|
| A) | 1.21 million | ||
| B) | 3.47 million | ||
| C) | 7.47 million | ||
| D) | 8.49 million |
According to the U.S. Department of Defense, there were 3.47 million military personnel as of 2021 [6]. The Army has the largest number of active duty members, followed by the Air Force, the Navy, and the Marine Corps [6]. In 2021, California, Virginia, and Texas were home to the greatest number of active duty military personnel [6]. Men make up the majority of active-duty personnel at 81.1%, with women comprising the remaining 18.9%. Since 2005, the percentage of active-duty female members has increased 15.6% [6]. Women are a growing segment of users of Veterans Administration services [8]. The majority of active-duty personnel are white, with 29.5% classifying themselves as belonging to a racial/ethnic minority group. Among activity-duty members, Black Americans are the largest racial/ethnic minority group (19%); the smallest segment is Native American Indians (1.1%) [6]. Approximately 23.1% of active-duty officers are 41 years of age or older. However, 50.8% of enlisted active-duty personnel are 25 years of age or younger [6]. A large proportion (84.6% of officers hold a Bachelor's degree or higher education, and the vast majority (99.4%) of active-duty enlisted individuals have graduated from high school and/or have completed some college [6]. In addition, one-half of the active-duty force is married, with 7.0% of active-duty personnel in dual military marriages [6]. In general, military individuals tend to marry at a younger age compared to the civilian population [9]. Both active duty and reserve personnel have an average of two children [6].
| A) | 38.9% | ||
| B) | 50% | ||
| C) | 77.8% | ||
| D) | 91.1% |
According to the U.S. Department of Defense, there were 3.47 million military personnel as of 2021 [6]. The Army has the largest number of active duty members, followed by the Air Force, the Navy, and the Marine Corps [6]. In 2021, California, Virginia, and Texas were home to the greatest number of active duty military personnel [6]. Men make up the majority of active-duty personnel at 81.1%, with women comprising the remaining 18.9%. Since 2005, the percentage of active-duty female members has increased 15.6% [6]. Women are a growing segment of users of Veterans Administration services [8]. The majority of active-duty personnel are white, with 29.5% classifying themselves as belonging to a racial/ethnic minority group. Among activity-duty members, Black Americans are the largest racial/ethnic minority group (19%); the smallest segment is Native American Indians (1.1%) [6]. Approximately 23.1% of active-duty officers are 41 years of age or older. However, 50.8% of enlisted active-duty personnel are 25 years of age or younger [6]. A large proportion (84.6% of officers hold a Bachelor's degree or higher education, and the vast majority (99.4%) of active-duty enlisted individuals have graduated from high school and/or have completed some college [6]. In addition, one-half of the active-duty force is married, with 7.0% of active-duty personnel in dual military marriages [6]. In general, military individuals tend to marry at a younger age compared to the civilian population [9]. Both active duty and reserve personnel have an average of two children [6].
| A) | Military spouses' wages tend to be higher compared to their civilian counterparts. | ||
| B) | Children express gratitude at getting to leave established relationships and routines. | ||
| C) | Parents report that multiple relocations can help children learn important skills of adjusting. | ||
| D) | Military spouses tend to have an easier time finding jobs because their experiences make them more desirable to employers. |
It has been said that the military is an example of a social institution that is "greedy," meaning that the military requires from its members a great amount of commitment, loyalty, time, and energy, which ultimately affects other role commitments [10]. Family members of military personnel are expected to relocate frequently, and this uprooting necessitates spouses and children to make transitions and adjustments to their lifestyles, to make new friends, and to develop new social networks [10]. For example, it is estimated that 20% of families in the United States relocate annually; however, approximately 33% of military families relocate each year [11]. It is estimated that children of active-duty parents will move more than 20 times over the course of their childhood, three times more often than their civilian counterparts [7]. Inevitably, the frequency of relocations brings about multiple levels of stress. In a focus group of military youths, military spouses, and school personnel, the youths stated that they sometimes felt angry toward their parents for having to move multiple times and expressed a feeling of loss for having to separate from friends. Some wondered whether it was even worthwhile to invest in making new friends. Some parents felt that multiple relocations could help children learn important skills of adjusting, but indicated concern that it would affect the children's ability to make commitments to relationships.
