Complex PTSD vs. PTSD treatment approaches
Summary
Deployment affects military family mental health at every stage: pre-deployment anxiety, separation, reunion, and reintegration. In families with children, the at-home parent's stability and pre-deployment communication are the two most critical protective factors.
Screen for PTSD early and often. Use tools like the PCL-5 immediately after deployment. Evidence-based treatments (CPT, PE, and EMDR) are most effective when started quickly, and combining individual trauma therapy with family work increases retention.
The non-deployed parent's mental health directly impacts children. A struggling at-home parent amplifies a child's distress. Connecting that parent with resources, respite care, and mental health support isn't just good for them; it's essential for the children.
Proactive military relationship counseling prevents crises. Offering couples therapy before, during, or immediately after deployment is far more effective than waiting for relationships to deteriorate. EFT, IBCT, and CBCT are proven interventions for military couples.
Therapists supporting military family mental health provide specialized counseling for deployment stress, trauma, and transition challenges.
This is especially true during high-stress transitions, such as when a new deployment is announced or another cross-country move is around the corner.
The trauma of war reshapes a parent’s psyche, and reintegration into civilian life can be anything but smooth.
Military families cycle through intense moments that would threaten anyone’s mental health. The data shows it: PTSD, anxiety, and depression are elevated in military families compared to civilian averages.
Supporting military family mental health and providing military relationship counseling requires more than clinical skill.
It requires understanding a world that most Americans never see.
How to handle deployments
The deployment cycle starts when a military member learns they are leaving. Pre-deployment anxiety, months of separation, reunion day, and the reintegration process are all phases of a deployment that carry a unique emotional weight.
According to the American Psychological Association (APA), “Military families may struggle with significant psychological distress before, during, and after a service member’s deployment.”
When considering how to handle deployments, it is important to understand and normalize the wide range of emotions the family might face.
There are several aspects of care that can support military family mental health when facing deployment.
Assessing and promoting protective factors
Early assessment should include the family's existing protective factors: coping skills, family cohesion, social networks, and awareness of military-specific resources, including guidance on how to access resources for support before deployment. Strengthening these foundations, particularly community connection and social support, can buffer against deployment stress.
Emotion regulation and coping skills
Teaching family members individualized tools for managing their emotions is beneficial. Skills such as DBT, CBT, or mindfulness skills can be applied throughout the deployment cycle.
Parent training
Two factors matter most during deployment: what families discuss before separation and how stable the at-home parent remains.
Clinicians can help parents develop age-appropriate communication plans and establish clear expectations before deployment. The Parent Management Training-Oregon model (PMTO) can be effective in guiding this.
Couples work
Interventions that facilitate better communication, conflict management, aligned parenting, and major decision-making during deployment can strengthen the relationship.
Emotionally focused therapy (EFT) or The Marriage Checkup are helpful interventions to support couples in this work.
What about reintegration?
Reintegration often proves harder than deployment itself.
The parent who stayed home has established new rhythms: handling finances, making decisions alone, and managing the household.
The returning parent may feel like a guest in their own home.
Children may have bonded more closely with the at-home parent or developed behaviors the returning parent doesn't recognize.
These shifts can create friction even in loving families.
As clinicians, offering understanding and normalizing this bumpy reintegration process is an important baseline intervention that supports military family mental health.
Applying research-based interventions, such as Families OverComing Under Stress (FOCUS) and After Deployment, Adaptive Parenting Tools (ADAPT), can support the child-parent dynamics.
Ongoing couples work, particularly with EFT, has also proven to be effective during reintegration.
When to address PTSD
Knowing when to address PTSD is crucial, as early screening can speed recovery. This should be a major priority for service members returning from deployment and their clinicians. Brief screens such as the PCL-5 can be applied to look for PTSD symptoms.
Clinicians and family members should keep an eye out for major categories such as intrusive symptoms (nightmares, intense memories, flashbacks), negative cognitions (negative beliefs, changes in mood), avoidance (avoiding memories, thoughts, or situations), and hypervigilance (startle response, feeling on edge, easily triggered).
When symptoms escalate or begin affecting family functioning, consider whether the client would benefit from specialized trauma treatment. STAIR and DBT are effective starting points for building trauma skills and a greater sense of safety.
The VA guidelines for PTSD treatment include cognitive processing therapy (CPT), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR) therapies as frontline treatments.
Some research also indicates that combining family therapy with individual PTSD treatment can increase the individual treatment retention rates.
How to support children
According to the APA, military children’s mental health is impacted by three main factors: their age and development stage, the length of deployment, and the mental health of the parent who is not deployed.
A struggling at-home parent amplifies a child’s distress. Supporting that parent is not only good for them, but also for the children.
