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Military Families: Enduring Continuous Cycles of Deployment and Implications for Treatment
1. Thank you for your interest in providing
therapeutic support to military families.
To request a presentation at your agency focused
on the Assessment and Treatment of Military
Families, please email for a quote.
James McAuley, MA LAMFT
Claddagh Counseling
Web: www.claddaghcounseling.com
Email: james@claddaghcounseling.com
Phone: 320-223-0015
Rebekah Miller, MA
Wellness Counseling Services (WCS)
Web: www.wellnesscounselingmn.com
Email: Rmiller@wellnesscounselingmn.com
Phone: 651-399-6920
4. THE MILITARY CULTURE
Unique in it’s diversity Responsibilities and
Norms & Rules Relationships
Value System Esprit De Corps
Language Soldier, Airmen,
Gender Roles Marine, Sailor, Coast
Guard
5. THE MILITARY CULTURE
Different Branch’s Component’s in MN
Army Reserve-National Guard
Navy Reserve
Marine Corps Reserve
Air Force Reserve, Air Guard
Coast Guard Reserve
6. Military Demographics
1,991,578 deployed as of 31 Aug 2009
89% male 11% female
72% AD 28% Reserve components
52% married 48% single
54% males M 46% males S
60% females M 40% females S
41% 20-24 YOA 21% 25-29 YOA
25% 30-39 YOA 13% 40 & above
63% Caucasian 13 % African American
1% American Indian 3% Pacific Islander
1% multi-race 19% Unknown
Data from Defense Manpower, Office of Asst Sec of Def for PA
7. Military Culture: Why We Enlist
To serve our country Be part of a team
Support family Have a purpose in life
Friend enlisted Get out of poverty
Educational benefits Warrior creed
Medical benefits
Structure
Travel
Financial stability
8. Military Culture
Women in the military- 11%
Women Veterans:
*135,000 in WWII (truck Positives
drivers since WWII) Opportunity for Advancement
*71,000 served in Korea Leadership Skills Nurtured
*256,000 Vietnam era Sense of Accomplishment, Satisfaction, & Strength
veterans Success Acknowledged (On subs 12/2011)
*More than 180,000 Drawbacks
women deployed since Hypervigilance: Comradery or Sexual Interest?
9/11/2001 Assumption/stereotype of incompetence & more
*Over 200,000 women on problems
active duty Stigma related to sexual harassment and assault
*1.7 Million women
veterans in USA
Statistics from
Disabled American Veterans
9. Strengths of a Military Family
Resilience More accepting of
More life experiences other people’s
Learn to step into new differences
roles in the family Learn to see things
Worldly through others eyes
Flexible & adaptable Appreciate value of
family and sacrifice
Learn to find positive
in difficult situations
10. Resilience in Military Families
Family Readiness for Optimism
deployment Acceptance of military
Active coping styles lifestyle
Strong community support
Ability to adopt gender
roles
Military Family Research Institute- Purdue University
July 2008 http://www.mfri.purdue.edu/
11. Risk Factors for Military Families
Families of jr.enlisted
Single parents
Foreign born spouses
Prior deployments
Dual military
Younger spouses
Newly married
Younger children
Multiple needs &
Socially isolated
problems before
deployment Family undergoes
transitions
12. Military Children
2007-2008: 20% hospitalized for mental health
Since the 2003 inpatient care among military
children has increased 50 percent
Outpatient mental health visits increased from
1 million in 2003 to 2 million in 2008
Adolescents with Army parents deployed in
OIF showed higher levels of perceived stress,
heart rates and blood pressure (Military
Medicine 2007)
2007 study of Army families: Reports of child
abuse and neglect were 42% higher when the
parent-soldier was deployed.
