In this paper, the authors argue that effective couple interventions are important for the military given the impact deployment-related posttraumatic stress disorder (PTSD) has on couple relationships. The authors review the literature on military relationships and how PTSD, in particular, is problematic for these relationships. The authors then review evidence based couple therapy interventions targeting military couples and argue that Emotionally Focused Therapy is an ideally suited means of working with these couples as they face PTSD.
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Allen, E. S., Rhoades, G. K., Stanley, S. M., & Markman, H. J. (2010). Hitting home: Relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for army couples. Journal of Family Psychology, 24(3), 280–288.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Barrett, T. W., & Mizes, J. S. (1988). Combat level and social support in the development of posttraumatic stress disorder in Vietnam veterans. Behavior Modification, 12, 100–115.
Batten, S., Drapalski, A., Decker, M., DeViva, J., Morris, L., Mann, M., & Dixon, L. (2009). Veteran interest in family involvement in PTSD treatment. Psychology Services, 6(3), 184–189. doi:10.1037/a0015392.
Bay, E., Blow, A. J., & Xie, Y. (2012). Interpersonal relatedness and psychological functioning following traumatic brain injury (TBI): Implications for marital and family therapists. Journal of Marital and Family Therapy, 38, 556–567.
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.
Bradley, B., & Furrow, J. (2004). Toward a mini-theory of the blamer softening event: Tracking the moment-by-moment process. Journal of Marital and Family Therapy, 30, 233–246.
Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for post-traumatic stress disorder in trauma exposed adults. Journal of Consulting and Clinical Psychology, 68, 748–766.
Calhoun, P. S., Beckham, J. C., & Bosworth, H. B. (2002). Caregiver burden and psychological distress in partners of veterans with chronic posttraumatic stress disorder. Journal of Traumatic Stress, 15, 205–212.
Carroll, E., Rueger, D., Foy, D., & Donahoe, C. (1985). Vietnam combat veterans with posttraumatic stress disorder: Analysis of marital and cohabiting adjustment. Journal of Abnormal Psychology & Health, 94, 329–337.
Cloutier, P., Manion, I., Walker, J., & Johnson, S. (2002). Emotionally focused interventions for couples with chronically ill children: A 2-year follow-up. Journal of Marital and Family Therapy, 28(4), 391–398.
Coan, J., Schaefer, H., & Davidson, R. (2006). Lending a hand: Social regulation of the neural response to threat. Psychological Science, 17(12), 1032–1039.
Cook, J. M., Riggs, D. S., Thompson, R., Coyne, J. C., & Sheikh, J. (2004). Posttraumatic stress disorder and current relationship functioning among World War II ex-prisoners of war. Journal of Family Psychology, 18, 36–45.
Dalton, J., Greenman, P., Classen, C., & Johnson, S. (2013). Nurturing connections in the aftermath of childhood trauma: A randomized controlled trial of emotionally focused couple therapy (EFT) for female survivors of childhood abuse. Couple and Family Psychology: Research and Practice, 2(3), 209–221.
Dekel, R., Goldblatt, H., Keidar, M., Solomon, Z., & Polliack, M. (2005). Being a wife of a veteran with posttraumatic stress disorder. Family Relations, 54, 24–36.
Dekel, R., & Solomon, Z. (2006). Marital relations among former prisoners of war: Contribution of posttraumatic stress disorder, aggression, and sexual satisfaction. Journal of Family Psychology, 20(4), 709–712.
Denton, W., Burleson, B., Clark, T., Rodriguez, C., & Hobbs, B. (2000). A randomized trial of emotion-focused therapy for couples in a training clinic. Journal of Marital and Family Therapy, 26(1), 65–78.
Denton, W., Wittenborn, A., & Golden, R. (2012). Augmenting antidepressant medication treatment of women with emotionally focused therapy for couples: A pilot study. Journal of Marital and Family Therapy, 38, 23–38.
Department of Defense. (2013). 2013 Demographics: Profile of the military community. http://download.militaryonesource.mil/12038/MOS/Reports/2013-Demographics-Report.pdf.
Dessaulles, A., Johnson, S., & Denton, W. (2003). Emotionally focused therapy for couples in the treatment of depression: A pilot study. American Journal of Family Therapy, 31, 345–353.
