Counseling Military Families

What Mental Health Professionals Need to Know

Lynn K. Hall

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9780415704519
• eBook ISBN: 9781134494927
• Edition: 2
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

How does the military really work? What issues are constants for military families, and what special stresses do they face? Counseling Military Families provides the best available overview of military life, including demographic information and examples of military family issues. Chapters focus on vital issues such as the unique circumstances of reservists, career service personnel, spouses, and children, and present treatment models and targeted interventions tailored for use with military families. Counseling Military Families provides clinicians with the tools they need to make a difference in the lives of families in transition, including those who may have an ingrained resistance to asking for help and who may be available for counseling for a relatively short period of time.

Part 1 Setting the Stage

DOI: 10.4324/9780203761984-1

Introduction

Rationale and Purpose

DOI: 10.4324/9780203761984-2

The Continued Need for Civilian Mental Health Professionals

A staff sergeant (SSgt), John, and his wife, Paula, are self-referred for counseling for acute marital distress following John’s return from his second tour in Iraq. The SSgt has filed for divorce. The couple have been married for 10 years and have two children. Before he joined the service, they had struggled with marital issues around how she spent money and the amount and frequency of his drinking. This conflict had abated until after his first deployment and has now escalated over the past three years, getting worse after his second tour in Iraq. They separated briefly after his first deployment following an argument that became physically aggressive on both their parts, but they later reconciled.

During the second deployment, Paula had an affair with an officer in the medical corps. Although John is very angry with his wife, he says he loves her and does not want to lose her or break up the family. Paula is feeling guilty and sorry for the affair, but she is also angry with him for his emotional distance, anger, and drinking. The SSgt had experienced intense combat and survived two improvised explosive device (IED) attacks where others under his command were killed, and he was slightly wounded. He downplays any lingering emotional or physical symptoms, but his wife reports that he has frequent nightmares, is drinking more, is emotionally distant, and has volatile and unpredictable moods. She is also having difficulty sleeping, has gained weight, and generally feels hopeless and lethargic.

What do we need to know to work with this family? Where do we start? How do we intervene? As Paul Harvey questioned in so many of his news broadcasts, what is “the rest of the story”? It is hoped that in the following chapters you will learn about the military, military families, and the ways that have been shown to work in a therapeutic setting with the military. As you do that, keep this family in mind, as the complete case study, or the rest of the story, is available in Chapter 10, with a set of discussion questions for you to ponder.

The Need for Services

More and more civilian counselors are working with military families and couples, both because military families are going off base for assistance and because the military is now employing, through employment assistant-type programs (EAPs), civilian counselors to help with the enormity of the task. As DeLeon and Stone (2013) pointed out in the foreword to a major recent work,

the signature wounds of this conflict are heavily psychological in nature, for example, recovering from head trauma due to unexpected blasts, psychological stress . . . and strategically addressing the beginning stages of reentry into civilian life for the Wounded Warriors and now equally important, their families.

(p. xii)

In 2006, the National Military Family Association’s (NMFA) Report on the Cycles of Deployment (Jumper et al., 2006) confirmed that there was a profound need for more professional counselors. Houppert (2005b) reported that there had been a 300 percent increase in overseas deployments in the past decade in a military force that has been cut by more than one-third. Families continue to be stressed, sometimes beyond the breaking point.

Troubled families or emergency situations are being thrust on often inadequately trained volunteer family members, because professionals who should be available are often few and far between. More professional support must be directed to the unit level to assist families in meeting these challenges. The NMFA study also pointed out that integrating the “suddenly military” families, families of the National Guard and Reserves, into the support system needs to begin prior to the activation of the service member and continue through reintegration of the service member back into the community. The program called Military OneSource remains one of the best examples of a joint family readiness program that is not dependent on a family’s service or geographic location. Military OneSource, as well as the Military and Family Life Counseling Program are, in essence, EAPs that provide services by civilian counselors with at least a master’s degree in a mental health field. The programs offer free face-to-face counseling as well as online and telephonic nonmedical counseling (7 Counseling Options, 2015).

