STEP 8

Grow

Fostering Lifelong Resilience

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Where we love is home, home that our feet may leave, but not our hearts.

—Oliver Wendell Holmes, Sr.

Michael, the medically retired police officer and Army Guardsman, and his wife Lisa, the school teacher, have put in the effort needed to conquer several challenges in their lives and relationship. Early in their work in therapy, Michael overcame his habit of isolating from his family. He stepped back into the role of father to their daughter by adding to the time that he spent with Abby and with the family. In addition to her devotion to taking care of her family, Lisa became better able to tend to her own needs by putting aside time for herself by practicing relaxation and exercising. This helped her overcome the resentment she felt when Michael spent time with his buddies. Michael and Lisa are now back in my office on a cold, rainy day. However, the climate between the couple is much sunnier than in the past.

THERAPIST: Michael and Lisa, what was your week like.

MICHAEL: It went pretty well. I’ve gotten into watching the TV channels that feature cooking.

LISA: He’s introducing Abby and I to some new cooking techniques.

MICHAEL: And some new dishes.

LISA (enthusiastically): Last night we made baked salmon. It was cooked in parchment paper. It was amazing!

THERAPIST: How nice!

LISA (sounding excited): And I have to tell you . . . I’ve signed up for a yoga class, believe it or not. It’s every Monday and Wednesday night, so now those are Michael’s nights with Abby.

THERAPIST: Good job taking care of yourself, Lisa! It sounds like you are doing a lot of proactive coping! Michael, you have found a new hobby to share with your family that you enjoy, and Lisa, you are taking time for yourself!

LISA: It’s true. Writing in my journal is a habit now. I look forward to it every night. Meditation has gone okay. It can be a struggle to fit my relaxation exercises in, so sometimes I still forget. I think it will be easier to commit to a whole yoga class, because I will have to be there when it starts.

THERAPIST: And how have Lisa’s new changes impacted you, Michael.

MICHAEL: Well, it’s nice to see Lisa happier now. She is much more relaxed. And she doesn’t give me the silent treatment anymore for hanging out with the guys.

LISA (sounding surprised): What?

MICHAEL (smiling): Yeah, you used to give me the cold shoulder! I can’t believe it now. Last Friday I told you I was going over Ben’s and you actually said “Have fun, honey.”

LISA: I used to give you the cold shoulder.

MICHAEL: Yeah! You used to look like you wanted to kill me when I said I was going over Ben’s. Now you have your own life too. So now you’re glad that I am doing something that is fun for me.

THERAPIST: Sounds like there have been a lot of positive changes for both of you.

Michaels nods, and looks at Lisa. Lisa is nodding as well, looking happy.

THERAPIST: How about your time with Abby? How has that been for you?

MICHAEL: I don’t know. . . . It’s up and down. Abby doesn’t seem to like anything I do. I’m not “cool” to her. . . . What do you think, Lisa?

LISA: I think Abby’s glad to be spending time with you, even if she doesn’t show it. You’re not the warmest person in the world either you know!

MICHAEL: Yeah, I know. I’ve got my own stuff going on.

THERAPIST: Michael, how do you think your “stuff” gets in the way?

MICHAEL: Sometimes I feel like Abby’s a stranger. Like, who is this person?

LISA: But you have to spend time finding out more about her. I just wish you would talk to her a little more.

THERAPIST: What do you think, Michael?

MICHAEL: I don’t know. I guess I feel like some people are born to be fathers, and the rest of us just have to do our best.

THERAPIST: So, Michael, you think you were not “born” to be a father? I know in the past that you said you felt like an “imposter.” Do you still feel like that?

MICHAEL: I guess not so much an imposter now. I feel like . . . I don’t know what to say to her . . . so I sometimes feel like I’m not cut out to be a good father.

LISA: You know what, Michael? You just need to continue to practice those basic skills of expressing interest in and listening to Abby. Just ask her about herself.

THERAPIST: Michael, remember when you brought Abby to her first therapy session? You did a fine job of listening to her then. How did that session feel?

MICHAEL: Well, on one hand I felt awful because I didn’t know that Abby was angry with me.

THERAPIST: What else did you feel?

MICHAEL: Well, I guess I understood her better.

THERAPIST: Did you feel close to her?

MICHAEL: Yeah, I felt close. I felt like a father.

THERAPIST: Do you think you could take some time to ask her more about herself from time to time?

MICHAEL: Sure.

Setting the Stage

Michael and Lisa have made considerable changes in their three months of therapy. Michael began to adjust to his injuries and new role at home in a healthy way. He was able to ease back into his role of parenting Abby and making decisions together with Lisa. The family found ways to spend quality time together, and they also made time to have quality time on their own. By using proactive coping and shifting some of the parenting responsibilities back to Michael, the family became more balanced.

