Military Family Therapy

The Military Family SystemPresenters: LeAnne Rozner, M.A.

& Dominic Moreno

Introductions

LeAnne Rozner• Marriage & Family Therapist Registered Intern• M.A. Counseling Psychology, JFKU• Spouse of a Veteran with PTSD

Dominic Moreno• Student, M.A. Counseling Psychology, JFKU• Marriage & Family Therapist Trainee, JFKUCC• Military Veteran (USCG)

Our Military Today

“No one comes back unchanged.”

Colonel (Dr.) Tom BurkeDepartment of Defense

Director of Mental Health Policy

Military Culture

Culture is the set of shared attitudes, values, goals and practices that characterize an

institution, organization, or group.

Core Values:•USCG - Honor, Respect, Devotion to Duty•US Army - Loyalty, Duty, Respect, Selfless Service, Honor, Integrity, and Personal Courage •USAF - Integrity, Service, Excellence•USN & USMC - Honor, Courage, Commitment

Military Culture

• Status• Rank• Pay Grade (E1 – O9)• Rate / MOS (Military Occupational Specialty)

• INCONUS / OCONUS• PCS• Deployment

What is a Veteran?

A Veteran is someone who,at one point in their life

wrote a blank checkmade payable to

the United States of Americafor an amount up to

and includingtheir life.

Our Wars Today

• 1 in 4 Americans have a connection to the Military• Over 1.5 million service members have served in

these wars• Over half of service members and their spouses are

under 30 years old• 53% married, 68% have children• High % coming home with PTSD and TBI• Nearly half experience multiple deployments• Psychological issues rise with repeated deployments• Civilian Soldiers

Army One Source Fact Sheet

Facts To Remember

• The emotions family members experience during the cycles of deployment are a normal reaction to an abnormal situation unique to the military.

• If the service member experiences combat stress, it can interfere with the family members’ ability to reintegrate as a family.

• Encourage them to seek help early rather than later.

The Deployment Cycle

Three Phases of Deployment Cycle:

•Pre-deployment•Deployment•Post-deployment

In the current conflicts, Service members and families are going through this cycle repeatedly.

Emotional Stages of Deployment

Pre-Deployment•Stage 1 – Anticipation of Departure•Stage 2 – Detachment and Withdrawal

Deployment•Stage 3 – Emotional Disorganization•Stage 4 – Recovery and Stabilization•Stage 5 – Anticipation of Return

Post-Deployment•Stage 6 – Return Adjustment and Renegotiation•Stage 7 – Reintegration and Stabilization

The Deployment Cycle

Pre-Deployment Phase

Notification, Preparation, & Training•A time of preparation for both the Service member and their family.

•Packing Up, Getting Squared Away, Shipping Out

•The Service member will experience a significant increase in military-related training demands

•The family must also prepare for the Service member’s absence both practically and emotionally

Pre-Deployment: Emotional Stage 1

Anticipation of Departure:•Spouses may alternately feel denial and anticipation of loss.

•Tempers may flare as couples attempt to take care of all the items on a family pre-deployment checklist, while striving to make time for “memorable” moments.

•May begin again before a couple or family has even had time to renegotiate a shared vision of who they are after the changes from the last deployment.

Pre-Deployment: Emotional Stage 2

Detachment and Withdrawal :

•Members become more and more psychologically prepared for deployment, focusing on the mission and their unit. •Sadness and anger occur as couples attempt to protect themselves from the hurt of separation; marital problems may escalate.

Deployment Phase

Restructuring the Family System

•Physical Separation begins

•Units and individuals depart from their respectiveinstallations into their designated assignments

•“Closing the Ranks”

Deployment: Emotional Stage 3

Emotional Disorganization :•With back to back deployments, one might think that this stage of adjusting to new responsibilities and being alone would get easier.

•Although a military spouse may be familiar with the routine, (s)he may also be experiencing “burn-out” and fatigue from the last deployment, and feel overwhelmed at starting this stage again.


Recovery and Stabilization :

•Spouses realize they are fundamentally resilient and able to cope with the deployment. They develop increased confidence and a positive outlook.

•Many resources are available to provide needed support.