Clinicians should prioritize connecting the non-deployed parent with resources, social support, respite care, mental health services, and guidance on how to access resources for the family.
For therapists wondering how to support children, FOCUS and ADAPT have proven to have a positive impact on children’s mental health. Providing consistent stability, routine, and age-appropriate communication are all important factors for caring for children.
If children are displaying behavioral or emotional challenges themselves, individual therapy and accessing mental health resources may be warranted.
For children who have developed their own PTSD, trauma-focused cognitive behavioral therapy (TF-CBT) and EMDR have proven to be frontline treatments.
Military relationship counseling
Relationship counseling can have immense benefit for military couples. It is important that this counseling be provided at key moments of the military family’s journey.
Pre-deployment, during deployment, post-deployment, or family moves can all be effective times for military relationship counseling. The more proactive the treatment is, the better.
Getting ahead of these difficult moments is much better than picking up the pieces afterwards.
EFT and integrated behavioral couples therapy (IBCT) are effective options. The National Center for PTSD of the VA also recommends cognitive-behavioral conjoint therapy for PTSD (CBCT) for those struggling with PTSD.
The core emphases of military relationship counseling should include ways to stay connected, communicate effectively, manage conflict and emotions, and build trust.
What about frequent moves?
Military children move six to nine times between kindergarten and high school, according to the APA. For spouses, each move disrupts housing, employment, friendships, and community ties.
While frequent relocation can build resilience in some children, it also correlates with increased mental health needs.
Clinicians can help families prepare by supporting open communication about the emotional weight of leaving: what they're losing, what they fear, and what they're curious about.
Connecting families with practical resources such as relocation assistance, school liaison programs, and community groups eases the transition and supports military family mental health.
Encourage families to maintain select relationships from previous locations through video calls or visits while still investing energy in building new connections. FOCUS has shown effectiveness in helping families navigate military moves.
How to access resources
Military families have access to specialized support systems and many may not know they exist. Introducing these resources early, ideally in the first few sessions, can extend your clinical work beyond the therapy room.
Military OneSource is a primary access point. It provides resources, information, and access to coaching and counseling to support military family mental health. Their relationships page offers specific guidance for couples navigating military-specific stressors.
VA mobile apps like Couples Coach, PTSD Coach, or STAIR Coach allow clients to practice skills between sessions. These free tools reinforce therapeutic work and provide on-demand support.
The National Alliance on Mental Illness (NAMI) facilitates veteran-specific support groups that can complement individual therapy or military relationship counseling. Peer connection often helps military families feel less isolated.
Veterans Crisis Line is available 24/7 for service members experiencing suicidal thoughts or acute mental health crises. Make sure every military client knows this number exists.
Military families navigate challenges most civilians never face: repeated separations, constant relocation, and the aftermath of combat trauma. The weight of these situations demands support that is understanding, informed, and effective.
Helping families with the strategies outlined in this article can be the first step to offering that kind of support.
Sources
American Psychological Association. (2021). Guidelines for psychological practice with military service members, veterans, and their families.
Creech, S. K., Hadley, W., & Borsari, B. (2014). The impact of military deployment and reintegration on children and families. Clinical Psychology Review, 34(8), 645–658.
Erbes, C. R., Meis, L. A., Polusny, M. A., & Compton, J. S. (2011). Couple adjustment and posttraumatic stress disorder symptoms in National Guard veterans of the Iraq War. Journal of Family Psychology, 25(4), 479–487.
Gewirtz, A. H., DeGarmo, D. S., & Zamir, O. (2018). After Deployment, Adaptive Parenting Tools: 1-Year Outcomes of an Evidence-Based Parenting Program for Military Families Following Deployment. Prevention Science, 19(4), 489–499.
Military OneSource. (n.d.). Homepage.
Military OneSource. (n.d.). Relationships.
National Alliance on Mental Illness. (n.d.). Homepage.
Ribeiro, S., Renshaw, K. D., & Allen, E. S. (2023). Military-related relocation stress and psychological distress in military partners. Journal of Family Psychology, 37(1), 45–53.
Steenkamp, M. M., Corry, N. H., Qian, M., Li, M., McMaster, H. S., Fairbank, J. A., Stander, V. A., Hollahan, L., & Marmar, C. R. (2018). Prevalence of psychiatric morbidity in United States military spouses: The Millennium Cohort Family Study. Depression and Anxiety, 35(9), 815–829.
United States Department of Veterans Affairs. (n.d.). How deployment stress affects families. National Center for PTSD.
United States Department of Veterans Affairs. (n.d.). VA/DoD clinical practice guideline for management of posttraumatic stress disorder and acute stress disorder.
United States Department of Veterans Affairs. (n.d.). VA mobile app store.
United States Department of Veterans Affairs. (n.d.). Veterans Crisis Line.
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