Military‐Related Posttraumatic Stress Disorder and Intimate Relationship Behaviors: A Developing Dyadic Relationship Model

The protracted conflict in Iraq and Afghanistan and an all‐volunteer military has resulted in multiple war zone deployments for many service members. While quick redeployment turnaround has left little time for readjustment for either the service member or family, dealing with the long‐term sequelae of combat exposure often leaves families and intimate partners ill‐prepared for years after deployments. Using a modified grounded theory approach, digitally recorded couple interviews of 23 couples were purposefully selected from a larger sample of 441 couples to better understand the impact of war zone deployment on the couple. The veteran sample was recruited from a randomly selected cohort of men in treatment for posttraumatic stress disorder (PTSD). Overall, it was found when veterans experiencing deployment‐related PTSD reenter or start new intimate relationships they may bring with them a unique cluster of interrelated issues which include PTSD symptoms, physical impairment, high rates of alcohol and/or drug abuse, and psychological and physical aggression. These factors contributed to a dynamic of exacerbating conflict. How these couples approached relationship qualities of mutuality, balanced locus of control and weakness tolerance across six axes of caregiving, disability, responsibility, trauma, communication, and community impacted the couple's capacity to communicate and resolve conflict. This dyadic relationship model is used to help inform implications for clinical practice.     

Mothers and deployment: Understanding the experiences and support needs of deploying mothers of children birth to five

ABSTRACT

Military deployments can demand long separations of service members and their families. The strain of separation is particularly acute for mothers of very young children. This study aimed to better understand the deployment and reintegration experiences of service members who are mothers of young children. Focus groups and interviews were conducted with 12 service member mothers who deployed to Iraq and/or Afghanistan when one or more of their children was younger than age 6. Discussions explored experiences before, during, and after deployment; needs and challenges at each stage; available support resources and gaps in support. Thematic data analysis was conducted, drawing on principles of grounded theory. Disruption and continuity were central themes as participants illuminated the challenges they faced and their profound dedication to sustaining strong family relationships across the deployment cycle. Relinquishing, reassuming, and balancing multiple roles and responsibilities are additional themes that were frequently evoked. Participants noted a lack of formal resources responsive to their needs and circumstances and highlighted a need for services tailored to mothers who are deploying. Military mothers, particularly mothers of young children, face distinct challenges surrounding deployment. Better understanding their experiences and support needs can inform tailored services to meet their needs.     

Military Deployment of an Adult Child: Ambiguous Loss and Boundary Ambiguity Reflected in the Experiences of Parents of Service Members

ABSTRACT

This study explored the experiences of parents of service members, military family members who are often overlooked even though they are likely a vital source of support for their military adult-children. Reflections on deployment of military adult-children were gathered from 21 parents in semistructured group interviews. A framework of ambiguous loss, boundary ambiguity, and ambivalence was used to analyze comments reflecting pre-deployment, deployment, and post-deployment experiences. Pre-deployment anticipation of leave-taking was associated with boundary ambiguity and ambivalence for parents, tempered by safety concerns. During deployment ambiguity in parental role expectations and parameters complicated parents’ attempts to manage physical absence and maintain psychological presence. Post-deployment challenged parents with ambiguous psychological presence and disruption of family boundaries, complicated by changes associated with the effects of war.     

People who live apart together (LATs) – how different are they?

‘Living apart together’– that is being in an intimate relationship with a partner who lives somewhere else – is increasingly recognised and accepted as a specific way of being in a couple. On the face of it, this is a far cry from the ‘traditional’ version of couple relationships, where co‐residence in marriage was placed at the centre and where living apart from one's partner would be regarded as abnormal, and understandable only as a reaction to severe external constraints. Some commentators regard living apart together as a historically new family form where LATs can pursue a ‘both/and’ solution to partnership – they can experience both the intimacy of being in a couple, and at the same time continue with pre‐existing commitments. LATs may even de‐prioritize couple relationships and place more importance on friendship. Alternatively, others see LAT as just a ‘stage’ on the way to cohabitation and marriage, where LATs are not radical pioneers moving beyond the family, but are cautious and conservative, and simply show a lack of commitment. Behind these rival interpretations lies the increasingly tarnished spectre of individualisation theory. Is LAT some sort of index for a developing individualisation in practice? In this paper we take this debate further by using information from the 2006 British Social Attitudes Survey. We find that LATs have quite diverse origins and motivations, and while as a category LATs are often among the more liberal in family matters, as a whole they do not show any marked ‘pioneer’ attitudinal position in the sense of leading a radical new way, especially if age is taken into account.     