Erbes, C., Meis, L., Polusny, M., Compton, J., & Wadsworth, S. M. (2012). An examination of PTSD symptoms and relationship functioning in U.S. soldiers of the Iraq war over time. Journal of Traumatic Stress, 25, 187–190.
Erbes, C., Polusny, M., MacDermid, S., & Compton, J. (2008). Couple therapy with combat veterans and their partners. Journal of Clinical Psychology, 64(8), 972–983.
Fincham, F. D., & Beach, S. R. H. (2010). Marriage in the new millennium: A decade in review. Journal of Marriage and Family, 72, 630–649.
Foa, E., Keane, T., & Friedman, M. (Eds.). (2000). Effective treatments for PTSD. New York: Guilford.
Ford, J. D., Chandler, P., Thacker, B., Greaves, D., Shaw, D., Sennhauser, S., & Schwartz, L. (1998). Family systems therapy after operations desert storm with European-theater veterans. Journal of Marital and Family Therapy, 24, 243–250.
Furrow, J., Edwards, S., Choi, Y., & Bradley, B. (2012). Therapist presence in EFT. Blamer softening events: promoting change through emotional experience. Journal of Marital and Family Therapy, 38, 39–49. doi:10.1111/j.1752-0606.2012.00293.x.
Furrow, J., Johnson, S., & Bradley, B. (Eds.). (2011). The emotionally focused casebook: New directions in treating couples. New York: Routledge.
Gerlock, A. A., Grimesey, J., & Sayre, G. (2014). Military-related posttraumatic stress disorder and intimate relationship behaviors: a developing dyadic relationship model. Journal of Marital and Family Therapy, 40(3), 344–356. doi:10.1111/jmft.12017.
Gewirtz, A., Polusny, M., DeGarmo, D., Khaylis, A., & Erbes, C. (2010). Posttraumatic stress symptoms among National Guard soldiers deployed to Iraq: Associations with parenting behaviors and couple adjustment. Journal of Consulting and Clinical Psychology, 78(5), 599–610. doi:10.1037/a0020571.
Glynn, S. M., Eth, S., Randolph, E. T., Foy, D. W., Urbaitis, M., Boxer, L., et al. (1990). A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 67(2), 243–251.
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.
Goff, B. S. N., & Smith, D. B. (2005). Systemic traumatic stress: The couple adaptation to traumatic stress model. Journal of Marital and Family Therapy, 31, 145–157.
Gorman, L., Blow, A. J., 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.
Greenman, P., & Johnson, S. (2012). United We Stand: Emotionally focused therapy (EFT) for Couples in the treatment of post-traumatic stress disorder. Journal of Clinical Psychology. In Session, 68(5), 561–569.
Guay, S., Billette, V., & Marchand, A. (2006). Exploring the links between posttraumatic stress disorder and social support: Processes and potential research avenues. Journal of Traumatic Stress, 19, 327–338.
Halchuk, R., Makinen, J., & Johnson, S. (2010). Resolving attachment injuries in couples using emotionally focused therapy: A three-year follow-up. Journal of Couple and Relationship Therapy, 9, 31–47.
Herman, J. (1992). Trauma and recovery. New York, NY: Basic Books.
Hoge, C. W., McGurk, D., Thomas, J., Cox, A., Engel, C., & Castro, C. (2008). Mild traumatic brain injury in US soldiers returning from Iraq. The New England Journal of Medicine, 358(5), 453–463.
Jankowski, M., Schnurr, P., Adams, G., Green, B., Ford, J., & Friedman, M. (2004). A mediational model of PTSD in World War II veterans exposed to mustard gas. Journal of Traumatic Stress, 17(4), 303–310.
Johnson, S. (2002a). Emotionally focused couple therapy with trauma survivors: Strengthening attachment bonds. New York: Guilford.
Johnson, S. (2002b). Marital problems. In D. Sprenkle (Ed.), Effectiveness research in marriage and family therapy (pp. 163–190). Alexandria, VA: The American Association for Marriage and Family Therapy.
Johnson, S. (2004a). Facing the dragon together: Emotionally focused couples therapy with trauma survivors. In D. R. Catherall (Ed.), Handbook of stress, trauma, and the family (pp. 493–512). New York: Brunner-Routledge.