Military spouses tend to have a more difficult time finding jobs because their transience makes them less desirable to employers [10]. When they do find jobs, their wages tend to be lower compared to their civilian counterparts who share the same demographics (e.g., age, educational level, ethnicity/race) [12]. In some cases, career advancement may be negatively affected [7]. Those who are not working and not seeking work report that there are too many barriers to employment including child care issues and the demands of the military lifestyle. Although some of these barriers are experienced by civilians as well, military families frequently cannot rely on extended family members for support [12]. In addition, military personnel often work long and unpredictable hours, which also impacts the family and the scheduling of activities. It is estimated that service personnel work an average of more than 50 hours per week, and it is higher (60 hours per week) for officers [10].
| A) | Camaraderie | ||
| B) | Supportive family networks | ||
| C) | Job security and retirement benefits | ||
| D) | All of the above |
Despite the negatives of a military lifestyle, there are many positive benefits for families as well. There is a sense of belonging among families living on base or post, and they rely on each other for support. Military service members experience a sense of camaraderie, and their family members may also experience this sense of deep rootedness and affiliation. There are also financial benefits, as military families have access to medical care, job security, and other benefits, often extending into retirement [10].
| A) | open. | ||
| B) | hierarchical. | ||
| C) | undemanding. | ||
| D) | female-dominated. |
Military culture is also hierarchical and male-dominated. Consequently, ideals of being tough, self-sufficient, and strong (i.e., "the masculine warrior") are reinforced, with the belief that these norms will help to ensure that service members are mission-prepared and will survive in difficult circumstances [16,17]. Emanating from this norm is the belief that all problems can be solved given enough time and effort [103]. This belief, referred to as the "warrior ethos," is based on the conviction that the mission is paramount and defeat should not be accepted [104]. The common mottos "tough it out" and "push through" conveying the importance of perseverance and overcoming adversity [136]. This belief is conveyed at the very start of recruits' training, during which they are taught that selfless service is paramount [136]. However, the downside of this type of promoted ideal is that experiences of psychologic, social, and/or emotional distress are viewed as signs of weakness; the military tends to reinforce the notion that a true soldier (or airman, seaman, etc.) does not need assistance [13,16]. Therefore, obtaining formal help further places them at risk for stigmatization [16]. As a result, many rely on the peer support of other military service members rather than professional help [18]. This mutual support has its benefits, but it only goes so far.
| A) | Acceptance | ||
| B) | Deployment | ||
| C) | Sustainment | ||
| D) | Reintegration |
The cycle of deployment and the associated transitions made by military personnel and their family members are significant. This cycle consists of five different phases: pre-deployment, deployment, sustainment, redeployment, and post-deployment or reintegration. In each of these phases, military personnel, spouses, children, and other family members experience a range of challenges and adjustments [21].
| A) | traumatic grief. | ||
| B) | ambiguous loss. | ||
| C) | complicated grief. | ||
| D) | disenfranchised loss. |
The next phase is the actual deployment, when the service member departs. It is the separation phase, and for some families, the holding pattern of the pre-deployment phase is so stressful that the actual deployment is viewed as a temporary relief of the anticipation of separation [21]. This loss associated with deployment is referred to as "ambiguous loss," meaning it is not physical but psychologic [23]. Unlike death, a permanent physical loss, the family of the military personnel experiences ongoing psychologic loss, and this uncertainty can lead to difficulties in decision making and planning for the future [22]. Within this context, spouses may experience negative mental health symptoms. In one study, spouses of deployed service members experienced higher levels of anxiety, depression, sleep disorders, and adjustment disorders compared with those without deployed spouses [24]. In a qualitative study about the stressors impacting military families during the Desert Storm deployment in the early 1990s, researchers found that families experienced three types of stressors: emotional (e.g., missing the deployed family member, feeling anxious about his/her safety), the day-to-day practicalities of life (e.g., budgets, powers of attorney, child care), and general life events [25]. The major stressors the families identified were loneliness, financial concerns, and childcare and disciplining. Not all families had social support networks readily available, as family, friends, and/or other extended family members were often not living nearby [25]. With modern video communication options (e.g., Skype), family members can see and speak in real time with the deployed family member. These opportunities may mitigate anxiety and loneliness, but witnessing realities of combat (e.g., hearing explosions or seeing injuries) may be traumatic, especially for children [105].