In Step 6, Michael was able to overcome his fears about “burdening” Lisa by sharing his war experiences with her. He also overcame an even bigger challenge—his own stigma-related beliefs about mental health problems. If you recall, Michael believed that, as a man, he “should not” be experiencing any mental health problems, that having these types of problems meant he was weak, and that it was unacceptable to be weak. However, we were informed about military culture and developed a strong, trusting therapeutic rapport with Michael. As such, Michael started to honestly admit to the difficulties he was having. Michael then courageously moved beyond his rigid beliefs about sharing emotions. For the first time, he let his guard down and shared his grief over his war experiences with Lisa. These experiences developed a new trust between Michael and Lisa, which helped them to integrate their new post-deployment roles at home and grow stronger as a couple.

According to some of the founders of the field of family resilience (e.g. McCubbin, McCubbin, Patterson, Cauble, Wilson, & Warwick, 1983; Trivette, Dunst, Deal, & Hamer, 1990) resilient families are those whose relationship patterns, interpersonal skills and competencies, and social and family identities do the following:

1. Promote satisfying interactions among family members.

2. Encourage the development of the potential of the family group and individual family members.

3. Contribute to the family’s ability to deal effectively with stress and crisis.

In Step 8, the military family is ready to finalize the stages of growing together and becoming resilient. They are ready to maintain fulfilling relationships with one another that reinforce their individual and collective strengths as a family. They continue to bolster each other’s fullest potential and support one another’s goals. These military families become resilient and therefore more able to face future challenges in their lives in ways that are positive, healthy, and empowering for everyone.

Overview of the Problem

Michael and Lisa’s experiences are typical of those of military families who are in transition. Changes occur—in this case, Michael’s injury, chronic pain, posttraumatic stress, and subsequent medical discharge—that can throw off the family balance. Without resilient coping, a spouse who is physically or emotionally injured may embrace a “disabled” role by foregoing their role as a spouse and/or parent. The resilient spouse, on the other hand, readapts to changes by resuming, to the extent that is possible, normal activities, including their responsibilities as parents.

Through open communication, flexibility, and shared decision making, the military couple draws on their own strengths to readjust to changes so that their families can thrive. Michael has made a good effort to overcome his urge to isolate. Because of their time spent apart during his three deployments, Michael has some catching up to do in his relationship with his wife and daughter. Michael still needs to take time to reestablish his relationship with his daughter, Abby. Even though this is difficult for Michael at first, it will lead to a more fulfilling relationship with her.

Promoting Family Cohesion

In Step 8, the family or couple will begin to see themselves as a well-functioning team. In the sports world, coaches know that teams that are able to work together and make the most of each player’s individual talents experience the most success. The same can be true for families. The highly functioning family uses the diverse strengths of its members and, at the same time, balances each other’s weaknesses.

Acceptance of Each Other’s Strengths and Weaknesses

In sports, good coaches know each player’s strengths and weaknesses. Basketball coach Sean Glaze (2010), for example, states that,

Team-building is the ON-GOING process of energizing a group to work together with an appreciation of diversity and talents and commit to their role in achieving the team’s chosen goals. Once they identify that shared purpose, GREAT teams take time to learn about and appreciate the background and talents of its members, and bonds together through shared experiences and activities.

Helping families to identify a shared identity and purpose will provide a powerful resilience to enable them to cope with their immediate problems.

Acceptance of Differing Values

Our values are the qualities in life that are most important to us. Even though we all have values that guide the way we live our lives, we rarely take a moment to think about what our values are. Like sports teams, everyone in the family team has diverse strengths and values that they bring to the table. The therapeutic process can be used to help families identify individual and shared strengths and values to increase their sense of cohesion. For example, a family can promote their sense of purpose and commit to a goal by talking and agreeing upon shared values. At the same time, identifying values can be yet another way to promote communication within a family.

For Your Information: Values, Growth, and Meaning Making

When service members first return from combat, they may be focused on the suffering, fear, or anger associated with a deployment (Reivich, Seligman, & McBride, 2011). Early in the transition, returnees may have difficulty in looking beyond some of the blatantly negative experiences that they had or witnessed. However, recognizing positive changes gained through adversity will help service members broaden their outlook on life (Reivich et al., 2011). The same can be true for the spouses left behind. When spouses focus on the negative, it can overshadow positive growth that is taking place. These attitudes often trickle down to the children.

