Contemporary Family Therapy

, Volume 37, Issue 3, pp 281–290 | Cite as

Crisis Management and Conflict Resolution: Using Technology to Support Couples Throughout Deployment

  • Adam M. Farero
  • Paul Springer
  • Cody Hollist
  • Richard Bischoff
Original Paper


The deployment cycle presents unique challenges for military couples. Marital outcomes have been shown to be negatively impacted throughout the deployment process, and at-home stressors can serve as distractions for service members that can compromise their effectiveness and safety. Tele-mental health, specifically the delivery of therapy via videoconferencing, has been shown to be an effective therapy medium, particularly for reaching underserved or isolated populations. A case can be made for the use of tele-mental health as a means of delivering therapy to military couples throughout the deployment process in an effort to strengthen their relationship and enhance service member well-being during deployment. This form of therapy may be particularly valuable to couples experiencing barriers to care due to stigma, rural location, or limited access to military resources (i.e. National Guard service members). Three general recommendations for this form of treatment are first provided, which include (1) work within the military culture, (2) capitalize on existing support structures, and (3) receive training in tele-mental health delivery. Five additional recommendations are provided which are specific to delivering couples therapy while the service member is deployed. These recommendations include (1) tailor treatment to fit the service member’s context, (2) prioritize service member safety, (3) encourage the development of couple skills in therapy, (4) be intentional about session management, and (5) engage the at-home spouse. Legal and ethical considerations, as well as intended benefits for this method of treatment are also discussed.