| A) | sustainment phase. | ||
| B) | reintegration phase. | ||
| C) | redeployment phase. | ||
| D) | post-deployment phase. |
The redeployment phase, also called the reunion phase, involves notification that the deployed family member is returning home. Both the deployed individual and the family members prepare themselves for the homecoming, and there is a tremendous amount of anticipation [26,27]. As with any potential change in the family system, there may be some anxiety about how the returning family member will affect the routines that have been established and the power and role dynamics and relationships [26,27]. During this time, family members are often attempting to prepare for the homecoming to ensure that everything is as perfect as possible [28]. Children may be asked to help in order to prepare.
| A) | Deployment | ||
| B) | Redeployment | ||
| C) | Pre-deployment | ||
| D) | Post-deployment |
Some military families will encounter challenges during the post-deployment phase, including substance abuse, post-traumatic stress, and domestic violence. In fact, it is estimated that the rate of relationship and family problems is four times higher during this phase than the other phases [29]. In a study involving 19,227 active U.S. soldiers from brigade combat teams who served in Iraq or Afghanistan between 2003 and 2009, problems of marital quality were reported and separation/divorce intentions increased during the reintegration period [51].
| A) | Ecologic theory | ||
| B) | Resilience theory | ||
| C) | Family systems theory | ||
| D) | Strengths-based perspective |
Ecologic theory is based on the inter-relationships of the individual and his/her behaviors on four different levels: macrosystem, exosystem, microsystem, and ontologic [34]. The core assumption is that alignment between individuals and the environment in which they operate is necessary, as resources and support are derived from the environment [35].
| A) | Overcoming the odds | ||
| B) | Sustained competence | ||
| C) | Recovery from trauma | ||
| D) | All of the above |
There are three categories of resilience [39]. The first is overcoming the odds, which encompasses positive outcomes despite adverse conditions. The second category is sustained competence, which involves being able to harness inner and outer resources to cope with adverse conditions. Finally, the third category is recovery from trauma, which comprises the capacity to move on, progress, and function in a healthy manner despite past and ongoing stressors.
| A) | True | ||
| B) | False |
There is a misconception that military spouses fall apart when their spouses are deployed. Some research indicates that spouses who are left behind take over family decision making, assume new roles, and seek assistance, ultimately demonstrating tremendous role flexibility [41]. Indeed, military families tend to be resourceful, flexible, and adaptable due to the many transitions they have undergone. Examples of resiliency in these families include an enhanced ability to make new friends, deftly transitioning from dual-parent to single-parent households and back, and adjusting to diversity [39].
| A) | Positive outcomes occur despite adverse conditions. | ||
| B) | The sociocultural context of the military affects families. | ||
| C) | Humans have the strengths and resources necessary to change the circumstances of their lives. | ||
| D) | Within all family structures, there are boundaries that determine who belongs in which subsystem. |
The strengths-based perspective was developed in the 1980s in order to move away from traditional theoretical models in mental health care that emphasized deficits and pathology [42]. It is now applied in many areas of mental and behavioral health. The core assumptions of the strengths-based perspective are that humans have the strengths and resources necessary to change the circumstances of their lives, and in doing so, they can learn and grow [42]. Strengths include a client's innate abilities and skills as well as external resources in the community and family. After the problem is identified, the goal is to move away from focusing on naming the problem or deficit and to move toward identifying possible solutions [43]. The strengths-based perspective encompasses honoring the past and acknowledging the gifts of varied life experiences [111]. In the case of working with families with a deployed member, the practitioner will not necessarily focus on asking one family member why he or she is depressed. Instead, the practitioner will spend time and effort with the client identifying the strengths within the individual, the family, and the community that can be garnered to help support the family members during deployment. Military families, like any family, experience challenges and strengths, and the strengths-based perspective is beneficial in working through issues unique to these families' circumstances [44]. For example, a family can focus on the benefits that result from the numerous relocations (e.g., new skills, adaptability) [103]. Families that value the social connectedness of living on a military base are more likely to adjust to family stressors [144].