According to Dr. Viktor Frankl (1946), striving to find meaning in one’s life is the most powerful and healing force driving human behavior. Frankl, a physician and survivor of Holocaust internment camps, discusses how identifying meaning in stressful or tragic events can be very therapeutic for trauma survivors. In his landmark book, Man’s Search for Meaning (1946), Frankl shares about his years in Nazi concentration camps during the Holocaust. He observed that the prisoners who had positive attitudes about the future and who were able to make meaning of their present situation were more likely to survive the brutal conditions of the camps. Frankl describes how his personal experience of finding meaning in what could have been an entirely horrific experience helped him to survive his years in the concentration camps.

Finding positive meaning in the face of adversity is associated with long-term resilience (e.g., Southwick, Vythilingam, & Charney, 2005). During stressful deployments, when service members are able to find a broader significance of their role in a mission, they find it easier to justify hardships or sacrifices they make (Litz, Orsillo, Friedman, Ehlich, & Batres, 1997). People who are able to see the positive side to stressful situations and are committed to higher values are much more resilient in stressful life situations (e.g., Tugade & Frederickson, 2004).

Even former prisoners of war (POWs) are able to identify ways in which they grew in some manner from being a POW (Solomon et al., 1999). Despite immeasurable losses, many POWs say that they would not give up having the experience, because being a POW helped give them the values that define who they are today. As a result of their POW experiences, these individuals gained a greater appreciation for freedom and for their family and friends, greater patience and understanding, more optimism about life, as well as the ability to know what’s important in life versus what is trivial (Feder et al., 2008; Solomon et al., 1999). Thus, amidst any adverse or even traumatic event, there are ways in which people can grow and improve as a result.

The Shared Values of the Family

Resilient families find meaning, purpose, and connection to something beyond themselves. By seeing themselves as part of something greater, families are able to take a larger view of any problems they may be having, which can lead to a heightened sense of purpose in their lives (Walsh, 2006). One way to promote shared meaning and purpose, while helping family members better understand each other, is by identifying their values both as individuals and as a family.

Dr. Brenda Thames (2008) describes values as a reflection of who we are, of our culture and of our own unique heritage, and of how our experience affects our behavior. Our values help us prioritize what is important to us. As such, our values guide our decision-making processes. Thames (2008) writes that, as children approach adolescence, they begin to act on the values that have been established by their families. Because peers become more influential during adolescence, it becomes even more critical that children develop positive values. Families become empowered to establish their priorities and make positive decisions when they have clear values. And that is where we are heading with our military families in this step’s first Making It Real exercise.

Making It Real: Our Core Values

In this exercise, we help the family identify their individual and shared values. In this exercise, each family member rates how often a variety of values are important to them, then rates how often they think those values are important to their family as a whole. You may wish to have family members complete the handout before the session. Then, in session, they can discuss their answers with one another. As follows, the family develops a list of their most important shared values.

Instructions: Please go to Family Handout Step 8.1.

1. Say to the family: “Our values are the qualities in life that are most important to us. Even though we all have values that guide the way we live our lives, we rarely take a moment to think about what our values are. Although values tend to be enduring, they can change over time and with experience. However, the more aware that we are about our values and the closer we follow our values in our day-to-day lives, the more meaningful our lives can be. In this exercise, I’d like you to think about and identify values—your own and what you think are your family’s core values.” You can provide them with examples of values, such as:

  • Being at peace
  • Being ethical and honest
  • Freedom of speech
  • Honoring my country
  • Respecting elders
  • Being a loyal friend
  • Being disciplined
  • Being a positive role model
  • Being a good parent, spouse, son or daughter
  • Having close and loving relationships
  • Honoring God
  • Being spiritual
  • Being honest
  • Being the best
  • Gaining financial success
  • Being successful
  • Being powerful
  • Being independent
  • Being creative
  • Being physically attractive
  • Living a healthy lifestyle
  • Commitment to a social cause or causes
  • Being responsible for one’s duties
  • Being valued by the community
  • Being a model citizen
  • Working hard
  • Gaining education
  • Intellectual pursuits
  • Being tolerant of differences in others
  • Having fun
  • Learning
  • Being fair
  • Respecting the environment
  • Having compassion for all living things
  • Seeking justice and equality for all
  • Having a sense of humor
  • Helping those who are less fortunate
  • Being adventurous
  • Being famous
  • Being popular
  • Being brave
  • Being happy

2. “On your own, choose five to ten values that are most important to you. Then, as a family, decide which values are most important to your family as a whole. This also might include five or so items.”

3. After the family has decided which are their most core values, have each family member provide a recent example of how these values influenced a decision or behavior. Then discuss with them if any of these values have become even more important to them in the last year.

Talking Points

In the case of Michael, Lisa, and Abby, a discussion of core values also served as a useful tool to promote communication and understanding among each other. Michael and Lisa were provided with three copies of Handout 8.1 and asked to have each family member complete the handout individually prior to their next session. In session, we review their responses. Here is some of that dialogue.

