Clin Soc Work J (2011) 39:28–38

DOI 10.1007/s10615-010-0310-5

ORIGINAL PAPER

Working with Military Families Through Deployment

Published online: 21 November 2010

Abstract Military families experience considerable estimated that half of all military personnel are married
stress, periods of long separation, and changes to the family with children (Duckworth 2009; Petty 2009). Thus, more
system due to family members planning to enter a war spouses and parents are leaving for war than ever in the
zone, actively living in a war zone, and reuniting after past. With an increased number of deployments to war
being in a war zone. Anticipation and understanding of the zones per service member and increased duration of
stages of deployment improves family, couple and indi- deployments (Duckworth 2009; Hall 2008; Mmari et al.
vidual functioning. The issues that the family and the 2009), family and couple issues are on the increase.
couple are confronting at each stage of deployment: pre- Additionally, these service members are not all men; over
deployment, deployment, and post-deployment are pre- 356,000 women now serve in the armed services or the
sented. Clinical interventions for the family and the couple reserves, which accounts for 16% of the military popula-
are presented at each stage of deployment. Additionally, tion (Alvarez 2009).
the impact of the service member’s war time experience on Though we will focus on traditional two-parent families
the family, couple, and her/himself is discussed. where one parent is being deployed, it should be noted that
military families like all other American families are
Keywords Military families
Deployment
comprised of many different family configurations such as
Family therapy
Couples therapy single-headed households, dual deployed parents, non-
married families, and gay/lesbian families. Each family
system has its own particular issues and stresses when a
Introduction loved one is being deployed. Single parent families and
dual deployed parents will need to grant guardianship of
Stress, separation, and change are universal to all families. her/his child(ren) to a family member or friend. Non-
However, military families experience considerable stress, married families and gay and lesbian families are often not
periods of long separation, and changes to the family sys- afforded the same level of support and information sharing
tem due to family members planning to enter a war zone, as those who are legally wed.
actively living in a war zone, and reuniting after being in a Additionally, there are differences in family needs
war zone. These events put unique demands on military between enlisted service members, National Guard, and
families. Reservists. Families of an enlisted service member often
The configuration of the military has changed to an all- have better support networks and resources. The enlisted
voluntary force, where many service members are older service member family may have greater knowledge of
and have established their own families. It has been what to expect about deployment due to the family’s
proximity to the base and to other military families.
National Guard or Reservist families may be isolated from
J. A. Laser (&)
P. M. Stephens
other military families or military support. Additionally,
Graduate School of Social Work, University of Denver, Craig
Hall 337, 2148 S. High St., Denver, CO 80208-7100, USA the deployed National Guard or Reservist family may
e-mail: [email protected] experience greater financial hardships since their military

