Feature Article

Group therapy with children in military families

This article discusses high-impact methods in clinical practice, specifically regarding group therapy among youth in military families.

By Krista H. Kovatch

Since 2001, over 2 million children have had at least one parent deployed and thousands have faced the loss of a parent. Children in military families face unique challenges and opportunities for growth that children in civilian families do not. According to the Department of Defense (2012), active duty families with a child between the ages of 6 and 11 years were 30.8 percent of all children within active duty families, and more than 2 million American children have had a parent deploy to Iraq or Afghanistan. Families who serve in the military often face additional psychological stressors, such as multiple deployments, frequent relocating, and possible parental injury or death.

With young families starting to develop new family roles and responsibilities, these children are often faced with challenges that may make it difficult for some of their peers to understand and may feel isolated. Children ages 3 to 5 with a parent deployed tend to exhibit more behavioral symptoms than children in the same age group without a deployed parent, and may struggle with peer acceptance (Coulthard, 2011). School-age children may cope by internalizing their stress, such as withdrawing from others, or externalizing their stress, such as making irritable comments. Throughout all phases of the deployment cycle, children have been identified to exhibit behavioral changes that affect school performance, irritability, and symptoms of depression that civilian youths do not. Youths in military families between the ages of 11 and 17 have higher prevalence of emotional and behavioral difficulties than youths in civilian families, with increases of distress during a parent's deployment (Chandra et al., 2011). With the increase of young children in military families who are facing longer deployments with shorter time between deployments, support is needed and group therapy is a particularly helpful intervention that has been underused.

Children and adolescents in military families have demonstrated the need for mental health support. Between 2003 and 2008, the mental health visits for youths of active duty parents have doubled from 1 million to 2 million outpatients, and one third of children with a deployed parent were identified to be “high risk” for psychosocial issues (Davis, 2011). Youths in military families who are 14 and under have increased in total inpatient psychiatric care from 35,000 in 2003 to 55,000 in 2008 (Sogomonyan & Cooper, 2010). Although more families are seeking mental health care, stigma continues to be a barrier associated with mental health care, and some fear it may jeopardize the service member's career. The most common risk factors identified for youth and the impact of deployment include age, mental health of the nondeployed parent, and reintegration. Protective factors include family support, parental well-being, religious organizations, and families who feel supported by their communities. One way to increase community support for youths in military families is group therapy. Military families typically engage in individual or family therapy, with minimal use of a group therapy modality, despite group psychotherapy being included in TRICARE benefits. It is possible that military families may not be aware of this option, or there are too few group options available.

Group therapy is designed to allow a member to be both a receiver and giver of care. Children in military families often epitomize resilience, and the ability to be in both roles may feel more comfortable. A group therapy format designed for children in military families can also normalize developmental issues and conflicts that are unique to these families. Children of military families may feel an opportunity to build insight and share coping strategies that their civilian peers may not be aware of. As peer groups are becoming increasingly more important during this age, school-age children may connect easier with those in their age group—an option not readily available in a traditional individual therapy format. Group therapy can also increase empowerment through family and peer connection, enhance emotional stability, and build competence.

Military culture already encompasses a strong support system, and group therapy can reflect that system. Overall, the application of group therapy for youths in military families has only begun to be examined in the literature. Rush and Akos (2007) designed a 10-session deployment group for middle- and high-school-aged students. With both psychoeducational and process groups, the purpose of the group was to increase knowledge of deployment, build competences (such as coping and developmental tasks), and build a peer network. A different study examined a creative arts approach for middle-school-age children in military families. Using an eight-session expressive arts process group, Kim, Kirchhoff, and Whitsett (2011) used arts as a medium to facilitate discussion on the unique challenges military families face. Both studies included a family component, in which additional family members were invited to either learn the child's experience of deployment or observe the works of art they created as an expression of being in a military family. Overall, both studies found the inclusion of family to be beneficial to increasing communication and improving family relations.

Overall, group therapy appears to be an effective modality; however, more research is needed. Most group therapy within military culture has examined benefits for the service member. Although research examining military family support is relatively new, this is an underresearched area that may decrease the negative impact of deployment. Programs may benefit from using an outcome measure to identify how long the benefits last and identify specific strengths of the group. Group therapy programs that address the intersection of multiple cultures and their impact on the family may also reach a wider range of children.

For military families who exemplify service before self, the need to support family resilience is evident. Overall, mental health professionals need to have general military cultural competency and would benefit from training with empirically supported practices when working with youth in military families. Research is needed in the development of empirically supported group therapy techniques and targeted intervention strategies at different phases of deployment with youths at different stages of development. Subgroups of military families, such as the intersection of multiple cultural identities and active duty compared with reserve duty, are areas that need further development to enhance effective therapeutic interventions.

Children and adolescents in military families are known to be a resilient group, but resilience does not mean impermeability. Development of effective group therapy may help mitigate the risk factors associated from deployment can help build upon the strength of this population. Stigma may continue to be a factor that limits some from obtaining help, and further public education to address stigma within the military and mental health may be beneficial. Advocacy for comprehensive mental health care coverage for children and adolescents in military families and awareness of the strength to face psychological distress may also help.

For further information, please contact Krista H. Kovatch, Florida School of Professional Psychology, Argosy University.

References

Chandra, A., Lara-Cinisomo, S., Jaycox, L. H., Tanielian, T., Han, B., Burns, R. M., & Ruder, T. (2011). Views from the homefront: The experiences of youth and spouses from military families . Santa Monica, CA: RAND Corporation.

Coulthard, J. (2011). The impact of deployment on the well-being of military children: A preliminary review. Res Militaris, 1, 1–30.

Davis, A. J. (2011). The effects of military deployment on children's health and well-being. Retrieved from https://research.wsulibs.wsu.edu/xmlui/bitstream/handle/2376/3075/A_Davis_010742856.pdf?sequence=1

Department of Defense. (2012). Profile of the military community. Retrieved from http://www.militaryonesource.mil/12038/MOS/Reports/2012_Demographics_Report.pdf

Kim, J. B., Kirchhoff, M., & Whitsett, S. (2011). Expressive arts group therapy with middle-school aged children from military families. Arts in Psychotherapy, 38, 356–362.

Rush, C. M., & Akos, P. (2007). Supporting children and adolescents with deployed caregivers: A structured group approach for school counselors. Journal for Specialists in Group Work, 32, 113–125.

Sogomonyan, F., & Cooper, J. L. (2010). Trauma faced by children of military families: What every policymaker should know . New York: National Center for Children in Poverty.