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The Unique Challenges ofMilitary FamiliesCenter for Deployment PsychologyUniformed Services University of the Health Sciences2DisclaimerAgendaThe views expressed are those of thepresenters and do not necessarily reflect theopinions of the Uniformed Services Universityof the Health Sciences, the Department ofDefense, or the U.S. Government. 3Demographics of Military FamiliesMilitary Family LifeThe Deployment CycleMilitary MarriagesMilitary BRATsRisk & ResiliencyResources4

Family DemographicsTotal Force Personnel & Family MembersDemographics of Military FamiliesFamilyMembers(n 3,066,717)57.9%“When one person joins the militarythe whole family serves.”5Marital Status Dependents––––Total Force Marital StatusSpouseChildrenStepchildrenSame‐Sex Spouses* Non‐DependentsParentsSiblingsExtended familyAdult children62012 Demographics ProfileMilitary Families––––MilitaryPersonnel(n 2,228,348)42.1%Single(n 1,056,112)47.4%U.S. Marine Corps photo byLCPL Jacob BarberPhotos: http://www.defense.gov; http://www.defenseimagery.milMarried toCivilian(n 1,062,700)47.7%Dual Military(n 109,536)4.9%U.S. Army photo by SSG Ben Navratil72012 Demographics Profile8

Estimated Divorce TrendsEstimated Divorce TrendsEstimated Percentage of Divorcesby Service Branch Trends (Active Duty): 2000‐2012Estimated Percentage of Divorcesby Reserve Component Trends (Selected Reserve): 2000‐201292012 Demographics ProfileParental StatusAge of Military SpousesActive DutyTotal Force Parental StatusMilitaryPersonnelwithoutChildren(n 1,258,112)56.5%2012 Demographics Profile102012 Demographics Profile41 orolder13.5%MilitaryPersonnel withChildren(n 970,236)43.5%36 to 4013.4%31 to 3519.5%1125 oryounger28%26 to 3025.5%Selected Reserve41 orolder32.4%36 to 4016.1%25 oryounger13.3%26 to 3019.7%31 to 3518.5%122012 Demographics Profile

Age of Military ChildrenActive DutySelected Reserve19 to 224.4%19 to 2211.9%12 to 1822.4%0 to 542.4%6 to 1130.8%Military Marriages0 to 529.3%12 to 1829.1%“If the Navy wanted you to have a wife,they would have issued you one.”6 to 1129.7%13142012 Demographics ProfileMarriage and Divorcein the MilitaryMilitary MarriagesUnique attributes of military marriages: Marriage/divorce rates Young marriagesWhen the military calls, the Service Member must goSeparation is standardReunification is also a normal occurrenceSeparation from family/friends is commonDevries et al. (2012) Marital quality Infidelity15Adler‐Baeder et al. (2005); Hogan & Seifert (2010); Karney & Crown (2007); Karney et al. (2012); Negrusa et al. (2014);Riviere et al. (2012); Schumm et al. (2012); Snyder et al. (2012); Photo by AzureCitizen: http://en.Wikipedia.org/wiki/Saber arch16

The Good and Bad of LongDistance RelationshipsBad Equivalent relationship satisfaction No greater risk of infidelity Often successful despite difficulties and distance Increased resilience and sense of self‐efficacy25% ReportingInterpersonal ConflictGoodImpact of Deploymenton Couples Mild depression common Tendency to isolate Difficult to communicate Difficult to maintain connectionPDHA20PDHRA151050Active Duty17Guldner (2003)Evidence-Based CouplesCounseling in the DoD/VAReserve Component18Millilken et al. (2007)Gottman’s Basic Tenets Gottman Method Couples TherapyHappy Marriages Based on deep friendship Use of repair attempts Shared sense of deep meaning Most marital argumentscannot be resolved– http://www.gottman.com– http://csf.army.mil Emotionally Focused Therapy for Couples (EFT)– http://www.iceft.com– http://www.strongbonds.org Integrative Behavioral Couples Therapy (IBCT)– http://www.ibct.psych.ucla.edu– http://drandrewchristensen.com19Gottman & Silver (1999)20