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pay may be less than what they were earning in the civilian member is making her/himself ready for battle, which
sector. The National Guard or Reservist may also be in includes emotionally separating from the family so that
jeopardy of losing her/his job due to lengthy or recurrent s/he can be singularly focused for war. The service member
deployments (Darwin 2009). may want to spend time with her/his unit members when
As the number of military personnel, active and veteran, not in training which may heighten feelings of separation
increase in the United States, there is a growing need for and impending loss for the family members being left
mental health providers in and outside the military (Castro behind. The service member may be excited and enthusi-
2009; Hall 2008). At each stage of deployment, clinical astic about the mission while the family only dreads the
social workers can provide support to military families to separation.
improve family functioning and coping. This article sum- Children may act out with tantrums and poor behavior
marizes the stages of deployment with emphasis on the once they are told that her/his family member will be
issues the family, couple, and service member face at each leaving (Hall 2008; Petty 2009; Pincus et al. 2008).
stage of deployment. Additionally, suggestions are given Research has shown that the most stressful time for chil-
for therapy at each stage of deployment. The impact of the dren is prior to deployment (Kelley 1994). Depending on
service member’s wartime experience on the service the stage of development, children may interpret the par-
member, her/his family, and on the clinician is explored. ent’s departure in different ways. For instance, younger
Finally, a brief case is presented. children may not be able to fully grasp the amount of time
their parent will be gone or why they are leaving. Younger
children, however, will be able to sense that family life has
changed, and that their parents are acting differently, which
Stages of Deployment
may elicit negative reactions. Magical thinking may cause
the young child to believe that the deployed parent is
There are three major stages of deployment: pre-deploy-
leaving because of her/his bad behavior; this misunder-
ment, deployment, and post-deployment. Understanding
standing needs to be corrected. Younger children may be
the stages of deployment improves family, couple, and
very angry with their parent leaving them, but may take out
individual functioning.
their anger and sadness on the parent who is remaining at
home. Due to the young child’s magical thinking, s/he may
feel that if s/he is openly angry with the parent who is
Pre-Deployment leaving, something awful may happen when s/he is away
(Darwin 2009). This behavior can be very difficult for the
Pre-deployment is the period that begins with the service parent who is remaining at home to understand and endure.
member receiving a warning order that s/he will be Older children and adolescents may be very fearful for
deployed and ends when s/he leaves home. The duration of their parent’s safety and saddened by the upcoming loss of
pre-deployment can vary from several weeks to over a year their parent in their daily lives. Youth may openly or
(Hall 2008; Pincus et al. 2008; Rotter and Boveja 1999). covertly have anxiety and stress about their parent’s
departure.
Family Issues
Couple Issues
There may be a great deal of dissonance in the family
system and within the individual psyche during pre- Partners often complain during pre-deployment that their
deployment. The family is trying to cope during pre- service member is emotionally distant. Some partners
deployment with the contradiction between denial that the would prefer that their service member were already gone
loved one is actually going to war and anticipation of loss rather than having a prolonged period of time to contem-
of the loved one from the family system (Hall 2008; Pincus plate their absence (Hall 2008; Pincus et al. 2008; Rotter
et al. 2008). Additionally, the military family may be and Boveja 1999). The service member is also trying to
experiencing feelings of fear, anger, resentment, and hurt get all of her/his affairs in order. This includes everything
(Rotter and Boveja 1999). These feelings may be directed from home maintenance, to taxes and wills, which can
at each other. Tempers may flare, feelings may easily get exacerbate feelings of fear, loss, anxiety, and stress (Hall
hurt, and each family member may be very defensive. 2008; Pincus et al. 2008; Rotter and Boveja 1999). The
During pre-deployment, the service member is often in financial and insurance issues that need to be completed by
training where s/he is bonding to unit members and dis- Reservist families may feel even more daunting since they
tancing her/himself from family members (Hall 2008; are less likely to have military supports or mentors to help
Pincus et al. 2008; Rotter and Boveja 1999). The service them prior to deployment.

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Arguments are often commonplace during pre-deploy- issues (see www.militaryonesource.com, www.battlemind.
ment due to the high level of stress that is being placed on org, www.realwarriors.net, www.va.gov as examples). This
the couple because of the serious issues that need to be promotion of mental health services by the military has
discussed and planned (Hall 2008; Pincus et al. 2008; made it more acceptable to seek counseling. However,
Rotter and Boveja 1999). For couples with a greater his- concerns about possible negative repercussions for the
tory, these arguments may be better tolerated, but for newer service member’s career persist.
couples these arguments may be extremely destabilizing
for their relationship (Hall 2008; Pincus et al. 2008; Rotter Affective Education
and Boveja 1999). Old arguments that that have been
dormant, but never resolved, may resurface due to the In therapy, families often need to learn that the multitude of
stress of getting affairs in order. strong emotions that they currently are feeling, which may
Sexual relationships are either extremely intimate or be manifesting themselves in erupting anger, are often
ambivalent during this time period. The final week before masking feelings of pain, fear, and loss due to the antici-
deployment, the couple may experience feelings of con- pated departure (Hall 2008; Pincus et al. 2008). Using
fusion, ambivalence, anger, and a sense of pulling away affective education (understanding one’s emotions, where
from each other (Hall 2008; Rotter and Boveja 1999). the emotions are coming from, what triggers the emotions,
Some service members during this time will rush to be and what the emotion may be signifying) is helpful for
married. This gives the service member an added sense of family and couples therapy during pre-deployment.
purpose while away and a feeling that someone is waiting
for them. It also solidifies the commitment to each other to Exploring Roles
be faithful in each other’s absence. Some service members
may feel that they should experience being married It should be stressed in therapy that both the service
because they are unsure whether they are returning. This member and the family left behind have difficult issues to
fear of not having ‘‘fully lived’’ prior to being deployed contend with and both need to be valued for their contri-
also causes impulse buying, and taking risks that they butions to the family. Role playing, where each partner
would normally not consider. Additionally, the service assumes the role of the other may help increase empathy
member receives a higher rate of pay as married than and understanding of each other’s responsibilities while
single, which may also influence her/his choice (Duck- they are separated. Therapy sessions that discuss each
worth 2009). partner’s expectations of the other during deployment need
Fears of infidelity while apart, regardless of the couple’s to be fully communicated. By creating open frank com-
marital status, can cause stress and feelings of suspicion munication prior to deployment, each partner can antici-
(Hall 2008; Pincus et al. 2008). These fears should be pate each other’s behavior, emotions, and needs (Pincus
discussed openly so that expectations are clear and et al. 2008).
articulated.
Exploring Unresolved Conflicts
Therapy During Pre-Deployment
Unresolved conflicts in the couple’s relationship can cause
Historically, there has been a great deal of stigma for the service member to have difficulties concentrating when
service men and women to seek mental health services away; therefore therapy during this stage can improve
(Bowen and Richman 1991). In the past, there has been an functioning for the service member at war (Pincus et al.
unwritten rule that the discussion of feelings and emotions 2008). This may be a salient point if the service member is
would make the service member weak and less valuable in less inclined then the partner to be involved in therapy.
battle. However, attitudes to clinical services for military Couples may need to be reminded in therapy that they can
personnel are changing. Recently, there are increased not completely ‘‘tie up all loose ends’’ prior to deployment
numbers of military families using clinical services prior to nor can they completely bury recurrent arguments in their
deployment, during deployment, and post deployment relationship. Helping the couple turn toward each other for
(Hall 2008). Family members may be concerned that support, rather than pull away from each other should be
seeking clinical services may negatively impact their ser- stressed in counseling during pre-deployment.
vice member’s career; therefore many may choose to seek
mental health services outside of military instillations Expectations of Fidelity
(Armstrong et al. 2006; Hall 2008). Military websites and
veteran affairs websites now both advocate seeking coun- Fears of infidelity also need to be addressed in therapy
seling and share information about coping with emotional (Hall 2008; Pincus et al. 2008). Stories of romantic trysts of

