Healing Stress in Military Families, Eight Steps to Wellness

Loroe T. Decarvalho and Julia M. Whealin: Healing Stress in Military Families, Eight Steps to Wellness. John Wiley & Sons, Hoboken, NJ, 2012, 230 pp., $55.00, ISBN: 978-1-118-03821-5.

Members of the military face significant stressors not just during deployment, but also upon return to their families. The physical and emotional changes that occur when service members witness or experience injury, death, or other dangers, can make it challenging for these individuals to re-integrate into family life. During a service member’s deployment, family members also undergo stressors of their own as they attempt to cope with their own fears while managing daily life tasks. Healing Stress in Military Families attempts to address the challenges service members and their families may encounter upon members’ return home and suggests using an accessible, strengths-based model for treatment.

As a whole, this book is a well-organized and descriptive manual geared towards managing challenges associated with readjustment to family life. It includes eight chapters, each of which identifies one “step to wellness” within a cognitive-behavioral-therapy (CBT) framework (the steps are: Connect, Explain, Discover, Empower, Improve, Process, Challenge, Grow). The topics covered in each chapter are meant to build upon each other, so the authors recommend that the steps are practiced in order. Each chapter begins with a quote, an introduction, and a family scenario illustrating the topic; together, these components present a clear overview of the chapter goals and a general description of the technique(s) to be learned.

“Making it Real Exercises” and “Talking Points” sections in each chapter provide in-session activities and follow-up discussions to practice and process the skills to be learned. In addition to the typical CBT worksheets (e.g., checklists, Likert-type scales) and brief written exercises, the authors also incorporate experiential activities such as one where family members are encouraged to make a collage reflecting their views of the family unit (pp. 24–25). Furthermore, take-home exercises, which allow families to practice the topic outside of the session, are identified at the end of each chapter.

Each chapter also includes empirical data about the topic explored within, including information from current peer-reviewed research. Brief sections at the end of each chapter summarize the major goals that, when met, reflect mastery of the topic. Finally, the appendices of the book include copies of handouts for families to use, as well as a resource guide directed towards military members, veterans, and their families.

Each of the steps has a strong foundation in cognitive-behavioral theory, and includes techniques, such as identifying positive and negative coping strategies (Step 3: Discover), and cognitive restructuring (Step 5: Improve). As emotional identification and expression is key to processing experiences—including trauma—and to empathic communication between individuals, an entire chapter (Step 6: Process) is devoted to understanding family members’ experiences of emotion.

Despite its cognitive-behavioral therapy roots, the book avoids jargon so that professionals or laypeople unfamiliar with CBT can clearly understand the therapeutic goals and processes of each section. As the authors do not presume prior familiarity with cognitive-behavioral techniques, clear descriptions of specific CBT techniques such as Socratic questioning (pp. 77–78) are interspersed in the book.

The authors identify the manual as a guide for both treatment providers and laypeople; however, it seems most appropriate for use by a clinician who has been trained to successfully navigate discussions around challenging topics such as traumatic stress or sexuality. Moreover, the level of detail included occasionally seems somewhat technical (e.g., research findings described within each chapter; the description of traumatic brain injury and polytrauma syndrome, pp. xxiv–xxvi), thereby more suitable for clinicians.

The book title suggests a focus on family processes. However, although a handful of activities and interventions are suitable for family members of all ages, the majority seems geared towards the parent/couple dyad (e.g., handout for “Defining Intimacy in the Relationship,” p. 176). Although older adolescents may be able to participate in some activities, most are too developmentally sophisticated for young children (e.g., handout for “Assessing Needs and Clarifying Values,” pp. 185–186).

Despite the ambiguity of its audience, this book is well-organized and provides interventions that directly address many challenges faced by military families. These interventions are concrete, structured, and empirically supported. Further, families hesitant to engage in mental health services may be more receptive to the strengths-based approach outlined in this manual, which includes a psychoeducational component and normalizes many of the challenges faced by military families. Overall Healing Stress in Military Families is clearly written, descriptive, and practical. It is recommended for use with couples and families with older children who are experiencing difficulties adjusting to a service member’s redeployment and reintegration. It would be especially valuable for a clinician who has limited familiarity with CBT or limited experience working with couples in a military population.