| A) | True | ||
| B) | False |
The types of stressors that military families experience vary tremendously depending upon numerous factors; therefore, it is important to keep in mind that there is no one homogenous military family system. Families who have experienced multiple deployments may have developed coping mechanisms and family rituals to handle the family member's departure. Living on or off a military base can also affect the types of stress family members experience. For example, if a family is surrounded by others with deployed members, there may be a shared understanding of deployment and necessary adjustments. Living in a non-military community may translate to less understanding of the emotional strains that a military family member is going through and greater levels of isolation [29]. Young, recently married military families may experience the greatest amount of stress because they are less financially stable [13]. Young enlistees are usually a lower hierarchical rung of the military, with low pay, and the economic stress can be great for family members who are left behind. Some may require government assistance, which can negatively impact self-esteem [13].
| A) | Excessive lying | ||
| B) | Security restrictions | ||
| C) | Inability to convey intent with nonverbal gestures | ||
| D) | Technical challenges related to unreliable communication |
In research involving deployed military personnel and their communication with their spouses, barriers to communication included security restrictions, technical challenges related to unreliable communication, and translation issues [145]. Using a large-scale dataset from the Millennium Cohort Family Study with a sample of 1,558 military service members and their spouses, stressful communication during the deployment stage affected both spouses' perceptions of stress at the reintegration or reunion stage [145]. Because family members are so far removed from the realities of a war zone, it can be difficult for military personnel to satisfactorily express their experiences and feelings. The problems with translation stemmed from being unable to convey intent with nonverbal gestures, facial expressions, and tone of voice can lead to "mistranslated" information [49].
| A) | Lack of information | ||
| B) | Free communication | ||
| C) | Excessive childcare help | ||
| D) | Military training preparing spouses for long separations |
In a study of 300 married couples in which the deployed husband was active duty in the Army and the wife was a civilian, stress existed for both partners [52]. However, it was higher overall for the wives, despite the fact that the husbands experienced more physical threat. The researchers speculate that there may be several reasons for this trend. First, the husbands' military training may help them to better deal with the stressors or perhaps make them more reluctant to admit to stress. The lack of information given to the wives was found to increase their stress levels [52]. It is not surprising then that a study examining outpatient medical visits of wives of active-duty Army personnel during a three-year period found that 36.6% had at least one mental health diagnosis, compared with 30.5% of wives whose husbands were not deployed [24]. The most common diagnoses included depression, anxiety, sleep disorders, and acute stress and adjustment disorders [24]. Prolonged periods of deployment were associated with higher risks of mental health diagnoses and greater frequency of medical outpatient visits [24].
| A) | Anxiety | ||
| B) | Depression | ||
| C) | Sleep disorders | ||
| D) | Antisocial personality disorder |
In a study of 300 married couples in which the deployed husband was active duty in the Army and the wife was a civilian, stress existed for both partners [52]. However, it was higher overall for the wives, despite the fact that the husbands experienced more physical threat. The researchers speculate that there may be several reasons for this trend. First, the husbands' military training may help them to better deal with the stressors or perhaps make them more reluctant to admit to stress. The lack of information given to the wives was found to increase their stress levels [52]. It is not surprising then that a study examining outpatient medical visits of wives of active-duty Army personnel during a three-year period found that 36.6% had at least one mental health diagnosis, compared with 30.5% of wives whose husbands were not deployed [24]. The most common diagnoses included depression, anxiety, sleep disorders, and acute stress and adjustment disorders [24]. Prolonged periods of deployment were associated with higher risks of mental health diagnoses and greater frequency of medical outpatient visits [24].