THERAPIST: Abby, Lisa, and Michael, first, what did each of you choose as your most important individual values?

ABBY: I have: doing my best job, being happy, being popular, and helping those who are less fortunate as most important. Oh, and having fun.

LISA: For me, being at peace, being a good parent and spouse, being ethical and honest, having close and loving relationships, and being happy are most important.

MICHAEL: I have being ethical and honest, being a good parent and spouse, honoring my country, doing my best job, and helping those who are less fortunate.

THERAPIST: Very good! Now, what values do you think are most core for your family?

LISA: Well, it looks like everyone agrees on helping those who are less fortunate. But I think that being ethical and honest should be one of our most important values. But I guess we are supposed to decide what our values are as a group.

MICHAEL: I would hope that being ethical and honest would be one of our core values.

LISA: But we’re supposed to decide what our values really are, not what we think they should be. We have to be honest.

ABBY: Being ethical and honest is an important value to me. I try to be honest all of the time, but sometimes I slip.

THERAPIST: Can you tell us more about that, Abby?

ABBY: Well, if I think about it, compared to being popular, being ethical is probably more important to me. But it’s hard sometimes.

THERAPIST: Abby, think about your life. Do you have an example that shows how these values are more important to you?

ABBY: Well, I did something really stupid last month. Everyone was making fun of this girl nobody likes, and I don’t know why, but I made fun of her too. She started crying. I wanted to be with the popular crowd, but then I’ve felt like a jerk ever since. When they did it again last week I just told them to leave her alone.

THERAPIST: It sounds like you made a tough decision.

ABBY: I was afraid that they would start making fun of me, but they didn’t.

MICHAEL: Abby, that was very ethical of you. You made the right choice not to give into peer pressure.

LISA: And you were very honest right now to tell us about what happened.

ABBY: Well, I want to be popular, but sometimes it’s more important to be ethical. I should have put that value down too.

MICHAEL: So, what do you think? Do we all agree that being ethical and honest is one of our core family values?

Everyone agreed.

THERAPIST: What else?

ABBY: I think it’s important to us to want to do our best job. I want to go to college and to go to a good one. I have to get good grades, so I try to do my best at school. But my Dad says to always do your best job, no matter what you’re doing. I do that. It just makes me feel good.

LISA: I agree.

MICHAEL: So doing our best job is one of our core family values?

Everyone nodded.

THERAPIST: What else would you suggest?

MICHAEL: Well, I put down being a good parent and spouse. I may not always be the best parent or husband, but it’s becoming more important to me all the time.

THERAPIST: Can you tell us more about that, Michael?

MICHAEL: I saw so much suffering while deployed—and losing Frank, being apart from my family—made me value Lisa and Abby.

THERAPIST: It sounds like you are able to recognize positive changes that have occurred despite all of the losses you went through.

MICHAEL: It’s true. Ironically, my grief almost ruined my relationships with Lisa and Abby. I used to think that moving on with my life was in some way betraying Frank, but I see now that I can honor Frank and get on with my life.

LISA: Thank you for that, Michael. That means so much to me.

MICHAEL (facing Lisa): Because I lost Frank, I recognize that I need to appreciate you and Abby while I have you in my life.

LISA: I agree that we all have to appreciate each other. That’s kind of why being happy has become more important to me. I realize that life is short. I can’t believe it, but Abby is going to be 13 years old next month. Time is going so fast, I want to enjoy my family and appreciate each day.

ABBY: Can being happy be one of our family values too?

MICHAEL: I think being happy should be one of our core family values.

For Your Information: Negative and Positive Statements

In addition to sharing core values, resilient families recognize the positive side of situations and people in their lives. By recognizing the positive and expressing gratitude to others, military families can put their day-to-day conflicts and annoyances into perspective. This helps family members maintain a larger context in which to view any problems they may be having.

A lack of positive statements between couples damages relationships. In his early research days, Dr. John Gottman videotaped married couples discussing a conflict (e.g., Buehlman, Gottman, & Katz, 1992). He then broke the conversations down into categories of positive, neutral, or negative emotion. Among couples who eventually divorced, the ratio of positive to negative interactions was 0.8 to 1. In stable and happy couples who did not eventually divorce, the ratio of positive to negative interactions was 5 to 1. These ratios predicted eventual divorce in approximately 90% of the cases.

This is not to say that resilient families don’t fight or sometimes hurt one another’s feelings. However, resilient families talk about fights or hurt feelings in order to repair the relationship. Relationships will have some negativity involved, but healthy relationships are based upon positive interactions, especially when couples are resolving conflicts. Similarly, expressing gratitude appears highly important for successful marriages and long-term resilience.

