Case Study – Addressing Abuse, Stress, and Loss in Military Families

Case Study – Addressing Abuse, Stress, and Loss in Military Families

To Report or Not to Report

Sharon, a military spouse, has come in for depression related to domestic violence. Her husband, Tom, verbally and physically abuses her; her three children watch sometimes. Parents’ fights can significantly affect the mental health of children who watch. Intimate partner violence can emotionally and mentally damage children. Therefore, as the psychologist, it would be my duty to report suspected child abuse in this case. Mandatory reporting laws require that psychologists report when there is a reasonable belief that a child is being abused or neglected (Mathews & Bross, 2015). Domestic violence can qualify as a form of abuse when children are allowed to watch it.

Where to Report

The appropriate agency to report this incident would be the U.S. Army Family Advocacy Program. The Family Advocacy Program was created to recognize and meet the unique needs of soldiers and their families associated with the challenges of the military lifestyle. The advocacy includes interventions that help to improve the quality of life for these families. This is an appropriate intervention because this family has not intentionally abused their children. They may need assistance to deal with their domestic violence before child protective services are involved.

Clinical and Legal Implications of Failure to Report

Failing to report the abuse in this family can have some clinical and legal implications. There is a significant risk of harm to the child if there is no intervention to the abuse. There is a risk that the children, in this case, may be physically harmed during domestic abuse. Children from abusive homes also risk developing mental health issues (Mathews & Bross, 2015). These children have a greater risk of depression and anxiety, among other issues. Thus, they should be protected from this potential harm. There may also be some legal implications if this abuse is not reported. A psychologist is a mandated reporter. If a mandated reporter fails to report abuse or something that they reasonably suspect to be abuse, they stand a risk of being found guilty of a misdemeanor charge that can attract fines of up to $1,000, jail time of up to 6 months, or both (Mathews & Bross, 2015).

Ethical Decision-Making Model

If I report this incident, I will use the following ethical decision-making steps. The first step will be gathering facts about the situation. I would clearly define the problem and the parties that are involved. The next step will be identifying the decision-making options. The options here are reporting to Child Protection Services or Family Advocacy Program. I will evaluate the consequences of each decision. With Child Protection Services, there is a risk of the children being taken away from the family. With the Family Advocacy Program, the family will receive assistance to solve the domestic violence first. Therefore, the best option here is to report to the Family Advocacy Program.

Combat-Related Stress Impact on Family

Being in combat has a significant impact on a person’s psychological health. As a result, a significant number of people who have been in combat develop mental health issues. The effects of this stress can be extended to their relationship with their family. The family of MSgt Johnson is experiencing the effects of his experience in combat.

Combat-related Stress Symptoms and Their Potential Impact on the Military Member

Combat-related stress can manifest in many ways. One of the common signs of this issue is irritability and anger outbursts. People who have been in combat can easily lose their temper because of things that would typically not irritate them. They may also experience excessive fear and worry (Creamer et al., 2011). They are easily startled by things around them, such as sounds and sudden movements. Military members who have been in combat may also struggle with sleeping problems. They will experience insomnia or have nightmares when they sleep. It is also common for this stress to be comorbid with other issues, such as depression and anxiety disorders. The symptoms of combat-related stress may have negative impacts on military members’ families (Creamer et al., 2011). They may have a hard time maintaining good relationships with their families as they are distracted by their stress. Their irritability also increases the risks of domestic violence. This problem can destroy the foundations of entire families.

Impact of MSgt Johnson’s Combat Stress on Each Family Member If Left Untreated

Each of the family members of MSgt Johnson can be affected by his combat stress if it is not treated. His wife stands the risk of being a victim of domestic abuse. People with combat-related stress tend to have anger outbursts that can cause physical or verbal abuse. On the other hand, the children, Claire and Nate, risk being abused. Their father might verbally abuse them in one of his anger outbursts. Their relationship with the father may also be destroyed due to his current situation.

Differing Impacts on Johnson’s Children Based on Their Gender

Mr. Johnson’s children can experience different effects of his changed behavior based on their gender. Claire can become a victim of abuse because she has watched her father abusing her mother. When female children watch their mothers being abused, they have an increased risk of accepting men in their adulthood who have similar characteristics to their fathers. His son Nate, on the other hand, has a risk of emulating the behaviors he sees, such as poor anger management and violent behaviors.

Assessment and Treatment of Substance Use and Couple Conflict

John and Sal are a same-sex couple that has been married for seven years. They have been together for 17 years. The couple met while they both were in the military. Today, they experience significant conflicts and arguments caused by John’s heavy drinking.

