Group Therapy for Partners of Combat Veterans with Post-Traumatic Stress Disorder
Armstrong, Merry A., Rose, Paula, Perspectives in Psychiatric Care
TOPIC. An 18-month group-therapy experience with women partners of combat veterans with post-traumatic stress disorder (PTSD).
PURPOSE. To describe the application of group process and feminist theory to the planning and development of a group of women partners of veterans with PTSD.
SOURCE. The authors' clinical work.
CONCLUSIONS. Using group psychotherapy theory and feminist theory, the group content and process involved the themes of rescuing, dissociation, and individuation. The exploration of transference and countertransference were useful in facilitating individual as well as process.
Key words: Countertransference, feminist theory, individuation, group process, group psychotherapy, post-traumatic stress disorder, transference
Veteran Outreach Centers, more commonly known as Vet Centers, were established in 1979 through an act of Congress to provide a variety of counseling and support services to Vietnam War veterans and their families because post-traumatic stress disorder (PTSD) was adversely affecting this population and, by extension, their partners and families. Because partners of combat veterans often speak of their sense of isolation and disconnection from others, group psychotherapy seemed a logical approach to addressing these problems. In response to this need, as psychiatric nurses, we proposed a plan to colead a support group for these women. We decided to use one theoretical model to Ode the structure and process of the group. We used another conceptual model that addressed women's experience to further group process by exploring relationships within the group and identifying common problems among group participants.
Planning the Group
Participation in the Women's Partner Group was through referral by the client's primary counselor at the Veterans Center. Candidates were interviewed by a facilitator to assess the readiness of the candidate for group therapy. Selection criteria were: a self-described significant relationship with a veteran being treated at the center for PTSD; expression of interest in a group experience; and absence of an identified active substance abuse problem, thought disorder, or problem incongruent with the general purpose of the group. The significance of the relationship was determined by the participants, and marriage was not a prerequisite for participation in the group. Prospective members were asked to commit to 12 weekly two-hour sessions, held in a group room at the Veterans Center from 6 to 8 p.m..
Six women expressed interest in joining the group, five of whom were in relationships with Vietnam War combat veterans and one woman who was in a relationship with a Persian Gulf War veteran. Some couples were married, others were not. Some couples lived together, others did not. Ages of participants ranged from mid-20s to late 40s. All 6 were employed outside of the home or were students. After the initial meeting, the group was closed and opened again to new members after 12 weeks passed. Five of the six original members decided to continue participation for another 12 sessions, and two new members were added. This pattern was repeated for approximately 18 months. The therapists met each week prior to the group meeting to plan interventions to facilitate group process and to discuss lingering issues from the previous week.
Our initial assumptions were that the group members felt isolated and that being part of a group could provide a corrective experience (Coughlan & Parkin, 1987). Based on experience and literature (MacPherson, 1984; Williams, 1987) we thought members would want to focus on the problems of their significant others. We knew issues specific to women would surface in the group, but we did not anticipate the importance of these individual problems apart from their relationships with the veterans. We acknowledged that problematic relationships with partners who had PTSD symptoms were the common experience that brought the women together in the group. …