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service members in theater and partners on the home front parent may have a strong positive effect on the child’s
are ubiquitous. Even though the couple’s relationship may functioning while the service member is away.
be strong, they will have probably heard stories of
unfaithful behavior and have unsettled feelings inside. Therapy for the Partner
Addressing this fear, allows them to discuss it and their
expectations for fidelity to each other. The partner may be experiencing stress, loneliness, anxiety
or depression. These symptoms may be aggravated by
Interventions Benefiting the Children increased work and responsibility, and decreased sleep, and
economic stability. Functioning is improved with inter-
For school age children and youth in therapy, activities that ventions that are strength-based, help the partner learn to
help children learn to express their emotions such as feel- reduce stress, and reframe problems. Techniques that help
ing face cards (Petty 2009), naming emotions, giving the partner relax such as deep breathing techniques, muscle
examples of when the emotion has occurred is helpful. relaxation, and meditation have been found to be helpful.
Parenting practices that stress routine and provide oppor- Cognitive behavior techniques that help the partner come
tunities for family play should be advised (Petty 2009). The to realize where s/he is making thinking errors are also
parents should not bring older children into the ‘‘co-par- effective.
ent’’ role (Petty 2009), even though they can use the
emotional and physical help. The parents need to support Children and Deployment
their children to be children and not mini-adults.
It is estimated that a half-million children currently are
living in a family where one or both parents are deployed
Deployment (Petty 2009). Depending on the child’s stage of develop-
ment, s/he may experience the absence of her/his parent in
Deployment is the period of time that the service member a wide variety of ways. Young children may experience the
is away from home. absence of the parent in somatic ways such as refusing to
eat, crying, refusal to sleep alone, and bathroom accidents
Family at Home (Petty 2009; Pincus et al. 2008). School age children may
experience the absence of the parent by whining, com-
Early Deployment plaining, and aggressive behavior (Petty 2009; Pincus et al.
2008). Teens may be irritable, rebellious, isolate from
The family adjusts to the loss of the service member. The family members or friends, use drugs or alcohol or become
family, during the first months, may feel a sense of aban- promiscuous (Mmari et al. 2009; Pincus et al. 2008).
donment, loss, emptiness, pain, and disorganization Additionally, both school aged children and adolescents’
(Duckworth 2009; Pincus et al. 2008; Rotter and Boveja grades may be affected. Teachers and school social
1999; Slone and Friedman 2008). This loss has been workers should be made aware of the parent’s deployment
termed an ‘‘ambiguous loss’’ where the service member is (Mmari et al. 2009).
physically absent, but psychologically present (Boss 2007,
2010). Ambiguous loss has been attributed to undermine Interventions for Children and Youth During Deployment
coping and block decision-making of the family members
left behind (Boss 2007, 2010). The partner at home may The child should be encouraged to have a normal routine
have trouble sleeping or have feelings of anxiety (Pincus and learn how to discuss her/his feelings when s/he is
et al. 2008). It has been found that when a service member feeling sad, lonely or missing her/his parent rather than
is sent to a war zone, it increases the vulnerability of the keep them inside (Mmari et al. 2009; Petty 2009). Teens
partner to depression and exacerbates personality disorders have found that it is helpful to create support groups with
(Kelley 1994). The stressful event of deployment may other teens whose parents have been deployed (Mmari
trigger mental health issues for the partner. Therefore, in et al. 2009). Children should be protected from viewing
therapy a thorough understanding of mental health func- war footage or hearing news stories about the war. War
tioning prior to deployment vis-à-vis current functioning stories can often be too scary for the child and legitimizes
should be evaluated. her/his fear for her/his parent. At holidays and important
Children that were found to be the most effected by their events in the child’s life where the parent is missing, the
parents’ deployment had parents who were experiencing child should be encouraged to take photos (Petty 2009),
more stress (Duckworth 2009). Therefore, therapy for the draw pictures or take video to commemorate the event so

