View
215
Download
0
Category
Preview:
Citation preview
7/30/2019 millitary families.pdf
1/14
O R I G I N A L P A P E R
Community Family Therapy with Military Families
Experiencing Deployment
W. Glenn Hollingsworth
Published online: 12 March 2011 Springer Science+Business Media, LLC 2011
Abstract The length and frequency of deployments in the current wars in Iraq and
Afghanistan are associated with increased vulnerability for both part- and full-time military
families who stand to benefit from systems-oriented practice by marriage and family
therapists. Community Family Therapy (CFT) is a modality designed to promote resilience
both within and beyond the four walls of the therapy room, facilitate family connections in
the community, and empower them for local leadership. The effects of deployment on
families are summarized and CFT principles are adapted as a framework for interventionwith this population.
Keywords Community engagement Deployment Family therapy Military families
In over 9 years of the Global War on Terror (GWOT), including Operation Iraqi Freedom
(OIF) and Operation Enduring Freedom (OEF), more than 1.8 million United States service
men and women have been deployed overseas (RAND Corporation 2009), leaving behind
a staggering number of loved ones, including parents, spouses, partners, and children. In
the last few years, research on the effects of a previously unforeseeable number of
deployments and increased operations tempo on military families has expanded rapidly.
There are still numerous gaps, such as program evaluation (Griffith 2010), clarification of
risk versus resilience (Ternus 2010), variations of deployment effects based on gender, and
developmental differences of children (Chandra et al. 2010; Chartrand et al. 2008; Lester
et al. 2010).
One significant and practical gap concerns how civilian counselors and therapists can
more effectively intervene with military families in this situation. In this article I address
the unique role that marriage and family therapists (MFTs) can play in promoting
W. G. Hollingsworth (&)
Family & Community Research Lab (0493), 1880 Pratt Drive, Blacksburg,
VA 24060, USA
e-mail: wghworth@vt.edu
W. G. Hollingsworth
Virginia Tech, Blacksburg, VA, USA
123
Contemp Fam Ther (2011) 33:215228
DOI 10.1007/s10591-011-9144-8
7/30/2019 millitary families.pdf
2/14
resilience in military families. I propose the Community Family Therapy model (CFT)
(Rojano 2004) as a framework for MFT intervention, and argue that therapists can promote
health by moving beyond the four walls of the therapy room and creating broader con-
nections among themselves, military families, and others in the community. Thus, I
respond to the lack of a guiding framework in the literature for the therapist wishing toengage more broadly with this population.
Introduction
While there are various deployment destinations and assignments, I focus here on the
effects of deployment in combat-related situations, namely OIF and OEF. As opposed to
deployments for peace-keeping or routine training missions, combat-related deployments
are more likely to occur with less preparation, more variability (e.g., when the deployment
is scheduled to end), and significantly increased stress for family members back home. A
great portion of the stress incurred by these families consists of worrying about the safety
of their deployed loved one (Flake et al. 2009; Lapp et al. 2010) given the inherent dangers
regardless of the service members proximity to the battlefield. This is particularly salient
given the prevalence of Improvised Explosive Devices in the current conflicts.
In addition, the unique role of National Guard and Reserve service members requires
emphasis. These individuals represent an under-studied group in the literature (Houston
et al. 2009; Mansfield 2009) and are in a unique position as citizen soldiers. They face
challenges that full-time service members do not, such as navigating civilian employment
(Griffith 2010), potentially significant drops in financial income when mobilized (Hosh-mand and Hoshmand 2007), isolation and a separation from unit affiliation (Wiens and
Boss 2006), and limited access to formal support resources provided by the military (Lapp
et al. 2010). Thus, National Guard and Reserve personnel and their families are more
vulnerable than other military professionals (Kline et al. 2010). This population stands to
benefit more directly from a therapist with a community-oriented perspective and ability to
facilitate connections across diverse systems.
My discussion of community engagement and social support networks is generally
informed by social organization theory (Mancini et al. 2005). According to this theory,
networks, social capital, and community capacity are vehicles for change in communities.
Formal networks are those typically indicated by some sort of obligation, and often involveagencies or organizations. Military examples would include unit leadership and various
human service delivery systems involving, for example, relocation or child care (Bowen
et al. 2000) as well as Family Readiness Groups (FRGs) (Huebner et al. 2009). Informal
networks are characterized by voluntary associations, such as naturally occurring groups
among nuclear and extended family members, friends, and work colleagues. Bowen et al.
(2000) argue that a primary function of formal networks is providing support to informal
networks. A larger-systems model of therapeutic practice can operate at the intersection of
these two entities and figure prominently in the promotion of resilience in military families
experiencing deployment.Ramon Rojano, William Doherty, and others recently have brought civic engagement,
collaboration, and turning consumers of family services into producers of change to the
forefront in the MFT field (e.g., Doherty and Beaton 2000; Doherty et al. 2009; Rojano
2004). While Imber-Black (1988) was one of the first family therapy professionals to offer
an assessment and guide for treating families within larger systems, Rojano (2004) has
provided a model of community-focused engagement aimed at low-income, urban families
216 Contemp Fam Ther (2011) 33:215228
123
7/30/2019 millitary families.pdf
3/14
that specifically includes helping families earn above the poverty line and other goals not
typically considered within the purview of MFT. I adapt principles from Rojanos model to
military families experiencing deployment and provide ideas for family therapists as to
how they can engage families not only with a community perspective, but also at and
within the level of community. After a review of the literature regarding the effects ofdeployment on families, I situate a variety of therapeutic interventions, many of which are
in the extant literature, within the models three levels of engagement (individual and
family therapy, wrap around networking, and leadership and civic engagement) (Rojano
2004). I also argue that family involvement in the final level is underrepresented in the
military family literature; thus the idea of turning consumers of services into promoters of
change is highly relevant and likely to be beneficial to many in this community.
It is indeed a failure of systems that makes such a broad therapeutic approach necessary.
