During my one year deployment to Afghanistan in support of Operation Enduring Freedom, VII, I had the opportunity to work with the unseen wounds of combat and operational stress; the hard to quantify psychological injuries. There was one type of injury in particular that caught my attention. However it is not unique to the combat zone. But it is one that is intensified by the distance of the battlefields. I'm talking about the wounds that are often inflicted by the ones we love.

The Combat and Operational Stress Control (COSC) clinic at Bagram Airfield, Afghanistan was being inundated by Soldiers with family and marital complaints. These patients were not troubled by the calamities of combat but rather they were plagued with the agony of failing relationships. As a result, many of these patients were anxious and subsequently developed concentration impairment, sleep disturbance and appetite changes. This symptomatology effectively impaired duty performance, morale and mission effectiveness. Even though these patients presented various problems ranging from affairs, family illnesses to an impending divorce, I noticed some commonalities with these patients. Although some presented with the secondary gain of acquiring a ticket home, the majority evidenced profound inflexibility and immaturity in the quality of their significant relationship. After establishing that my role was to help them cope and return to duty, our therapeutic relationship was posed to get down to business.

One does not ordinarily think about doing marital therapy in a combat zone, but that is essentially what our Soldiers were demanding. Hence, relying on my training and background as a Marriage and Family Therapist, I developed an educational seminar called Relationship 101. The goal of the seminar was to educate deployed Soldiers about how they interact with their family and how their family impacts them, even from a distance. Through the work of the seminar, I further developed a therapeutic group to meet the needs of individuals that necessitated additional help.

More specifically, the seminar and group aimed to promote flexibility and personal responsibility, while concomitantly blunting the anxiety that is often generated from relationship introspection and growth. So often within a relationship, the focus is on the other individual rather than addressing our own shortcomings. Adhering to the path of least resistance, it is far easier to shift responsibility and blame others for one's own problems. Relationship 101 helped Soldiers to recognize where they end and where their partner began. It taught Soldiers to understand the complimentary role they have within their relationships and how to keep those functions flexible. It helped patients become aware of the boundaries if their roles in order to modify and change those roles as needed. Patients further learned how to effect change within their relationships by responding to their partner rather than emotionally reacting. Essentially, Relationship 101 provided insight for pattern recognition and demanded accountability from those enrolled in the curriculum.

Although each installment did not follow a strict curriculum, both the seminar and group emphasized five fundamental components of relationships.

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RECIPROCITY:

Relationships are fluid, reciprocal interactions that tend to compliment each other. Sustaining a relationship takes more than communication skills. Some families are able to cope and flex with the adversities of deployment while others shatter and crumble under the pressure. Deployments are the ultimate test of flexibility for any relationship. Flexible systems tend to survive while the rigid systems tend to suffer damage.

POLARITY:

Opposites do attract; until they are stressed. Then they repel. Many couples are attracted to each because of being opposites. These seemingly opposite roles compliment each other and fill a need. Every relationship has its dance and rhythm. While he is the knight in shinny armor, she is the damsel in distress. While she over-functions, he under-functions. She's close while he's distance. He pursues, she runs. The examples go on and on. These roles are not confined to gender. Roles within a family provide members with connection and predictability. Predictability within these roles provides some stability. However these roles need to flex and change as the needs of the family changes due to growth, crisis or enters into a new lifecycle.

MAGNETISM:

The invisible magnetic powers of the family can hinder any Soldier. Even on foreign soil, the pull and effects of the family are strong. They can feel as if they were in the next room, especially with the plethora of communication options linking home with the area of operations. The pull of the family is felt most when the patient feels helpless to fulfill inflexible roles from afar. Sometimes the magnetic pull comes in the form of guilt, shame, or even blame. It can be self-imposed due to a lack of trust, or a belief that family can not function with out him or her.

IDENTITY:

Deployments jeopardize the identity of traditional roles and rhythms established by the family. Each individual within the relationship are dependent on the other for support and identity. The knight only has a role so long as there is a damsel. Additionally, he can under function so long as she continues to over function. Roles that are rigid risk an identity crisis and typically do not function well with the high demands and distance of a deployment.

SYMMETRY:

Every relationship has a complimentary balance to it; a unique symmetry. Some relationships are too immature to flex when needed. Maturity has nothing to do with the length of the relationship. In fact, the length of the relationship can work against flexibility. "That's the way we've always done it". In order for the relationship to mature, individuals must take responsibility for their selves and individually grow while remaining connected to each other.

With the current frequency and length of deployments, many relationships are taxed to their max. The strain is taking its toll as evident by the many hurting husbands and wives reporting to the COSC. Marital therapy with one individual is equivalent to inoculating the family system. The effects can be felt like ripples though out the system. When, one member changes, the whole system changes. The systemic approach of family therapy provided our Warriors with additional tools to help their relationships flex and grow despite the added demands place on them.

Doing marriage and family therapy with only one partner is nothing new. However, its application in the combat environment has not been described. Although the success of Relationship 101 will not be determined until after our Warriors return home and re-unite, preliminary feedback suggests that a coordinated psycho-educational relationship program in theater would decrease emotional discord and enhance relationship resiliency, and, ultimately conserve the fighting strength and enhance mission effectiveness.

© 2007 Association of Military Surgeons of the United States Provided by ProQuest LLC. All Rights Reserved.