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Chapter 25

Chapter 25. Couples Therapy for Redeployed Military and Veteran Couples. Rationale. Families face a range of adjustments and transitions.

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Chapter 25

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  1. Chapter 25 Couples Therapy for Redeployed Military and Veteran Couples

  2. Rationale • Families face a range of adjustments and transitions. • Current troops experience co-occurring conditions of posttraumatic stress, PTSD, depression, suicidal thinking, TBI, substance abuse, and intimate partner violence. • Stigma is a negative force that deters help-seeking behaviors.

  3. Relation-Based Therapy • Relation based therapy is important because of disruptions to attachment from exposure to traumatic stressors. • Values the tenets of resiliency and empowerment.

  4. Synthesis of Theory Models • Couples therapy developed on synthesis of social and psychologically based theories. • Focus on role of attachment and trauma.

  5. Attachment Theory • Relationships of military couples are challenged by separations and role shifts. • Mentalization (capacity to self reflect and regulate affect). • Be able to anticipate another person’s affect and behaviors. • Military couples need to assess the nature of attachments to each other, children, and key family members.

  6. Trauma Theory • Some individuals may return with heightened anxiety, panic attacks, and rage eruption. • Service member can identify a victimizer, victim, or bystander. • Internalization of combat experience can disrupt earlier relationship constructs of safety.

  7. Cultural Responsiveness • Clinician and client explore the meaning and meaning-making process attached to ethnicity, race, and gender. • Explore how cultural themes have shaped client’s place in the world.

  8. Research-Based and Research-Informed • Cognitive Behavioral Conjoint Therapy • Limitation • Lack of suitability for those who suffer mild to moderate TBI

  9. Role of Gender • Clinicians need to recognize complex issues related to the role of gender in shaping an individual’s worldviews.

  10. Demographics • Women comprise 14% of active duty force. • Women are 7.7% of the veteran population. • Women are being deployed to combat areas that are high risk even though they are barred from combat roles.

  11. Mental health and Physical Health issues • Women face unique stressors. • Veterans report more medical illnesses and a lower quality of life. • Rates of PTSD, depression, and substance abuse are higher for women who experienced sexual assault.

  12. Health Care Needs • There is a differentiated response to trauma. • Range of health care problems reported. • Lower back pain • Headaches • Pelvic pain • GI pain/symptoms • Sexual dysfunction • Gynecological symptoms • Chronic fatigue

  13. Gendered Response to Trauma • Women can experience a “tend and befriend” reaction to traumatic events not just “flight or freeze.” • Cultural beliefs and ethnicity can also impact a reaction to trauma.

  14. Intimate Partner Violence • High rates of IPV may be connected to: • Hyperarousal cluster of PTSD: • Affect dysregulation • Alternating numbness and hyperarousal • Occasional rage outbursts

  15. Caregivers • Women may have unique challenges and stressors related to multiple roles. • Children are affected by deployment with heightened emotional and behavioral difficulties.

  16. Phase-Oriented Couples Therapy With Military Couples • Institutional/sociocultural (social constructionist, feminist, and critical race theories) • Interactional (intergenerational, narrative family therapies) • Individual/interpersonal • Individual, cognitive, affective, and behavioral functioning (trauma and cognitive behavior therapies) • Intrapersonal/intrapsychic (grounded in attachment, object relations, and relational theories)

  17. Couples Therapy Phases • Phase 1: Safety, self-care, stabilization, and establishing a context for change • Phase 2: Reflection on trauma narratives and grieving • Phase 3: Consolidation of new perspectives, attitudes, behaviors, and social vindication

  18. Chapter Discussion Questions • How do the sociocultural factors of gender and ethnicity shape responses to traumatic stress? • How do cultural mores influence gendered roles for parenting? Work? And family life? • How do ethnicity and culture influence the losses of identity as a soldier? A temporarily able-bodied citizen? Mother? Worker? Wife? And daughter-in-Law? • What are some of the mental health outcomes that service members might expect to experience in response to deployment and combat stressors? • What are the key features in completing a biopsychosocial-spiritual assessment of a military couple? • What are the central guiding principles in crafting a multimodality couples therapy treatment plan that ensures safety, and adequate pacing and integrates evidence-based treatment models in context?

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