Children need role models who promote and support positive values. Being aware of what family members believe is important, can give both parents and children a sense of direction and help them develop their strengths. When families have a clear sense of direction, they can act more consistently on their values. In turn, the closer the family follows their values in their day-to-day lives, the more meaningful their lives will be.

By discussing and deciding upon their core values, Lisa, Michael, and Abby showed that they had diverse opinions, but they also shared some common values. This will help Michael, Lisa, and Abby’s family to have a stronger sense of meaning, direction, and cohesion. The exercise also allowed Michael to embrace his role as father in the family, while focusing his attention on Lisa and Abby’s beliefs and feelings.

Fostering Gratitude in Robert and Felicia’s Family

Luckily, experiencing and expressing gratitude is a skill that can be acquired with practice. For some families, the ability to identify and express gratitude may need to be developed. We provide a segment of Felicia and Robert’s therapy session to illustrate this point.

THERAPIST: Felicia and Robert, how was your week?

FELICIA: It was okay. We had Robbie’s baseball game as usual on Saturday and went to church on Sunday, then spent all afternoon cleaning the yard. But that was okay. Work was the same.

ROBERT (rolling his eyes playfully): Work was work.

FELICIA (laughing): Yes, work was work!

ROBERT (smiling): Felicia is dealing with a new Commander. I don’t think that guy knows what he’s doing yet.

FELICIA (looking I know he doesn’t know what he’s doing. annoyed):

ROBERT: Well, it’s not the first time you whipped a new boss into shape.

FELICIA: Well, I got your butt in shape this week.

ROBERT (laughing): Yeah you did! I had my final written training exam, and Felicia helped me study for it. I probably wouldn’t have passed otherwise.

THERAPIST: Sounds like there’s a compliment in there somewhere, Robert.

ROBERT (smiling): Nah!

For Your Information: Gratitude

Gratitude is the quality of being thankful. In addition, gratitude implies a readiness to show appreciation for and to return kindness. Emmons & Crumpler (2000) describe gratitude as an emotional state and an attitude toward life that is a source of human strength to enhance personal and relational well-being. Research that examines individual differences in gratitude has recently shown that gratitude is uniquely and strongly related to well-being. People who habitually recognize the positive sides of situations and people, and who express gratitude toward others, have better health and even sleep better (Wood, Froh, & Geraghty, 2010).

Interventions designed to increase gratitude appear to also increase well-being. Training people to habitually focus on and appreciate the positive aspects of life has been shown to increase their well-being (Wood et al., 2010). For example, research participants in one study were randomly assigned to one of three experimental conditions: (1) writing about hassles, (2) gratitude listing, or (3) listing either neutral life events or social comparison on a daily basis (Emmons & McCullough, 2003). Those who were instructed to list things they were grateful for reported a better mood, healthier behaviors, and more positive overall life appraisals compared to the people in the other two groups.

In a second study, persons with neuromuscular disease were randomly assigned to either the gratitude writing condition or to a control writing condition. Compared to the control group, the gratitude group developed a more positive affect. The authors conclude that a conscious focus on gratitude likely has both emotional and interpersonal benefits (Emmons & McCullough, 2003).

Family members who are stuck in negative thoughts will benefit from assistance with identifying the positive in other people and events. With practice, people can begin to habitually recognize the positive sides of situations and people in their lives. Furthermore, to enhance family relationships, family members can be trained to become aware of and express gratitude toward others.

Helping families identify the positive can be particularly important following stressful deployments. At this time, service members often benefit from identifying things related to their service that they can be grateful for, such as positive characteristics they have gained through their time in the military. For example, even though many combat-related skills may not be useful in other contexts, many positive characteristics can develop (e.g., maturity, leadership skills, and the ability to quickly synthesize information and make difficult decisions). By appreciating what they are gaining from their hardships, individuals’ outlooks can be more balanced.

Also following deployments, helping family members identify things they are grateful for in each other will help increase cohesion. Too often, family members only focus on the negatives in each other. Parents may forget to focus on their children’s good behavior and end up only paying attention to them when they are bad. Additionally, certain cultural groups believe that making positive statements to children “spoils” them. We know from the research on positive reinforcement by parents, however, that identifying positives in others leads to more positive behavior. In the next Making It Real exercise, we help our military families develop their attitude of gratitude for each other.

Making It Real: Communicating Gratitude

The goal of the following exercise is to help family members continue practicing healthy communication, and also to build resilience by showing gratitude toward one another. The first component is a warm-up.

Instructions: Please go to Family Handout Step 8.2.

I am most grateful for you, ______, because . . .

I admire that you . . .