Redeployment

“At Ease” •Demobilization is the period when Service Members returning from theater arrive at the demobilization station.•Service Members may be extremely eager to get home•Family members will be just as anxious for their arrival


Anticipation of Return:

•Demobilization

•A happy and hectic time as families prepare for the return of the service member

•Spouses, children, and parents need to talk about realistic plans and expectations for the reunion•Close your eyes …•Troops in Combat•Welcome Home Parade

http://www.youtube.com/watch?v=I4LD8Mczktc&noredirect=1

Post-Deployment

• The Service member reunites with his/her family

• The process of “reintegrating” into his/her family begins

• An exciting but challenging time, filled with mixed emotions (anticipation, joy and relief)

• The most stressful phase of the deployment cycle for many families

Post-Deployment: Reunion

“Fall In”•Reintegration into civilian life poses new challenges

•Service member & family strive to regain normalcy

•Post-Deployment events occur at 30, 60, and 90-day marks

•Service members receive information about services and entitlements earned

Post-Deployment: Emotional Stage 6

Adjustment & Renegotiation:•Families must reset their expectations and renegotiate their roles

•Negotiation of the “new normal” begins

•Attempts at renegotiation may result in increasing marital arguments

•Families need to be prepared to deal with the effects of combat stress

Post-Deployment: Reintegration

“As You Were”•Can take up to 6 months for the family to stabilize

•Even more difficult when a family must make a Permanent Change of Station (PCS) move immediately

•While the Service member was deployed, the family may have changed a great deal

Changes for Family & Veteran

Family has...•New routines

•New responsibilities

•More independence and confidence

•Made many sacrifices

•Worried, felt lonely

•Gone through milestones that were missed

Veteran’s return can...•Interrupt routine

•Throw off decision-making

•Cause family to walk on eggshells

•Disrupt space

•Not make everything perfect

•Not replace the sacrifices and missed milestones

Post-Deployment: Emotional Stage 7

Reintegration and Stabilization:•The couple and family stabilize their relationships

•The return of the Service member can sometimes feel disruptive requiring renegotiated roles and routines.

•Back to back deployments create stress as families stabilize only to begin Stage 1 again.

•Combat stress can severely disrupt the stabilization process

Treatment Approaches

Family treatment should focus on:

•Improving communication

•Reducing conflict among family members

•Addressing family disruption

•Educating family members about the effects of combat stress on service members

(Foa, 2009)

Treatment Approaches

• Cognitive Behavioral Family Therapy

• Brief Strategic Family Therapy

• Emotion Focused Family Therapy

Cognitive Behavioral Family Therapy

General Concepts:•Thoughts cause Feelings and Behaviors•Emotions and reactions to life events are shaped by interpretations of these events•In relationships, cognitions, emotions and behavior mutually influence one another•Identify and challenge distorted cognitions•Interventions are proactive, educational, and problem solving

(Schwebel and Fine, 1992)


Goals:•Behavior change: Increase positive behavior, decrease maladaptive behavior.

•Cognitive Change: Facilitate family’s ability to recognize and challenge distorted thinking.

•Education / Skill building: Teach communication, negotiation, and problem solving skills



Strengths:•Structured and Goal oriented•Present focused and Time limited (10-20 sessions)•Collaboration between family and therapist•Research evidence supports its efficacy•Appealing to clients – Proactive, problem solving and skill building•Flexible - Easily integrated with other approaches


Brief Strategic Family Therapy

General Concepts:•Problems are created by dysfunctional interactional patterns (communications & behaviors)•Dysfunctional interactional patterns maintain the problem and make it worse•Symptoms have functions•Dysfunction originates from mishandled transitions•Works within the client’s frame of reference

(Szapocznik, Schwartz, Muir, & Hendricks Brown, 2012)


Goals:•Preserving the family is desirable outcome•To eliminate or reduce problem behaviors•To change family interactions associated with problem behaviors•Focus on changing family dynamics•To change the way family members behave toward each other



Strengths:•Flexible approach•Applicable across a range of ethnic/cultural groups •Provides motivation that increases family involvement•Supports healthy family development •Efficacious in treating child and adolescent behavior problems and impaired family functioning•Labeled as “model program” by USDHHS


Emotion Focused Family Therapy

General Concepts:•The relationship is the client•Validates family members’ emotions and attachment needs•Therapy is a healing place where a corrective emotional experience happens•Views current negative emotional responses as having been adaptive at some time•However, previously adaptive behaviors are now mismatched to the situation and are now maladaptive

(Johnson, 1996)


Goals:•Family members learn to understand and express underlying feelings•Family members change their perceptions of each other•To create secure and lasting bonds between family members•To reinforce positive bonds that already exist•To create an atmosphere of harmony and respect where relationships can flourish

(Johnson, 1996)


Strengths:•Present focused, Brief & Time limited(8-12 sessions)•Research supports its efficacy with couples and families•Effective treatment for families facing depression, grief, chronic illness, and PTSD•Culturally sensitive - universal emotions are examined within a personal cultural context•Humanistic based and believes the family can heal itself•Couple in therapy

(Johnson, 1996)

http://www.youtube.com/watch?v=xaHms5z-yuM

The Military Family System

Questions?