Turning Points and Trajectories in Military Deployment

Previous military family research has assumed a stable set of deployment phases. In line with critiques of such models within family communication, we identified the varied turning points and trajectories military spouses experience across deployment. We interviewed 50 Army and Army National Guard wives whose husbands served in missions to Iraq and Afghanistan. Participants graphed turning points and corresponding marital satisfaction levels across a recent deployment. Participants reported 519 turning points that fell into four supraordinate categories: Deployment/Military-Related Events, Life Events, Communication Events, and Other. Trajectories within each deployment phase reflected five patterns: Turbulent, Increasing, Decreasing, Stabilized, and Dipped. Most participants' trajectories reflected turbulence during the predeployment and deployment phases, and declining or dipped satisfaction during the postdeployment period. Results reflect varied experiences and provide useful information for those experiencing wartime separations or those supporting military families through deployment.     

Family‐of‐Origin Experiences and Adjustment in Married Couples

Within this article a model is tested that examines the relationship between married individuals' experiences in their family of origin and patterns of marital adjustment. Data were analyzed using structural equation modeling procedures, making the couple the unit of analysis. This allowed for an exploration of how one partner's family‐of‐origin experience and the other partner's family‐of‐origin experience uniquely influence each of the partner's experiences of the marriage. Two aspects of the results stand out. First, both husbands' and wives' family‐of‐origin experiences emerged as significant influences on marital adjustment. Second, the data suggest that wives' experiences within their family of origin are more strongly related to both their own accounts of their marriages and their husbands' accounts of their marriages than are husbands' family‐of‐origin experiences.     

People who live apart together (LATs): new family form or just a stage?

‘Living apart together’ – that is being in an intimate relationship with a partner who lives somewhere else (LAT) – is increasingly recognised and accepted as a specific way of being in a couple. On the face of it, this is a far cry from the ‘traditional’ version of couple relationships, where co-residence in marriage was placed at the centre and where living apart from one's partner would be regarded as abnormal, and understandable only as a reaction to severe external constraints. Some commentators regard living apart together as a historically new family form where partners can pursue a ‘both/and’ solution to partnership – they can experience both couple intimacy, but at the same time maintain personal autonomy and pre-existing commitments. Alternatively, others see LAT as just a ‘stage’ on the way to cohabitation and marriage, where LATs are not radical pioneers moving beyond the family, but are cautious and conservative, and simply show a lack of commitment. Behind these rival interpretations lies the increasingly tarnished spectre of individualisation theory. Is LAT some sort of index for a developing individualisation in practice? We take this debate further by using information from the 2006 British Social Attitudes Survey and from in-depth interviews with LAT partners. We find that LATs do resemble cohabitating (unmarried) couples in demographic and social terms, but also display quite diverse origins and motivations. One group of LATs do not see themselves as couple partners at all, but more as special boy/girlfriends. Others live apart mainly in response to external circumstances. But some LATs do seem to be developing a new way of living in their relationships, as a means of balancing both couple intimacy and personal autonomy over the longer term.     

Divorce:

This article approaches divorce from a combined family systems, individual life cycle and stage theory of development perspective. It posits that the choice of what kind of therapy is apt to be most efficient and most efficacious for any patient/couple should be made after identifying at what stage in the divorce process the person(s) is/are in when they enter treatment and what their respective ego strengths, cognitive functioning, and social and resource networks are. There is an assumption of flexibility in the therapist's style and philosophic orientation. It is recommended that therapy encompass interventions that are likely to be the most effective in the various stages rather than be a rigid adherence to one dogma. Several illustrative case vignettes are presented.     