Gottman’s “SoundRelationship House” TheoryCreate SharedMeaningManage ConflictThe Positive PerspectiveTurn Towards Instead of AwayShare Fondness & AdmirationCommitmentMake LifeDreams ComeTrueTrustThe Four Horsemenof the ngBuild “Love Maps”Gottman & Gottman (2008); Stanley (2013); http://www.gottmanblog.com21Gottman & Gottman (2008); WRAIR (2011)22Impact of Military Culture Following OrdersMilitary Family Life Leadership Communication Style“Military families are families withunique challenges.” “Mission First”23Devries et al. (2012)24

“Greedy Institutions”Family StressorsBoth the military andfamilies demand:– Commitment– Loyalty– Time– EnergyNormative Occur for most families ExpectedNormativeMilitary Occur for most military families ExpectedCatastrophic25Blaisure et al. (2012); Segal (1986) Do not occur to most families UnexpectedBlaisure et al. (2012)26Normative Stressors ofMilitary Family Life Frequent relocations (PCS) Spouse employment opportunitiesIf you knew you had to move your entirehousehold every 2‐3 years, how would youlive your life differently than you do now? Separations Deployments Risk of injury or deathBlaisure et al. (2012); Lim & Schulker (2010)27Blaisure et al. (2012), p. 5728

Emotional Cycle ofDeploymentPre‐DeploymentPost‐DeploymentThe Deployment CycleDeploymentRe‐Deployment2930Pincus et al. (2001)MilSpouseCycle of DeploymentPatricia Santiago (2010)SustainmentParentingCycle of ymentLookingAheadParenting(War Zone /Home Front)FacingRealitySayingGoodbyeSurviving theHomeStretchMovingForwardDeVoe & Ross (2012)32

Emotional ReactionsGriefPre‐Deployment StageDetachmentPre‐Deployment“A holding pattern during which lifecannot yet begin.”Conflict33DeVoe & Ross (2012)ParentingHelping Families Facilitate communication Looking Ahead– Sharing of feelings– Discussion of expectations– How/when to communicate with children aboutimpending departure– Handling feelings & responding to children Saying Goodbye– Importance of saying goodbye face‐to‐facePre‐DeploymentDeVoe & Ross (2012)34DeVoe & Ross (2012)35 Foster connectionTeach positive coping skillsEmphasize the importance of supportHelp couples address practical issuesDiscuss parenting issuesPavlicin (2003); Pincus et al. (2001)Pre‐Deployment36

Themes for Therapy Affective Education Exploring RolesDeployment Stage Exploring UnresolvedConflicts“Repeat after me I can do this.” Expectations of FidelityPre‐Deployment37Laser & Stephens (2012)38Emotional ReactionsParenting Deployment Parenting from the Home Front– Disorientation, mixed emotions– Relief that anticipation is over– Increased responsibilities increased stress Parenting from a War Zone Sustainment– Relinquishment of daily involvement– Adaptation of new strategies– Self‐growth, independence– Less angry, but lonelier Surviving the Home Stretch Re‐Deployment (Anticipation of Return)– Excitement, apprehensionDeVoe & Ross (2012); Pincus et al. (2001)– How will children respond to reunion?DeploymentDeployment39DeVoe & Ross (2012)40

Impact of Deploymenton ChildrenSigns of Distressin Children Emotional / Behavioral Difficulties Cumulative Months ofDeployment Child MaltreatmentU.S. Army photoAgeBehaviorsMoodsInfantsChange in eating/sleepingListlessnessToddlersCrying, tantrumsIrritability, sadnessPre‐SchoolersClinginess, potty accidentsIrritability, sadnessSchool Age ChildrenBody aches, whining,problems at schoolIrritability, sadnessAdolescentsIsolation, drug useAnger, apathyDeploymentDeployment41Cederbaum et al. (2013); Chandra et al. (2011); Flake et al. (2009); Gibbs et al. (2007);Lester et al. (2010); Rentz et al. (2007); Photo: http://www.defense.govHelping Families 42Military OneSource (2012); Pincus, et al. (2001)Themes for Therapy Deployment:Stress ReductionFacilitate setting personal goalsEncourage creation of a support networkTeach stress management techniquesHighlight the importance of self‐care Sustainment:Resilience & Growth Re‐Deployment:Expectation ManagementDeploymentPavlicin (2003)Deployment43Laser & Stephens (2012)44