I am thankful for your . . .

Talking Points

Here’s what Felicia and Robert had to say during this last exercise:

FELICIA: Three things I am most grateful about my family are that they are good people, that we support each other, and that . . . they put up with me!”

The couple laughs.

ROBERT: Okay, three things I am most grateful for about my family are that they are intelligent, fun, and they put up with Felicia!

FELICIA: Hey!

ROBERT (laughing): I’m just joking. I am grateful that my family is intelligent, fun, and has strong moral values.

THERAPIST: Very nice, you two!

I explain Part Two of the exercise to them. Additionally, to encourage Robert and Felicia to move past their defenses, I encourage them to be genuine.

THERAPIST: Okay, next I’d like you to share at least three things that you are grateful for about each other using the sentence stems on Part Two of this handout. Now, remember, this part is serious. The reason you are here in therapy is to be honest and authentic with one another. This exercise is a chance to be authentic. Are you ready to give it a go?

They both agree.

THERAPIST: Felicia, you have the ball. Would you like to start?

FELICIA: Okay, let’s see. Robert, I am most grateful for you because you stuck by me all these years. I admire that you are strong, and that you are such a good role model for the boys. I am thankful for your loyalty, and thankful that I can go home and see you every night.

Robert repeats back the statement. They are both smiling.

THERAPIST: Nice job, Felicia! Now it’s Robert’s turn.

ROBERT: Let me think for a second. Okay. I am most grateful for you, Felicia, because you are an amazing woman. I admire that you are beautiful, sexy, intelligent, and strong. I am thankful that you have been so loyal to me, and thankful that I get to be with you every night.

Felicia looks surprised. As she repeats the statements back to Robert, her voice cracks. She looks at him earnestly, and I see that her eyes are brimming with tears.

THERAPIST: Now just take a minute and let that sink in.

After a minute . . .

FELICIA (still looking at Robert): Thank you, Robert.

ROBERT: Thank you, Angel-boo.

FELICIA: Angel-boo! You haven’t called me that in ten years!

Felicia and Robert are laughing but look grounded and connected.

THERAPIST, (after a pause): Wow! What was that like for you?

ROBERT (obviously touched): It . . . was good.

FELICIA (grabbing a tissue and wiping her eyes): Yes.

THERAPIST: What else?

FELICIA (smiling): It feels real nice.

ROBERT: I guess it works.

FELICIA (laughing): Who would have known?

ROBERT (not taking his eyes Yes, and you know what? We used to do this! off of Felicia):

THERAPIST: I want you to keep doing it.

Felicia and Robert hadn’t shared their gratitude for one another in a long time. They thought that they didn’t need to say such things out loud, that the other person should “just know it.” However, in reality, the messages they had been sharing with each other conveyed the opposite message. They often cut each other down “jokingly.” This is a common pattern among military peers, and that culture had become a part of their relationship with one another. However, successful romantic relationships require intimacy and trust. The cutting messages between them were slowly eating at each person’s self esteem and undermining their relationship.

Communicating appreciation for each other deeply touched Robert and Felicia. We discussed together what the couple was like when they first met. Felicia related that they were “in love” and that, when they were dating, Robert used to “sweet talk” to her “all the time.” We talked about how positive changes can fuel a healthy relationship and keep trust from eroding. Robert and Felicia agreed to find time to keep telling each other why they are grateful on a regular basis.

Termination: A Resilient Future

In the first session, the therapy timeline should have been discussed, so family members should have an idea of what to expect by the end of therapy. However, especially if termination was not discussed, or if family members do not recall the discussion, family members should be prepared for termination. Ideally, in family counseling, each client who participated in most of the therapy sessions should be involved in termination. However, participation will be less important for children or other parties who were involved in only one or two sessions.

In Dr. John Gottman’s couples’ therapy, follow-up sessions are planned at 6 months, 12 months, 18 months, and after two years as part of an outcome-evaluation phase. These sessions have been shown through research to significantly decrease the chances of relapse into previous, unhelpful patterns. We suggest having one follow-up session that allows for a little more time between sessions. This session might be one to several months following the termination of regular therapy, based on the needs and situation of the family. In the case of military families, the lapse until the follow-up session often has to be titrated due to deployment or changes of station.

The last session is a good time to review what the family has learned, discuss progress that was made, and talk about any feelings that termination may bring up for the family members. If necessary, you may also discuss what goals were not accomplished in therapy and what the client may do about them. And that leads us to our last Making It Real exercise with all of our military families.

Making It Real: Toward a Resilient Future

The goal of this exercise is to help family members solidify the progress they have made in therapy and develop a plan to maintain their resilience in the future. After recounting their areas of growth, family members plan ahead and imagine themselves implementing their new skills and attitudes when new problems arise.