Tele-mental health Distance therapy Couples therapy Deployment 


  1. Allen N.B., Hetrick S.E., Simmons J.G., et al. (2007). Early intervention for depressive disorders in young people: the opportunity and the (lack of) evidence. Medical Journal of Australia, 187, S15–S17. Retrieved from
  2. Allen, E., Rhoades, G., Stanley, S., & Markman, H. (2010). Hitting home: Relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for army couples. Journal of Family Psychology, 24, 280–288. doi: 10.1037/a0019405.PubMedCentralCrossRefPubMedGoogle Scholar
  3. Antonacci, D. J., Bloch, R. M., Saeed, S. A., Yildiram, Y., & Talley, J. (2008). Empirical evidence on the use and effectiveness of telepsychiatry via videoconferencing: Implications for forensic and correctional psychiatry. Behavioral Sciences and the Law, 26, 253–269. doi: 10.1002/bsl.812.CrossRefPubMedGoogle Scholar
  4. Bang, M., Timpka, T., Erkisson, H., Home, E., & Nordin, C. (2007). Mobile phone computing for in situ cognitive behavioral therapy. Study of Health Technology Information, 129, 1078–1082. Retrieved from
  5. Baptist, J. A., Amanor-Boadu, Y., Garrett, K., Nelson Goff, B. S., Collum, J., Gamble, P., et al. (2011). Military marriages: The aftermath of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) deployments. Contemporary Family Therapy, 33, 199–214. doi: 10.1007/s10591-011-9162-6.CrossRefGoogle Scholar
  6. Bischoff, R. J., Hollist, C. S., Smith, C. W., & Flack, P. (2004). Addressing the mental health needs of the rural underserved: Findings from a multiple case study of a behavioral telehealth project. Contemporary Family Therapy, 26, 179–198. doi: 10.1023/B:COFT.0000031242.83259.fa.CrossRefGoogle Scholar
  7. Blow, A. J., Gorman, L., Ganoczy, D., Kees, M., Kashy, D. A., Valenstein, M., et al. (2013). Hazardous drinking and family functioning in National Guard veterans and spouses postdeployment. Journal of Family Psychology, 27, 303–313. doi: 10.1037/a0031881.CrossRefPubMedGoogle Scholar
  8. Blow, A. J., MacInnes, M. D., Hamel, J., Ames, B., Onaga, E., Holtrop, K., et al. (2012). National Guard service members returning home after deployment: The case for increased community support. Administration and Policy in Mental Health and Mental Health Services Research, 39, 383–393. doi: 10.1007/s10488-011-0356-x.CrossRefPubMedGoogle Scholar
  9. Carter, S., Loew, B., Allen, E., Stanley, S., Rhoades, G., et al. (2011). Relationships between soldiers’ PTSD symptoms and spousal communication during deployment. Journal of Traumatic Stress, 24, 352–355. doi: 10.1002/jts.20649.PubMedCentralCrossRefPubMedGoogle Scholar
  10. Caselli, L. T., & Motta, R. W. (1995). The effect of PTSD and combat level on Vietnam veterans’ perceptions of child behavior and marital adjustment. Journal of Clinical Psychology, 51, 4–12. doi: 10.1002/1097-4679(199501)51:1<4:AID-JCLP2270510102>3.0.CO;2-E.CrossRefPubMedGoogle Scholar
  11. Chartrand, M. M., Frank, D. A., White, L. F., & Shope, T. R. (2008). Effect of parents’ wartime deployment on the behavior of young children in military families. Archives of Pediatric and Adolescent Medicine, 162, 1009–1014. doi: 10.1001/archpedi.162.11.1009.CrossRefGoogle Scholar
  12. Cigrang, J. A., Talcott, G. W., Tatum, J., Baker, M., Cassidy, D., Sonnek, S., et al. (2014). Intimate partner communication from the war zone: A prospective study of relationship functioning communication frequency, and combat effectiveness. Journal of Marital and Family Therapy, 40, 332–343. doi: 10.1111/jmft.12043.CrossRefPubMedGoogle Scholar
  13. De Las Cuevas, C., Arredondo, M., Cabrera, M., Sulzenbacher, H., & Meise, U. (2006). Randomized clinical trial of telepsychiatry through video conference versus face-to-face conventional psychiatric treatment. Telemedicine and e-Health, 12, 341–350. doi: 10.1089/tmj.2006.12.341.CrossRefPubMedGoogle Scholar
  14. Department of Defense Task Force on Mental Health. (2007). An achievable vision: Report of the Department of Defense Task Force on Mental Health. Falls Church, VA: Defense Health Board.
  15. Dunstan, D. A., & Tooth, S. (2012). Treatment via videoconferencing: A pilot study using clinical psychology students. Australian Journal of Rural Health, 20, 88–94. doi: 10.1111/j.1440-1584.2012.01260.x.CrossRefPubMedGoogle Scholar
  16. Durham, S. W. (2010). In their own words: Staying connected in a combat environment. Military Medicine, 175, 554–559. doi: 10.7205/MILMED-D-09-00235.CrossRefPubMedGoogle Scholar
  17. Eaton, K. M., Hoge, C. W., Messer, S. C., Whitt, A. A., Cabrera, O. A., McGurk, D., et al. (2008). Prevalence of mental health problems, treatment need, and barriers to care among primary care-seeking spouses of military service members involved in Iraq and Afghanistan deployments. Military Medicine, 173, 1051–1056. doi: 10.7205/MILMED.173.11.1051.CrossRefPubMedGoogle Scholar