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that s/he can share the event with her/his parent via email, Therapy in Late Deployment
Facebook, YouTube or when the parent returns.
In therapy, it is helpful to work with the family to set
Mid-Deployment realistic expectations for reunification. It can be beneficial
for the family to consider that during the period of
After the first few months of separation, the family adjusts deployment they have grown and changed and so has their
to the absence of the service member. The family begins to service member. Family members can be asked to create a
be more self-sufficient and has increased periods of growth list of areas where they have grown or changed during the
and confidence in their new roles (Duckworth 2009; Pincus intervening months. Using this self-knowledge helps the
et al. 2008; Rotter and Boveja 1999). The family begins to family members consider that the service member has also
establish new routines and sources of support (Pincus et al. experienced changes. Getting to know each other again
2008). without preconceived ideas of how the reunion will tran-
spire should be stressed in therapy. The practitioner can
help family members anticipate that time is needed for the
Therapy During Mid-Deployment
family system to readjust.
When working with the family or the partner in therapy, it is
Service Member Away
important to help them celebrate their resilience and growth.
Additionally, accolades should be given to the partner for
The service member needs to adjust to the routine of war
her/his problem-solving ability and perseverance.
(Pincus et al. 2008), which includes the skills needed to
survive in a war zone. Service members who have diffi-
Support Groups culties with separation from family may externalize their
behaviors into anger and misbehavior (Rotter and Boveja
If the family lives on or near a military base the partner 1999; Slone and Friedman 2008).
may participate in a Family Readiness Group (FRG) or as a During lengthy deployments, the service member may
Reservist family at the National Guard Armories. The be granted a leave for a week or two. This can be a great
FRGs provide social support and networking for the partner opportunity to rejoin and reconnect with the family for a
(Duckworth 2009; Hall 2008; Pincus et al. 2008). How- short period of time or can cause the family to revert to the
ever, unhealthy FRGs are notorious for rumor mongering, pre-deployment feelings of anger, suspicion, hurt, and
and in some instances these rumors can travel all the way to resentment. It may also make it more difficult emotionally
the war zone where they can negatively affect the service for the service member to return to theater after her/his
member (Pincus et al. 2008). When working with the leave. Some service members will choose not to return
family, it is important to help them connect to organiza- home, but go on leave with members of their unit to avoid
tions and groups that can be supportive and to differentiate the emotional ‘‘rollercoaster’’ of feelings and remain more
between activities that can offer support and those that may combat-focused. However, the service member’s not
undermine the family. returning home for leave can be interpreted negatively by
the family.
Late Deployment Prior to returning home, the service member may
experience apprehension, excitement, high expectations,
The last few months before reunification, the family begins worry, and fear for the reunion with her/his family (Rotter
to feel a mixture of apprehension, excitement, high and Boveja 1999). S/he may feel these emotions simulta-
expectations for the future, and worry (Rotter and Boveja neously or in quick succession.
1999). The partner may have concerns that s/he will need
to relinquish her/his newly found independence and deci- Communication During Deployment
sion-making ability once the service member returns (Hall
2008; Pincus et al. 2008). The partner may second-guess Research shows that keeping connected through deploy-
her/his decisions, so that they are closer in alignment to the ment maintains stronger relationships (Mmari et al. 2009;
desires of the returning service member (Hall 2008; Pincus Slone and Friedman 2008). When telephone calls go well,
et al. 2008). Some partners will have increased fears that they can boost morale for the family and the service
their service member will have an untimely end prior to member (Pincus et al. 2008). Most telephone calls are short
her/his leaving the war zone. This is a period of time of in duration. The interval between phone calls may be as
heightened excitement and fear due to the fact that the end long as several weeks and can be sporadic (Hall 2008;
of separation is in sight. Pincus et al. 2008). Calls can be unsettling for both the