Johnson, S. (2004b). The practice of emotionally focused couple therapy (2nd ed.). New York: Brunner-Routledge.
Johnson, S., Hunsley, J., Greenberg, L., & Schindler, D. (1999). Emotionally focused couples therapy: Status and challenges. Clinical Psychology: Science and Practice, 6, 67–79.
Johnson, S., Makinen, J., & Millikin, J. (2001). Attachment injuries in couple relationships: A new perspective on impasses in couples therapy. Journal of Marital and Family Therapy, 27, 145–156.
Johnson, S., Moser, M., Beckes, L., Smith, A., Dalgleish, T., Halchuk, R., et al. (2013). Soothing the threatened brain: Leveraging contact comfort with emotionally focused therapy. PLoS One, 8(11), 1–10.
Johnson, S., & Rheem, K. (2012). Surviving trauma: Strengthening couples through emotionally focused therapy. In P. Noller & G. Karantzas (Eds.), Couple and family relationships: A guide to contemporary research, theory, practice and policy. New York: Wiley.
Johnson, S., & Williams Keeler, L. (1998). Creating healing relationships for couples dealing with trauma. Journal of Marital and Family Therapy, 24, 25–40.
Keane, T., Marshall, A., & Taft, C. (2006). Posttraumatic stress disorder: Etiology, epidemiology, and treatment outcome. Annual Review of Clinical Psychology, 2, 161–197. doi:10.1146/annurev.clinpsy.2.022305.095305.
Lambert, J., Engh, J., Hasbun, A., & Holzer, J. (2012). Impact of posttraumatic stress disorder on the relationship quality and psychological distress of intimate partners: A meta-analytic review. Journal of Family Psychology, 26(5), 729–737. doi:10.1037/a0029341.
Lepore, S., & Greenberg, M. (2002). Mending broken hearts: Effects of expressive writing on mood, cognitive processing, social adjustment, and mental health following a relationship breakup. Psychology & Health, 17, 547–560.
Litz, B., & Schlenger, W. (2009). PTSD in service members and new veterans of the Iraq and Afghanistan wars: A bibliography and critique. PTSD Research Quarterly, 20(1), 1–7.
MacDermid Wadsworth, S. M. (2010). Family risk and resilience in the context of war and terrorism. Journal of Marriage and Family, 72, 537–556.
MacIntosh, H., & Johnson, S. (2008). Emotionally focused therapy for couples and childhood sexual abuse survivors. Journal of Marital and Family Therapy, 34, 298–315. doi:10.1111/j.1752-0606.2008.00074.x.
Makinen, J., & Johnson, S. (2006). Resolving attachment injuries in couples using EFT: Steps towards forgiveness and reconciliation. Journal of Consulting and Clinical Psychology, 74, 1055–1064.
Marshall, A. D., Panuzio, J., & Taft, C. T. (2005). Intimate partner violence among military veterans and active duty servicemen. Clinical Psychology Review, 25, 862–876.
Monson, C., Fredman, S., Adair, K., Stevens, S., Resick, P., Schnurr, P., et al. (2011). Cognitive-behavioral conjoint therapy for PTSD: Pilot results from a community sample. Journal of Traumatic Stress, 24, 97–101. doi:10.1002/jts.20604.
Monson, C., Fredman, S., MacDonald, A., Pukay-Martin, N., Resick, P., & Schnurr, P. (2012). Effects of cognitive-behavioral couple therapy for PTSD: A randomized controlled trial. Journal of the American Medical Association, 308(7), 700–709.
Monson, C., Schnurr, P., Stevens, S., & Guthrie, K. (2004). Cognitive-behavioral couple’s treatment for posttraumatic stress disorder: Initial findings. Journal of Traumatic Stress, 17, 341–344.
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129, 52–73.
Pincus, S., House, R., Christenson, J., & Adler, L. (2001). The emotional cycle of deployment: A military family perspective. Journal of the Army Medical Department, 2, 15–23.
Renshaw, K., & Campbell, S. (2011). Combat veterans’ symptoms of PTSD and partners’ distress: The role of partners’ perceptions of veterans’ deployment experiences. Journal of Family Psychology, 25(6), 953–962. doi:10.1037/a0025871.