  18. Flake, E. M., Davis, B. E., Johnson, P. L., & Middleton, L. S. (2009). The psychosocial effects of deployment on military children. Journal of Developmental and Behavioral Pediatrics, 30, 271–278. doi: 10.1097/DBP.0b013e3181aac6e4.CrossRefPubMedGoogle Scholar
  19. Foster, P. H., & Whitworth, J. M. (2005). The role of nurses in telemedicine and child abuse. Computers, Informatics, Nursing, 23, 127–131. doi: 10.1097/00024665-200505000-0007.CrossRefPubMedGoogle Scholar
  20. Glenn, D. M., Beckham, J. C., Feldman, M. E., Kirby, A. C., Hertzberg, M. A., & Moore, S. D. (2002). Violence and hostility among families of Vietnam veterans with combat-related posttraumatic stress disorder. Violence and Victims, 17, 473–489. doi: 10.1891/vivi.17.4.473.33685.CrossRefPubMedGoogle Scholar
  21. Gorman, L., Blow, A., Ames, B., & Reed, P. (2011). National Guard families after combat: Mental health, use of mental health services, and perceived treatment barriers. Psychiatric Services, 62, 28–34. doi: 10.1176/ Scholar
  22. Greene, C. J., Morland, L. A., Macdonald, A., Frueh, B. C., Grubbs, K. M., & Rosen, C. S. (2010). How does tele-mental health affect group therapy process? Secondary analysis of noninferiority trial. Journal of Consulting and Clinical Psychology, 78, 746–750. doi: 10.1037/a0020158.CrossRefPubMedGoogle Scholar
  23. Green-Shortridge, T. M., Britt, T. W., & Castro, C. A. (2007). The stigma of mental health problems in the military. Military Medicine, 172, 157–161. doi: 10.7205/MILMED.172.2.157.CrossRefGoogle Scholar
  24. Griffith, J. (2005). The Army National Guard soldier in post-9/11 operations: Perceptions of being prepared for mobilization, deployment, and combat. Journal of Political and Military Sociology, 33, 161–165. Retrieved from
  25. Hall, L. K. (2008). Counseling military families: What mental health professionals need to know. New York, NY: Taylor and Francis Group.Google Scholar
  26. Hoge, C. W., Auchterlonie, J. L., & Milliken, C. S. (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Journal of the American Medical Association, 295, 1023–1032. doi: 10.1001/jama.295.9.1023.CrossRefPubMedGoogle Scholar
  27. Hoge, C. W., Castro, C. A., Messer, S. C., et al. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 35, 13–22. doi: 10.1056/NEJMoa040603.CrossRefGoogle Scholar
  28. Jacobson, I. G., Ryan, M. A., Hooper, T. I., Smith, T. C., Amoroso, P. J., Boyko, E. J., et al. (2008). Alcohol use and alcohol-related problems before and after military combat deployment. Journal of the American Medical Association, 300, 663–675. doi: 10.1001/jama.300.6.663.PubMedCentralCrossRefPubMedGoogle Scholar
  29. Jenkins, D.M. & Barry, M.J. (2007). Relationship 101: Couples therapy in theater. Military Medicine, 172, iii–iv. Retrieved from
  30. Jensen, P. S., Martin, D., & Watanabe, H. (1996). Children’s response to parental separation during operation desert storm. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 433–441. doi: 10.1097/00004583-199604000-00009-&gt.CrossRefPubMedGoogle Scholar
  31. Lexcen, F. J., Hawk, G. L., Herrick, S., et al. (2006). Use of video conferencing for psychiatric and forensic evaluations. Psychiatric Services (Washington, D.C.), 57, 713–715. doi: 10.1176/ps.2006.57.5.713.CrossRefGoogle Scholar
  32. 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 US army wives. New England Journal of Medicine, 362, 101–109. doi: 10.1056/NEJMoa0900177-&gt.CrossRefPubMedGoogle Scholar
  33. Marek, L. I., & D’Aniello, C. (2014). Reintegration stress and family mental health: Implications for therapists working with reintegrating military families. Contemporary Family Therapy, 36, 443–451. doi: 10.1007/s10591-014-9316-4.CrossRefGoogle Scholar
  34. Martin, J., Ghahramanlou-Holloway, M., Lou K., & Tucciarone, P. (2009). A comparative review of US military and civilian suicide behavior: Implications for OEF/OIF suicide prevention efforts. Journal of Mental Health Counseling, 31(2), 101–118. Retrieved from
  35. McCarroll, J. E., Ursano, R. J., Liu, X., Thayer, L. E., Newby, J. H., et al. (2000). Deployment and the probability of spousal aggression by US. Army Soldiers. Military Medicine, 165, 41–44. doi: 10.7205/MILMED-D-10-00048.PubMedGoogle Scholar
  36. McGorry, P. (2013). Prevention, innovation and implementation science in mental health: The next wave of reform. British Journal of Psychiatry, 202, s3–s4. doi: 10.1192/bjp.bp.112.119222.CrossRefGoogle Scholar
  37. Merolla, A. J. (2010). Relational maintenance during military deployment: Perspectives of wives of deployed US soldiers. Journal of Applied Communication Research, 38, 4–26. doi: 10.1080/00909880903483557.CrossRefGoogle Scholar
