Female and Deployed Into Combat- Part II: An Approach to Group Therapy With Military Women

Part II-
Group Developmental Stages

Other than having PTSD, the women participating in the group have all been cleared of comorbid psychological disorders by psychiatrists. In most therapy groups there is a jockeying for dominance and power. Within this military therapy group there is a power structure already in play because of an actual ranking system. As a Major Patricia is the highest ranking member of the group. Additionally, she has flown top secret missions and therefore everyone defaults to her. Many times officers are viewed by enlisted troops as “not in the trenches” and not “actually working for a living.” There is a saying in military culture that speaks to this amongst the enlisted. If a lower ranking troop refers to a higher ranking troop as “sir” the senior member will often reply, “Don’t sir me! I work for a living.” In other words, the troop is communicating “save the term ‘sir’ for officers who don’t really do anything but sit behind a desk.” Patricia is a Major but has been in harm’s way and has performed duties in combat zones typically reserved for men. She need not do anything except be present to be deferred to. As a civilian I am not the least bit affected by the ranking system. I can treat all members equally without the slightest worry about harming myself professionally. I have kicked out high ranking officers and have given low ranking members opportunities to be heard. As the group leader I do not believe it is healthy for Patricia to be automatically deferred to. Also, I do not want Lisa, the lesbian, to feel intimidated because she is least ranking member.

Therapeutic Interventions and Group Evolution

Patricia tells us that her hair began to fall out when she returned from her eighth deployment to Afghanistan. She asked her doctor if this was normal and he told her it was her body’s way of reacting to stress. Patricia has a PTSD diagnosis presently but is responding well to Cognitive Behavioral Therapy and Reason and Emotional Behavioral Therapy. She takes direction well and her self-disciplined life helps her avoid most panic attacks very well. Angie is showing increased signs of PTSD but does not have a formal diagnosis. She takes Xanax to relax her nerves but I am worried that she may become dependent on pills and less inclined to do the psychological work necessary to find the greatest relief. I am concerned that Angie’s fondness for drinking on the weekends coupled with Xanax will lead her down a negative trajectory. She has severe panic attacks when she thinks about going back to war. I believe she may actually try to harm her professional career as a way to avoid deploying in 13 months. Further, Angie has seen many members lose life and limb by IED’s that her peers also driving convoys have been blown up by. I consider Angie to have Complicated Grief and survivor guilt. She has seen carnage and lost many friends. She needs Bereavement counseling as well. I want to use Mentalization and psychodynamic psychotherapy with Angie to help alleviate some of her stress. Jody is a Captain which is one rank below Major. She is an officer and she is married to a Lt. Colonel attack fighter pilot who is well liked. She has everything going for her. She has served her country honorably and is now looking forward to transitioning into a new phase of her life. She wants to be a mom and she brings this maternal mindset into group. She is empathic and able to connect with all the group members. She can even connect with Lisa the lesbian because her brother is a proud gay man whom she adores. As a Captain Jody can hold her own with me, the therapist, and does not attempt to challenge me or become my favorite. She is a real “gal’s gal” who genuinely cares for the women in the group. Interesting point I note is that Jody has a Bachelor’s degree in psychology. She may pursue her Master’s in psychology now as well. I contain my own counter transference, however, because I feel she may be sizing up my skills as therapist. I am careful not to “perform” for her or become distrustful of her knowledge of psychology. Rosa is pregnant with twins and her husband is currently deployed which heightens her emotional state and affect. She is concerned about her role as a “single mother to twins” which makes her seem unstable and unpredictable to those unfamiliar with the emotions of an expectant mother. I sense that Rosa scares tough girl Lisa who never even wants to have children. Lisa does not seem to be able to connect with Rosa at all while Rosa doesn’t seem to care. Rosa has strict Catholic values and cannot understand why Lisa is a lesbian and “refuses” to be “normal.” Rosa never related to the “military wives” before because they are mostly civilians and she is a proud service member. I find it is crucial to her that she makes every effort to connect with the broad social support network these wives already have in place. Rosa needs to have girlfriends and needs help while her husband is deployed. These civilian wives will be empathic towards her and offer her the structure and support she craves. I think it is Rosa’s best interest to get individual psychodynamic psychotherapy therapy as well as continue in our group. Over time I believe CBT will benefit her too. Margie is showing signs of depression. She is angry more often than not and her temper is easily ignited. She seems defensive and ready to attack. I expect Margie will soon receive a PTSD diagnosis. As a young girl she was bounced around between different relatives because her parents were young and not too well equipped financially or emotionally to handle raising her or her siblings. She decided she wanted a stable life and to be a great wife and mother so she joined the military. She was too naïve to understand that she would unwittingly put her own kids through a very similar cycle due to her and her husband’s deployments. No one saw the 10 year war and multiple deployments coming when she enlisted in 1997. She is resentful at herself for doing this to her kids and resentful towards her husband as well. She is experiencing herself and her husband through her own eyes as a young girl who desperately wanted her parents to come for her and raise her. Margie may need an antidepressant and antipsychotic to help her manage her anger. Perhaps Risperidol and Wellbutrin would be a good combo to suggest to the psychiatrist. I think psychodynamic psychotherapy combined with psychopharmacology will help Margie cope better and understand herself more. Eventually CBT will work for her to keep herself on track and push back any mood disorders she may have.