There are over 3.5 million military
personnel in the U.S., including Department of Defense (DoD) Active Duty, Coast
Guard, and Reserve members (DoD, 2014). Along with the active duty population,
it is estimated that there are currently over 22 million Veterans in the U.S.
(U.S. Census Bureau, 2012). The number of family members- spouses, children,
and others-is staggering. While services on military bases and Veterans Affairs
clinics or hospitals are available for both mental and physical health care
needs, military and veteran families also receive services for their health
care in civilian communities. Yet research indicates 87% of civilian clinicians
are not equipped to meet the unique needs of military service members
(Tanielian et al., 2014).
As such, clinicians must become more involved in
professional development that includes a cultural awareness to military and
veteran health and healthcare systems, regardless of a clinician’s own
healthcare system delivery methods (see list of select training opportunities
and books are provided below). Understanding the unique health experiences of
military, veterans, and their families is relevant because it is almost
inevitable that clinicians and providers will encounter someone who has either
served or had a family member who served in the military.
Given the likelihood that most clinicians and
providers will care for military personnel, it is important to recognize some unique
differences between military and civilian families. For example, service
members often marry younger, divorce less, have more young children in the
home, and relocate homes more frequently than their civilian counterparts
(Clever & Segal, 2013). In addition, the family dynamics of military and
veterans differ from civilians, particularly due to child school
and peer adjustments because of frequent relocation and family adjustment after
parental injury (Hisle-Gorman,
Harrington, Nylund, Tercyak, Anthony, & Gorman, 2015). Furthermore,
parents in military and veteran families have commonly had to navigate the role
of a deployed parent, role of the stateside parent, trustworthy and reliable
child care services, family support, and school based support for children.
Differences between branches or reserve
components, rank, number of deployments, and experiences with combat are also
important to recognize when delivering services or designing research projects.
Demographic differences provide only a small piece of a very big picture. For
example, what is known about active duty women’s health is often times limited
to her reproductive or sexual health matters, (Lacks, 2016), and even less is
known about the complexities associated with single parenting, dual military
couples, or the health of LGBT couples and their families.
Based on our experiences,
our charge to clinicians and researchers is to recognize and honor the
diversity of military and veteran families. This is possible when extending
care or research programs through a biopsychosocial-spiritual (BPSS) framework
(Engel, 1977, 1980; Wright, Watson & Bell, 1996), and attending to the relational
dynamics that emerge through common military and veteran health matters. Some
of the most common BPSS challenges include: amputations, traumatic brain
injury, insomnia, chronic pain, intimate partner violence, military sexual
trauma, substance use, and relational distress (Blaisure, Saathoff-Wells,
Pereira, MacDermid Wadsworth, & Dombro, 2016; Goff, Crow, Reisbig, &
Hamilton, 2007; Mansfield, Kaufman, Marshall, Gaynes, Morrissey, & Engel,
2010; Trump, Lamson, Lewis & Muse, 2015).
In our clinical work, through
integrated behavioral health care and traditional therapy sessions, we quickly
recognized the complex interaction between physical or behavioral health challenges
and relational distress unique to military and veteran lives. There was the civilian
husband and his active duty wife, who was preparing for her first deployment.
His physical health had begun to decline, resulting in increased weight gain
that he attributed to stress about the unknown expectations for his wife’s
safety while on deployment. The integrated care team worked with the couple on
behavioral health goals for the husband and constructing ways to support one
another during the deployment. In another example, a service member in his
early 30’s had come into his medical visit reporting back pain that he believed
occurred during a training exercise.
This resulted in loss of sleep, limited ability
to play with his children, and distress in his marriage due to irritability
associated with the pain. The medical provider and family therapist
collaborated on a variety of treatment strategies for this patient for both his
physical and psychosocial concerns and discussed a treatment plan with the
patient including exercises and medications that would not interfere with his
job duties. In addition, the therapist provided techniques to reduce relational
stress. In a follow up visit, the patient and his wife reported the relational techniques
were very helpful for them as a family. The patient reported a lower score on
the pain scale. He believed his pain was more manageable because of the medication,
exercises, and positive experiences he and his wife had shared through the
techniques they learned from his integrated care visit.
However, we have also met with individuals,
couples, or families who struggled to imagine a future without the presence of
physical, emotional, relational, or spiritual pain. Many of our nation’s heroes
fight a battle beyond those in the air, field, or sea; many fight the internal
battles of guilt, shame, or confusion that result in suicidal ideation. Some
are left with moral injuries, leaving lacerations on the soul and spirit.
