Facilitators and Barriers in Effective Clinical Practice With Postdeployed Military Couples and Families

Although many military couples navigate the stressors and rewards of deployment without difficulty, others contend with “signature injuries,” including post-traumatic stress, or post-traumatic stress disorder, and co-occurring conditions of depression, substance abuse, traumatic brain injury and intimate partner violence. Research data reveal that partners and children suffer the effects associated with deployment cycle stressors as well. Although a pressing need exists to provide couple and family behavioral health care, there is a paucity of evaluation research. More recently, such efforts have been undertaken to explore the efficacy of innovative couple and family therapy practice models. In this article, standards for high-quality behavioral health care are discussed within the framework of the Quality Chasm reports published by the Institute of Medicine, while barriers and facilitators are addressed from the perspectives published by the Rand Corporation (Tanielian & Jaycox, 2008). A clinical vignette depicts the range of structural, financial, personal and social barriers to accessing high-quality care. Finally, two different courses of treatment with a Latino post-deployed Operation Iraqi Freedom Army Reservist couple demonstrate the usefulness of a phase-oriented, trauma-informed, and culturally responsive couple therapy approach that facilitates progress in meeting goals and overcoming barriers to accessing high-quality care.