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Redeployment and Reintegration

he current war on terrorism continues to affect military service members and their families in a variety of ways. Our soldiers are risking their lives in service to our country. Family members also sacrifice and suffer their own internal battles. Many enjoy success in making the bridge from deployment to reunion. However, major concerns still exist in the areas of reintegration and reunion. This article addresses issues related to pre-deployment, during deployment, and post- deployment, with emphasis on the emotional and relationship issues returning soldiers and their families face.

Deployment Stages and the Family The emotional turmoil that deployment has on soldiers and their families is as old as war itself. Due to current legislation and programs created by the military, the stigma of receiving treatment for these emotional issues is being lifted. As a result, there is an increase in the number of soldiers and their families receiving assistance. In order to understand the issues that need to be addressed, Haynes (2006) has noted that there are seven emotional stages that the soldier and his or her family experience. A modification of these stages will be addressed as well.

Pre-deployment can be described in terms of anticipation, detachment, withdrawal and/or need for increased intimacy, and emotional disorganization/confusion. A family during deployment may exhibit:• Recovery/stabilization or increased emotional disorganization/confusion due to

problems in relationships at home • Anticipation of homecoming • R&R (rest and relaxation, a two week visit) • Confusion• Recovery/stabilization or increased emotional disorganization/confusion due to

problems in relationships at home • Anticipation of homecoming

T

m i l i t a r y f a m i l y i s s u e s Debbie King Mabray, MS Maryann Bell, MS Chaplain Major Dan Bray, MS

Post-deployment may include a brief honeymoon period or re-negotiation of the marriage, re-integration and stabilization.

Examining the Stages The pre-deployment stage is consuming. The soldier attends a myriad of special training and field exercises, as well as numerous mandatory meetings to address the deployment process. A will and testament is prepared and the married couple must discuss the chance of needing to plan a funeral. It is normal for the couple to either begin withdrawing from each other or to want increased intimacy. What is needed is support from each other, but couples often choose isolation and anger. It helps for couples to be aware of these tendencies and to compromise on ways to get their needs met. The time off leading to the deployment is also a hectic time of family visits and trying to fit in any vacations or goals they have not addressed. The family unit becomes exhausted, fearful, and emotional disorganization begins at this time.

The deployment stage often begins with a family farewell at the departure area on post. This is often difficult for couples, but having no one there to bid farewell to the soldier is often more traumatic. The spouse remaining at home is now a single unit, and if children are involved, he or she becomes a single parent in all aspects. The remaining spouse has a tremendous responsibility for home, work, children, self, finances, etc. Many times this is overwhelming and therapeutic intervention is sought. We often encourage couples to engage in telephonic and/or e-mail discussion (e.g., Marriage Repair 101: A Workbook for Building a Stronger Relationship, Mabray, 2007). This book is designed to address sensitive issues such as communication, trust, goal setting, parenting decisions, and various means of staying connected to each other.

Approximately halfway through the deployment stage, the soldier will return for a two-week rest and relaxation “visit” with his or her family. Although this is emotionally draining, it may also be ecstatically energizing, because the family has an opportunity to reconnect. Many times, extended family and

friends will also descend upon the recently reunited family, making their private time allotment much less. This can also be a time when the spouse left at home begins to first see signs that “things are different” with the soldier in regards to personality and how they are in the marriage relationship. After the soldier returns to the deployment site, the spouse must pick up again where he or she left off. The spouse has transitioned from married with spouse, single spouse/parent, married with spouse (during R&R), then back to single spouse. This is easily nerve-racking and anxiety provoking.

Post-deployment occurs when the soldier returns from the deployment assignment. This is a time for major readjustment and redefining the relationship. Deployments may last from several months to over 15 months. After such time apart, it is often difficult to reconnect with the “stranger” you married. Other factors may complicate this reunion even more: post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, combat fatigue, and substance abuse.