The helping professions are quite specialized, creating somewhat rigid distinctions among
counselors, family therapists, social workers, community psychologists, and others. As a
result, military families, especially those of the Guard and Reserve, may not benefit from
all relevant services and sources of support due to a lack of communication among these
professionals. Hoshmand and Hoshmand (2007), representing community psychologists,
bring attention to the need for community-minded intervention with military families that
also could bridge this gap. MFTs have simultaneous regard for the individual, family, and
larger systems in treatment, and as a result are in a unique position to provide robust
services to this population.
Such intervention and outreach is crucial given the length of the current wars in Iraq and
Afghanistan and the nature of contemporary, all-voluntary military service. A number of
factors can influence someones choice to remain in the military, and officials are recog-nizing the link between family factors, retention, and readiness for deployment (e.g., Doyle
and Peterson 2005; Karney and Crown 2007). A sample of Army Guard and Reserve
members and their families who reported coping well with deployment were more likely to
express intention of extending their service (Castaneda et al. 2009). Similarly, among a
sample of Army soldiers stationed in Europe, positive beliefs about the military providing a
familyfriendly work environment were also linked to retention (Huffman et al. 2008).
Finally, Amen et al. (1988) even suggested a spouses satisfaction with the military ulti-
mately is associated with better adjustment to deployment. Thus, strategic family support
can promote healthier coping, pro-military attitudes, and, in turn, readiness and retention.
While there are many positives associated with military life, like quality healthcare andopportunity for advancement, and even with deployment itself, such as increased pay and
enhanced sense of family closeness (Castaneda et al. 2009), social factors make inter-
vention by professionals such as MFTs quite valuable. Multiple researchers have written
about the possibility of adverse effects of being a military family, such as the impact of
frequent relocations (Ternus 2010) and a more rigid organizational culture that may
conflict with a broad range of cultural dynamics associated with diverse personnel (Wiens
and Boss 2006). Adolescents have noted that military culture prompted their learning to not
talk about their feelings (Huebner and Mancini 2010). Indeed, the military is experiencing
an increasing number of officers who belong to a generation marked by a relativeunwillingness to sacrifice family and marriage for the demands of an Army career
(Caliber Associates 2007, p. 4); it remains to be seen what kind of long-term effects these
generational changes might promote.
Given current literature on the effects of deployment on families, spouses or partners,
and children, we can address how the MFT can intervene at various levels of community
engagement. Compared to traditional therapeutic encounters bound within the four walls of
Contemp Fam Ther (2011) 33:215228 217
123
7/30/2019 millitary families.pdf
4/14
an office, it is my belief that a community approach will have a higher likelihood of
ameliorating certain persistent effects of deployment stress and maladjustment as well as
simultaneously strengthening the communities in which full- and part-time military fam-
ilies live.
Effects of Deployment
In narrative terms, there are dominant and marginalized discourses on the effects of
deployment. It appears that the negative effects of deployment belong to the former. After
all, common sense would suggest that separating loved ones for anywhere from 4 to
15 months under the best of circumstances would be quite stressful, but especially so with
one being in harms way every day and the other experiencing a dramatic shift in roles and
responsibilities as well as conflicts in and outside of the home. However, some families
come out of the deployment experience stronger, with new skills, independence, and self-
reliance (Caliber Associates 2007). A survey by the Kaiser Family Foundation (2004)
found that 58% of Army spouses thought deployment strengthened their marriage com-
pared with 31% who thought it had no effect and 10% who thought their marriage
weakened as a result. There are also those who stress the fact that not everyone or every
family will experience deployment in the same way, leading some to downplay effects like
the relatively mild degree of childrens symptom severity (Mabe 2009, p. 352) and with
others producing more alarming reports (Salamon 2010). Effects also can differ according
to the phase of the deployment cycle (MacDermid Wadsworth 2010).
Regarding the marital relationship, Karney and Crown (2007) found that deploymentactually can strengthen marriages and was associated with greater stability that even
increased with the length of deployment. While the focus here is on effects during the
sustainment phase of deployment (i.e., when the service member is actually in theater),
Allen et al. (2010), on the other hand, found that an Army soldiers deployment status in
the last year was not related to differences in relationship satisfaction between deployed
and non-deployed active duty personnel.
Individually, at-home spouses or partners appear to face a general increase in stress,
with 42% of respondents in one study indicating clinically significant stress levels during
deployment (Flake et al. 2009). Grandparents as well have reported elevations in stress
while raising grandchildren who had a deployed parent (Bunch et al. 2007). Spouses alsomay face increased depressive symptoms (Warner et al. 2009), and loneliness is a common
struggle that may lead to other difficulties in coping (Caliber Associates 2007). Mansfield
et al. (2010) found that, regardless of the length of deployment, Army wives with deployed
husbands also experienced significantly more depressive disorders, as well as sleep dis-
orders, acute stress reactions, and adjustment disorders than wives whose husbands were
not deployed. In addition, stress in the family has been shown to increase along with the
cumulative length of deployment (Lester et al. 2010), and elsewhere a sample of Army
families made more frequent mental health care-related visits to professionals as deploy-
ments drew on (Mansfield 2009).Children face a variety of stressors during deployment, and while many children are
resilient (Jensen et al. 1996; Lester et al. 2010), this can lessen with the length of
deployment (Chandra et al. 2010). Despite the variability of responses to deployment, there
appears to be significant agreement that children may experience increased anxiety and
uncertainty (Chandra et al. 2010), vulnerability for general relationship conflict (Huebner
et al. 2007), higher frequency of depressive symptoms (Jensen et al. 1996; Huebner et al.
218 Contemp Fam Ther (2011) 33:215228
123
7/30/2019 millitary families.pdf
5/14
2007), and a higher resting heart rate indicative of increased stress (Barnes et al. 2007).
One of the most significant predictors of how well a child will cope with deployment is the
mental health and coping of the primary caregiver (Flake et al. 2009; Jensen et al. 1996;
Palmer 2008; Chandra et al. 2010). However, some authors (e.g., Mmari et al. 2009)
acknowledge this but de-emphasize it in order to keep searching for other salient factorsaffecting childrens adaptation such as their social milieu (e.g., the presence of anti-war
sentiment in the school or community).
