For more than 20 years, trauma specialist Robin Gurwitch, PhD, has successfully used the evidence-based intervention known as parent-child interaction therapy
to improve caregivers’ parenting skills, children’s behavior and
parents’ stress levels. The intervention is easy to learn, fun for
participants, and it doesn’t take long to complete, the Duke
University Medical Center psychologist says.
“I still get excited about it because positive changes happen
so fast,” she says.
Given the stress that military families face, in 2009, Gurwitch
reasoned they might benefit from the treatment as well. With
funding from the Substance Abuse and Mental Health Services
Administration and in collaboration with colleagues at several
military bases, her team developed a protocol for implementing
the therapy with military families. In 2013, 11 families
completed the tailored treatment.
Preliminary results show the adaptation is working: Parents’
stress levels went down, their parenting skills improved, and
the couples even reported greater marriage satisfaction. Their
children’s behavior also improved significantly. Now the team
plans to implement the intervention with more than 60 military
families nationwide in an expanded demonstration project.
The program is just one example of the ways psychologists
are adapting resiliency treatments to help military families and
couples. The programs share several features: They are evidence-based, they are often tweaked from interventions already shown
to work with other populations, and they are standardized across
sites, so if families move — as military families often do — they
can reconnect with the program right where they left off.
An added plus? Families say they enjoy the treatment. “They
show up for appointments, they do what is asked of them, and they
complete their homework assignments,” Gurwitch says with a grin.
The best of these interventions align with APA’s and the
federal government’s emphasis on family well-being as a
key component in ensuring the long-term health of service
members, says Heather O’Beirne Kelly, PhD, APA’s lead staffer
for military and veterans policy.
“Family interventions are particularly important with the
people who served in Iraq and Afghanistan because unlike in
previous conflicts, about half have children, many of them very
young,” she says.
“Parenting young children and negotiating the many
stressors associated with all phases of deployment can present
a major challenge,” she adds. “We are thrilled to see the
Department of Defense collaborating with psychologists to
employ empirically based programs that capitalize on military
families’ resilience and strengths.”
Effective parent training
Parent-child interaction therapy combines coaching, practice
and support to ensure that parents learn positive parenting skills.
The treatment starts with the therapist observing from
behind a one-way mirror how parents and children interact in
increasingly demanding situations. In one five-minute interaction,
for instance, the parent is told to let the child take the lead in
play; in another, the parent takes the lead while the child follows.
All interactions are assessed using a coding system derived from
previous research to allow therapists to monitor progress and give
feedback to parents about how well they’re mastering skills.
Based on the interaction the therapist observes between the
parents and child, the therapist then coaches parents in skills
designed to improve the relationship and address behavioral
concerns. For example, parents are coached in how to use
specific praise statements to improve behaviors or follow a
specific protocol to manage a child’s defiant behavior.
Parents then practice the skills at home with their children
for a “therapeutic dose” of five minutes a day, Gurwitch says.
Knowing that parent-child interaction therapy had been
successfully adapted in families where a member had a cognitive
impairment, Gurwitch and colleagues are adopting some of the
same strategies for military families coping with traumatic brain
injury. The team will be assessing families for PTSD symptoms.
While the tailored treatment is not designed as a PTSD
treatment per se, the researchers are hoping to minimize such
symptoms by helping to create a calmer, more predictable, and
more stable home environment for both parents and children —
a hypothesis she and others will examine in future research.
“We believe parent-child interaction therapy may help to
complement ongoing PTSD treatment,” Gurwitch says.
Helping families and couples connect
Another prevention and resiliency intervention that draws from
successful evidence-based programs in nonmilitary populations
is FOCUS, or Families OverComing Under Stress, designed for
military families with children ages 3 to 18. FOCUS has been
implemented at 22 major military installations nationwide and
served thousands of family members to date. The researchers
have adapted it for couples, families with very young children
and families that include service members who are wounded,
ill or injured. They also have tailored it for different service
branches and groups, including the Navy SEALs.
A 2012 American Journal of Public Health study of 331
Psychologists are adapting evidence-based resiliency programs
to help military families, couples and children.
BY TORI DEANGELIS