Challenges in the Deployment Stage There are significant challenges during a deployment. One of the biggest hurdles observed by Chaplain Major Bray, a currently deployed serviceman, is maintaining communication with the spouse, family, or significant other back home. Some places have fair to good Internet capability, but this method of communication can vary greatly due to geographical location. Internet service enables service members to at least send e-mail notes and when the connection is reasonable, they can use visual tools such as Web cams. According to Bray, cell phone use can be very expensive due to roaming charges; hence, many service members use the military phone long distance system called “Defense Switch Network” or DSN. Talking with a spouse and/or family member regularly can alleviate potential future problems within the family unit. It is suggested to not always call home at the same time because the family members may assume the worst if they did not receive a call at the expected time.

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Intimacy and Deployment It can also be extremely helpful to plan ways to keep intimacy alive while the couple is apart during deployment. One way is to identify the “love language” for each person in the relationship. According to Cuthrell (2005), there are five ways of communicating love, and each person has one or more love languages that are more important to them than the others. Dr. Gary Chapman identifies these as (1) words of affirmation, (2) quality time, (3) gifts, (4) acts of service, and (5) physical touch.

Each person can determine what his or her own unique love language is by noticing how he or she expresses love to others, and identifying what a significant other does not do that causes upset the most. Before deployment, each person can make a list of specific things that relate to love language(s) that he or she would want the other to do, and to purchase these things in advance (i.e., cards, stamps, small gifts, etc.) Also, with most deployed soldiers having access to the Internet, things can be purchased while away.

How to Help the Child of a Deployed Parent Deployment not only affects intimacy in a marriage, it also affects the children left behind. When a parent must leave his or her child to deploy, it is common to feel a mixture of guilt, confusion, fear, and separation anxiety. A child may respond to the deployment with numerous fears, including fear of abandonment or death of the parent. It is common for the child to hear news reports, well-meaning people discussing their opinions of the deployment situation, and even reading partial articles and not completely understanding any of them. Child often develop their own translations of the deployment, which may be extremely different than what is accurate. Mabray & LaBauve (2006) noted that the deployed parent can remain active in the child’s life by helping to maintain family structures, rules and traditions with the child wherever he or she may be. The deployed parent can also communicate by utilizing voice recordings, Web cams, e-mail, packages, homemade cards/items, or even slide shows. Suggestions for the spouse at home to help with keeping the deployed soldier active in the family

are to have a tent at home with pictures of the soldier inside so the children can go in there and “talk” to the deployed parent, or use a calendar to mark the days until the parent returns.

A child who was previously positive may begin to withdraw from favorite activities or exhibit negative behavior in school. School counselors should be made aware of this and urged to provide outlets for the children of deployed family members. Some schools offer lunch groups for the children, to eat and discuss the challenges they are currently experiencing due to deployment. Research indicated that educating children on appropriate coping skills and anger management techniques is helpful in diffusing possible deployment conflicts.

Parents should also acknowledge the child’s feelings, such as frustrations and fears, and allow them to express these through verbal and nonverbal means, such as drawing, painting, and play dough. It is also important to keep the same routine and expectations as when the deployed soldier was home in order to give a sense of safety and control. Caregivers should take care to discipline the children without anger. If the adult is agitated, frustrated, and experiencing anger, the punishment should wait until a later time, after the adult is able to rationalize what has transpired and the anger has retreated.

Postdeployment Reunion from a long deployment may seem like an easy transition, but it is very difficult to accomplish. Marriage or family issues present before the deployment will still await the service member and family upon the soldier’s return home. This process takes a great deal of patience on everyone’s part. When the reunion is rushed, critical issues will not receive the proper attention and can lead to future unresolved conflict.

Reintegration issues with the family can be compounded by how the soldier was trained to survive in combat, termed Battlemind training. Walter Reed Army Institute of Research has identified how each of these skills can also cause problems when transitioning back into civilian life if not adapted. Soldiers may withdraw from their family and want to spend more time with their battle buddies, with whom they bonded. They may need to be in control and have things in order due to the necessity of this in combat. Increased anger and aggression may be displayed due to learning that anger can keep them motivated and alert. Soldiers may be hypervigilant to any perceived threat, due to combat requiring focused attention and alertness. The outcome of always being on guard can become addictive, and at-risk behaviors may be adopted to keep the adrenaline rush going and to feel normal. Soldiers may emotionally detach since controlling emotions in combat is needed. They may not talk about their experiences or feelings related to deployment because of the belief that others will not understand, or in an effort to protect loved ones. And soldiers may demand discipline and their orders obeyed at home because this is what was expected in combat. In order to be able to successfully transition back home, it is often necessary for the soldier to modify this Battlemind thinking to reduce conflict in relationships.