School difficulties can occur as anxiety and uncertainty related to deployment lead to
sadness and anger, causing disruptions (Chandra et al. 2010) as well as overall declines in
academic performance (Huebner et al. 2007). While Flake et al. (2009) found that 32% of
school-aged kids facing the deployment of a parent were at increased risk for psychosocial
morbidity, associated school related declines were not evident. Flake et al. also found more
internalizing symptoms (e.g., worry, anxiety, crying) among children than externalizing or
inattention problems, a finding that is contrary to that of others who suggest that older
children and boys face more school problems, likely due to a tendency to act out anger and
aggression (Chandra et al. 2010).
Gender and developmental differences in deployments effects are also evident. It
would be too simplistic to generalize that boys externalize while girls internalize, though
this is not without some support. Chandra et al. (2010) found that girls internalize more
than boys as measured by anxiety or depression indicators. These authors also note that
girls may struggle in more dangerous ways as a portion of girls in their sample also
engaged in risk-taking behavior such as self-mutilation. Lester et al. (2010), on the other
hand, suggest that girls may externalize more than boys during deployment, with boys
struggling more upon return and reintegration in adjusting to reduced autonomy andincreased structure (p. 318). Manos (2010) takes the aforementioned evidence into
consideration when noting that girls may indeed struggle more with behavioral problems
overall than boys. Still, others have found that girls may struggle more with reintegration
(RAND Corporation 2009), a phase that may be more difficult than sustainment (Huebner
et al. 2007). Developmentally, Chartrand et al. (2008) found that 35 year olds had more
externalizing problems, and that these were independent of caregiver stress, while children
between 1.5 and 3 years of age showed no changes in behavior during deployment.
Overall, younger school-aged children may struggle more than older children (Jensen et al.
1996; Lincoln et al. 2008).
Families of National Guard and Reserve service members face additional challengesleading to greater stress (Lapp et al. 2010; Griffith 2010), heightened vulnerability to
the adverse effects of deployment (Kline et al. 2010), and more reports of mental
health concerns upon return (Milliken et al. 2007). These are also families that could
be alone and without unit affiliation, placing them at higher risk for maladaptation
(Wiens and Boss 2006). Such families also may have less access to the formal and
informal networks of support provided by the military (Lapp et al. 2010). Children in
these families may experience less social support while attending schools that are
unaware of the dynamics of military life (Chandra et al. 2010). A sample of Guard and
Reserve spouses indicated five stressors that summarized their experience: worrying,waiting, going it alone, pulling double duty, and loneliness (Lapp et al. 2010).
Moreover, they also acknowledged believing that others could not understand their
experiences unless they too had faced the deployment of a loved one. These aspects of
disconnection are particularly salient to the discussion of how MFTs can intervene at
community and network levels.
Contemp Fam Ther (2011) 33:215228 219
123
7/30/2019 millitary families.pdf
6/14
Risk Factors
According to McCubbins Double ABCX model of family stress and adaptation, risk
factors would impact a familys existing resources (B) and perceptions of the stressor
(C) (McCubbin and Patterson 1983). These would be the various disparate elements thateither increase or decrease the chance of a familys bonadaptation (effective, optimal
coping and adjustment) or maladaptation to a stressor, in this case, deployment, and
occur on individual, familial, and contextual levels.
Individual stressors of at-home caregivers include facing barriers to mental health care,
such as getting time away from family and off from work, as well as a concern that seeking
mental health treatment would be detrimental to a spouses career (Warner et al. 2009).
Wiens and Boss (2006) utilize Bosss (2002) Contextual Family Stress Framework in
identifying internal and external contexts that affect an individuals response to stress.
Internal contexts refer to ones philosophy, perceptions, appraisals of the individual
regarding his or her view of the stressor, and use of support resources. External contexts
include past history, culture, economy, and development. Pile-ups of stressors overall can
make the family more vulnerable to dysfunction, such as lower socioeconomic status,
young and inexperienced families, being without unit affiliation, and first time deploy-
ments (Stafford and Grady 2003; Wiens and Boss 2006; MacDermid Wadsworth 2010).
Additionally, children appear more vulnerable based on the at-home parents mental
health (e.g., Chandra et al. 2010) and the extent to which family routines are disrupted
(McFarlane 2009). Increased responsibilities at home can take a toll, as can multiple and or
extended deployments (Chandra et al. 2010), and fear of death of the deployed parent
(Houston et al. 2009). Exposure to media coverage refers to an external context that canadversely affect children (Cozza et al. 2005), as can challenges at school regarding per-
ceptions of war held by others in the community (Houston et al. 2009). Thus, children may
have difficulty confiding in friends and suppress their feelings as a result (Huebner and
Mancini 2010), and overall may face deficits in the availability of social support, especially
if the family leaves what it considers home to live with or be closer to extended family
(Cozza et al. 2005).
On the contextual level, risk factors include the type of deployment (Wiens and Boss
2006; Lincoln et al. 2008), as well as military culture as it relates to the suppression of
emotion, for example, or the potential for conflict given contrasts with a diversity of family
structures and dynamics (Wiens and Boss 2006). In addition, there may be barriers relatedto mental health care provided by the military, such as the need to go off-base for mental
health services as well as awareness of resources, finances, and child care responsibilities
more generally (Eaton et al. 2008).
Protective Factors
Maladjustment to deployment is not inevitable, and there are a variety of protective factors
and positive coping activities to consider. A brief review of the literature reveals thatemployment and higher level of parental education (Flake et al. 2009), parental adjustment
and mental health (Lester et al. 2010; Manos 2010; Chandra et al. 2010), parental value of
a childs education (Chandra et al. 2010), parental support for children (Morris and Age
2009), appropriate communication around deployment (Huebner and Mancini 2010),
clarity around issues of control (i.e., what can and cannot be changed; Huebner et al. 2007)
and the meaning attributed to deployment (Antonovsky and Sourani 1988; Wiens and Boss
220 Contemp Fam Ther (2011) 33:215228
123
7/30/2019 millitary families.pdf
7/14
2006; Mabe 2009; Lapp et al. 2010) are all important variables in determining how a
family responds to the pile-up of stressors associated with deployment. Wiens and Boss
(2006) also suggest that family preparedness for deployment, flexible gender roles, and
active coping strategies can increase a familys resilience during deployment.