You may choose to give family members 5 minutes to complete these questions together or, as with previous exercises, have them complete the questions individually on their own.

Instructions: Please go to Family Handout Step 8.3.

Alternatively, it is also valuable to simply ask the family these questions in session. What is important is that each member takes the time to reflect on their progress, to share their own thoughts about the therapy process and plans for a resilient future.

1. What are the most important ways your family has grown through therapy?

2. What do you see as your newfound strengths?

3. What new behaviors or skills have you learned that your family will use to manage challenges in the future?

4. What is the most important thing that has changed about how you act as a family?

5. How do you see yourselves as being more resilient as the result of going through this process?

Talking Points

In this section, we hear from each of our military families. First up are Felicia and Robert. It’s our last session together, and I have read question 1 out loud to them.

THERAPIST: Felicia and Robert, you have made so many positive changes in therapy. I’d like you to take some time to think about where you were when you decided to begin therapy and where you are today.

ROBERT: Sure.

THERAPIST: In thinking about these past few months, what do you think are the most important ways your family has grown as a result of your work in therapy?

FELICIA: I feel that the biggest changes had to do with my way of approaching Robert and the boys. I didn’t realize how tightly wound up I became when I was in Kabul. Looking back, I see how much my family life became mixed with my professional role and life in Kabul. I had Robert to balance me, but then when he deployed, my attitude just became worse. I’ve grown by stepping back and reevaluating how we do things.

ROBERT: I agree. I’d say being able to take a broader look at the situation made me see how we got on a downhill path. I didn’t realize that I was unhappy in our marriage or that we all had changed so much. I feel like a family again, and feel great about my family.

Michael, Lisa, and Abby

Next is an excerpt from Lisa, Michael, and Abby answering question 2 during their last session.

THERAPIST: Michael and Lisa, since being in therapy, what do you see as your newfound strengths?

LISA: Our family feels much more stable now. I feel like one strength is that we all have a new commitment to appreciating each other. For myself, I’ve found the strength to put myself first sometimes.

MICHAEL: I love that Lisa woke me up and made me stop sitting around and feeling sorry for myself. When she said she was going to take time to exercise and relax, I have to admit I felt a little panicky. I didn’t know if I was going to like it. But her having the strength to take care of herself gave me the determination to do the same.

LISA: And you found the determination to be a great father!

MICHAEL: I feel like I now have the strength of character to be a father. I want to be a role model. I know I’m not the perfect Dad, but I don’t have to be perfect.

THERAPIST: Abby, what about you?

ABBY: I think I realized that I care about people a lot. I want to treat others with respect. I also love that my dad and I are getting closer. It’s been cool getting to spend time with him every day. We didn’t have that before all of this. (looks at her father) You are not a perfect father. Probably no one is, but you are a great Dad to me. I’m glad we get to be friends now.

Michael, Lisa, and Abby all smile in unison.

LISA: I feel like we now have the strength to overcome any challenge. No matter what it is, we can do it.

Dan and Kate

Here is an excerpt from the last session with our couple, Dan and Kate.

THERAPIST: Dan and Kate, what new behaviors or skills have you learned that your family will use to manage challenges in the future?

KATE: I think we have learned a lot of new skills. Probably the biggest for us, I think, is ways that we can communicate better with each other. And for me personally, I can’t tell you how much of a relief it was to be open and honest with Dan about how ashamed I felt about the rape, and how his sexual behaviors and needs were making me feel worse. That was a big step for me. And I think it helped our relationship to get it all out in the open. From that point, things seemed to get better.

THERAPIST: That’s great, Kate! Taking that a step further, what did you learn that you can use in your married life in the future?

KATE: Well, I would say I learned that it’s okay to take risks and be honest. I also realized that secrets in our family just lead to us trying to guess what was bothering the other. So, it’s just better to get the truth out and deal with it.

THERAPIST: That’s great insight, Kate. Dan, how about you? What did you learn in this process that you can use in your family life?

DAN: I realized how much I need my family. And I guess I would agree with Kate about being honest and open with each other, about anything and everything. A lot of times the secrets get bigger and are worse than the real deal. You know? So, I think we will just continue to be honest with each other and try to not keep things from each other.

John and Amy

Here is a snapshot of our last session with John and Amy.

THERAPIST: Next, I’m curious, what do you both see as the most important thing that has changed about how you behave or act with one another?

JOHN: If I could go first on that one, I think I have changed for the better. I never realized how much I expected from Amy, or how selfish I was being. I take time now to consider Amy’s needs too. I ask her what she needs. And I am stoked about helping her get back on track to finish her schooling. For the first time in a long time, I feel really connected to her because I feel like we are on the same page about something important in our lives.