Both the soldier and family members have changed during deployment. The returning service member might wonder whether the family will still need him or her (Channing & Bete, 2004), and worry about fitting back into the family structure. Similarly, family and friends could be anxious about how they will be treated by the returning soldier. The truly successful families are the ones who learn how to adapt, adopt, and change as needed for the long-term health and growth of their family and relationship.

Bray recommends service members and families share their feelings about these new roles and expectations. Sharing

how one feels might be difficult for the military member (“Battlemind,” 2008). However, the reunion and reintegration process now requires them to open up and express to others how they feel and think. For some, this is extremely difficult. Service members can refer to movie legends, such as John Wayne, who often portrayed an example of a military hero. Some may say, “Well, John Wayne would not get teary-eyed and emotional at coming home. So, why should I?” This very attitude can seriously hamper the sharing of feelings needed to help make reintegration smooth.

When soldiers return home, marital therapy is often needed to reintegrate. Common issues include lack of trust due to possible extramarital affairs, financial issues and disagreements about how money was spent, the returning soldier having difficulty thinking in terms of “we” instead of “I,” and the spouse who was left at home becoming more independent during deployment and having difficulty relinquishing duties. Other issues the couple may face include

the soldier feeling he or she does not have a place in the family anymore, the spouse left at home feeling resentment for having to do it alone and then expecting the returning soldier to do everything in order to provide a break, the returning soldier wanting more of his or her partners attention and time and the spouse who was left at home still wanting to share time with friends and activities began during deployment, and unrealistic expectations that things will be the same as before deployment.

Soldiers coming back from deployment also face challenges in dealing with their children. Some have expectations that things will be the same, and are often confused when their children feel resentment towards them, seem distant or afraid, or do not show the same respect as before. The child may be emotionally attached to the parent who remained at home, and homecoming can bring back the child’s fear of separation again. It is important for the returning soldier not to take these behaviors personally, but to allow time

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for reintegration.

For younger children, or infants born while the soldier was away, it is important to bond with them by spending time with the child(ren), playing with them, and taking care of their needs. For older children and teenagers, the soldier needs to reintegrate back into the routine and discipline process that has been set up while they were gone. Both spouses need to negotiate how this will occur and work together so the children do not play each against the other. Allowing the children to express their feelings, in a respectful way, is also very important. Other helpful tips include: doing fun things together as a family, continuing with routines that have been in place and not to make sudden changes, and have weekly family meetings to work on communication and problem-solving skills.

Post-deployment Aftercare and Resources There are factors within the military that assist in making the soldier uneasy in seeking professional assistance for mental health concerns. Many soldiers cite concerns about how their peers and leadership will view them if they need to leave work to attend a therapeutic appointment (Kessler et al., 2003). The leadership is under orders to allow these appointments, but numerous complaints and cancelled appointments occur because the soldier is not allowed to leave work. The real or perceived stigma created by seeking such assistance is a powerful detriment to pursuing care. The military has contracted with an insurance company, Ceridian One Source, an employee assistance program (EAP), which allows the soldier (and or dependents) to seek assistance off post. Tricare is another insurance benefit for personnel, which also pays for the soldier and/or dependents to seek off post care. In the Walter Reed study, only 25 to 40

percent of soldiers with mental health problems actually got help because of the stigma attached to receiving such help (“Battlemind,” 2009). The latest casualty list reports over 4,200 service members in Operation Iraqi Freedom (Operation Iraqi Freedpm, 2009). Now, imagine the increased number of mental health cases that go unreported.

During this deployment, there have been a number of advertisements by the Joint Chiefs of Staff, Admiral Mike Mullen. He encouraged service members to seek out help with mental health professionals. He said that it is indeed an act of courage to admit that an individual needs assistance with mental health issues (Bray, 2008). This type of guidance from top leaders should help to remove part of the stigma associated with service members and family members who desperately need mental healthcare.