Protective factors that center on social support and relationships that family membershave with others outside of the family are prominent in the literature as well as being a
focus of this article. Living on a military base is associated with less vulnerability to
negative effects (Chandra et al. 2010), as is feeling supported by the military community, a
religious organization in which a family is involved, and/or the community in general
(Wiens and Boss 2006; Flake et al. 2009). It is important for these families to have ongoing
relationships with other families as well (Castaneda et al. 2009). For children, appropriate
and adequate supervision in the home and community is beneficial (Chandra et al. 2010).
Huebner and Mancini (2008) argue for more explicit attention to be paid to teenagers and
their social networks in this regard, since youth appear to socially construct meanings
about deployment in their interactions with others (Huebner et al. 2007). Adolescents also
can benefit from giving advice to other deployed kids (Huebner and Mancini 2010),
especially as these young people may tend to feel understood only by others who have
experienced similar circumstances. Children can benefit when there is sufficient social and
emotional support provided at their school by staff as well as peers (Chandra et al. 2010).
A variety of social connections are vital. In a survey completed by the National Military
Family Association (2006), only 47% of respondents indicated sustained support
throughout deployment, and 17% of respondents indicated that no support programs were
available to them. In addition to emotional support, these informal network connections
also can provide important information regarding benefits and resources in the form ofother formal supports and programming (Huebner and Mancini 2008; Faber et al. 2008;
Houston et al. 2009), such as Operation Purple Camp (McFarlane 2009), a summer camp
for youth with a deployed parent. Ongoing family support groups (Huebner et al. 2007;
Faber et al. 2008) and initiatives such as Operation: Military Kids can be healthy avenues
for families to get emotional as well as instrumental needs met, and more formal ones can
be used for teaching coping skills, promoting neighborhood outreach to target at-risk
families, and promoting a sense of community (Lombard and Lombard 1997; Bowen et al.
2003). Other groups that families can engage in include those provided by the military
itself, such as Family Readiness Groups (Doyle and Peterson 2005; Di Nola 2008;
Mansfield 2009). Social support and connection figure prominently in the literature, pro-viding an avenue of opportunity for community-minded MFTs.
The Unique Role of the Family Therapist
Families do not exist in vacuums, but are embedded within a variety of larger systems
(Bronfenbrenner et al. 1986). Just as it is important that a sibling subsystem maintain
healthy boundaries and responsive communication with a parental subsystem, so, too, is it
necessary for families and their individual members to remain in healthy relationships withothers outside and beyond the familys borders. Darwin (2009) notes that isolation creates
a fertile ground for trauma (p. 437). Moreover, a sense of community is a significant
variable in how well a family adapts to military life (Bowen et al. 2003). Numerous risk
and protective factors point to the importance of social support and connection with others
via informal (such as religious organizations or support groups) and formal networks (such
as ones work or even a Family Readiness Group). In addition to the simple fact of human
Contemp Fam Ther (2011) 33:215228 221
123
7/30/2019 millitary families.pdf
8/14
connection and emotional or instrumental support, such robust relationships can aid in the
transfer of support or resource-related information, thus reducing barriers to intervention
(Eaton et al. 2008) and enhancing the effectiveness of programs already in place. Thus, the
systemically focused MFT who places a premium on relationships is in a unique position to
help address the needs of individual family members by facilitating their connection toother sources of support and engagement in the community.
While there are resources available for therapists working with these families, many
institutions and organizations fail to consider adequately the familys involvement in other
relational systems. For instance, Darwin (2009) cites an example of a child being sus-
pended from school for acting out behaviors, yet the school was unaware that the child had
a parent who was deployed. The schools response likely exacerbated the childs mal-
adaptive coping, whereas had the staff been aware of the effects of deployment and this
students particular circumstances, a different plan of intervention could have been
implemented and likely increased the resilience of the family overall. The blind spots in the
literature regarding the familys relationship with and to other systems leave the family
therapist with the lack of a guiding framework for such intervention. The therapist who is
content to simply see an adolescent or a parentchild dyad once a week to address coping
in the face of deployment likely will see suboptimal results, given the emphasis in the
literature on social supports and systems beyond the family. To be sure, within the family
therapy field there are those who have offered models of intervention with families and
larger systems (e.g., Imber-Black 1988), yet only recently has there been a burgeoning
movement within the field to expand the influence of MFT into the community proper and
even reshape the actual practice of therapists.
What distinguishes Rojanos model of Community Family Therapy from other sys-temically-oriented interventions is best summed up by Doherty when he writes that the
CFT therapist is a vigorous collaborator with multiple systems, including families, citi-
zens groups, professional groups, and community-based services (Doherty and Beaton
2000, p. 154). Whereas in other theoretical orientations the therapist may talk about
community or network issues (e.g., the relational selves of narrative approaches), in CFT
the therapists and clients involvement in community issues becomes part of the treatment
plan itself. Other responsibilities of the therapist include increasing availability and
access to necessary community resources and developing leadership skills and capacity
for civic engagement (Rojano 2004, p. 63). Similarly, there are three broad treatment
goals for clients that include (a) constructing an autobiography that focuses on strengthsand a life plan that invites positive action and self development, (b) developing a functional
and effective community network of personal and supportive resources, and (c) providing
for leadership development and civic engagement (p. 67). These three goals then cor-
respond to Rojanos levels of engagement mentioned earlier: individual and family ther-
apy, wrap around networking, and leadership and civic engagement.