THERAPIST: That’s great, John! Amy, how about you? What do you see as the most important thing that has changed about your behavior?

AMY: Well, I do feel supported by John now. I think for me, the biggest change is that I am actually focusing on my needs. I haven’t done that in a long time. For the first time in years, I am considering what I need too. I don’t feel like I’m being selfish, and I don’t feel racked with guilt that I’m a bad wife or mother. That is a huge step of growth for me.

THERAPIST: That’s terrific, Amy! And to feel supported in your efforts by John has to feel good. How do you think that has helped strengthen your family as a whole?

AMY: I think I can speak for both John and I when I say that we have grown closer together as a family. When I put all of my needs aside, I would get to the point where I felt resentful, irritable, and stressed out sometimes. Now I let John or our daughter know that I need to have some “me time.” That’s when I relax and then focus on what’s important to me for a half hour or so. I think it actually helps me be an even better wife and mom. We frequently ask each other what we need. And then we support each other. It’s made a big difference in our family. I think just that one tool has helped us to grow closer and stronger as a family.

Josh, Sarah, Amanda, and Tyler

Finally, here is a snippet from our last session with Josh, Sarah, Amanda, and Tyler.

THERAPIST: Josh and Sarah, how do you see yourselves as being more resilient as the result of going through this process?

SARAH: I think we have gotten stronger as a family. We have worked together as a family to help Josh. I can’t explain it. I just know that we have become closer. We spend focused time together every day. We focus on the positives in each other. We practice appreciation in our family now. All I know is that the arguing has taken a back seat. We like being around each other now.

THERAPIST: That’s great news, Sarah. Josh, what do you think?

JOSH: Well, I know none of this has been easy. I was feeling sorry for myself, I guess. I still have days like that. I’m not gonna lie. But, it is awesome that we all work together as a family. I can’t say I ever had that with my parents or sisters. It feels good when we do stuff together. When I get frustrated, I try my best not to snap at Sarah or the kids. But if I do, they point it out. Then I remind myself that they are trying to help me, not hurt me. And that we are in it together as a family.

THERAPIST: And how do you feel that your family is more resilient?

SARAH: I would second what Josh said. We work together. It’s like we are driven as a family. We are united. And let me give you an example. One thing we have done, just to make sure we stay positive in our family, is to have an appreciation jar. If any of us complains or says anything negative about each other, that person has to put a dollar for every negative comment in the other person’s jar. Then the other jokes and says, “Hey, I appreciate it, Dad.” Or, “I appreciate it, Mom.” Maybe it sounds goofy. But, when you have to put money in someone else’s jar, it quickly makes you realize what you’re doing. It has helped us to refocus our energy and our thoughts to being positive and expressing appreciation with our mouths, not our wallets (smiles). Somehow, it has bonded us closer together because we just automatically appreciate each other more.

THERAPIST: Amanda, what do you think? How do you think your family has gotten stronger?

AMANDA: I think we work together now. Before, it felt like we were kind of working against each other. Now it feels different. It’s like we are all doing stuff together as a family. I like it much better.

THERAPIST: That’s great, Amanda! Tyler, what about you?

TYLER: I get to swim in the pool with my Daddy every day now. I love doing things with him. And Mommy seems happier too.

THERAPIST: It sounds like your family has come a long way, everybody! Great work! Anyone have anything else they’d like to say as we wrap it up?

SARAH: I do. I think we all realize we can take on whatever comes because we love each other so much. And it feels like now we are in it together as a family.

Final Thoughts

These families have grown more resilient. That is not to say that they will be without struggles, problems, or difficulties in the future, but they have learned a lot. They have grown a lot. In our work with these military families, we watched them learn to communicate more openly with each other. We witnessed a gradual transformation, from negativity and isolating from one another to family members getting to know each other again and spending time with each other. We shared in their struggles and their joys as they reconnected. We supported them as they gave their pain a voice and honestly expressed it with their loved ones. We guided them to look for the positive in each other and appreciate one another more.

We were honored to play a part in helping these family members to work through these steps together. We were moved as we heard their stories of growth—coming from a place of hurt, pain, isolation, and confusion—to deeper love, connection, unconditional acceptance, strength, and resiliency as a family. Our experiences of success with military families compelled us to share these steps with you. It is our greatest hope that the military family members with whom you work will experience this deep healing as well.

Keys to Family Wellness

Taking Action

Taking action will help rebuild the family. Please check off each step as the family accomplishes it.

  • The family should continue to focus on the positive aspects of their situation.
  • The family should take time to think about and express gratitude every day.
  • The family should feel prepared to face the future as a strong and resilient team!