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This chapter delves into the complexities faced by redeployed military and veteran couples, exploring the impact of trauma, attachment, gender, and culture on their relationships. It highlights the importance of relation-based therapy, synthesis of theories, and understanding trauma responses. The chapter also addresses unique challenges faced by women in the military with a focus on mental and physical health issues. It emphasizes the need for a research-informed approach, gender sensitivity, and caregiver support in providing effective couples therapy. Discussion questions prompt reflection on sociocultural influences, gender roles, and mental health outcomes in military couples.
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Chapter 25 Couples Therapy for Redeployed Military and Veteran Couples
Rationale • Families face a range of adjustments and transitions. • Current troops experience co-occurring conditions of posttraumatic stress, PTSD, depression, suicidal thinking, TBI, substance abuse, and intimate partner violence. • Stigma is a negative force that deters help-seeking behaviors.
Relation-Based Therapy • Relation based therapy is important because of disruptions to attachment from exposure to traumatic stressors. • Values the tenets of resiliency and empowerment.
Synthesis of Theory Models • Couples therapy developed on synthesis of social and psychologically based theories. • Focus on role of attachment and trauma.
Attachment Theory • Relationships of military couples are challenged by separations and role shifts. • Mentalization (capacity to self reflect and regulate affect). • Be able to anticipate another person’s affect and behaviors. • Military couples need to assess the nature of attachments to each other, children, and key family members.
Trauma Theory • Some individuals may return with heightened anxiety, panic attacks, and rage eruption. • Service member can identify a victimizer, victim, or bystander. • Internalization of combat experience can disrupt earlier relationship constructs of safety.
Cultural Responsiveness • Clinician and client explore the meaning and meaning-making process attached to ethnicity, race, and gender. • Explore how cultural themes have shaped client’s place in the world.
Research-Based and Research-Informed • Cognitive Behavioral Conjoint Therapy • Limitation • Lack of suitability for those who suffer mild to moderate TBI
Role of Gender • Clinicians need to recognize complex issues related to the role of gender in shaping an individual’s worldviews.
Demographics • Women comprise 14% of active duty force. • Women are 7.7% of the veteran population. • Women are being deployed to combat areas that are high risk even though they are barred from combat roles.
Mental health and Physical Health issues • Women face unique stressors. • Veterans report more medical illnesses and a lower quality of life. • Rates of PTSD, depression, and substance abuse are higher for women who experienced sexual assault.
Health Care Needs • There is a differentiated response to trauma. • Range of health care problems reported. • Lower back pain • Headaches • Pelvic pain • GI pain/symptoms • Sexual dysfunction • Gynecological symptoms • Chronic fatigue
Gendered Response to Trauma • Women can experience a “tend and befriend” reaction to traumatic events not just “flight or freeze.” • Cultural beliefs and ethnicity can also impact a reaction to trauma.
Intimate Partner Violence • High rates of IPV may be connected to: • Hyperarousal cluster of PTSD: • Affect dysregulation • Alternating numbness and hyperarousal • Occasional rage outbursts
Caregivers • Women may have unique challenges and stressors related to multiple roles. • Children are affected by deployment with heightened emotional and behavioral difficulties.
Phase-Oriented Couples Therapy With Military Couples • Institutional/sociocultural (social constructionist, feminist, and critical race theories) • Interactional (intergenerational, narrative family therapies) • Individual/interpersonal • Individual, cognitive, affective, and behavioral functioning (trauma and cognitive behavior therapies) • Intrapersonal/intrapsychic (grounded in attachment, object relations, and relational theories)
Couples Therapy Phases • Phase 1: Safety, self-care, stabilization, and establishing a context for change • Phase 2: Reflection on trauma narratives and grieving • Phase 3: Consolidation of new perspectives, attitudes, behaviors, and social vindication
Chapter Discussion Questions • How do the sociocultural factors of gender and ethnicity shape responses to traumatic stress? • How do cultural mores influence gendered roles for parenting? Work? And family life? • How do ethnicity and culture influence the losses of identity as a soldier? A temporarily able-bodied citizen? Mother? Worker? Wife? And daughter-in-Law? • What are some of the mental health outcomes that service members might expect to experience in response to deployment and combat stressors? • What are the key features in completing a biopsychosocial-spiritual assessment of a military couple? • What are the central guiding principles in crafting a multimodality couples therapy treatment plan that ensures safety, and adequate pacing and integrates evidence-based treatment models in context?