The first level of engagement consists of interventions aimed at what typically are
identified in the literature as the stressors faced by military families. It is in individual or
family sessions where discussions of role responsibilities and realignments, boundaries,
hierarchy, and the like can be held. Therapists can work at this point with clients onidentifying strengths as well as internal and external resources, and developing positive,
active coping strategies. Issues of control (Huebner et al. 2007; Morris and Age 2009),
helplessness, and hopelessness can be addressed here as well. Strategies to promote self-
care are essential given the increased responsibilities undertaken by family members that
may lead to fatigue and difficulty functioning at work or school (Chandra et al. 2010). And
since the meaning or interpretation given to deployment has received attention in the
222 Contemp Fam Ther (2011) 33:215228
123
7/30/2019 millitary families.pdf
9/14
literature (Huebner and Mancini 2010), narrative work also can occur at this level. In
particular, dominant discourses around the military family syndrome (Bradshaw et al.
2010) and the inevitable harm associated with deployment can be deconstructed in favor
of alternative narratives of resilience, adaptation, and strength.
Community Family Therapy principles become more salient for our purposes at thesecond level of engagement. Rojano (2004) writes, This level seeks to help clients
connect or re-connect with the community of resources that can offer sources of support
and opportunities to meet basic and developmental needs (p. 69). In the same article, he
notes a need to help clients construct a nuclear network of family members and close
friends the personalized community (p. 69). Therapists can have explicit discussions
about sources of social support available to the family and how to improve access,
including addressing any individual issues that may be a barrier to outreach, such as ones
attachment issues (Huebner 2009) or trauma history.
Perhaps more importantly, there is an opportunity for therapists to begin moving beyond
the four walls of the therapy room by actually facilitating the connection of these families
with a variety of supports (i.e., formal or informal networks) in the community. First,
therapists must be aware of what is actually available. For instance, it would be helpful to
know that Family Readiness Groups (FRGs) are essentially Army-sponsored support
groups for families. FRGs also disseminate military-related information (e.g., on a soldiers
deployment status, military benefits) and provide general support for families (Di Nola
2008; Mansfield 2009). Other service branches also provide similar resources, such as
those associated with the Navys Fleet and Family Support Programs. MFTs could
establish relationships with military chaplains or others who would be a rich source of
information regarding other prevention services (e.g., parenting programs, financialcounseling). Therapists also must educate themselves (and possibly clients) on other
aspects of military culture, such as how to go about receiving mental health benefits and
even the vast array of acronyms the various branches employ, an ignorance of which can
quite clearly identify one as an outsider. This is especially significant since families of the
deployed, unlike the service men themselves, must seek mental health care away from the
post (Eaton et al. 2008). A well-educated therapist can be a rich source of information to a
multi-stressed caregiver, as well as a catalyst in working with a family to get something
like a support group started if it does not exist (Faber et al. 2008). Therapists can facilitate
other groups in collaboration with clients, such as support groups for the teaching of coping
skills (Lombard and Lombard 1997) or providing stress management workshops (Faberet al. 2008).
Di Nola (2008) notes the role of independence and financial responsibility in adapting to
deployment. In Community Family Therapy in general there is a goal of increasing median
family income, and this principle applies as well to military families with respect to
deployment. Since many National Guard or Reserve service members families may
experience significant reductions in income due to departures from regular employment,
therapists could assist the at-home parent in a coaching fashion to perhaps find alternative
sources of income or ways to enhance his or her vocational skills. The therapist can make
the client aware of job-training programs based in the community if needed. Thus, therapytakes on a more robust focus in enhancing resilience to include such contextual economic
factors.
Another way a therapist could engage at this level is in advocacy for a family or child
with the local school system. In the previous example, a child was punished at school for
acting out. If the school had been aware of the context of the misbehavior, an alternative
and more beneficial intervention could have ensued. Incidents like this can be reduced
Contemp Fam Ther (2011) 33:215228 223
123
7/30/2019 millitary families.pdf
10/14
significantly if there are improvements in the flow of information between schools and the
military (Chandra et al. 2010). Therapists can help facilitate this communication directly as
advocates and by working with caregivers to become more proactive in making a school
aware of a parents deployment, anticipated return, or any other event associated with the
military that may put the child under increased stress, thus heightening vulnerability formisbehavior at school. In all of these interventions, the therapist is becoming more
involved in the systems affecting a family for the clients sake; it is at the next level of
engagement that the families themselves take up the mantle of leadership and advocacy
related to community concerns.
In the book Bowling Alone, Robert Putnam (2000) notes the single most common
finding from a half-century of research on the correlation of life satisfaction, not only in the
United States but around the world, is that happiness is best predicted by the breadth and
depth of ones social connections (p. 332). As suggested by the Community Family
Therapy model, connecting families to larger communities in leadership capacities not
only empowers families, bringing them out of a one-down or marginalized position, but it
also has the capacity to set in motion various changes, such as increases in community
resilience, that can affect a much larger number of people than the therapist seeing only
one family at a time during his or her weekly practice. Furthermore, this is an overlooked
area in the research on military families and deployment. While there are programs such as
Operation: Military Kids Speak Out for Military Kids youth presentation (Operation:
Military Kids, n.d.) teams that consist of non-military youth raising awareness of military
issues with their peers, there is little in the literature regarding how members of military
families can be promoters of change themselves and not simply consumers of services.
Altruism, Rojano (2004) writes, is a major curative factor (p. 66), and Huebner andMancini (2010) allude to the altruistic effects of adolescents giving advice to peers also
facing deployment. Beyond that recognition, (to my knowledge) there appears to be little
else said about how military families can become more resilient by proactively addressing
the needs of others in their community.
