Fathers With War-Related PTSD
By Erika Curran, LCSW
NCP Clinical Quarterly 7(2): Spring 1997
Veterans with war-related Post Traumatic Stress Disorder come from all over the country to the National Center for PTSD Clinical Labatory and Education Division in Menlo Park, California. Many are fathers who come with concerns about how their problems with PTSD have affected their children. Some veterans are actively parenting their children, some have been "long distance" parents to their children, and some have not had contact with their children for many years and are not sure how they might still be involved in their children's lives. In the past ten years, more than 1000 of these veterans have chosen to participate in the program’s Parenting Group (1) and to be involved in family therapy, receiving an opportunity to explore and work on changes with their families.
As I look with families at the changes they want and need to make, my own thinking has been greatly influenced by the work done in structural family therapy by Salvador Minuchin (2-4) and in strategic therapy by Jay Haley (5-7) and Cloe Madanes (8-10). These treatment approaches draw the clinician's attention to fostering the emergence of strengths and competencies within families. Both schools emphasize changing habitual interaction patterns among family members and using an awareness of the life stage needs of the family and of individual family members to facilitate planning for family change. In working with veterans and their families, I have observed some characteristic ways that a father’s PTSD can impact on their children and ways families can work on reducing that impact.
A FATHER’S PTSD CAN IMPACT ON A CHILD WHEN:
1. Father’s PTSD symptoms model self defeating behaviors that the child learns.
Goal: Father models and teaches appropriate behaviors for the child to learn
Veterans coming for treatment at the National Center for PTSD frequently report problems with expressing anger. Alex Brown and his wife Carol had been married for 24 years and had two children, a son Tom, 17, and a daughter Alice, 16 (note, all names appearing in article are ficticious). When Alex was angry at home he used to yell and throw things, often frightening his children. In a family session with Alex and Tom, taught his son what he had learned about expressing anger safely. He used as an example a recent incident he had experienced in the treatment program and showed his son step-by-step the use of a cognitive technique for managing immediate emotional responses and choosing less emotionally reactive behaviors. Alex then described an incident that had happened between he and his son a year before that both recalled in great detail. Alex told his son about how he wished he had handled himself at the time, based on what he had learned. He demonstrated the use of the cognitive technique retroactively and talked about other choices he could have made to express his feelings safely and appropriately at the time. Father and son then discussed a recent incident, when they had been working together on a project. Bill recalled his father's growing frustration with the task and told his father how surprised and pleased he had been by how he had handled his anger.
When the father teaches and models new skills and behaviors for his child, several messages are communicated. By coming into treatment and learning new ways of behaving, the father demonstrates to his children that he is taking responsibility for making changes. In teaching through examples within the child's own experience, the parent's learning becomes personally meaningful to the child. The father can feel proud of taking this responsibility and earning his child's respect.
2. A father's behavior has traumatized the child.
Goals:
Father talks with child about traumatizing behavior (in age appropriate way)
Father encourages child to talk about what they experienced
Father shares reasons for behavior that was traumatizing
Father makes apologies as needed
Bill White and his partner Ellen have two daughters, Sissy, age 12, and Susan, age 10. In a family session, the two daughters recalled and described in great detail a troubling incident from the previous year. The girls had been at a gas station with their father, and when he had gone to pay for the gas, an intoxicated stranger had leaned into the car and made inappropriate reRicks to the girls. Sissy squeezed Susan's arm and told her not to tell their father what had happened. When Bill returned to the car and asked about the man he had observed at the car window, the younger sister told him about the man's drunkenness and inappropriate remarks. Bill went after the man and beat him up. In the family session Sissy and Susan were able to tell their father that they were much more frightened by his behavior than they had been by the stranger's approach. Sissy talked about how she had for years worked to "protect" her father from being aware of situations where she or her sister might have been at risk. She was afraid that her father might get angry, hurt someone, and go to jail.
It became clear to Bill for the first time that his choice of violence was frightening to his daughters. He began to understand that his history of violence had led Sissy to assume a vigilant and protective stance on his behalf, actually leaving her more at the risk of harm from which he wanted her protected. Bill made a commitment to his children to beto resolve these situations non-violently. He told his daughters that he wanted them to feel safe enough about his ability to control his own behavior that they could let him know if they felt themselves to be at any risk. Bill shared with his family, in an age appropriate way, some of the war-related reasons for his past readiness for violence, not to make excuses for his behavior but to give his daughters a context for understanding. He apologized to Sissy for having put her in the position of responsibility and, further, for not having recognized that he had done so.
Fathers have similarly given their children an opportunity to talk with them about what it was like to not have their father more available in their lives, to personally experience their father's anger, to observe family violence, to witness or know of a suicide attempt, to feel unable to help a parent in distress, or to feel uncared for when a parent's behavior has been self destructive through substance use. When children can talk with their father about what has been traumatizing, the father can acknowledge and apologize for the child's distress. The father can offer a context for understanding the behavior while at the same time take responsibility for his own actions. This discussion can be healing and promote change for all family members.
3. Father’s PTSD symptoms interfere with the father seeing and meeting the child's needs.
Goal: Father receives treatment for own symptoms
Julius Orcett, a single parent, came to the National Center for PTSD depressed, demoralized, and unable to care for himself. By the time he came into treatment his two sons, Ben, 16, and Larry, 15, had started living in the streets. Julius was greatly distressed by the circumstances in his sons' lives but felt so unable to take care of himself that he had given up on providing any guidance to or home life for his sons. As Julius’ depression lifted, he, his sons, and Julius’ very caring significant other (who Julius had kept at arm's length) participated in the Parenting Group. They began family therapy and talked about the kind of life they wanted to have together. Julius shared with his sons enough information about his war experiences and about PTSD that they could begin to understand how emotionally incapacitated he had felt and that he had not wanted to withhold love and caring. The father and sons were eager for a reconciliation and for starting a new life together. Once Julius felt stronger and was able to again provide leadership for the family, his sons returned home.
