Military Families: Enduring Continuous Cycles of Deployment and Implications for Treatment

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

Military Families:
Enduring Continuous Cycles of
Deployment and
Implications for Treatment

Rebekah Miller, MA

Introduction
 Introductions
 Who’s in the audience?
 Operation In Their Boots Video Clip

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

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

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

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

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

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

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/

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

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.

Deployment Cycle

 Pre-deployment: Preparation
 Deployment: Separation
 Post Deployment: Reintegration

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

Deployment
 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

Post-Deployment
“Physically Present & Psychologically Absent”

Post Deployment
 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

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

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)

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)

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)


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)

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.”

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)

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)

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.

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

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)

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

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

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

 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

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)

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)

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

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)

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).

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

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

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

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

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.

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!")

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


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)

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

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

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

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

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

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

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