Family Reintegration Difficulties and Couples Therapy for Military Veterans and Their Spouses

There is compelling evidence that mental health problems complicate the process of family reintegration of military service members after a wartime deployment. Couples in which one spouse has recently returned from military deployment in Iraq or Afghanistan and are experiencing marital problems can present a significant treatment challenge. There is little empirical evidence regarding effective treatments for this population, and these couples tend to exhibit a wide range of difficulties, including the following: conflicts about reintegration, problems with posttraumatic stress disorder and/or depression, chronic injury, infidelity, and personal and social challenges associated with rejoining civilian life. Behavioral couples therapy provides a useful framework for intervention with these couples, combined with individual treatment and education about the impact of combat deployment. This paper discusses considerations for integrating these treatment approaches and future clinical and research needs for these couples.One of the enduring effects of the controversial war in Vietnam has been an ever-increasing focus on the problems of military service members returning from a wartime deployment. The literature pertaining to this issue has expanded after every major military conflict or involvement since that time, including the first Gulf War, peace-keeping missions in Bosnia, and, most recently, the conflicts in Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]). In the wake of the OEF and OIF conflicts, we have another such painful opportunity to examine the impact of wartime deployment, problems in family reintegration after deployment, and our therapeutic methods of helping these families.Existing literature suggests that there is a negative impact of war on couples and family functioning (Kulka et al., 1988). As discussed below, that impact does not appear to be as universal and devastating as popularly believed. Over the long term, many families successfully navigate the challenge of the service member returning and becoming part of the family again, a process termed family reintegration. It is clear, however, that extended difficulty with family reintegration after wartime deployment is most acute when there are preexisting couple and family vulnerabilities as well as service member injury and psychiatric complications of combat ( Peebles-Kleiger & Kleiger, 1994). In this context, there is a range of co-occurring difficulties often challenging the military couple: financial problems, problems with negotiating family roles, child behavioral challenges, posttraumatic stress disorder (PTSD), depression, physical injury and rehabilitation, difficulty making the transition to new career roles, and relocation. In addition, couples may be facing severe marital discord and the impact of infidelity that occurred during the deployment (Peebles-Kleiger & Kleiger). Existing treatments do not fully address how to help service members and their families with this level of complexity.This article will focus on treating couples with a service member recently returned from OEF or OIF conflicts, with particular attention toward dealing with problems with reintegration. Broader interventions focusing on child difficulties of military veterans are outside the scope of the current paper; indeed, child difficulties and treatments are sufficiently broad topics that they deserve special focus (see Campbell, Brown, & Okwara, 2010; 2011). I discuss below the difficulties faced by these couples, an organizing framework for understanding their problems, and considerations for applying couples-based interventions to these complex clinical situations. I also present several case illustrations of work conducted with OEF-OIF veterans and their spouses, with a discussion of applying these considerations to treatment.