| A) | True | ||
| B) | False |
It is interesting to note that anxieties and fears about deployment can also bring couples closer. Some military wives indicated that the fear of possibly losing their spouse increased the level of communication and intimacy in the marital dyad. The deployed husbands expressed similar sentiments, reporting valuing their wives and marriages more [48]. Consequently, it is crucial not to generalize all military marriages as burdened with stress and marital discord due to deployment. For example, older spouses, those who are married to military personnel in higher ranks, and spouses with more military experience tend to experience fewer challenges [53]. Protective factors that can mitigate marital stress and instability include couples' communication and their involvement with and access to formal and informal support and resources [146].
| A) | Parental deployment may negatively impact a child's need for security. | ||
| B) | Boys tend to have more difficulties during the reintegration phase than girls. | ||
| C) | The most consistent predictor of how well a child will adjust to a parent's deployment is the length of the deployment. | ||
| D) | It is the length of the current deployment, not the cumulative length of all separations, that correlates with psychologic challenges for the child. |
Attachment theory may provide a helpful theoretical framework in understanding the potential effects of parental deployment on children. Attachment theory is based on the belief that children have a need to attach themselves to a key figure, such as a parent, and separation results in displays of emotional distress. The parental bond is crucial to developing healthy emotional relationships when the child moves to adulthood; childhood separation is linked to depression, anxiety, aggressive behaviors, and other emotional and psychologic problems throughout life [54]. Based on attachment theory, lack of secure relationships with peers, teachers, and/or other authority figures could also have adverse consequences. It is estimated that, on average, military children attend six to nine different schools by the end of high school.
| A) | Neglect | ||
| B) | Sexual abuse | ||
| C) | Physical abuse | ||
| D) | Psychologic abuse |
In one review of the Army's central registry, researchers found that, between 1989 and 1997, there were 61,827 initial substantiated cases, 5,772 subsequent incidents, and 3,921 reopened cases [60]. Victim rates varied between 8 and 10.5 per 1,000 married persons. More than 65% of the victims were female, and almost half of the referrals were from law enforcement. The vast majority (93%) involved physical violence resulting in minor injuries [61]. Other Department of Defense data indicate that 19 of 1,000 Navy and Air Force wives and 21 of 1,000 Army wives were abused in the last year. In a 2010 analysis of data from the U.S. Air Force Family Advocacy Program, there were a total of 33,787 substantiated incidences of spousal abuse [62]. Physical abuse was the most frequent type of abuse to be substantiated, while neglect was the least likely to be substantiated. Newer reports from the Congressional Research Service indicate that among the active-duty population, there were 16,912 reported incidents of spouse and intimate partner abuse in 2018. Among these, 8,039 reports (6,372 victims) met the DoD definitions. Physical abuse accounted for the highest number of reports (73.7%), followed by emotional abuse (22.6%), sexual abuse (3.6%), and neglect (0.06%) [63]. A meta-analysis assessing 69,808 military participants found that the pooled prevalence rate for physical intimate violence was 21% among men and 13.6% for women [153]. In another study, most of the physical and verbal violence reported was mutual, and more research is needed to evaluate the extent to which mutual violence is occurring [154].
| A) | 3% | ||
| B) | 13% | ||
| C) | 33% | ||
| D) | 53% |
Female veterans appear to be at increased risk of physical and sexual violence from their intimate partners (33%) compared with nonveteran counterparts (23.8%) [66]. Female veterans who experienced previous childhood sexual abuse are three times more likely to be victims of spousal abuse, and those who experienced an unwanted incidence of sexual victimization during military service were more likely to have experienced interpersonal violence in the last year. Being in the Army (versus other military branches) is also a risk factor for past-year victimization [131]. In a study examining directionality of abuse, a sample of 248 women enlisted in the Army and married to civilian spouses were assessed for domestic violence [64]. Researchers found that the enlisted women were four times more likely to be victimized by minor violence and three times more likely to be victims of severe violence than to be perpetrators. A disconcerting 60% of all types of violence reported was bi-directional (i.e., both parties were inflicting the violence) and severe [64]. These couples tended to be younger and more recently married. Furthermore, if an enlisted woman's spouse was employed less than full-time, bi-directional violence was more common compared to families with full-time employed civilian spouses.