The third level is about leadership and civic engagement and ideally would obviate the
need for a therapist. The goal is to facilitate both family empowerment and their com-
munity connections toward the enhancement of community capacity, which refers to a
sense of shared responsibility and collective competence among members of a
community, leading to heightened community resilience (Mancini and Bowen 2009). Thus,
the client becomes more actively engaged in the community, perhaps by advocating for theneeds of other military families at city council meetings or arranging food drives for
families with fewer financial resources. Individuals could petition local organizations (e.g.,
the Y) to reduce fees for children with deployed parents or coordinate a fund-raising
effort to this end. These strategies would be especially applicable to those families who
have experienced multiple deployments and who have grown considerably as a result of
their experiences. Such families could be models for others who are new to the deployment
process and all its inherent challenges, especially since some families believe that only
those who also have experienced deployment will understand what they are going through
(Lapp et al. 2010). Another option would be for the spouse of a deployed service memberto facilitate some sort of adopt a family program. Military families during deployment
have a number of instrumental needs that usually cannot be addressed directly by a
therapist, such as childcare, grocery shopping, and house cleaning. A community-minded
at-home parent could raise awareness of deployment issues and help create a network of
other local families who sign up to adopt a military family, perhaps providing them with
transportation to appointments, purchasing of groceries, or cooking a meal, and the like.
224 Contemp Fam Ther (2011) 33:215228
123
7/30/2019 millitary families.pdf
11/14
An adolescent with a deployed parent could even recruit a cadre of babysitters from among
his or her social networks to offer free services to multi-stressed caregivers who need time
for self-care. There are obviously numerous options at this level and I cannot list all that
could be born out of a spirit of collaboration and empowerment.
Conclusion
A variety of factors affect resilience, making definitive statements about how a family will
experience the deployment of a loved one useless as well as impossible. What we do know
is that relationships and connections matter, inside the family and out. The flexibility of the
Community Family Therapy model enables its application to military families facing
deployment. Of course, this does not answer all questions about how a family therapist can
best intervene, but it does provide a general framework that better takes into account the
role of larger systems as contexts for growth. Future research could certainly test such a
framework and gain clarity regarding the influence of the social context on adjustment.
There is also a need to evaluate programs for military families and how well these pro-
grams are incorporating social factors. The myriad experiences of service members and
their families in the current wars in Iraq and Afghanistan have taught us much about what
promotes resilience and what does not. Researchers, clinicians, and others are fortunate to
have access to their triumphs and struggles and with such continued collaboration, optimal
outcomes for more families likely will result.
References
Allen, E. S., Rhoades, G. K., Stanley, S. M., & Markman, H. J. (2010). Hitting home: Relationships between
recent deployment, posttraumatic stress symptoms, and marital functioning for Army couples. Journal
of Family Psychology, 24(3), 280288.
Amen, D. G., Jellen, L., Merves, E., & Lee, R. E. (1988). Minimizing the impact of deployment separation on
military children: Stages, current preventive efforts, and system recommendations. Military Medicine,
153(9), 441446.
Antonovsky, A., & Sourani, T. (1988). Family sense of coherence and family adaptation. Journal of
Marriage and the Family, 50(1), 7992.Barnes, V. A., Davis, H., & Treiber, F. A. (2007). Perceived stress, heart rate, and blood pressure among
adolescents with family members deployed in Operation Iraqi Freedom. Military Medicine, 172(1),
4043.
Boss, P. (2002). Family stress management: A contextual approach (2nd ed.). Thousand Oaks, CA: Sage.
Bowen, G. L., Mancini, J. A., Martin, J. A., Ware, W. B., & Nelson, J. P. (2003). Promoting the adaptation
of military families: An empirical test of a community practice model. Family Relations, 52(1), 3344.
Bowen, G. L., Martin, J. A., Mancini, J. A., & Nelson, J. P. (2000). Community capacity: Antecedents and
consequences. Journal of Community Practice, 8(2), 121. Retrieved 10/14/10, from http://www.infor
maworld.com/10.1300/J125v08n02_01.
Bradshaw, C. P., Sudhinaraset, M., Mmari, K., & Blum, R. W. (2010). School transitions among military
adolescents: A qualitative study of stress and coping. School Psychology Review, 39(1), 84105.
Bronfenbrenner, U., Kessel, F., Kessen, W., & White, S. (1986). Toward a critical social history ofdevelopmental psychology: A propaedeutic discussion. American Psychologist, 41(11), 12181230.
Bunch, S. G., Eastman, B. J., & Moore, R. R. (2007). A profile of grandparents raising grandchildren as a
result of parental military deployment. Journal of Human Behavior in the Social Environment, 15(4),
112.
Caliber Associates. (2007). What we know about Army families: 2007 update. Retrieved 10/27/10, from
http://www.cfs.purdue.edu/mfri/pages/military/2005_Demographics_Report.pdf.
Contemp Fam Ther (2011) 33:215228 225
123
http://www.informaworld.com/10.1300/J125v08n02_01http://www.informaworld.com/10.1300/J125v08n02_01http://www.cfs.purdue.edu/mfri/pages/military/2005_Demographics_Report.pdfhttp://www.cfs.purdue.edu/mfri/pages/military/2005_Demographics_Report.pdfhttp://www.informaworld.com/10.1300/J125v08n02_01http://www.informaworld.com/10.1300/J125v08n02_017/30/2019 millitary families.pdf
12/14
Castaneda, L. W., Harrell, M. C., Varda, D. M., Hall, K. C., Beckett, M. K., & Stern, S. (2009). Deployment
experiences of Guard and Reserve families: Implications for support and retention. Arlington, VA:
RAND Corporation.
Chandra, A., Martin, L. T., Hawkins, S. A., & Richardson, A. (2010). The impact of parental deployment on
child social and emotional functioning: Perspectives of school staff. Journal of Adolescent Health,
46(3), 218223.Chartrand, M. M., Frank, D. A., White, L. F., & Shope, T. R. (2008). Effect of parents wartime deployment
on the behavior of young children in military families. Archives of Pediatrics and Adolescent Medi-
cine, 162(11), 10091014.
Cozza, S. J., Chun, R. S., & Polo, J. A. (2005). Military families and children during operation Iraqi
freedom. Psychiatric Quarterly, 76(4), 371378.
Darwin, J. (2009). Families: They also serve who only stand and wait. Smith College Studies in Social Work,
79(3), 433442.