Emotional ReactionsReunionPost‐Deployment StageReintegration Elation Relief Frustration“Hello, Stranger.Let’s cohabit and raise these kids.” Tension Resentment ComfortPost‐ Deployment45Sanderlin (2012)46Logan (1987); Pincus, et al. (2001)ReintegrationChallengesParenting Facing Reality– Reconnect & rebuild parent‐child relationships– Role negotiation / co‐parenting challenges Moving Forward– Re‐establish equilibrium– Develop new routines– Incorporate legacy of deploymentFamiliesService Members New routines /responsibilities Loss of independence “Walking oneggshells” Things are notperfect Make meaning ofdeployment Grieve loss of friends Acclimate to civilianlife Re‐adjust to being aspouse/parentPost‐ DeploymentDeVoe & Ross (2012)47 SM will seemdifferent Family willseem different Feelings ofresentment Role/boundaryre‐negotiationPost‐ DeploymentMorris (2008); Pavlicin (2003); Pincus, et al. (2001)48

FacilitatingSuccessful ReunionsThemes for TherapyService pist’s Role(how to help)Isolate vs. great sex 24/7Fairy‐tale reunionSet realisticexpectationsImmediate return to “old ways”New routinesRemind thatadjustment takes timeSeparated from familyEarned a breakStress that both madesacrificesNo one understandsDrill with questionsTeach communicationskills Opening Communication49Military OneSource (2012); Pavlicin (2003) Revisiting Family Roles Creating Opportunities forAppreciation and CaringPost‐ Deployment50Laser & Stephens (2012)Normative MilitaryStressors for Children Relocation Child CareMilitary BRATs EducationBrave, Resilient, Adaptable, Trustworthy Deployments51Blaisure et al. (2012)52

Resiliency inMilitary Children Helping Children:Pre-Deployment Encourage quality time with each child Emphasize honesty Help parents providereassurance Foster connection Create communication planU.S. Navy photo Facilitate conversationsby PO2 Stephanie Tignerwith schools/teachersSense of belonging/communityAdaptableTolerant of diversityResponsible/independentRespect for authorityPre‐Deployment53Easterbrooks et al. (2013); Hall (2012); Park (2011)Helping Children:DeploymentSuccessful Reunionswith Children Encourage consistency & routine Highlight the importance of support fromother adults Help parents model self‐care Facilitate good communication Emphasize the importance of fun Remind parents to let kids be kidsThings to remember:– Children react differently to homecoming dependingon their age & relationship with deployed parent– Children are often loyal to the parent that staysbehind– Children may feel anxious about the ServiceMember leaving again– Children will wonder if rules at home will changePost‐ DeploymentDeploymentHall (2008); Pavlicin (2003)54Military OneSource (2012); Pavlicin (2003); Photo: http://www.defense.gov55Pavlicin (2003); Pincus et al. (2001)56

Infant/ToddlerDevelopmentReunion & Reintegration:Infants/ToddlersdevelopmentalDerenne (2008); Photo: http://www.morguefile.com57 “Stranger Reaction” Increased sensitivity Crying, clinginess,disrupted schedule Delayed milestones Temper tantrums Nightmares Regression in skillsPre-SchoolerDevelopmentRealistic expectationsDirect contactConsistencyOpportunities forconnection Take things slowly Expect regression58Reunion & Reintegration:Pre-SchoolersHomecoming Reactions Growth/development continue at a rapid pace The child’s perception is that everythingrevolves around him/her Magical thinkingpredominatesDerenne (2008); Photo: http://www.morguefile.com Barnett et al. (2012); Photos: http:///flickr.com/photos/thenationalguard, http://www.beaufort.marines.mil59 Personalize stressRegression in skillsActing outTime to warm upFostering Reintegration Attachment is a majormilestoneHomecoming Reactions– Physical– Cognitive (language skills)Fostering Reintegration A time of rapid growth and development Ignore regressivebehaviors Listen & answerquestions Opportunities forconnection Take things slowlyBarnett et al. (2012); Photos: http:///flickr.com/photos/thenationalguard, http://www.beaufort.marines.mil60