| A) | True | ||
| B) | False |
In 2021, the Department of Defense reported a rate of child abuse and neglect of 13.2 per 1,000 children [155]. The overall rate of child maltreatment in the United States appears to be decreasing, but rates in military families may be increasing [155]. According to a study published in 2013, there was a 40% increase in cases of child abuse in Army families between 2009 and 2012 [68]. Interestingly, in a study of child abuse in Air Force families, emotional abuse was the most likely to be substantiated, with physical abuse the least likely to be substantiated [62].
| A) | True | ||
| B) | False |
Among all military service members, the overall prevalence rate for heavy alcohol use in the past 12 months is 5.4% [73]. A Department of Defense report indicates that the heaviest rates of drinking were among Marines (12.4%), followed by the Navy (6%), Army (4.1%), Coast Guard (3.5%), and Air Force (2.7%) [73]. When comparing illicit substance use among civilian and military populations, civilian past-year usage is higher (16.6%) compared with military servicemen and women (0.7%). This lower rate of illicit substance use is due in part to the military's random testing procedures and zero-tolerance policies [73]. According to the Department of Defense, in 2021, there were 100,000 deaths related to opioid misuse, an increase of 15% compared with 2020 [158]. There has been some speculation that veterans and service members with PTSD may be self-medicating with opioids [158]. Military spouses are also affected by the opioid crisis. In one study, 48% of military spouses had employed their health insurance to fill at least one opioid prescription in the Military Health System during a two-year time period [159]. During this same time, 7% met the criteria for high-risk opioid prescriptions. Adverse childhood experiences, social isolation, and experiencing physical pain were predictors of high-risk opioid prescriptions.
| A) | True | ||
| B) | False |
For military families, deployment and reintegration trigger additional stressors that can lead to substance and alcohol abuse. For example, servicemen and women returning from deployment have a higher prevalence rate of new-onset drinking problems compared to nondeployed active-duty personnel [76]. In a study examining veterans returning from Iraq, 13.9% of the veterans were determined to have probable post-traumatic stress disorder (PTSD), 39% probable alcohol misuse, and 3% probable substance abuse [77]. Military members who have been in combat and who have PTSD are more likely use substances and alcohol to cope [78]. However, one study found that a clinical diagnosis of PTSD was a less important predictor of alcohol, substance, or aggressive behavioral problems than the presence of symptoms of a stress response [78]. In another study, the prevalence rate for alcohol use disorder among transgender service members was 8.6%; the rate for drug use disorders was 7.2%, and the rate of comorbid alcohol and drug use disorders was 3.1% [161]. Social and economic stressors, such as housing instability, family problems, and military sexual trauma, were more prevalent among this group. The authors recommended targeting social and economic risk factors in screening and interventions for this highly marginalized group.
| A) | Military Visual Assessment Tool. | ||
| B) | Post-Deployment Health Assessment. | ||
| C) | Post-Deployment Psychological Screener. | ||
| D) | post-traumatic stress disorder diagnostic evaluation. |
Military personnel returning from deployment are required to complete the Post-Deployment Health Assessment [79]. This medical screener is composed of 10 mental health questions and must be completed by a medical provider within 30 days of returning from military assignment [79]. In addition, the mental health departments in the Army and Navy use the Post-Deployment Psychological Screener, which consists of 22 questions assessing for symptoms for depression, PTSD, communication issues, interpersonal problems, alcohol abuse, and anger [79]. PTSD is commonly assessed due to the many distressing events that military personnel experience in combat. However, avoidance behaviors such as substance and alcohol abuse, withdrawing from others, and dissociating should be assessed as well [80].