When Watching A Sunset Can Help A Relationship Dawn Anew: Nature‐Guided Therapy For Couples And Families

Based on the case of a couple in conflict who were available for only two sessions of Therapy, this article explores the application of a brief, integrative ecopsychology, Nature‐Guided Therapy, in relationship work. It discusses what nature‐guided Therapy is, where it fits in the spectrum of Therapypeutic interventions, and how it can be applied. As there is a paucity of literature linking the growing field of ecoTherapy with family and couple Therapy, the relevance of nature‐guided approaches is discussed. Its goal goes beyond problem resolution, aiming at the creation of positive, effective and joyful relationships. Step‐by‐step procedures for applying nature‐guided interventions in family and couple work are presented.     

The feminist/emotionally focused therapy practice model: an integrated approach for couple therapy

Emotionally focused therapy (EFT) is a well-developed, empirically tested practice model for couple therapy that integrates systems, experiential, and attachment theories. Feminist family therapy theory has provided a critique of biased assumptions about gender at play in traditional family therapy practice and the historical absence of discussions of power in family therapy theory. This article presents an integrated feminist/EFT practice model for use in couple therapy, using a case from practice to illustrate key concepts. Broadly, the integrated model addresses gender roles and individual emotional experience using a systemic framework for understanding couple interaction. The model provides practitioners with a sophisticated, comprehensive, and relevant practice approach for working with the issues and challenges emerging for contemporary heterosexual couples.     

Conceptualizing and Treating Problem Gambling as a Family Issue

Few family therapists have training in the identification, assessment, and treatment of problem gambling and its impact on couple and family relationships. The authors conceptualize problem gambling (PG) as a family issue and encourage clinicians and researchers to pay attention to the systemic antecedents and consequences of PG on family relationships. A review of the literature and clinicians' experiences regarding the impact of PG on couple and family relationships are presented and discussed. In light of the limited systemic-based treatments for PG, marriage and family therapists are urged to begin paying attention to this emerging issue that has significant couple and family ramifications.     

THE INTEGRATIVE PSYCHOTHERAPY ALLIANCE: FAMILY,COUPLE AND INDIVIDUAL THERAPY SCALES*

The therapeutic alliance concept has been confined primarily to the literature on individual psychotherapy. This paper formally introduces the concept into the family and marital therapy domain and presents various clinical hypotheses about the nature of the alliance and its role in familyand marital therapy. A systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework. The implications of this integrative-alliance concept for family, couple and individual therapy research are examined. Three new system-ically oriented scales to measure the alliance in individual, couple and family therapy are presented along with some preliminary data on their methodological characteristics.     

Sexual addiction and marriage and family therapy: facilitating individual and relationship healing through couple therapy

In recent decades there has been an increase in literature regarding sexual addiction as well as a growing number of clients presenting in therapy with problems related to their sexual behaviors (including internet sexual addiction). This article (a) presents a synthesis of the research on the impact of sexual addiction on the addict, the partner, and the couple; (b) outlines the process of healing for each based on the research synthesis; and (c) discusses the role of marriage and family therapy in facilitating both individual and relationship healing from sexual addiction. Implications for future research in sexual addiction, generally, and in marriage and family therapy, specifically, are presented.     

“This will help your children”: Service providers’ experiences with military families during cycles of deployment

ABSTRACT

Military families face not only the same challenges as other families, but also unique issues due to their military involvement. Parenting programs for civilian families can be helpful, but they do not generally cover the specific issues faced by military families. The purpose of this qualitative study was to gather information from a focus group of eight service providers about the types of issues that affect military families, such that content and delivery of workshops at a social service agency could be formed to specifically cater to military families. This study utilized a phenomenological approach, and analyses revealed areas for social service involvement around the cycle of deployment. Specifically, social services could be helpful by using psychoeducational and normalization techniques around the five major themes that resulted from this study: (1) the issues of servicemembers psychologically withdrawing before deployment, (2) family cohesion and connectedness during and after deployment, (3) family stability during reintegration of the service member, (4) military families experience many of the same challenges that nonmilitary families do (such as domestic violence and financial issues), and (5) utilizing a military culture framework for all military family programs.     