Often military families need assistance in developing realistic expectations about what they can and cannot do, but they do not believe they are in such a crisis or have such long-term concern that they need the services of a psychiatrist or psychologist. They may also believe they have to handle everything on their own, because asking for help would reflect badly on the service member. As Jumper et al. (2006) pointed out, counselors and volunteers should never assume families know what they need to know. Even experienced family members may find new challenges during a subsequent deployment or find that the accumulated stress from multiple deployments can become overwhelming. “A consistent level of resources is crucial in giving them the flexibility to create the comprehensive, responsive support system families need in order to succeed in the face of repeated deployments” (p. 9).

It is difficult to believe that in 1999, Rotter and Boveja debated whether there was sufficient interest in this population to even warrant a journal article, but finally decided that it was “clear that a substantial portion of our population is affected by what happens to families in the military” (p. 379). They noted at the time there were 2.3 million active duty and reserve U.S. military personnel, and when spouses, children, and living former members of the military and their families were added to the mix, the total figure accounted for close to one-third of the U.S. population. Indeed, they stated, “A significant portion of the citizenry is either presently functioning under potentially threatening, stressful situations or have experienced such in the past” (p. 379).

Navy Commander Mark Russell, in an article for USA Today (Military Faces Mental Crisis, 2007), stated, “Mental health trauma is on the rise. Army studies show that more than a third of combat-deployed troops seek mental health care when they return home.” In a survey done by Commander Russell from 2003 to 2005, 90 percent of psychiatrists, psychologists, and social workers report that they received no formal training or supervision in PTSD therapies. Everson and Figley wrote in the introduction to their 2011 book that “by the middle of the next decade, these large-scale conflicts will likely be over, the military may once again be downsized, and most of these service members will have returned to their lives as civilians” (Everson & Figley, 2011a, p. xxi) pointing out the ongoing need for well-trained providers of mental health services.

In addition, many mental health workers who are actually in the military have been deployed overseas, thereby depleting the resources at home, as well as increasing the burnout and making it difficult to keep skilled therapists. The Army has contracted with civilian mental health professionals to help meet this huge need. The Statement before the Department of Defense Task Force on Mental Health (NMFA, 2006) pointed out,

The military fuels the shortage of deploying some of its child and adolescent psychology providers to the combat zones. Providers remaining at home stations report they are frequently too busy treating active duty members who have either returned from deployment or are preparing to deploy to fit family members into their schedules.

(p. 8)

Jones (2013) explained that during both Iraq and Afghanistan conflicts, “the principles of forward deployed mental health care have been and continue to be implemented, reducing the number of psychological casualties associated with combat” (p. 6). However this author explained that this in-combat military mental health service which “started as rudimentary mental health principles . . . designed to get service members back to combat has blossomed into a . . . panoply of available services to military members, their families and retirees” (p. 6). In reality many of the symptoms of combat, including “traumatic brain injury (TBI) . . . one of the signature wounds of both operations” (p. 6), are not always immediately recognizable and have long-term effects, even after leaving the military.

In many service communities, just as in many civilian communities, there is a shortage of child and adolescent mental health providers. According to the NMFA (Raezer, 2007), the Department of Defense and Congress have worked to increase the resources available to enhance mental health care for service members and families, but the challenges are increasing at a faster pace than resources. “Ensuring the strong mental health of service members and their families is a readiness issue and the cost of ensuring that health is a cost of war” (p. 1).

Continuum of Care

Civilian counselors want to be trained to help military families meet their needs, therefore it is essential that we understand the worldview, mind-set, and culture of the military before attempting to intervene and work with these families. My goal is to bring together researched and documented information to assist civilian counselors in working with military families. I am not the expert, even though I have years of experience working with military families and their dependents; those who are currently working with and researching the concerns of the military families are the experts, and the task here is to bring their voices together in one document to assist those who might be interested and empower them to better work with this segment of our population.

With the return of service members to their families from war-torn countries, the family burden of reintegrating these members into the household, and increased utilization of behavioral healthcare services by families in the military system, several . . . factors have converged, creating a need for a major volume in the field of family therapy that outlines the issues confronting practitioners who conduct clinical work with these families.