Additionally, there are a number of interactive Web sites available for use

by service members. One is specifically dedicated to dealing with issues and concerns upon redeployment (www.afterdeployment.org). Through a quiz, the site allows a member to answer a series of questions to ascertain his or her own mental health status. There is some holistic balance on this site, as it gives information on spiritual fitness, overcoming anger, having success at work, etc. A second site, called Military One Source, is a type of one-stop shop for practically any military-related issue. Regarding therapeutic help, a service member only has to call the Military One Source toll-free number to get information on counselors and therapists who live near the service member. All One Source counselors are at least master’s-level practitioners. Service members have six free sessions per issue. In reality, some people can have more than one issue to discuss. Hence, there could be virtually free assistance as long as there is a real need (Military One Source).

Conclusion The stages of deployment (pre-deployment, deployment, and post-deployment) always occur in the same order for each person involved. After that point, people begin their own uncharted journey through this emotionally exhausting event. This process affects the soldier, each family member and friend. The impact of deployment reaches far. The authors of this article are dedicated to assisting these families by helping the individual and family reconnect through the philosophy that to heal the individual, you must reconnect the family. n

Debbie King Mabray, MS,

LMFT, LPC, CART, is a co-owner of Adult, Child & Family Counseling Center

with offices in Killeen, Temple, Round Rock, and Austin, TX. She has published eight books and several magazine articles and is an adjunct psychology professor at Temple Junior College. Mabray is working with a group of therapists to establish a holistic learning site for clients (and families)

experiencing PTSD, TBI, and a host of clinical disorders. She is a Board-approved supervisor for LPC and LMFT interns and a

Clinical Member of the AAMFT.

Maryann Bell, MS, LPC, has over 15 years of clinical experience working with addictive disorders,

depression, anxiety, parenting, family/relationship issues, trauma survivors, and corporate team building. She is currently in private practice at Adult Child Family Counseling Center in Killeen, TX, serving the military and their families. Bell also has extensive experience and training in experiential therapies, and is co-owner of Stable Life Solutions using Equine Assisted Psychotherapy in treatment of mental health

issues.

Chaplain (Major) Dan Bray,

MS, served this past year as the U.S. Army’s first-ever deployed Family Life Chaplain during Operation

Iraqi Freedom. He now serves as the Deputy Command Chaplain for the 63rd Regional Support Command with headquarters in San

Jose, CA.

The authors thank Christy McDonald, PhD

candidate, for her editorial assistance.

References Battlemind. (2008). Military training briefing software, Walter Reed Army Institute of Research, U.S. Army Medical Research and Material Command.

Cantrell, B. C., & Dean, C. (2005). Down range to Iraq and back. Seattle, WA: WordSmith Books, LLC.

Castro, C. A., Bienvenu, R. V., Huffmann, A. H., & Adler, A. B. (2000). Soldiers dimensions and operational readiness in U.S. Army forces deployed to Kosovo. Int Rev Armed Forces Med Serv, 73,191-200.

Channing & Bete, (2004). Are you ready for reunion? Military slide briefing presentation software.

Cuthrell, M. & Cuthrell, M. (February 12, 2005). Keeping the spark alive: Loving each other long distance. Retrieved December 31, 2008, from www.behindthebluestarbanner.com/articles/article/5562765/96384.html.

Diagnostic and Statistical Manual of Mental Disorders, 4th ed. DSM-IV. Washington, DC: American Psychiatric Association, 1994.

Haynes, P. & Mabray, D. K. (2006). Deployment: A family affair. Publish America: Maryland.

Henkel, V., Mergl, R., Kohnen, R., Maier, W., Moller, H. J., & Hegerl, U. (2003). Identifying depression in primary care: A comparison of different methods in a prospective cohort study. BMJ, 326, 200-201.

