Understanding and treating military members and their families

Lorie T. DeCarvalho, PhD, is the CEO and a Licensed Clinical Psychologist at the Center for Integrative Psychology & Wellness, Inc. and an Associate Clinical Professor of Psychiatry at Loma Linda University Medical Center.  She recently spoke to an audience of professionals on an Addiction Professional webinar titled, “Understanding and Treating Unique Issues in Military Families.”  She shares the statistic that nearly two million service members have been deployed to fight in Operation Iraqi Freedom/Operation Enduring Freedom (OIF-OEF) and Operation New Dawn (OND).

Speaking about families, she notes that more than 3.1 million individuals are part of a military family, and that 2 million of those are children.  About 900,000 children have one or both parents who have been deployed multiple times, according the numbers from an April 2010 report from the Department of Defense.

It is beneficial for professionals to recognize the deployment cycle and its effects on the service members as well as their families.  DeCarvalho says that the cycle most people use is the original one, with five stages of deployment.  The five stages are as follows:

·       Pre-deployment:this stage varies as to how long it can last; includes preparation to leave, getting one’s personal, work, and family affairs in order.

·       Deployment:this stage usually lasts about a month after the service member has been deployed;  includes adapting to a new environment (for the service member), and adapting to life without loved one (for the family).

·       Sustainment:this stage can run from the second month through the fifth or sixth month that the service member has been deployed; this is when the family and service member are each establishing new sources of support and new routines in their lives.

·       Re-deployment:this stage is the last month before the soldier returns home; feelings of anticipation are present as the re-arrival approaches.

·       Post-deployment:lasts about three to six months after the service member has returned home; includes a homecoming, a honeymoon period, and then the service member reintegrating with the family and society.  

DeCarvalho explains that in clinical practices, it’s a good idea for counselors to be providing psycho-education to the solider and family members about each of these stages and lay out some struggles that they may experience within each one.  Normalizing their experience may help minimize emotional problems with adjustment, she says.

Experience of deployment on the military family

Spouses of service members will most likely feel excited during the homecoming, but they will also sometimes feel awkward and have trouble connecting emotionally or sexually with their partner.  They may carry feelings of abandonment from being left behind and made to take care of everything while the spouse was away, says DeCarvalho.  They may also feel irritable or have difficulties allowing their partner to retake over some of the household roles or duties.

For children 0-3 years old, DeCarvalho says they may cry a lot, especially when held, and they may have difficulties warming up and/or bonding with the service member.  Children 3-6 years old may show feelings of guilt, anxiety, anger, temper tantrums, and fear of separation.  In the category of 6-12 years old, she says children this age will “need lots of attention.”  They will also be clingy, anxious, and constantly be worried that they’re not doing good or not being good enough.  Once they hit the teenage years, DeCarvalho says children ages 13-18 will be moody, irritable and show signs of guilt.  They will act like they don’t care, challenge rules and responsibilities, and tend to be rebellious.

Helping the family reconnect

When veterans return from the war, they may often have mixed feelings about being reunited with their loved ones, according to DeCarvalho.  She says that they are changed and may feel like those they deployed with are the only ones who can understand them.  Many times spouses or partners may feel insignificant or left out because the veteran does not want to discuss what happened in the warzone.  The children and/or partner may have become more independent, may have gained different coping skills, and may not remember the service member if they were too young at the time of deployment.

Family and friends are extremely important in helping the veteran deal with transitional stress by providing companionship, a sense of belonging, self-esteem, practical support, emotional support in coping with life stressors and opportunities to make positive contributions by helping others, says DeCarvalho.

In the family, it’s important to take things slowly and understand that honest and open communication is key.  She also suggests that it’s a good idea for the veteran to take breaks from the family as needed to reconnect with their friends or to get “alone” time.  Veterans should support and reinforce the good things the family has done while they were away, she says, and they should try to tell stories about their deployment as they feel comfortable.  That will help the family to better understand and provide emotional support to help heal the gap that formed during deployment.

Key Treatments

DeCarvalho notes that treatment for military families should focus on helping reduce fear and anxiety and increasing a sense of control in the veteran.  Pyschoeducation about posttraumatic stress reactions, experiences and effects are often helpful, as are one-one-one psychotherapy sessions with the veteran.  Cognitive-behavioral therapy (CBT) can be used to help with anger, survivor guilt, maladaptive thoughts, and self-blame, she says. 

Since the situation deeply affects the family in most cases, family and/or couples counseling is important to address specific changes in family dynamics, such as:

·       independence vs. reliance among family members;

·       trust issues;

·       role reversals and changes;

·       problems with emotional, physical, and sexual intimacy;

·       and abandonment issues with children.