(Everson & Figley, 2011a, p. xxiii)

David Crary (2007) quoted a mother from Georgia who states that when families talk to counselors, nobody understands them, particularly with the huge losses the families of the military have to deal with. Even though the military has made great strides by improving schools, health programs, and child care (Crary, 2007), they have never before been faced with the toughest problem of all, which is doing right by the ever-growing ranks of the bereaved. In the preface to their current major work on military psychology, Moore and Barnett (2013) stated that:

it is imperative that not only the military clinician have access to a comprehensive resource covering this vast and expansive field, the nonmilitary clinician, researcher, educator and policymaker should also have access to the most relevant and up to date information in the field.

(p. xv)

There is no greater need than for Congress to ensure access to quality mental health services and programs for service members, returning war veterans, their families, and survivors . . . as well as easily-accessible and responsive mental health services, from stress management programs and preventative mental health counseling through therapeutic mental health care.

(Raezer, 2007, p. 1)

A Web-based survey by the National Military Family Association (NMFA) in February of 2011 asked 1,257 military families their highest priorities and received a 95 percent completion rate. They were asked what their families’ most significant events were in 2010, and 40 percent replied service member deployment as first with 30 percent replying that the return of the service member from deployment was their third most significant event.

Across the Services the top priority identified by more than 84 percent of survey participants was to ensure support programs meet the needs of families experiencing multiple deployments. The second priority with an 80 percent rating was helping wounded service members and their families. The third priority rated as very important with 79 percent was to help surviving spouses, children, and other family members.

(NMFA, 2011, p. 3)

The 2007 MHAT-IV (2007) findings reported that marital concerns relating to deployment length were rated higher than in previous surveys. We now know that predictions of the NMFA (Raezer, 2007) that the need for confidential, preventative mental health services would continue to rise and remain high even after military operations scale down in Iraq and Afghanistan, have indeed come true. Families believed then and still do that more must be done to link service members and families with the services they require and find ways for the families to get the information they need about post-traumatic stress disorder (PTSD) and other mental health issues. Families want to know mental health services are available when they or their service member need them. They want to know how to recognize the danger signs for themselves, their children, and the service member, and they want to know that seeking care will result in improved health at no danger to their service member’s career (Raezer, 2007). Springle and Wilmer (2011) point out that there are a lot of reasons for veterans, active duty service members and family members to seek care outside of the system, including “stigma and the fact that care, especially mental health care, may affect future assignments and security clearances” (p. 238). In addition, these authors point out that once someone leaves the military they may not live near military or treatment facilities (Springle & Wilmer, 2011).

Family Preparedness

In the NMFA’s Statement before the Department of Defense Task Force on Mental Health (2006), family readiness is imperative for service member readiness; therefore the emotional well-being and mental health of service members are linked to those of their families. Family well-being affects a service member’s entire career from recruitment to retention to retirement. The NMFA calls for the Department of Defense to refine and improve the mental health support for families and service members to retain highly trained and qualified service members. The report stated, “No need is greater for military family readiness than a robust continuum of easily accessible and responsive mental health services, from stress management programs and preventative mental health counseling through therapeutic mental health care” (p. 4). The President’s 2012 Executive Order is evidence that this has been taken seriously, even though at this writing there is still a long way to go. The executive action includes improving the transition from the Department of Defense (DoD) to civilian care providers, improving access and care at the Veterans Administration (VA), improving treatment for mental health conditions, raising awareness and encouraging service members and families to seek help, suicide prevention, and strengthening community resources (Joint Fact Sheet, 2014).

The authors of the 2006 NMFA statement shared that there is a need to expand services and support the programs already in existence, such as Military OneSource. As mentioned earlier, Military OneSource is available for active duty service members and their families, as well as for Guard and Reserves members and their families, regardless of whether they are activated. This program enables service members and families to receive free face-to-face mental health visits wit...

Table of contents

• Cover Page
• Half-Title Page
• Title Page
• Copyright Page
• Table of Contents
• Foreword to the Second Edition
• Foreword to the First Edition
• Preface
• Acknowledgments
• Part 1 Setting the Stage
• Part 2 The Military Family
• Part 3 Working with Military Families
• Appendices
• Bibliography
• Index