Therapist effects on dropout in couple therapy

Marriage and family therapy scholars have argued that therapists play a crucial role in successful couple therapy, yet little research has empirically documented that the therapist in couple therapy has a significant impact on outcomes. Known as the study of therapist effects, this study sought to assess the amount of variance attributed to the therapist in couple therapy outcomes. Using dropout as the outcome variable, this study analyzed data from 1,192 couples treated by 90 masters and doctoral student therapists at a university‐based training clinic. Results from multilevel analysis indicated that therapists in the sample accounted for 9.4% of the variance in couple dropout while controlling for initial couple impairment. Therapist gender and therapist experience did not significantly predict variability in therapist effects. These findings give promise to future research on therapist effects in couple therapy and encourage exploration into which therapist characteristics and behaviors contribute to successful clinical outcome.     

Traumatic Stress and Affect Management in Military Families

The war-time deployment of a service member creates significant stress for the family system that supports that person’s transition into combat, combat duty, and readjustment into civilian and family life upon return. The stressors associated with the deployment cycle are significant and can lead to depression, anxiety, and behavioral concerns for all family members including the children and partners. A family’s adaptation to these stressors can also impact the functioning of the service member during the phases of mobilization, deployment, sustainment, and reintegration. Social work interventions that offer support to the military family can reduce levels of distress within and between the members and improve overall family functioning. A case vignette will be presented that highlights some of the salient interpersonal challenges that can develop in a military family when a veteran returns home with posttraumatic stress that is left untreated. Recommendations for interventions will be considered through the application of psychoeducational approaches for managing traumatic stress in families.     

What Novice Family Therapists Experience During a Session… A Qualitative Study of Novice Therapists' Inner Conversations During the Session

“What do novice family therapists experience during a session with a couple or family?” This is the central question in this article. A videotape‐assisted recall procedure was used to study novice family therapists’ inner conversations. The therapists' reflections were analyzed using thematic analysis. This resulted in a coding system that distinguishes four main domains: (a) reflections concerning the self; (b) reflections about the therapy process; (c) reflections on emotions about the family members; and (d) managing the session as well as own emotions. The study furthermore revealed that during a session, novice family therapists experience strong emotions, such as self‐criticism and irritation. Both emotions may encompass dangers, as well as opportunities for the therapeutic alliance and the process.     

A Model for Assessing the Impact of Combat-Related Deployments on U.S. Army Spouses

Cognitive appraisal and coping theory were used to examine parental stress, family stress, and personal stress among wives of deployed soldiers. A random sample of wives of U.S. Army personnel deployed to Iraq provided evidence that length of deployment, rank of deployed soldier, and number of previous deployments, impacted these wives during deployments. Results suggest that rank of deployed soldiers and number of deployments influenced the spouse's perception of family stress; whereas rank and length of the deployment influenced her experience of parental stress. All three factors served as indicators of the personal stress experienced during deployments by these wives.     

Exploring the deployment and reintegration experiences of active duty military families with young children

Active duty military families are experiencing increased stress as service members deploy to and return from lengthy and repeated deployments to multiple war zones. These deployments have a cumulative impact on the behavioral health and well-being of not only the service member, but also the family, particularly in families with very young children (Lester et al., 2016). Emergent research concerning families with young suggests that greater attention to the military spouse is needed to ensure effective, supportive service provision for these families. The purpose of the present study is threefold: (1) to identify the challenges faced by families with young children during and after deployment, (2) to understand resource utilization by these families, and (3) to explore the strengths and strategies used during these experiences. Data were collected through semi-structured interviews with 19 active duty Marine Corps family members with young children (under 5 years old) and 10 key program providers on or near a large military base in the southeast region of the United States. Findings reveal significant social isolation, which is consistent with the literature, the need for formal and informal social supports as well as self-care for the at-home parent, challenges in co-parenting and utilizing known resources, and a range of strategies used to manage deployment and reintegration. Implications for practice are discussed.