Service members and
veterans are trained to be strong for the unit and strong for the country. Vulnerability
is contrary to the mission. Yet, guilt and shame in relation to active duty experiences
have emerged as predictive of suicide among military and veteran populations. Military
and veteran family members serve by-proxy, and often do not know of or how to
navigate life alongside a loved one who is suffering from mental health
In providing both traditional and
integrated behavioral health care to service members and veterans as well as their
partners and families, we have come to learn several important lessons: (1) extend
a genuine and curious stance to assessment, diagnosis, and treatment with these
populations, (2) honor the biospsychosocial-spiritual complexities of health,
as most health visits included at least one significant behavioral health
concern (primarily challenges with quality sleep and pain management), (3)
promote integrated behavioral health care (it was very well received by the
patients as well as by the providers), and (4) encourage and deliver
couple-centered or family-centered health care visits in medical and mental
health venues, particularly when treating complex biopsychosocial-spiritual
Blaisure, K. R., Saathoff-Wells, T., Pereira, A., MacDermid-Wadsworth,
S., & Dombro, A. L., (2016).
Serving Military Families (2nd Ed). Florence, GA: Routledge.
Clever, M., & Segal, D. R. (2013). The demographics of military
children and families. The Future of Children, 23(2), 13-39.
Department of Defense (DoD). (2014). Demographics report. Retrieved from
Goff, B. S. N., Crow, J. R., Reisbig, A. M. J., & Hamilton, S.
(2007). The impact of individual trauma
symptoms of deployed soldiers on relationship satisfaction. Journal of Family Psychology, 21(3), 344-353. doi:10.1037/0893-3184.108.40.2064
Hisle-Gorman, E., Harrington, D., Nylund, C. M., Tercyak, K. P.,
Anthony, B. J., Gorman, G. H. (2015). New research: Impact of parents’ wartime
military deployment and injury on young
children’s safety and mental health. Journal of the American Academy of Child
& Adolescent Psychiatry, 54,
294-301 doi: 10.1016/j.jaac.2014.12.017
Kang, H. K., MA, T. A., Smolenski, D. J., Skopp, N. A., Gahm, G. A.,
& Reger, M. A. (2015). Suicide
risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars. Annals of Epidemiology, 25(2), 96-100. doi:10.1016/j.annepidem.2014.11.020
Lacks, M. H. (2016). The biopsychosocial-spiritual health of active duty
women: Service members in need
of service. (Unpublished doctoral dissertation). East Carolina University. Greenville, NC.
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. The New England Journal of Medicine, 362(2),
101–109. doi:10.1056/ NEJMoa0900177.
Tanielian, T., Farris, C., Batka, C., Farmer, C. M., Robinson, E.,
Engel, C. C. … Jaycox, L. (2014).
Ready to serve: Community-based provider capacity to deliver culturally competent, quality mental health care to
veterans and their families. Santa Monica, CA: RAND
Trump, L. J., Lamson, A. L., Lewis, M.
E., & Muse, A. R. (2015). His and hers: The interface of military couples’ biological, psychological,
and relational health.Contemporary Family Therapy,37(3), 316-328. doi:10.1007/s10591-015-9344-8
U.S. Census Bureau. (2012). A snapshot of our nations Veterans.
Retrieved from https://www.census.gov/library/infographics/veterans.html
1. The Center for Deployment Psychology
offers an archive of resources for civilian providers. This website also
includes free military culture training modules for healthcare professionals
that encourage providers to better understand military culture and its impact
on health-related behaviors. http://deploymentpsych.org/psychological-training
2. The Defense Centers of Excellence
for Psychological Health and Traumatic Brain Injury offer free monthly webinars
that discusses content on a variety of topics related to military life. http://www.dcoe.mil/Training/Monthly_Webinars.aspx
3. The National Center for PTSD offers
a large array of resources and training opportunities for providers regarding
Anderson, W. (2015). Battlefield Doc: Memoirs of a Korean War
combat medic. St. Louis,
MO: Moonbridge Publications.
Benimoff, R. (2010). Faith under Fire: An Army chaplain's memoir.
New York, NY:Three
Bonsper, D. (2015). Vietnam memoirs: Part 1. AroSage
Kyle, T. (2015). American wife: A memoir of love, war, faith, and renewal. New York, NY:
Harper Collins Publishers.
Miller, T. & Brotherton, M. (2015).
Tough as they come. New York, NY:
Tillman, M. (2008). Boots on the ground by dusk: My tribute to
Pat Tillman. New York, NY: Rodale, Inc.
|Dr. Angela Lamson is Associate Dean for
Research and Graduate Studies (CHHP) at East Carolina University. |
|Dr. Meghan Lacks currently serves as the policy and research analyst
for AAMFT where she is responsible for implementing military and Veteran
training, research, and policy initiatives for MFTs across the nation.|