14. Pre-Deployment
Service Member Family
Normal duties plus Pending deployment
Necessary military initiates significant stress
training (12 to 16 hr Separation and loss
days) anticipated
Complete wills and Possible periods of anger
power of attorney and protest followed by
Screenings/evaluations emotional detachment
Family needs Guard/Reserve families
Prepare for separation Short periods of
“Mission focus” & preparation
emotional withdrawal Need information on
Educate on financial pay and resources
matters & spend time Military pay may not
with children match civilian pay
15. Deployment
Service Member Family
Difficult events may produce Destabilization/disorganization
intense feelings
Fear Reports of Depression
Horror Anxiety
Helplessness Loneliness
(required for diagnosis of Anger
PTSD)
Numbness/Relief
Traumatic events magnified by Physical reactions
Harsh living conditions Sleep disturbances
130 degree temperatures Health complaints
Unrelenting noise
Lack of privacy Added family
Constant threat of attack responsibilities
17. Post Deployment
Service Member Family
Documented psychological
Homecoming exciting
problems within weeks of
returning home and joyful event
Symptoms increased between Not uncommon for both
homecoming and 3 to 4 months spouses to have
Okie (2005) reported Traumatic unrealistic expectations
Brain Injury (TBI) in 22% Family roles and routines
wounded must be renegotiated (1
Cyclical depression month)
Hearing loss Reintegration into a
Coordination problems family that has changed
Memory problems May resent loss of
Affective instability independence
Decreased ability to concentrate
Disengaging from combat
18. Military Family Stressors
Recurrent Stressors: generally experienced by
most military families who face deployment
Combat-Related Stressors: experienced by
families when the returning veteran is exhibiting
PTSD symptomology
19. Recurrent Family Stressors
•Relationship Satisfaction & Relationship Distress
•Pain/Grief: Saying “goodbye” for a year
•Limited communication & loneliness
•Declining intimacy
•Keeping hardships from partner
•Temptations for emotional or physical infidelity
•Feeling like strangers
•Families report that reunion is more stressful
•Married soldiers: higher levels of stress than single
soldiers
(Rosen, Teitelbaum, & Westius, 1993, as cited in Lombard & Lombard,
1997; Reinkober Drummet, Coleman, & Cable, 2003)
20. Recurrent Family Stressors
Role Strain and Ambiguous Loss
•Planning for changing roles
•Ambiguous absence: absent physically but present
psychologically (while deployed)
•Ambiguous presence: present physically, but absent
psychologically (upon reunion)
•Boundary Ambiguity: “family members are uncertain
in their perception about who is in or out of the family
and who is performing which roles and tasks within the
family” (Boss & Greenberg, 1984)
•Upon Reunion: Restarting life together,
employment, parenting, grief over changes
(Faber et al., 2008; Boss, 2004; Reinkober Drummet et al., 2003)
21. Recurrent Family Stressors
Parenting and Child Adjustment
•Family cohesion and adaptability declines
•Greater risk of mental health problems
•Non-deployed Parent’s Depression/Anxiety
increasing mental health symptoms of children
•Children/Teens Acting out at home or at school
(Kelley, 1994; Rosen, Teitelbaum, & Westius, 1993, as cited in Lombard
& Lombard, 1997; Reinkober Drummet, Coleman, & Cable, 2003)
22. Recurrent Family Stressors
Mental Health Concerns (often not diagnosed)
•Anger
•Anxiety & Depression
•Increased Substance Use
•Survivor Guilt
•Suicidal Ideation
(Faber, Willerton, Clymer, MacDermid, & Weiss, 2008; Boss, 2004, as
cited in Faber et al., 2008)
23. Recurrent Family Stressors
Overwhelming Feeling from Nondeployed
Partner/Parent AND Deployed Partner/Parent:
“I need a break. I’m tired. This
deployment/separation was hard for me.
YOU take over for a while.”
24. Combat-Related Family Stressors
•Mental Illness
•Clinical Depression & Anxiety
•Suicidal Ideation/Attempts
•Significant, ongoing substance abuse
•Uncontrollable rage
•20 % of veterans of Iraq war have
requested treatment for mental health
concerns (Van der Kolk et al., 2007)
•Injury or Disability
•Traumatic Brain Injury (TBI)
(Reinkober Drummet, Coleman, & Cable, 2003; Sherman, Sautter,
Jackson, Lyons, & Han, 2006; Nelson Goff et al., 2007; Renshaw,
Rodrigues, & Jones, 2008; Taft et al., 2008; Sherman et al., 2005)
25. Combat-Related Family Stressors
•Intimate Partner Violence
•Study found that veterans with PTSD were
5.4 times more likely to commit violence
against their partner and 26.4 times more
likely to commit “severe violence”
(Sherman et al., 2006)
•Post Traumatic Stress Disorder (PTSD)
•Reexperiencing
•Avoidance
•Hyperarousal
(Reinkober Drummet, Coleman, & Cable, 2003; Sherman et al.,
2006; Nelson Goff et al., 2007; Renshaw, Rodrigues, & Jones,
2008; Taft et al., 2008; Sherman et al., 2005)
26. Overcoming Stressors
*Couples therapy that facilitates connection and intimacy
following deployment can significantly influence the
successful treatment of a veteran’s PTSD symptoms
(Sherman et al., 2005).