Chaplain Bray stands in front of the spiritual center where he served during Operation Iraqi Freedom

The U.S. Army “Battlemind” program (2007) asserted that Mild Traumatic Brain Injury (mTBI) results from a hard blow to the head, often occurring when a soldier is exposed to the shock waves of an IED (Improvised Explosive Device) explosion. The blast from an IED was noted to cause significant pressure changes in the vehicle, which could result in the brain being shaken within the skull. Brain functions were found to possibly become disrupted with possible immediate symptoms of loss of consciousness, confusion, brief loss of memory, blurred vision, headaches, increased sensitivity to sounds and lights, feeling dazed and confused, and/or ringing in the ears. Research suggested that long-term symptoms could include mood changes, becoming easily irritated or angered, depression, anxiety, trouble with memory, attention or concentration, impaired decision making or problem solving skills, impulsive behaviors, difficulty organizing daily tasks, or a change in sleep patterns. It was also said that if a soldier suffered another concussion without having recovered from the first, the second concussion is more likely to cause permanent brain damage. Arenofsky (2008) reported studies indicating that the symptoms of Mild Traumatic Brain Injuries are very similar to mood

disorders or PTSD. Therefore, it is important to assess for a soldier’s involvement in explosions, the number of times they were in an explosion, the symptoms immediately following the explosion, and if they experienced unconsciousness during deployment. According to Arenofsky, it turns out that hearing loss is often associated with brain injury and may be a good indicator. It was stated that typical ways of diagnosing mTBIs include using an MRI or CT scan, which may fail to pick up brain injuries, or a SPECT imaging test which has been shown to be more effective.

References: Arenofsky, J. (2008). Traumatic brain injury: An exploding problem. Retrieved January 15, 2009, from http://www.vfw.org/index.cfm?fa=news.magDtl&dtl=1&mid=4406.

Battlemind. (2007). Mild traumatic brain injury and post traumatic stress disorder: Facilitator’s guide. Retrieved January 15, 2009, from http://www.washingtonpost.com/wp-srv/nation/documents/walter-reed/mTBI_PTSDInstructorGuideApprovedVersion.pdf.

Traumatic Brain Injury (TBI)

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Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. I. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. The New England Journal of Medicine, 351, 11-22.

Kellicker, P. Less than half our soldiers with mental health problems seek treatment. Retrieved November 22, 2008, from https://www.mentalhealth.va.gov.

Kessler, R. C., Sonnega, A., Bromet, F, Hughes, M., & Nelson, C.B. (1995). Post-traumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048 - 1060.

Kessler, R. C., Burgland, P., Demler, O., et al. (2003). The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R), JAMA, 289, 3093-3105.

Kessler, R. C., McGonagle, K. A., Zhao, S., et al. (1994). Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders in the United States; Results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8-19.

Lowe, B., Spitzer, R. I., Grafe, K., et al. (2004). Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnosis. J Affect Discord, 8, 131-140.

Mabray, D. K., & LaBauve, B. J. (2006). Let’s talk to our kids: Successful communication with your child. Whitmore Publishing: Pennsylvania.

Mabray, D. K. (2007). Marriage repair 101: A workbook for building a stronger relationship. ACFC Publishing: Texas.

Narrow, W. I., Rae, D. S., Robins, L. N., & Regier, D. A. (2002). Revised prevalence estimates of Mental disorders in the United States: Using a clinical significance criterion to reconcile 2 surveys’ estimates. Archives of General Psychiatry, 59, 115-123.

National Center for PTSD. (2006). Returning from the war zone: A guide for families of military families. Retrieved December 31, 2008, from http://www.mentalhealth.va.gov/MENTALHEALTH/ptsd/files/pdf/GuideforFamilies.pdf

Operation Iraqi Freedom U.S. Casualty Status (2009). Retrieved January 29, 2009,

from http://www.defenselink.mil/news/casualty.pdf.

Reducing homecoming strain. Retrieved November 21, 2008, from https://www.benning.army.mil/infantry.

Regier, D. A., Narrow, W. I., Rae, D. S., Manderschneid, R. W., Locke, B. Z., & Goodwin, F. K. (1993).

The defacto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives General Psychiatry, 50, 83-94.

Reintegration/Reunion and marriage. Retrieved November 21, 2008, from http://www.afcrossroads.com/famseperation/ret

Reunion tips and changes to expect. Retrieved November 21, 2008, from https://www.benning.army.mil/infantry

Schlenger, W. I., Kulka, R. A., Fairbank, J. A., et al. (1992). The prevalence of post-traumatic stress disorder in the Vietnam generation: A multimethod, multisource assessment of psychiatric disorder. J Trauma Stress, 5, 333-363.