Di Nola, G. M. (2008). Stressors afflicting families during military deployment. Military Medicine, 173(5),
vvii.
Doherty, W. J., & Beaton, J. M. (2000). Family therapists, community, and civic renewal. Family Process,
39(2), 149161.
Doherty, W. J., Mendenhall, T. J., & Berge, J. M. (2009). The families and democracy and citizen healthcare project. Journal of Marital and Family Therapy, 36(4), 114.
Doyle, M. E., & Peterson, K. A. (2005). Re-entry and reintegration: Returning home after combat.
Psychiatric Quarterly, 76(4), 361370.
Eaton, K. M., Hoge, C. W., Messer, S. C., Whitt, A. A., Cabrera, O. A., McGurk, D., et al. (2008).
Prevalence of mental health problems, treatment need, and barriers to care among primary care-seeking
spouses of military service members involved in Iraq and Afghanistan deployments. Military Medicine,
173(11), 10511056.
Faber, A. J., Willerton, E., Clymer, S. R., MacDermid, S. M., & Weiss, H. M. (2008). Ambiguous absence,
ambiguous presence: A qualitative study of military Reserve families in wartime. Journal of Family
Psychology, 22(2), 222230.
Flake, E. M., Davis, B. E., Johnson, P. L., & Middleton, L. S. (2009). The psychosocial effects of deployment
on military children. Journal of Developmental and Behavioral Pediatrics, 30(4), 271.Griffith, J. (2010). Citizens coping as soldiers: A review of deployment stress symptoms among reservists.
Military Psychology, 22(2), 176206.
Hoshmand, L. T., & Hoshmand, A. L. (2007). Support for military families and communities. Journal of
Community Psychology, 35(2), 171180.
Houston, J. B., Pfefferbaum, B., Sherman, M. D., Melson, A. G., Jeon-Slaughter, H., Brand, M. W., et al.
(2009). Children of deployed National Guard troops: Perceptions of parental deployment to Operation
Iraqi Freedom. Psychiatric Annals, 39(8), 805811.
Huebner, A. J. (2009). Exploring processes of family stress and adaptation: An expanded model. In
J. A. Mancini & K. A. Robert (Eds.), Pathways of human development: Explorations of change
(pp. 227242). Lanham, MD: Lexington Books/Rowman & Littlefield.
Huebner, A. J., & Mancini, J. A. (2008). Supporting youth during parental deployment: Strategies for
professionals and families. Prevention Research, 15(Supplement), 1013.Huebner, A. J., & Mancini, J. A. (2010). Resilience and vulnerability: The deployment experiences of youth
in miltary families. Final report submitted to the Army Child, Youth, and School Services, and the
National Institute of Food and Agriculture. Retrieved 10/25/10, from www.fcs.uga.edu/cfd/docs/
resilience_and_vulnerability.pdf.
Huebner, A. J., Mancini, J. A., Bowen, G. L., & Orthner, D. K. (2009). Shadowed by war: Building
community capacity to support military families. Family Relations, 58(2), 216228.
Huebner, A. J., Mancini, J. A., Wilcox, R. M., Grass, S. R., & Grass, G. A. (2007). Parental deployment and
youth in military families: Exploring uncertainty and ambiguous loss. Family Relations, 56(2),
112122.
Imber-Black, E. (1988). Families and larger systems: A family therapists guide through the labyrinth . New
York, NY: Guilford Press.
Jensen, P. S., Martin, D., & Watanabe, H. (1996). Childrens response to parental separation duringoperation desert storm. Journal of the American Academy of Child and Adolescent Psychiatry, 35 (4),
433441.
Kaiser Family Foundation. (2004). Military families survey. Retrieved 11/15/10, from http://www.kff.org/
kaiserpolls/upload/Military-Families-Survey-Toplines.pdf.
Karney, B. R., & Crown, J. S. (2007). Families under stress: An assessment of data. theory, and research on
marriage and divorce in the military. Santa Monica, CA: RAND Corporation.
226 Contemp Fam Ther (2011) 33:215228
123
http://www.fcs.uga.edu/cfd/docs/resilience_and_vulnerability.pdfhttp://www.fcs.uga.edu/cfd/docs/resilience_and_vulnerability.pdfhttp://www.kff.org/kaiserpolls/upload/Military-Families-Survey-Toplines.pdfhttp://www.kff.org/kaiserpolls/upload/Military-Families-Survey-Toplines.pdfhttp://www.kff.org/kaiserpolls/upload/Military-Families-Survey-Toplines.pdfhttp://www.kff.org/kaiserpolls/upload/Military-Families-Survey-Toplines.pdfhttp://www.fcs.uga.edu/cfd/docs/resilience_and_vulnerability.pdfhttp://www.fcs.uga.edu/cfd/docs/resilience_and_vulnerability.pdf7/30/2019 millitary families.pdf
13/14
Kline, A., Falca-Dodson, M., Sussner, B., Ciccone, D. S., Chandler, H., Callahan, L., et al. (2010). Effects of
repeated deployment to Iraq and Afghanistan on the health of New Jersey Army National Guard troops:
Implications for military readiness. American Journal of Public Health, 100(2), 276283.
Lapp, C. A., Taft, L. B., Tollefson, T., Hoepner, A., Moore, K., & Divyak, K. (2010). Stress and coping on
the home front: Guard and Reserve spouses searching for a new normal. Journal of Family Nursing,
16(1), 4567.Lester, P., Peterson, K., Reeves, J., Knauss, L., Glover, D., Mogil, C., et al. (2010). The long war and
parental combat deployment: Effects on military children and at-home spouses. Journal of the
American Academy of Child and Adolescent Psychiatry, 49(4), 310320.
Lincoln, A., Swift, E., & Shorteno-Fraser, M. (2008). Psychological adjustment and treatment of children
and families with parents deployed in military combat. Journal of Clinical Psychology, 64(8),
984992.
Lombard, D. N., & Lombard, T. N. (1997). Commentary: Taking care of our military families. Families,
Systems, and Health, 15, 7984.