*Couples therapy for a veteran with PTSD and their
non-deployed partner can:
1. Increase the veteran’s ability to cope with distress
related to traumatic experiences
2. Help the partners "understand and empathize with
confusing behavior"
3. Strengthen the attachment relationships (Sherman et
al., 2005).
*Strengthen the dyad, strengthen the individuals, and
strengthen the families.
27. Assessment of Veterans
Military deployments
Phase of military life
Promotions
Reason for enlisting
AFSC, MOS
Positives/Negatives of
deployment
Faith in deployment leadership
Meaning attributed to
Deployment
Losses at home or on deployment
Traumatic Brain Injury (refer for
medical evaluation)
PTSD Symptomology/Triggers
28. Assessment of Female Veterans
•Clip: Two Women’s Experience
•Hypervigilance during deployment
•Combat Experience (Often at least
explosions near/within camp)
•Experience with sexual harassment
or assault
“. . . After completing important jobs in war, women
with the disorder often smack up against old-
fashioned ignorance: male veterans and friends who
do not recognize them as real soldiers; husbands
who have little patience with their avoidance of
intimacy; and a society that expects them to be
feminine nurturers, not the nurtured.”
(Quote From NY Times series: Women at Arms: Combat Role,
and Anguish, Too by Damien Cave: published 10/31/2009)
29. Assessment of Military Families
Strength of Dyad Before & After
Children/Teen’s response to
reunion (fear, anger, etc.)
Conflict Management(pre-post)
Parenting Style (pre-post)
Role navigation
Deployment Experiences
Example: Assessment Gap for
Couples Therapy
30. Implications for Treatment
Solution-Focused Therapy
People have existing Emphasis on process
strengths, resources Strategic approach to
and problem solving Eclecticism
skills Brief by design but not
Realities co-created in always
conversations between
people
Small changes = Big
results
31. Implications for Treatment
Solution-Focused Therapy
Problems are maintained by If it ain’t broke – don’t fix it
Doing More of the Same Once you know what
Expecting no change works, do it more
If it doesn’t work, do
something different
32. Implications for Treatment
Solution-Focused Therapy
Scaling Questions
Observe Differently
Do Something Differently
Try To Rate The Other’s Experience
Coping Questions
The Miracle Question
Suppose a Miracle Doesn’t Happen
Exceptions
33. Emotionally Focused Therapy
Evidence-based and time-limited (10-15 sessions)
Based on research on attachment theory (Bowlby)
Stages of Treatment
1. Cycle De-escalation (steps 1-4)
2. Changing Interactional Positions (steps 5-7)
3. Consolidation & Integration (steps 8-9)
Parallelled w/ 3 Stages of Trauma Treatment (McCann and
Pearlman, 1990)
1. Stabilization (steps 1-4)
2. Building Self & Relational Capacities (steps 5-7)
3. Integration (steps 8-9)
34. Emotionally Focused Therapy for
Military Couples & Families
Couples:
EFT-style couples weekends for servicemembers and their
partners since February 2006:
*Increased awareness of their relationship dynamics: 95%
*Increased self-awareness: 91.5%
*Increased awareness of partner’s feelings and needs: 94%
Families:
Couples interventions that help service members express
emotions to support system and decrease avoidance can
improve family adjustment
(Strong Bonds, Strong Couples (SBSC) ; Monson et al., 2005; Taft et al., 2008)
35. EFT for Recurrent &
Combat-Related Stressors
Relationship distress: Successfully addressed in
73% of couples (Johnson et al., 2001)
Resolution of Attachment Injuries can:
1. Improve parenting and child adjustment
2. Decrease role strain and ambiguous loss
3. Improve mental health concerns
Mental illness
Intimate partner violence
Symptoms of PTSD
36. Emotionally Focused Therapy
Attachment Injuries
Small incidents or significant failures and
betrayals by one of the partners
Highly emotional, resulting in feelings of
abandonment and fear of vulnerability in the
future
Commonly result from:
Experiencing grief and loss
Fears of the unknown or uncontrollable
aspects of life
Periods of adjustment to transition
Physical Danger
What did you experience this year?
(Johnson et al., 2001)
37. EFT & Combat-Related
Stressors
The decline of trauma symptoms and
maladaptive trauma-related conduct
correlates more significantly with the
traumatized individual’s ability to seek
comfort from a support system
than with the severity of the individual’s
trauma experiences.
(van der Kolk, Perry, & Herman, 1991, as cited in Johnson & Williams-
Keeler, 1998).
38. Emotionally Focused Therapy
Stage 1. Cycle De-escalation
1. Identify topics of conflict.
2. Identify the related negative interaction cycle.
3. Draw out each partner’s “unacknowledged emotions”
that relate to their “interactional position” in the cycle
4. Redefine the problem as being related to the
interaction cycle, the deeper emotions involved, and
attachment needs of each partner.
