to Lt. Kimble once a week has helped him the most, he says.

In late September, a female suicide bomber, clad in a man's robes, slipped into a line of Army recruits and blew herself up, killing six and wounding 35. Sgt. Parkinson was standing about 20 yards away when she exploded. "The whole thing was just depressing and aggravating," he says.

That night he called his wife and told her a little bit about the incident. A couple of days later he recounted it in detail to Lt. Kimble. As he was talking, Lt. Kimble pictured the grisly scene in her head and a shiver went up her spine.

"I'm sorry ma'am," Sgt. Parkinson recalls saying.

Lt. Kimble urged him to keep talking. "I want to hear about it," she told him.

To Lt. Kimble, Sgt. Parkinson's willingness to talk about the incident was a small victory. "Maybe it is a sign that he is coming to terms with some of the violence. He is able to process it," she says.

In the days following the incident, Sgt. Parkinson says he began to experience a grisly series of nightmares. In one of them he is sitting in a guard tower with one of his fellow soldiers from Iraq when mortar fire starts to rain down. Sgt. Parkinson watches as his friend is torn to shreds. Certain smells, such as the aroma of steak in the chow hall, he says, remind him of burning human flesh and make him physically ill.

"I'm proud I've lasted, but I know this deployment has hurt me," he says.

Lt. Kimble says that his condition is probably staying level. "Anyone dealing with post-traumatic stress disorder should have a calm, safe environment and not have to go back to such traumas," she says.

Sgt. Parkinson, however, will likely finish his deployment, which ends in the spring. By the standards of Iraq, Lt. Kimble says that is a success.