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partner and the service member if they do not connect feeling during discharge, they may have to delay their
emotionally during the call (Hall 2008; Pincus et al. 2008). reunion with their family or it may undermine their mili-
Telephone calls from the partner should try to diminish tary career in the future.
problems on the home front. The reasoning for this is that
issues the service member cannot address while s/he is Reunification with Children
away will only increase feelings of anxiety and stress for
the service member and may make her/him less focused in Younger children may not remember their parent and may
the war zone which could have devastating repercussions. need time to get to know her/him, which may be painful for
In turn, the service member may not be able to state much the returning service member (Petty 2009). School age and
of what is actually happening to her/him while in theater. adolescent children may be loyal to the parent who has
Therefore, communication by phone is often reduced to cared for them and may quietly or openly refuse to be
shallow, non-specific dialogue in order to avoid problems parented by the returning service member (Hall 2008; Petty
between the couple (Darwin 2009). 2009; Sayers et al. 2009). Interestingly, it has been found
Email can filter out strong emotions and issues. It may that for adolescents the service member’s return is the most
be the best choice for families where there are unresolved stressful period in the deployment cycle (Mmari et al.
conflicts. Skype and other visual communication tools are 2009). It may take several months for children to reestab-
also available at larger bases. These tools are great to see lish bonds with the returning parent (Petty 2009; Pincus
each other, but after the conversation is over can add to et al. 2008; Rotter and Boveja 1999; Sayers et al. 2009;
loneliness and feelings of loss. Slone and Friedman 2008). In therapy, the returning parent
In therapy, the partner may feel the need to speak of her/ should be helped to understand that the distance the child
his inability to communicate in the way s/he wishes with her/ feels is normal due to her/his developmental stage and that
his service member. S/he may really miss being able to talk s/he should try not to take it personally. Activities that
to her/his partner about behavioral issues of their children, support family play should be suggested such as going to
malfunctioning cars, problematic issues with home appli- the park or playing board games or cards.
ances, health issues or loneliness. Helping her/him find a
support network helps her/him contend with the stresses of Couple Reunification
daily living and normalizes the experiences s/he is facing.
Reunion begins with a honeymoon stage, which ends with
the first argument (Rotter and Boveja 1999; Slone and
Post-Deployment Friedman 2008). The couple will often reunite physically,
but not emotionally for some time (Pincus et al. 2008). This
Family Reunification reconnection may be punctuated with arguments and jeal-
ousy. The service member may feel more comfortable with
The family is feeling a blur of excitement during reunifi- her/his unit members than her/his partner and may actively
cation (Rotter and Boveja 1999). The family needs to begin seek time with unit members rather than her/his partner.
to communicate and reconnect (Sayers et al. 2009). The The partner may resent the service member’s inability to
service member may want to reassert her/his role in the rejoin the family and feel a sense of abandonment, frus-
family, however, the family has learned to cope without tration, and anger (Hall 2008).
her/his daily input and may not welcome re-changing the
family organization (Pincus et al. 2008; Rotter and Boveja Therapy Directly Post-Deployment
1999; Sayers et al. 2009). Some returning service members
report feeling like a guest in her/his own home (Sayers In therapy, a discussion between family members about
et al. 2009), which can be both hurtful and frustrating. needs and expectations should occur. The service member
The service member may return with underlying phys- remembers how the family functioned before s/he left and
ical or mental issues that will need to be addressed. It is cannot readily see the growth in the family. The family is
estimated that more than 300,000 service members suffer well aware of the changes that they have experienced over
from Post Traumatic Stress Disorder (PTSD) and 320,000 the intervening months; they also remember their service
service members suffer from Traumatic Brain Injury (TBI) member exactly as s/he was when s/he left for war.
from the current wars in Iraq and Afghanistan (Darwin
2009). Prior to rejoining their family, service members Revisiting Family Roles
must go through physical and mental exams, but some
issues may not be reported or visible at this time. Many In therapy, both, those who were left behind, as well as, the
service members feel that if they do share how they are service member, need to learn who each are now. Roles