Assessment and Treatment

An appropriate assessment of John’s drinking behaviors is needed to determine whether he has a substance use disorder. The best approach to use for this assessment is to consult the American Psychological Association’s Diagnostic and Statistical Manual Fifth Edition (DSM-5). According to DSM-5, substance use disorder is a maladaptive pattern of substance use that is characterized by at least two of the following: taking the substance in larger amounts and longer periods than is intended, the person has tried to stop but cannot, the substance use is causing significant impairments in the person’s life such as family or workplace, and a great deal of time is spent in activities to acquire the substance (Hasin et al., 2013). The best way to determine if John meets this criterion is to interview him and Sal, who has likely seen his behaviors.

After an official diagnosis is made, the following treatments can be explored. The first thing to do is have the couple undergo the cognitive behavioral therapy (CBT) process. CBT is a therapeutic approach that focuses on connecting a person’s cognition with their behaviors. This therapy helps one to understand the thoughts that cause them to behave the way they do (Puleo et al., 2013). In this case, John’s drinking behavior is likely connected to his experience working in the military. The therapy may help them to understand the dysfunctional thoughts that cause the drinking behavior and, hence, the conflict in their marriage.

Relevant Clinical Considerations Related to the Couple’s Military History

The main consideration that should be made for this couple is their experience in the military during the Don’t Ask, Don’t Tell (DADT) policy. DADT is a policy that prohibits gay, lesbian, and bisexual people from disclosing their sexual orientation or discussing homosexual activities while serving in the military. Any person who broke this policy stood the risk of being discharged from the military (Kerrigan, 2012). This policy likely had a great impact on John and Sal’s relationship. They have been together for 17 years, meaning they experienced this policy. It is important to consider how the policy may have affected their relationship. For instance, it may have caused a rift between them when they could not openly be together.

Name That Loss

Military families are likely to experience situations where their loved one is physically available but mentally absent or mentally present, but physically absent. This kind of experience represents an ambiguous loss. Ambiguous loss is one that occurs without clear understanding or closure. It is a form of complicated loss that delays the grieving process (Boss & Yeats, 2014). It leaves the person experiencing it searching for answers instead of starting the grieving process.

How the Loss May Be Exhibited in the Family During Each Stage of Deployment

Ambiguous loss can exhibit itself at different stages of the deployment process. In the pre-deployment phase, the military member’s family starts to anticipate their departure. This anticipation can be accompanied by concerns over the person’s safety when leaving the family. Ambiguous loss can be experienced because the person is still physically present, but the family is experiencing the anticipated loss. It is hard to understand why one is grieving someone’s loss when they are still present. During the deployment, the person has already left, but they may sometimes still keep in touch with the family. In this situation, they are not physically present, but mentally they are. In post-deployment, military members may come back with mental health issues that cause them to be mentally absent, even though they are physically at home. This problem also causes ambiguous loss.

Other Situations that Can Lead to This Type of Loss

Ambiguous loss is not unique to people in the military. There are other instances where one may be unable to understand their loss. For example, when a family member is incarcerated, the family may feel like they have physically lost them, but they are still psychologically connected (Boss & Yeats, 2014). This kind of loss can also be experienced by children who have been adopted. They feel the loss of their biological parents even though they have adoptive parents taking care of them. When a person migrates to another country, they may also experience ambiguous loss of their loved ones at home even though they can still communicate with each other.

References

Boss, P., & Yeats, J. R. (2014). Ambiguous loss: A complicated type of grief when loved ones disappear. Bereavement Care, 33(2), 63-69.

Creamer, M., Wade, D., Fletcher, S., & Forbes, D. (2011). PTSD among military personnel. International Review of Psychiatry, 23(2), 160-165.

Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. American Journal of Psychiatry, 170(8), 834-851.

Kerrigan, M. F. (2012). Transgender discrimination in the military: The new don’t ask, don’t tell. Psychology, Public Policy, and Law, 18(3), 500.

Mathews, B., & Bross, D. C. (Eds.). (2015). Mandatory reporting laws and the identification of severe child abuse and neglect. Springer Netherlands.

Puleo, C. M., Conner, B. T., Benjamin, C. L., & Kendall, P. C. (2011). CBT for childhood anxiety and substance use at 7.4-year follow-up: a reassessment controlling for known predictors. Journal of Anxiety Disorders, 25(5), 690-696.

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Case Study – Addressing Abuse, Stress, and Loss in Military Families

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