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

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

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

    • Thank you for your interest in providingtherapeutic support to military families.To request a presentation at your agency focusedon the Assessment and Treatment of MilitaryFamilies, please email for a quote.James McAuley, MA LAMFTCladdagh CounselingWeb: www.claddaghcounseling.comEmail: james@claddaghcounseling.comPhone: 320-223-0015Rebekah Miller, MAWellness Counseling Services (WCS)Web: www.wellnesscounselingmn.comEmail: Rmiller@wellnesscounselingmn.comPhone: 651-399-6920
    • Military Families:Enduring Continuous Cycles of Deployment and Implications for Treatment James McAuley, MA LAMFT 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 CULTUREDifferent 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 200989% male 11% female72% AD 28% Reserve components52% married 48% single54% males M 46% males S60% females M 40% females S41% 20-24 YOA 21% 25-29 YOA25% 30-39 YOA 13% 40 & above63% Caucasian 13 % African American1% American Indian 3% Pacific Islander1% multi-race 19% UnknownData 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 Positivesdrivers since WWII)  Opportunity for Advancement*71,000 served in Korea  Leadership Skills Nurtured*256,000 Vietnam era  Sense of Accomplishment, Satisfaction, & Strengthveterans  Success Acknowledged (On subs 12/2011)*More than 180,000 Drawbackswomen deployed since  Hypervigilance: Comradery or Sexual Interest?9/11/2001  Assumption/stereotype of incompetence & more*Over 200,000 women on problemsactive duty  Stigma related to sexual harassment and assault*1.7 Million womenveterans in USAStatistics fromDisabled 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 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
    • Post-Deployment“Physically Present & Psychologically Absent”
    • 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
    • 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 singlesoldiers (Rosen, Teitelbaum, & Westius, 1993, as cited in Lombard & Lombard, 1997; Reinkober Drummet, Coleman, & Cable, 2003)
    • Recurrent Family StressorsRole 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)
    • Recurrent Family StressorsParenting 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)
    • Recurrent Family StressorsMental 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)
    • Recurrent Family Stressors Overwhelming Feeling from NondeployedPartner/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 leastexplosions near/within camp)•Experience with sexual harassmentor 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
    • 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
    • Implications for Treatment Solution-Focused TherapyProblems 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
    • Implications for TreatmentSolution-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
    • 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 & FamiliesCouples: 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
    • Emotionally Focused TherapyAttachment 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).
    • Emotionally Focused TherapyStage 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
    • 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
    • Emotionally Focused TherapyStage 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
    • Implications for TreatmentGottman-Sound Relationship House Increase everyday positive affect Decrease negative affect and increase positive affect during conflict management. Help the couple to create shared meaning
    • Implications for TreatmentGottman-Sound Relationship House
    • Gottman-Sound Relationship House Four Horseman of the ApocalypseCriticism- blaming Defensiveness- defend Bringing up the past yourself , refuse to discuss an issueContempt- 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.
    • 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 cant believe shes saying this!")
    • Gottman-Sound Relationship HouseLove Map-Having interest in your partners worldHaving partner willing to share their worldHaving cognitive room to store this informationIf you know it do you update itFavorites Dreams HopesMilitary couples- distancing; maps maybe outdated
    • Gottman-Sound Relationship HouseLove Map Combat Love Map What do you remember about how What was your day like during we met Who was your battle buddyWhat was the best part of our What was the hardest thing you wedding had to deal withWhat 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 goThe thing I admire most about you. Robert P. Obrien, Central Texas Veterans Health Care System Austin Texas (2008)
    • 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
    • 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
    • Conclusion &Questions
    • James McAuley, MA LAMFT Claddagh Counseling Web: www.claddaghcounseling.com Email: james@claddaghcounseling.com Phone: 320-223-0015Rebekah Miller, MA Wellness Counseling Services (WCS) Web: www.wellnesscounselingmn.com Email: Rmiller@wellnesscounselingmn.com Phone: 651-399-6920
    • ResourcesBeyond 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 deploymentGive 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 ReadingsFaber, 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- 3200.22.2.222Johnson, 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.74.6.1055Nelson 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: 10.1037/0893-3200.21.3.344Pittman, 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.20151Price, 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 ReadingsReinkober 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- 3200.22.3.586Riggs, 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