  38. Milliken, C., Auchterlonie, J., & Hoge, C. W. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq War. Journal of the American Medical Association, 298, 2141–2148. doi: 10.1001/jama.298.18.2141.CrossRefPubMedGoogle Scholar
  39. Minuchin, S. (1974). Families and family therapy. Cambridge: Harvard University Press.Google Scholar
  40. Moelker, R., & van der Kloet, I. (2006). Military families and the armed forces. In G. Caforio (Ed.), Handbook of sociology of the military (pp. 201–223). New York: Springer.CrossRefGoogle Scholar
  41. Moll, S. E. (2014). The web of silence: A qualitative case study of early intervention and support for healthcare workers with mental ill-health. BMC Public Health, 14, 138. doi: 10.1186/1471-2458-14-138.PubMedCentralCrossRefPubMedGoogle Scholar
  42. O’Reilly, R., Bishop, J., Maddox, K., Hutchinson, L., Fisman, M., & Takhar, J. (2007). Is telepsychiatry equivalent to face-to-face psychiatry? Results from a randomized controlled equivalence trial. Psychiatric Services, 58, 836–843. doi: 10.1176/ps.2007.58.6.836.CrossRefPubMedGoogle Scholar
  43. Pietrzak, R. H., Johnson, D. C., Goldstein, M. B., Malley, J. C., & Southwick, S. M. (2009). Perceived stigma and barriers to mental health care utilization among OEF-OIF veterans. Psychiatric Services, 60, 1118–1122. doi: 10.1176/ Scholar
  44. Poon, P., Hui, E., Dai, D., Kwok, T., & Woo, J. (2005). Cognitive intervention for community-dwelling older persons with memory problems: Telemedicine versus face-to-face treatment. International Journal of Geriatric Psychiatry, 20, 285–286. doi: 10.1002/gps.1282.CrossRefPubMedGoogle Scholar
  45. Riggs, D. S., Byrne, C. A., Weathers, F. W., & Litz, B. T. (1998). The quality of intimate relationships of male Vietnam veterans: Problems associated with posttraumatic stress disorder. Journal of Traumatic Stress, 11, 87–101. doi: 10.1023/A:1024409200155.CrossRefPubMedGoogle Scholar
  46. Ruskin, P. E., Silver-Aylaian, M., Kling, M. A., et al. (2004). Treatment outcomes in depression: Comparison of remote treatment through telepsychiatry to in-person treatment. The American Journal of Psychiatry, 161, 1471–1476. doi: 10.1176/appi.ajp.161.8.1471.CrossRefPubMedGoogle Scholar
  47. Sahlstein, E., Maguire, K. C., & Timmerman, L. (2009). Contradictions and praxis contextualized by wartime deployment: Wives’ perspectives revealed through relational dialectics. Communication Monographs, 76, 421–442. doi: 10.1080/03637750903300239-&gt.CrossRefGoogle Scholar
  48. Shore, J. H., Aldag, M., McVeigh, F. L., Hoover, R. L., Ciulla, R., & Fisher, A. (2014). Review of mobile health technology for military mental health. Military Medicine, 179(8), 865–878. doi: 10.7205/MILMED-D-13-00429.CrossRefPubMedGoogle Scholar
  49. Singh, S. P., Arya, D., & Peters, T. (2007). Accuracy of telepsychiatric assessment of new routine outpatient referrals. BMC Psychiatry, 7, 55–68. doi: 10.1186/1471-244X-7-55.PubMedCentralCrossRefPubMedGoogle Scholar
  50. Studenicka, E. (2007). Suicide seen as major threat to National Guard. Retrieved February 27, 2015, from
  51. van Beijouw, I. M., Verhaak, P. F., Cuijpers, P., et al. (2010). The course of untreated anxiety and depression, and determinants of poor one-year outcome: A one-year cohort study. BMC Psychiatry, 10, 86. doi: 10.1186/1471-244X-10-86.CrossRefGoogle Scholar
  52. Warner, C. H., Appenzeller, G. N., Warner, C. M., & Grieger, T. (2009). Psychological effects of deployments on military families. Psychiatric Annals, 39, 56–63. doi: 10.3928/00485713-20090201-11.CrossRefGoogle Scholar
  53. Warner, C. H., Breitbach, J. E., Appenzeller, G. N., Yates, V., Grieger, T., & Webster, W. G. (2007). Division mental health in the new brigade combat team structure: Part I. Predeployment and deployment. Military Medicine, 172, 907–911. Retrieved from
  54. White, C. J., de Burgh, H. T., Fear, N. T., & Iversen, A. C. (2011). The impact of deployment to Iraq or Afghanistan on military children: A review of the literature. International Review of Psychiatry, 23, 210–217. doi: 10.3109/09540261.2011.560143.CrossRefPubMedGoogle Scholar
  55. Wong, L. & Gerras, S. (2006). CU@ the FOB: How the forward operating base is changing the life of combat soldiers. Retrieved November 24, 2014, from Strategic Studies Institute, US Army War College website:

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Adam M. Farero
    • 1
  • Paul Springer
    • 2
  • Cody Hollist
    • 2
  • Richard Bischoff
    • 2
  1. 1.Michigan State UniversityEast LansingUSA
  2. 2.Department of Child, Youth, and Family StudiesUniversity of Nebraska-LincolnLincolnUSA

Personalised recommendations