Spitzer, R. I., Kroenke, K., & Williams, J. B., (1992). Validation and utility of a self-report version of PRIMF_MD: the PHQ primary care study. JAMA, 282, 1737-1744.

The Centers for Disease Control Vietnam Experience Study Group. (1988). Health status of Vietnam veterans 1. Psychosocial characteristics. JAMA, 259, 2701-2707.

The Iowa Persian Gulf Study Group. (1997). Self-reported illness and health status among Gulf-War veterans: A population-based study. JAMA, 277, 238-245.

Training briefing (2008). Battlemind. Walter Reed Army Institute of Research, U.S. Army Medical Research and Material Command.

Walter Reed Army Institute of Research. Battlemind training1: Transitioning from combat to home. Retrieved January 9, 2009, from http://www.ptsd.ne.gov/pdfs/WRAIR-battlemind-training-Brochure.pdf.

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InfIdelIty:T h e W a r W a i T i n g a T h o m e

A search through recent literature does not reveal any specific insights on research conducted on the prevalence of extra

marital affairs by members of the military (Karney & Crown, 2007). The number of divorces in the military is higher than in previous years, which can correlate to the increase in deployments to the GWOT, but the divorce rate has yet to surpass the percentages of non-military couples (2007). The most recent and thorough research into military families and divorce is the Rand report (2007); however, there is not much available that specifically addresses infidelity in the military, particularly in the wake of the GWOT.

The information available for those of us around military installations who invest our careers counseling military families is mostly anecdotal. Our appointment books are filled with distressed military couples. Many of them are looking for help resolving extramarital affairs and help with affair recovery. Those who have opted to go straight to a lawyer, or to divorce court, seldom get to our offices. While affairs are the most significant single contributor to divorce (Amato & Rogers, 1997), neither the military or non-military records are able to determine the relevancy of affairs in the present military environment.

There are three specific contributors to consider. The first is the anxiety of separation during deployment by the spouse left at home, which contributes to infidelity; the second is the fear and anxiety of having a spouse living in harm’s way, which leads to seeking relief through infidelity; and the final contributor is that infidelity can be a form of retaliation against a spouse who is separated from his or her partner during a deployment.

Soldiers* are mentally and physically trained to go to war: it is part of their mission and for many, the reason they volunteered to serve in the military. Until that mission is accomplished, the veteran will not come home. Unfortunately, there is no mental training for spouses. The anxiety of separation can be an ever increasing burden for the partner who remains at home.

Personal interviews and surveys completed by military wives suggest that the demands and strains of military life compromise their efforts to maintain their relationship with their spouse (decreasing opportunities for intimacy, closed line of communication in problem solving, by creating new problems to solve) thus leading to outcomes that could have been avoided otherwise (Karney & Crown, 2007). Since Vietnam, casualty rates among military members are higher than ever. The inherent risks of military service are palpable around military installations and families of deployed military. The demands that are placed upon service members are at an all-time high; with the ongoing deployments to Iraq and Afghanistan, more service members are exposed to combat. It’s a time of vulnerability when infidelity can become a way of dealing with the anxiety (Subotnick, 1994. 35).

Separation is one of those transitional life stages that involves loss. Separation is part of the new normal in the military, implying that all military deployments involve loss. Those who may struggle with abandonment and attachments may be particularly vulnerable if they experience the deployment as a traumatic event in their lives (Johnson, 2002). Occasional danger or distress can be handled in small doses, but a seemingly endless barrage of emotional battering can be devastating. The normal elements of fear and abandonment and dependency, which are contained in low doses, can cause problems when they occur in excessive amounts (Pittman & Wagers, 1995, p. 299). The continued anxiety can reach unmanageable proportions for some, and are then dealt with inappropriately, sometimes resulting in an affair.

Some partners may take the opposite approach. Rather than experiencing anxiety, they sense nothing at all. No longer feeling like they need sexual attention, some spouses develop an asexual attitude, while others, due to forced suppression of their desires and needs, may have thoughts of cheating (Pavlicin, 2003). The affair is unexpected and the consequences are not

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