Staff Perspective: Engaging Military-Connected Couples in Treatment

Staff Perspective: Engaging Military-Connected Couples in Treatment

During my 20+ years working in the mental health field, I have worked with multiple military-connected couples. Often, the entry point for couples’ work was a spouse who had been given an ultimatum about working on resolving marital conflict or face separation/divorce. In one study by Pflieger et al. (2018), researchers found that while military couples face additional stressors, the majority of marital dissatisfaction can be explained by stressors not unique to the military service. In my work with couples, I found this to be true. While many of the stressors may have surfaced during their military service (i.e., conflict regarding parental responsibilities during the deployment cycle), the stressors themselves are also found in civilian couples

It’s not surprising that post-deployment is often the most stressful period in the deployment cycle, and romantic relationships are not immune to the effects of this stress. Reserve Component couples can benefit from programs offered during a deployment cycle, especially as they reintegrate to life following a deployment. Ensuring that couples are aware of what resources are available is critical, especially for Reserve Component families who may not have immediate access to services that are located on military installations. Navigating civilian behavioral health care may be an additional barrier for Reserve Component couples, leading to delayed or inadequate counseling services. Many times, knowledge of community resources rely on Service members sharing information with their spouses which can also pose a challenge. Resource information can also be funneled through Family Readiness Groups (FRGs), but this can also be problematic given Reserve Component FRGs tend to be less active when a unit is not in a deployed status.

Equipping Reserve Component families with resources to help facilitate engagement in counseling when the need arises is an important way of addressing post-deployment stress in couples. While the following study looked only at Veteran couples, the findings may apply to Reserve Component couples as well, even more so since these couples may not have access to VA care.

The Path to Couples Therapy: A Descriptive Analysis on a Veteran Sample by Jarnecke et al. (2020), looks at three factors that lead couples to enter into counseling. The study looked retrospectively at Veteran couples who received care at a VA Medical Center. The study examined 1) the problems couples reported experiencing prior to engaging in treatment, 2) the length of time it took couples to seek treatment after relationship problems were identified, and 3) what efforts were made to repair the relationship prior to seeking counseling.

The analysis showed that external factors (i.e., finances) and communication were the most reported marital concern prior to entering treatment. The stress of employment/financial difficulties was evident in my work with National Guard couples. During periods of economic instability (i.e., recession, pandemic), Reserve Component members may experience financial problems due to unstable civilian employment. As the conflict in the relationship was addressed, these themes of financial and employment stressors appeared frequently.

Jarnecke et al. (2020) also found that on average, Veteran couples wait four to seven years after identifying marital discord before seeking counseling. There was almost a three-year difference between when men (3.73 years) and women (7.39 years) entered treatment after identifying problems in the marriage. While this sample was exclusively those in Veteran status, it would be interesting to see if a similar pattern exists for those still serving. Additional barriers to care can also occur if the person who has information regarding available mental health services requires longer to identify distress within the marriage. As such, entry into counseling can be delayed for a variety of reasons and allows the problems experienced by the couple to continue, likely leading to increased marital distress and entrenched unhelpful behaviors. Identifying and addressing these barriers may help couples resolve these conflicts. In addition to this potentially increasing marital satisfaction, this may also lead to improvements in retention and operational readiness.

One of my most memorable private practice patients was a National Guardsman who had returned home after a combat deployment. His wife had picked him up from the airport, dropped him off at their home, and told him she wanted a divorce. The patient had volunteered for the most recent deployment, not because his National Guard unit was deploying, but because his best friend was deploying and he felt a sense of responsibility to go with him. Coupled with the fact that his civilian employment was insecure, it made the decision easy for him. He would go with his friend and be able to provide his family with income and insurance for the next year. This deployment came less than a year after a previous deployment and his spouse was not on board with his decision to deploy. He was looking at practical benefits, while she was looking at the emotional toll of him being gone and being a single parent for a second year. While at first glance, it appeared that the conflict was because of his military service. However, when looking deeper, the couple had a pre-existing history of communication difficulties. In fact, the wife shared about a long history of conflicts that had never truly been resolved. This final volunteer deployment was the proverbial final straw for her. The couple reconciled briefly, but later divorced, never fully being able to resolve their long-standing communication issues.

The third factor looked at by Jarnecke et al. (2020) was what efforts were made to repair the relationship prior to entering counseling. The study found that women had a higher number of unique attempts to improve their relationships than men. The attempts to repair the relationship reported by participants showed that many of the attempts were non-evidenced-based attempts. For example, they reported seeking advice from friends, reading mainstream self-help books, etc. In my practice, the most common attempt to repair the relationship was seeking advice from family or a faith-based helper. The second most commonly employed action was one partner reading popular self-help books and then relaying information to the other partner. While these efforts may have helped address some of the marital distress, entrance into counseling after these attempts indicate that it was not enough to repair the relationship.

The Jarnecke et al. (2020) study’s findings around entry into service found that external stressors, the delay of entry into counseling after distress was identified, and the multiple attempts to repair the relationship through other resources, provide clinicians information about how to better serve this population. Delaying treatment led to couple’s reporting more significant marital distress and highlights the importance of assessing the couples’ distress. Increased efforts to promote couple’s counseling can help couples address problems earlier and therefore can help decrease the level of distress the couple experiences.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Christy Collette, MA, LMHC, is a Program Associate for the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, she is coordinating the expansion of the Star Behavioral Health Providers into new states across the nation.

Jarnecke, Amber & Ridings, Leigh & Teves, Jenna & Petty, Karen & Bhatia, Vickie & Libet, Julian. (2020). The path to couples therapy: A descriptive analysis on a Veteran sample. Couple and Family Psychology: Research and Practice. 9. 10.1037/cfp0000135.

Pflieger, J.C., LeardMann, C.A., McMaster, H.S., Donoho, C.J., Riviere, L.A. and (2018), The Impact of Military and Nonmilitary Experiences on Marriage: Examining the Military Spouse's Perspective. JOURNAL OF TRAUMATIC STRESS, 31: 719-729.