(Johnson, 2005)
**Case Study
39. Emotionally Focused Therapy
Stage 2. Changing Interactional Positions
5. Encourage and facilitate “identification with
disowned attachment emotions, needs, and aspects of
self.”
6. Facilitate mutual acceptance of the experience of the
other
7. Help the couple communicate needs and desire, which
restructures interactions and facilitates bonding even
(Johnson, 2005)
**Case Study
40. Emotionally Focused Therapy
Stage 3. Consolidation & Integration
8. Assist the couple in finding “new solutions to
old problems.”
9. Reinforce new cycles, positions, and
communication of attachment needs. (Create
new narrative and resolve formerly emotionally
charged problems). (Johnson, 2005)
**Case Study
41. Implications for Treatment
Gottman-Sound Relationship House
Increase everyday positive affect
Decrease negative affect and increase
positive affect during conflict
management.
Help the couple to create shared
meaning
43. Gottman-Sound Relationship House
Four Horseman of the Apocalypse
Criticism- blaming Defensiveness- defend
Bringing up the past yourself , refuse to
discuss an issue
Contempt- making fun,
belittling, looking Stonewalling- showing
down at your partner no reaction, having a
blank look, or ceasing
to care
Gottman, John M., and Nan Silver. (1999). How I Predict Divorce,” in The Seven Principles for Making Marriages
Work (Chapter Two, 25-46). New York: Three Rivers Press (Random House, Inc.
44. Gottman-Sound Relationship House
Four Horseman of the Apocalypse
Criticism - "What kind of person are you?"
Contempt - "I would never be so low as to do something like
that!"
Defensiveness - "Yeah? Well what about what you did?"
Stonewalling - (shutting down, associated with high
physiological arousal and efforts to self-soothe with thoughts
like "I can't believe she's saying this!")
45. Gottman-Sound Relationship House
Love Map-
Having interest in your partners world
Having partner willing to share their world
Having cognitive room to store this information
If you know it do you update it
Favorites Dreams Hopes
Military couples- distancing; maps maybe outdated
46. Gottman-Sound Relationship House
Love Map Combat Love Map
What do you remember about how What was your day like during
we met Who was your battle buddy
What was the best part of our What was the hardest thing you
wedding had to deal with
What part of our relationship has Did any fun things happen
been the most fun for you Is it hard to talk about your exp.
If we had a free weekend where How can I make it easier
would we go
The thing I admire most about you.
Robert P. Obrien, Central Texas Veterans Health Care System Austin Texas (2008)
47. Gottman-Sound Relationship House
Fondness & Admiration
• Frequency of spontaneous expressions of fondness
and admiration
• Positive statement to and from each partner
• General attitude of respect and consideration
• Willingness to accept influence
• Perception of fondness and admiration
• A sense of “we-ness”
• Mutual connection sexual connection
48. Gottman-Sound Relationship House
Fondness & Admiration
• List 3 things I most admire about my spouse
I feel loved and cared for in this relationship
I feel accepted and liked by my partner
We rarely go to sleep w/out show of love or
affection
I am really proud of my partner
Our sex life is generally satisfying
My partner appreciates the things I do in this
relationship
50. James McAuley, MA LAMFT
Claddagh Counseling
Web: www.claddaghcounseling.com
Email: james@claddaghcounseling.com
Phone: 320-223-0015
Rebekah Miller, MA
Wellness Counseling Services (WCS)
Web: www.wellnesscounselingmn.com
Email: Rmiller@wellnesscounselingmn.com
Phone: 651-399-6920
51. Resources
Beyond the Yellow Ribbon: www.btyr.org
MN program developed to connect service members and their families with support, services, and resources.
Courage After Fire by Keith Armstrong, Suzanne Best, & Paula Domenici.
For veterans and their families to navigate post deployment challenges. Provides helpful insight for therapists.
Military Family Care Initiative: https://www.militaryfamilies.state.mn.us/
Practitioners can sign up to provide discounted health and wellness services to military families.
Strong Bonds Strong Couples Website: http://www.strongbondsstrongcouples.com/index.html
Using EFT to help Military Couples reunite after deployment
Give an Hour - http://www.giveanhour.org
Give an hour of your time to provide critical mental health services to U.S. troops and their family members.
Provider resources section.
Center for Deployed Psychology- http://www.deploymentpsych.org
Trains military & civilian mental health professionals on deployment related behavioral health services for
veterans and their families.