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need to be clarified and reestablished. The roles regarding would be as disturbed as s/he is (Armstrong et al. 2006).
decision-making will need to be negotiated, especially if Additionally, when the returning service member is con-
prior to deployment the service member was the primary tinually on edge it can act as a contagion for the partner,
decision maker and in the intervening months the partner creating increased volatility in the couple (Armstrong et al.
was the decision maker (Pincus et al. 2008; Rotter and 2006). The stress that is felt by the returning service
Boveja 1999). The practitioner can help the couple explore member may become generalized throughout the entire
how they can share the decision-making process. family (Mmari et al. 2009).
The returning service member may need time to grieve
Opening Communication the losses that s/he has experienced during the war
(Armstrong et al. 2006). Feelings of depression can occur if
Communication that highlights patience and taking time to the service member has lost a friend during the war (Slone
get to know each other should be stressed (Hall 2008; and Friedman 2008). Additionally, the solider may have
Pincus et al. 2008). Techniques in therapy that focus on the feelings of guilt if s/he survived when others s/he was close
couple taking turns to actively listen to each other and then to did not (Armstrong et al. 2006; Lifton 2005). The
repeat what they have heard are helpful. Additionally, the experience of surviving may actually connect the service
practitioner should address that both partners need to learn member to earlier experiences of trauma compounding the
to not be guided by pre-conceived ideas of how their effect of the current trauma (Lifton 2005). The returning
relationship should be. This may include lowering expec- service member may withdraw to deal with these losses,
tations and not making comparisons to earlier times in their however, in doing so s/he distances her/himself from the
relationship or the relationships of others. family and the support that s/he may need (Armstrong et al.
2006). The service member may need time to contemplate
Creating Opportunities for Appreciation and Caring any wisdom that can be gained from her/his experience of
survival and how s/he wants to honor those who have fallen
The partner’s feelings of resentment to the service member (Lifton 2005).
should be investigated. Often the partner feels that s/he was However, the service member’s withdraw from the
the real hero who has taken care of the family ‘‘single- family can be interpreted by family members as rejection
handedly’’ in the service member’s absence (Hall 2008; (Armstrong et al. 2006). In therapy, helping the family
Pincus et al. 2008). In therapy, helping each partner discuss understand why the service member needs time alone or
what they value in their partner can improve functioning with unit members to heal can help family members better
for the couple. The couple should work on reconnecting understand the service member’s behavior, so that they can
and appreciating each other and the gifts and talents that act with compassion rather than contempt.
they each bring to the relationship and the family.
Post-Traumatic Stress

The Impact of the Service Member’s Wartime In the current wars in Iraq and Afghanistan, where there is
Experiences on Her/Himself and the Family an ambiguous frontline, post-traumatic stress is more likely
to occur (Castro 2009; Hall 2008). Post-Traumatic stress
The service member may have experienced difficult, if not includes symptoms of emotional numbing, over active
horrible events during her/his deployment. Upon return, the startle reflex, hyper-arousal, lack of impulse control, and
service member may have trouble sleeping, nightmares, emotional explosiveness (Armstrong et al. 2006; Darwin
stomach issues, fear of crowds, loud noises, or new situa- 2009; Ginsburg 2009; Hall 2008; Sayers et al. 2009; Taylor
tions (Armstrong et al. 2006; Darwin 2009; Sayers et al. 2006; Tick 2005). In the war zone, these adaptations may
2009; Slone and Friedman 2008). Panic attacks may also be be effective for staying alive. However, it is the ‘‘staying in
normal after returning from war. However, if they last combat mode’’ post deployment that can be self-destructive
longer than 6–8 weeks, the service member should seek (Sontag et al. 2008). Post-traumatic stress occurs more
individual counseling (Slone and Friedman 2008). frequently in those who have been closest to combat, have
The partner should try to understand that the service been injured or with someone who was injured (Castro
member needs to heal from the terrors of war and may need 2009; Hall 2008). Additionally, service members who are
time to do so (Hall 2008; Slone and Friedman 2008). The deployed more than 13 months are more likely to be
partner may not be able to fully understand or appreciate affected by PTSD (McFarlane 2009). Current statistics
the depth of the issues that the service member experienced report that 30% of service members who experienced a
or is currently feeling. The returning service member may medium level of combat exposure, and 40–50% of service
be afraid that if s/he shared all s/he experienced, loved ones members who experienced a heavy level of combat