Rheem, K., Woolley, S., & Weissman, N. (2012). Using emotionally focused couple therapy with military couples. In B. Moore & J. Carlson (Eds.), Handbook of counseling military couples. New York: Routledge.
Riggs, D., Byrne, C., Weathers, F., & Litz, B. (1998). The quality of the intimate relationships of male Vietnam veterans: Problems associated with posttraumatic stress disorder. Journal of Traumatic Stress, 11(1), 87–101.
Roberts, W., Penk, W., Robinowitz, R., & Patterson, E. (1982). Interpersonal problems of Vietnam veterans with symptoms of PTSD. Journal of Abnormal Psychology, 91, 444–450.
Schneiderman, A., Braver, E., & Kang, H. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology, 167(12), 1446–1452.
Schnurr, P., Lunney, C., & Sengupta, A. (2004). Risk factors for the development versus maintenance of posttraumatic stress disorder. Journal of Traumatic Stress, 17(2), 85–95.
Shadish, W., & Baldwin, S. (2002). Meta-analysis of MFT interventions. In D. Sprenkle (Ed.), Effectiveness research in marriage and family therapy. Alexandria, VA: The American Association for Marriage and Family Therapy.
Sherman, M., Sautter, F., Jackson, H., Lyons, J., & Han, X. (2006). Domestic violence in veterans with PTSD who seek couples therapy. Journal of Marital and Family Therapy, 32, 479–490.
Sherman, M., Zanotti, D., & Jones, D. (2005). Key elements in couples therapy with veterans with combat-related posttraumatic stress disorder. Professional Psychology: Research and Practice, 36(6), 626–633. doi:10.1037/0735-7028.36.6.626.
Sneath, L., & Rheem, K. (2011). The use of emotionally focused couples therapy with military couples and families. In R. Everson & C. Figley (Eds.), Families under fire: Systemic therapy with military families (pp. 127–151). New York, NY: Taylor & Francis Group.
Solomon, Z., Dekel, R., & Zerach, G. (2008). The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans. Journal of Family Psychology, 22(5), 659–666. doi:10.1037/a0013596.
Solomon, Z., Waysman, M., & Mikulincer, M. (1990). Family functioning, perceived social support, and combat-related psychopathology: The moderating role of loneliness. Journal of Social and Clinical Psychology, 9, 456–472.
Taft, C. T., Street, A. E., Marshall, A. D., Dowdall, D. J., & Riggs, D. S. (2007). Posttraumatic stress disorder, anger, and partner abuse among Vietnam combat veterans. Journal of Family Psychology, 21, 270–277.
Tanielian, T., & Jaycox, L. H. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: Rand Monographs.
Tarrier, N., Sommerfield, C., & Pilgrim, H. (1999). Relatives’ expressed emotion (EE) and PTSD treatment outcome. Psychological Medicine, 29(4), 801–811.
Thomas, J. L., Wilk, J. E., Riviere, L. A., McGurk, D., Castro, C. A., & Hoge, C. W. (2010). Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. Archive of General Psychiatry, 67(6), 614–623. doi:10.1001/archgenpsychiatry.2010.54.
U.S. 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.
Walker, J., Johnson, S., & Manion, I. (1996). An emotionally focused marital intervention for couples with chronically ill children. Journal of Consulting and Clinical Psychology, 64, 1029–1036.
Waysman, M., Mikulincer, M., Solomon, Z., & Weisenberg, M. (1993). Secondary traumatization among wives of post-traumatic combat veterans: A family typology. Journal of Family Psychology, 7, 104–119.
Wittenborn, A. K., Liu, T., Ridenour, T. A., & Seedall, R. B. (2015). Emotionally focused therapy for depression and relationship distress: A randomized clinical trial. (in preparation).
Wortman, C., & Lehman, D. (1985). Reactions to victims of life crises: Support attempts that fail. In I. Sarason & B. Sarason (Eds.), Social support: Theory, research and applications. Dordrecht: Martinus Nijhoff.
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Blow, A.J., Curtis, A.F., Wittenborn, A.K. et al. Relationship Problems and Military Related PTSD: The Case for Using Emotionally Focused Therapy for Couples. Contemp Fam Ther 37, 261–270 (2015). https://doi.org/10.1007/s10591-015-9345-7
- Couple therapy
- Marital therapy
- Military couples
- Emotionally focused therapy