Mabe, P. A. (2009). War and children coping with parental deployment. In S. M. Freeman, B. A. Moore, &
A. Freeman (Eds.), Living and surviving in harms way: A psychological treatment handbook for pre-
and post-deployment of military personnel (pp. 349370). New York, NY: Routledge/Taylor & Francis
Group.MacDermid Wadsworth, S. M. (2010). Family risk and resilience in the context of war and Terrorism.
Journal of Marriage and Family, 72(3), 537556.
Mancini, J. A., & Bowen, G. L. (2009). Community resilience: A social organization theory of action and
change. In J. A. Mancini & K. A. Robert (Eds.), Pathways of human development: Explorations of
change (pp. 245265). Lanham, MD: Lexington Books/Rowman & Littlefield.
Mancini, J. A., Bowen, G. L., & Martin, J. A. (2005). Community social organization: A conceptual linchpin
in examining families in the context of communities. Family Relations, 54(5), 570582.
Manos, G. H. (2010). War and the military family. Journal of the American Academy of Child and
Adolescent Psychiatry, 49(4), 297299.
Mansfield, A. J. (2009). Combat deployment and mental health in military dependents (Doctoral disserta-
tion). Retrieved from Dissertations & Theses: Full Text. (Publication No. AAT 3352682).
Mansfield, A. J., Kaufman, J. S., Marshall, S. W., Gaynes, B. N., Morrissey, J. P., & Engel, C. C. (2010).Deployment and the use of mental health services among U.S. Army wives. New England Journal of
Medicine, 362(2), 101109.
McCubbin, H. I., & Patterson, J. M. (1983). The family stress process: The double ABCX model of
adjustment and adaptation. Marriage & Family Review, 6(12), 737.
McFarlane, A. C. (2009). Military deployment: The impact on children and family adjustment and the need
for care. Current Opinion in Psychiatry, 22(4), 369373.
Milliken, C. S., Auchterlonie, J. L., & Hoge, C. W. (2007). Longitudinal assessment of mental health
problems among active and reserve component soldiers returning from the Iraq war. Journal of the
American Medical Association, 298(18), 21412148.
Mmari, K., Roche, K. M., Sudhinaraset, M., & Blum, R. (2009). When a parent goes off to war: Exploring
the issues faced by adolescents and their families. Youth and Society, 40(4), 455475.
Morris, A. S., & Age, T. R. (2009). Adjustment among youth in military families: The protective roles ofeffortful control and maternal social support. Journal of Applied Developmental Psychology, 30(6),
695707.
National Military Family Association. (2006). Report on the cycles of deployment: An analysis of survey
responses from April-September 2005. Retrieved 11/15/10, from http://www.militaryfamily.org/assets/
pdf/NMFACyclesofDeployment9.pdf.
Operation: Military Kids. (n.d.). Speak out for military kids(SOMK): Giving military youth a voice.
Retrieved 11/10/10, from http://www.operationmilitarykids.org/public/somk.aspx.
Palmer, C. (2008). A theory of risk and resilience factors in military families. Military Psychology, 20(3),
205217.
Putnam, R. D. (2000). Bowling alone: The collapse and revival of American community. New York, NY:
Simon & Schuster.
RAND Corporation. (2009). Too many months of military deployment can reduce reenlistment rates.Retrieved 11/16/2010, from http://www.rand.org/news/press/2009/10/07/.
Rojano, R. (2004). The practice of community family therapy. Family Process, 43(1), 5977.
Salamon, M. (2010). Kids of deployed soldiers may face more mental health woes. U.S. News and World
Report. Retrieved 11/8/2010, from http://health.usnews.com/health-news/family-health/brain-and-
behavior/articles/2010/11/08/kids-of-deployed-soldiers-may-face-more-mental-health-woes.html.
Stafford, E. M., & Grady, B. A. (2003). Military family support. Pediatric Annals, 32(2), 110115.
Contemp Fam Ther (2011) 33:215228 227
123
http://www.militaryfamily.org/assets/pdf/NMFACyclesofDeployment9.pdfhttp://www.militaryfamily.org/assets/pdf/NMFACyclesofDeployment9.pdfhttp://www.operationmilitarykids.org/public/somk.aspxhttp://www.rand.org/news/press/2009/10/07/http://health.usnews.com/health-news/family-health/brain-and-behavior/articles/2010/11/08/kids-of-deployed-soldiers-may-face-more-mental-health-woes.htmlhttp://health.usnews.com/health-news/family-health/brain-and-behavior/articles/2010/11/08/kids-of-deployed-soldiers-may-face-more-mental-health-woes.htmlhttp://health.usnews.com/health-news/family-health/brain-and-behavior/articles/2010/11/08/kids-of-deployed-soldiers-may-face-more-mental-health-woes.htmlhttp://health.usnews.com/health-news/family-health/brain-and-behavior/articles/2010/11/08/kids-of-deployed-soldiers-may-face-more-mental-health-woes.htmlhttp://www.rand.org/news/press/2009/10/07/http://www.operationmilitarykids.org/public/somk.aspxhttp://www.militaryfamily.org/assets/pdf/NMFACyclesofDeployment9.pdfhttp://www.militaryfamily.org/assets/pdf/NMFACyclesofDeployment9.pdf7/30/2019 millitary families.pdf
14/14
Ternus, M. P. (2010). Support for adolescents who experience parental military deployment. Journal of
Adolescent Health, 46(3), 203206.
Warner, C. H., Appenzeller, G. N., Warner, C. M., & Grieger, T. (2009). Psychological effects of
deployments on military families. Psychiatric Annals, 39(2), 56.
Wiens, T. W., & Boss, P. (2006). Maintaining family resiliency before, during, and after military separation.
In C. A. Castro, A. B. Adler, & T. W. Britt (Eds.), Military life: The psychology of serving in peace andcombat (Vol. 3): The military family (pp. 1338). Westport: Praeger Security International.
228 Contemp Fam Ther (2011) 33:215228
13
Recommended