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exposure suffer from PTSD (Castro 2009). With preva- modified when reentering the civilian world. Battlemind
lence of PTSD this high, it has caused some in the field to Training helps the service member understand that in dif-
suggest that PTSD is a psychological injury of war and not ferent environments different skills are needed and valued.
a disorder (Shay 2009). Depression may occur simulta- Battlemind Training does not diminish her/his identity as a
neously to post-traumatic stress (Castro 2009; Shay 2009; warrior, but explains that the skills necessary for being in
Slone and Friedman 2008). Some negative behaviors theater are different than the skills needed at home.
related to post-traumatic stress include substance abuse, Family therapy that uses Family Focused Treatment
risk-taking, over-working or overeating (Armstrong et al. (FFT) has been found to be effective with returning service
2006; Shay 2009). members experiencing post-traumatic stress and their
Mental health services are usually needed to overcome families (Miklowitz 2008). FFT uses the family as allies
post-traumatic stress and depression for the returning ser- and supports to the returning service member. FFT
vice member (Slone and Friedman 2008; www.ptsd.va.gov). involves educating each family member about the illness
However, guilt can undermine the ability of the returning and treatment issues (Miklowitz 2008). Family members
service member to get the help s/he needs because s/he may complete homework assignments and make a commitment
feel s/he does not deserve to feel better (Armstrong et al. to be involved in therapy (Miklowitz 2008). FFT works to
2006). It may be necessary to refer the returning service improve communication and problem solving in the family.
member to a clinical social worker who specializes in post- The family learns to anticipate specific problems prior to
traumatic stress for individual treatment prior to family or their occurrence. FFT teaches the family skills they can use
couples therapy. An individual with severe PTSD may be at when problems arise (Miklowitz 2008).
risk for suicide and/or domestic violence if s/he is not first
stabilized in individual treatment (Darwin 2009). Domestic Violence
Cognitive Behavioral Therapy (CBT) has been found to
be one of the most effective therapies for working through Returning service members with higher levels of war
trauma issues (Dass-Brailsford 2007; Mulick et al. 2005). related trauma and post-traumatic stress have been found to
By helping the returning service member reappraise and have decreased levels of family functioning and increased
revise her/his cognitive schemas, as well as creating cog- incidence of domestic violence compared to those who
nitive dissonance in current thinking errors, the client can have not experienced trauma and post-traumatic stress
improve functioning. The CBT techniques that are partic- (Sayers et al. 2009). Domestic violence can often be a
ularly helpful are: relaxation techniques, role playing, negative outcome of post-traumatic stress with the return-
restructuring negative thoughts, anger management tech- ing service member unable to control her/his emotions
niques, guided imagery, positive self-talk, creating thought (Hall 2008).
records, and learning distraction techniques (Beck 1995; In therapy, issues of anger management need to be
Dobson 2001; Dass-Brailsford 2007; Greenberger and discussed. Interventions that help the service member
Padesky 1995; Laser and Nicotera 2011). In each of these assess and understand when and why anger is beginning to
techniques by changing the returning service member’s envelope her/him and how to de-escalate those strong
thinking about the traumatic event(s), her/his emotions and feelings are beneficial. Additionally, the safety of the
behaviors change. partner and the children need to be explored.
Retelling the trauma story to the practitioner has been If the couples’ relationship was unhealthy prior to
found to be useful in reducing PTSD symptoms (Dass- deployment, the time apart may have only made the rela-
Brailsford 2007; Mulick et al. 2005). The act of retelling tionship more problematic. Service members, who left for
the trauma story until it no longer holds power over the war with marital conflict, have been found to return from
returning service member helps in recovery. This therapy war with an increased propensity for domestic violence
technique takes both time and trust but can be a very (Sayers et al. 2009). Therefore, the volatility of the rela-
powerful intervention. tionship may predate deployment. With these couples in
A technique called Battlemind Training has been found therapy, it is important to get to the root cause of marital
to be effective in giving returning service members a disharmony, which has been exacerbated by the couple’s
vocabulary to discuss mental health issues, and talk with separation.
other service members about their experiences in theater
thereby normalizing their experiences (Castro 2009; Divorce
www.behavioralhealth.army.mil/battlemind/index.html).
Battlemind Training works by discussing the skills that are The divorce rate for returning service members has
necessary for being successful in a combat zone, and then increased with over a thousand more divorces in 2008 than
in juxtaposition, discussing how those skills need to be 2007, which has been attributed to multiple deployments

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(Darwin 2009; Duckworth 2009). Returning service with returning service members and their families need to
members with depression or post-traumatic stress are five practice self-care by respecting their own need for rest,
times more likely to have problems readjusting to family relaxation, and renewal (Figley 2005; Herman 1997; Tyson
life than returning service members who do not experience 2007). Practitioners who are feeling despondent, helpless,
depression or post-traumatic stress (Sayers et al. 2009). incompetent, distrustful of others, or isolating themselves
Additionally, returning service members with post-trau- from their support systems need to seek therapy themselves.
matic stress are twice as likely to become divorced than To reduce compassion fatigue, colleagues need to connect
those who do not have post-traumatic stress (Hall 2008). to each other as a support network. The support network can
These statistics underscore the importance of therapy for act as a mechanism to assess if clinical support is needed for
the returning service member and her/his partner and the one of its members and help access support for her/him.
adverse affect for the family system if mental health ser- Additionally, organizations need to show appreciation and
vices are not sought. recognition for the important work that is being done
(Figley 2005) and to reduce caseloads for those working
Suicide with returning service members (Tyson 2007).