In Their Boots http://www.intheirboots.com
Video series that sheds light on how veterans and their families deal with pre, during and post deployment.
Defense Centers of Excellence for Psychological Health & TBI http://www.dcoe.health.mil
Webinars, Resources, Emails
52. References & Suggested Readings
Faber, A. J., Willerton, E., Clymer, S. R., MacDermid, S. M., & Weiss, H. M. (2008). Ambiguous absence,
ambiguous presence: A qualitative study of military reserve families in wartime. Journal of Family
Psychology, 22(2), 222-230. doi: 10.1037/0893- 3200.22.2.222
Johnson, S. M. (2008). Emotionally focused couple therapy. In A. S. Gurman (Ed.), Clinical handbook of
couple therapy (pp. 107-137). New York: Guilford.
Johnson, S. M., Makinen, J. A., & Millikin, J. W. (2001). Attachment injuries in couple relationships: A new
perspective on impasses in couples therapy. Journal of Marital and Family Therapy, 27(2), 145-156.
Johnson, S. M. & Williams-Keeler, L. (1998). Creating healing relationships for couples dealing with trauma:
The use of emotionally focused marital therapy. Journal of Marital and Family Therapy, 24(1), 24-40.
Lombard, D., & Lombard, T. (1997). Commentary: Taking care of our military families. Families, Systems &
Health, 15(1), 79-83.
Makinen, J. A., & Johnson, S. M. (2006). Resolving attachment injuries in couples using emotionally focused
therapy: Steps toward forgiveness and reconciliation. Journal of Consulting and Clinical Psychology, 74(6),
1055-1064. doi: 10.1037/0022- 006X.74.6.1055
Nelson Goff, B. S., Crow, J. R., Reisbig, A. M. J., & Hamilton, S. (2007). The impact of individual trauma
symptoms of deployed soldiers on relationship satisfaction. Journal of Family Psychology, 21(3), 344-353.
doi: 10.1037/0893-3200.21.3.344
Pittman, J. F., Kerpelman, J. L., & McFadyen, J. M. (2004). Internal and External Adaptation in Army Families:
Lessons from Operation Desert Shield and Desert Storm. Family Relations, 53(3), 249-260.
Poundja, J., Fikretoglu, D., & Brunet, A. (2006). The co-occurrence of posttraumatic stress disorder symptoms
and pain: Is depression a mediator? Journal of Traumatic Stress, 19(5), 747-751. doi: 10.1002/jts.20151
Price, J. L., Monson, C. M., Callahan, K., & Rodriguez. B. F. (2006). The role of emotional functioning in
military-related PTSD and its treatment. Journal of Anxiety Disorders, 20(5). 661-674.
doi:10.1016/j.janxdis.2005.04.004
53. References & Suggested Readings
Reinkober Drummet, A., Coleman, M., & Cable, S. (2003). Military families under stress: Implications for
family life education. Family Relations, 52(3), 279-287.
Renshaw, K. D., Rodrigues, C. S., & Jones, D. H. (2008). Psychological symptoms and marital satisfaction in
spouses of Operation Iraqi Freedom veterans: Relationships with spouses’ perceptions of veterans’
experiences and symptoms. Journal of Family Psychology, 22(3), 586-594. doi: 10.1037/0893-
3200.22.3.586
Riggs, D. S. (1997). Posttraumatic stress disorder and the perpetration of domestic violence National Center for
PTSD Clinical Quarterly, 7(2), 22-25.
Riggs, D. S., Byrne, C. A., Weathers, F. W., & Litz, B. T. (1998). The quality of intimate relationships of male
Vietnam veterans: Problems associated with posttraumatic stress disorder. Journal of Traumatic Stress,
11(1), 87-101.
Rotter, J. C., & Boveja, M. E. (1999). Counseling military families. The Family Journal: Counseling and
Therapy for Couples and Families, 7(4), 379-382.
Sherman, M. D., Sautter, F., Jackson, M. H., Lyons, J. A., & Han, X. (2006). Domestic violence in veterans with
posttraumatic stress disorder who seek couples therapy. Journal of Marital and Family Therapy, 32(4), 479-
491.
Sherman, M. D., Zanotti, D. K., & Jones, D. E. (2005). Key elements in couples therapy with veterans with
combat-related posttraumatic stress disorder. Professional Psychology, 36(6), 626-633.
Taft, C. T., Schumm, J. A., Panuzio, J., & Proctor, S. P. (2008). An examination of family adjustment among
Operation Desert Storm veterans. Journal of Consulting and Clinical Psychology, 76(4), 648-656. doi:
10.1037/a0012576