| A) | True | ||
| B) | False |
Visual assessment tools can be helpful during the assessment phase. Deployment narrative maps, for example, can be used. The goal with these tools is to have family members tell their stories about deployment individually and describe how it brought about concerns, stresses, and challenges [82]. Any family challenges identified in the stories are graphically depicted on a timeline. After everyone completes their narrative, all family members are brought into a family session to review the deployment narrative maps and see how certain events triggered stress or reactions. Not only can narrative maps be used as an assessment tool but they can instigate greater communication and foster problem-solving strategies [82].
| A) | Yoga | ||
| B) | Deep breathing | ||
| C) | Physical exercise | ||
| D) | All of the above |
Interventions to teach family members and military personnel how to regulate emotional responses, such as anger, frustration, and numbness, are vital. This includes skills such as deep breathing, yoga, meditation, exercise, and other deactivation activities that can decrease the intensity of stress reactions and even trauma [84]. When a deployed man or woman returns home, it is inevitable that things will have changed for the whole family. All family members will have to adapt to a "new normal" [84]. This "new normal" may mean adjusting to physical injuries and the new caregiving activities associated with new limitations. Practitioners may help the caregiving spouse engage in self-care and reduce stress [85]. During deployment, there is also a "new normal," however temporary, and the now single parent may benefit from concrete child-rearing and parenting strategies (e.g., specific scripts to use when feeling angry or tips for providing clear directions to children) [85]. Similarly, children may require assistance regulating their emotions and communicating their fears and anxieties when a parent deploys or returns home injured or traumatized [85].
| A) | True | ||
| B) | False |
Home visiting interventions have become more popular for military families in part because they reduce the stigma of public help-seeking [126]. These interventions are implemented in the home and reflect a strengths-based perspective; many help family members handle deployment, address communication challenges, cope with isolation and loneliness, and connect family members to support and resources [126].
| A) | True | ||
| B) | False |
One of the main ethical dilemmas for practitioners employed by the military is the issue of dual relationships. Practitioners working with military families often have multiple roles, which can cause ethical tension [128]. For example, counselors should have a goal of building rapport and conveying empathy, but this can be difficult if the counselor outranks the client. Alternatively, counselors are expected to act in the role of expert, but this can be difficult if he or she is subordinate to the client [128]. Furthermore, practitioners who reside and work on military bases may frequently encounter their military clients and family members, which challenges personal and professional boundaries [171].
| A) | A gradual lessening of compassion over time | ||
| B) | Traumatic physical injury experienced by bystanders | ||
| C) | The natural, consequent behaviors and emotions resulting from knowledge of a traumatizing event | ||
| D) | Extreme stress experienced by practitioners that depletes emotional, mental, physical, and psychologic resources |
Burnout refers to extreme stress experienced by practitioners that depletes emotional, mental, physical, and psychologic resources [96]. Signs of burnout include depression, physical and mental exhaustion, anger, cynicism, acting out, frustration, lack of productivity at work, and difficulty controlling feelings [97]. A practitioner experiencing burnout often feels drained or tired and at times emotionally detached from clients [96]. Vicarious trauma is defined as "the natural, consequent behaviors and emotions resulting from knowledge about a traumatizing event experienced by a significant other. It is the stress resulting from helping or wanting to help a traumatized or suffering person" [98]. Vicarious trauma can affect practitioners' beliefs about the world, others, and self, including concepts of safety, trust, control, and intimacy [99]. Hearing stories of trauma, military missions, and killings, as well as family members' anxieties and fears, can affect practitioners' worldviews, their own sense of safety and control, and sense of self [100]. Some practitioners will help deal with a military member's death and family members' loss and grief, which can ultimately raise personal reactions to death [100]. Practitioners should engage in self-care techniques, including seeking social support, spending time with friends, engaging in hobbies and recreational activities, and seeking out other professionals for consultation and professional supervision in order to address vicarious trauma and avoid burnout.