Though the government does not track suicide among Case Example
veterans, anecdotal stories suggest suicide is a significant
concern for returning service members (Kerr 2007). Henry has been married to Maria for 6 years. Henry is 25
Therefore, the clinical social worker should assess if the and Maria is 24, they were high school sweethearts prior to
returning service member has suicidal ideation, suicidal getting married. Henry just returned from his second
intent, and a suicide plan (Laser and Nicotera 2011). deployment. They have two children: Benji age five and
Additionally, the service member’s family should be edu- Laura age two. Henry’s most recent deployment lasted
cated about the particular signs associated with suicidal 16 months.
behavior. Maria had a really hard time during this last deployment
juggling her work, single parenting of two small children,
and maintaining the family home. She was often stressed,
Concerns for the Clinician’s Mental Health lonely, and exhausted. Maria was so relieved when Henry
returned home safely. She hoped that he would be able to
The practitioner should be aware of her/his own involvement jump into the Dad role and give her the break she felt she
in the family system and counter-transference (Watkins deserved. However, this has not happened.
1985). The stories of bravery and the willingness to sac- Henry was involved in an exercise while in theater that
rifice for one’s country may make the practitioner want to ended in a group of school-age boys throwing homemade
cheer for the returning hero and the family that supported bombs and rocks at them. Several of Henry’s friends were
her/him rather than create and maintain appropriate hurt, one severely. Henry thinks about the event frequently
boundaries with the family or service member. Addition- and how these children were filled with so much anger and
ally, the experiences the service member witnessed during hatred to people who were only trying to help. He has not
deployment may create feelings of sympathy or pity that shared much of his experiences in theater with Maria.
may undermine the work that needs to be done in the Henry, who normally is jovial and charming, returned
therapeutic process. The anger, rage or despair that the from war sullen and distant from Maria. Maria feels like
returning service member feels may be internalized in she has undergone a huge ordeal, and has done so to help
the practitioner (Herman 1997). Feelings of guilt, shame, Henry further his military career. Henry seems not to
anger, helplessness, and incompetence can envelope the notice all she has done or the sacrifices she has made for
clinician when working with a returning service member the family. Maria is hurt, angry, and frustrated by Henry’s
(Tyson 2007). distancing her.
Moreover, the enormity of the issues heard and the When Henry left, Laura was only 7 months old. As a
successive hearing of many stories of the horrors of war can 2 year old, Laura has no memory of Henry. Laura is not
cause ‘‘compassion fatigue’’ for the clinician. Compassion comforted by Henry and wants only Maria when she cries.
fatigue has been termed as the ‘‘extreme state of tension and Benji remembers his father, but Henry does not laugh so
preoccupation with the suffering of those being helped’’ much anymore and wants to go out with his buddies from
(Figley 2005, p. 1). Compassion fatigue can lead to a sec- his unit instead of spending time with him. When Benji
ondary trauma reaction where the practitioner is no longer talked to his dad on the phone during deployment, Henry
able to function optimally (Figley 2005; Herman 1997; used to tell Benji how he was looking forward to playing
Tyson 2007). Therefore, clinical social workers that work catch with him. Benji asks his dad to play catch almost

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every day, but Henry is usually too busy at his work, with therapy, helping the family organize a schedule that
other grown-ups or is too tired. incorporates shared family time, couple time, and personal
time should be created. This would allow each family
Case Discussion member to feel that her/his needs were being better met. In
general, the family needs time to get to know each other
Using Henry, Maria, Benji and Laura as a case example, again. The family should try to be planful in creating
individual, couples and family therapy techniques will be opportunities for shared time. Henry needs to make time to
discussed briefly. reconnect with each of his family members and understand
the importance of making this effort. Maria needs to allow
Individual Therapy Henry the time and flexibility to heal. With love, under-
standing, lowering expectations, and compassion, the
Henry’s experience of war related trauma should be eval- family can be made whole and strong again.
uated to ascertain if individual therapy for post-traumatic
stress or depression is needed apart from couples or family
therapy. Henry’s change of affect and personality post Conclusion
deployment should be considered in this evaluation. It is
recommended that a clinical social worker that specializes Military families facing long and repeated deployments are
in post-traumatic stress be sought for the evaluation. under a great deal of stress. Understanding the issues that
face military families prior to deployment, during deploy-
Couple’s Therapy ment and post-deployment are crucial for providing
appropriate clinical services. With a better understanding
Though it may not be necessary to tell Maria all of the details of the issues facing military families, better mental health
of the ambush by the school-aged boys, the couple can services can be provided.
benefit from Maria becoming aware of the situation and
understanding the need for Henry to have time to heal. By
giving Maria this knowledge, she can understand Henry References
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