4. Father’s anticipation of symptoms interferes with father seeing and meeting the child's needs.
Goal: Father recognizes preoccupation with symptoms, use skills to decrease overall stress and impact of symptoms, and prioritize needs of child.
Rick Thompson and his wife Nancy have three sons, Mike, age 15, Alan, age 13, and Jim, age 9. The family lived in a rural area and the two older sons needed a ride to the nearby town to spend time with their friends on weekends. The boys would begin early in the week to make plans, asking their father to drive them to town. Rick would repeatedly tell them, "I'll let you know." By the end of the week, the father would have still not made a commitment to drive them, the boys were frustrated and still asking, and the father found their asking and frustration irritating and would take that to be reason to not drive them.
In exploring with the family how this pattern had become established, Rick said that he could not let the boys know if he could drive them before Saturday morning because if he was stressed that day he felt especially vulnerable to intrusive thoughts about war experiences when he drove past a particular tree line on the way to town. He had never shared this with his family. What felt to Rick like a way of avoiding the possibility of feeling overcome by intrusive thoughts, by putting off the decision of whether or not to drive the boys, had in fact been contributing to increased stress in the family, increasing the likelihood that he would experience that stress in the way of intrusive thoughts. Rick and his wife made a plan with their sons which included the sons providing more thorough and specific information about their plans for a weekend and a commitment from the father early in the week about whether or not he would drive them. The overall stress level declined for the whole family, and the drives into town were uneventful.
5. Father is preoccupied with child’s safety, leading to intrusiveness or withdrawal.
Goal: Father teaches child safety skills and develops own tolerance for the child's increasing autonomy
Some veterans with PTSD have described an intense fear and anxiety regarding the safety of their children. Some feel that their children are safe only if within the vigilant, constant protection of the father. Fathers have at times distanced themselves from their children in order to gain a buffer from their own incapacitating fears regarding the child's very life. Others describe distancing from their children in order to protect the children from what they know would be their own overwhelming intrusiveness. Parents need to know that all parents (not just veterans with PTSD) have concerns for the safety of their children, and that all parents have a responsibility to teach children personal safety skills and to develop their own personal tolerance for their children's age increasing autonomy.
6. Father leaves or distances self from child in order to protect the child from father’s potential anger
Goal: Father learns anger management, conflict resolution, and assertiveness skills
Anger has been a common concern for combat veterans with PTSD. They have often experienced a personal intensity of anger and consequences of anger that most parents have been spared by not having participated in war. Veterans need to know that all parents get angry with their children, and that anger in and of itself does not make one an unacceptable parent. All parents struggle with expressing anger appropriately and safely and with separating anger from discipline. All parents have a responsibility to themselves and to their children to learn and practice safe and appropriate expressions of anger.
7. Father distances from self or leaves child because of intrusive thoughts or nightmares that are frightening to the father
Goal: Father learns to control intrusive thoughts (that they are memories, not the beginning of actions) and knows that nightmares are just that -- nightmares
Some veterans with PTSD come to the Parenting Group and talk of having left children due to frightening memories of war events that are activated when they are with their children. When coupled with fear about their potential rage and with what they experienced in combat as necessary impulsivity, some veterans have described great discomfort in being close to or with their children. One veteran described waking from a nightmare about a war event that involved children, going into his infant son's room, and looking down at his son sleeping in his crib. The veteran was so fearful of the potential that the dream represented to him that he packed his bags, left, and had not seen his son for over twenty years. Now, over twenty years later, he came to Parenting Group wondering if he might still be able to offer something to his son.
As a family therapist, I will support a reconnecting between parent and child(ren) if it is sought by either. I recommend that a father who has been estranged from his children approach reconciliation thoughtfully and with awareness of the emotional risks. Veterans have reported good success in reconnecting with minor children when they pursue contact in a way that includes the child's mother, as awkward as this can seem initially. When reconnecting with adult children, the veteran can initiate contact with the child directly. My experience has been that most children of all ages welcome renewed contact with their fathers. At times when no contact with children can be achieved, I suggest to fathers that they write to their children periodically, such as on the child's birthday, and save the letters to give to the child at a time of possible future contact.
REFERENCES
1. Curran, E. (1996). Parenting group manual. Available from the Education Division, National Center for PTSD, 415-493-5000, Ext 22673.
2. Minuchin, S. (1974). Families and family therapy. Massachusetts: Harvard University Press.
3. Minuchin S., & Nichols, M. (1993). Family healing: Tales of hope and renewal from family therapy. New York: The Free Press.
4. Minuchin, S., & Fischman, C. (1981). Family therapy techniques. Massachusetts: Harvard University Press.
5. Haley, J. (1980). Leaving home. New York: McGraw Hill.
6. Haley, J. (1976). Problem-solving therapy. San Francisco: Jossey-Bass Inc.
7. Haley, J. (1963, 1990). Strategies of Psychotherapy. Rockville, Maryland: The Triangle Press.
8. Madanes, C. (1990). Sex, love, and violence: Strategies for transformation. New York: W. W. Norton & Co.
9. Madanes, C. (1984). Behind the one way mirror. San Francisco: Jossey-Bass, Inc.
10. Madanes, C. (1981). Strategic family therapy. San Francisco: Jossey-Bass, Inc.
Erika Curran is a licensed clinical social worker at the National Center for PTSD in Menlo Park, California. As a family treatment specialist using a structural/strategic model she has worked with more than 1000 veterans and their families on decreasing the impact of the veteran’s PTSD on the family system.
|
