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THE STORIES OF CAREGIVER WIVES OF COMBAT INJURED ARMY

SERVICE MEMBERS: A NARRATIVE APPROACH

APPROVED BY SUPERVISING COMMITTEE:

________________________________________

Thelma Duffey, Ph.D., Chair

________________________________________ Shane Haberstroh, Ed.D.

________________________________________

Michael Moyer, Ph.D.

________________________________________ Janeé Avent, Ph.D.

Accepted: _________________________________________

Dean, Graduate School

DEDICATION

All glory, honor, and praise be to God Almighty. I thank you Father for giving me strength in my weakness. For I can do everything through Christ, who gives me strength. This dissertation is dedicated to my dear family. Lou and Michaela thank you for supporting me and being there every day, every step of the way. You held me up and encouraged me from day zero till the end. Mom and Dad, Ruth and Russell, thank you for always praying and sending tangible support. Ria, Roxanne, and Anthony I thank you for talking, laughing with me, and praying with me. Thank you everyone for providing me with constant prayers, inspiration, and support in a myriad of ways. I love you for always. To God be the glory great things He has done! .



by

RENEÉ A. FOYOU, M.A., M.A.R.

DISSERTATION Presented to the Graduate Faculty of

The University of Texas at San Antonio in Partial Fulfillment of the Requirements

for the Degree of

DOCTOR OF PHILOSOPHY IN COUNSELOR EDUCATION AND SUPERVISION

THE UNIVERSITY OF TEXAS AT SAN ANTONIO College of Education and Human Development

Department of Counseling May 2015

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iv

ACKNOWLEDGEMENTS

My many thanks to my dissertation committee members for your assistance in this phase

of my journey. Dr. Thelma Duffey thank you for your confidence in my work, for your

mentorship, and periodic “visits”. Dr. Michael Moyer thank you for your persistent words of

encouragement and the knowledge you imparted. Dr. Shane Haberstroh thank you for sharing

your extensive knowledge of qualitative methodologies. Dr. Janeé Avent thank you for

exhibiting an approachable demeanor and for your willingness to join me in this process. Thank

you Dr. KristiAnna Santos for sitting with me, talking, sharing your work, and modeling good

research practices. I wish all of you the best in your continued work in counselor education and

supervision.

I am grateful to the Army caregiver wives who shared their stories in conjunction with

this work. I thank you for sharing your narratives. I continue to cherish the times we shared

together. You have impacted my life tremendously. I trust that my rendering of your individual

narratives was favorable and will shed light on your honorable yet difficult work. May you

continue to find hope, support, and purpose. To my extended family members, friends, peers,

supervisors, professors, and mentors, thank you for your support, wisdom, and the knowledge

you gave to me. I bless God for you all!

May 2015

v



Reneé A. Foyou, Ph.D. The University of Texas at San Antonio, 2015

Supervising Professor: Thelma Duffey, Ph.D.

Military service members and their families experienced significant changes following

combat deployments to war zones in Iraq or Afghanistan. These changes were related to

physical, environmental, cognitive, and emotional stressors. These changes for some service

members affected their overall capabilities post-deployment. Wives of combat injured service

members often were charged with the caregiving duties for their husbands. Over a decade later

researchers scarcely began to understand the experiences of this population of women. There

was a significant need for insight into the post-deployment functioning of these military families.

Educated mental health professionals could be instrumental towards the overall wellness of these

military families. The purpose of this study was to understand the narratives of caregiver wives

whose Army active duty enlisted husbands experienced a combat related functional disability. A

narrative inquiry was employed to describe, analyze, and restory the narratives of some of these

women.

vi

TABLE OF CONTENTS

Acknowledgements ........................................................................................................................ iv

Abstract ............................................................................................................................................v

List of Tables ................................................................................................................................ ix

Chapter One: Introduction ...............................................................................................................1

Overview of Current Military Related Research .................................................................1

Need for the Study ...............................................................................................................3

Purpose of the Study ............................................................................................................5

Research Questions ..............................................................................................................6

Researcher Position in the Study .........................................................................................7

Limitations ...........................................................................................................................8

Definition of Terms..............................................................................................................9

Chapter Two: Literature Review ...................................................................................................11

The Military .......................................................................................................................11

Military Life .......................................................................................................................17

Cycle of Deployment .........................................................................................................23

Post Deployment Stressors ................................................................................................30

Functional Disability ..........................................................................................................37

Current Considerations for Military Families ....................................................................39

Caregivers Burden .............................................................................................................40

Conclusion .........................................................................................................................41

Chapter Three: Methods ................................................................................................................43

Theoretical Framework ......................................................................................................43

vii

Research Questions ............................................................................................................46

Participants .........................................................................................................................47

Methods of Recruitment ....................................................................................................49

Why Study These Women? ...............................................................................................50

Data Collection ..................................................................................................................51

Data Analysis Plan .............................................................................................................55

Conclusion .........................................................................................................................59

Chapter Four: Data Analysis ..........................................................................................................60

Summary of Participants ....................................................................................................60

Conducting the Narrative Interviews .................................................................................62

Individual Narratives and Analysis ....................................................................................64

Common Themes in Group Narratives ..............................................................................87

Differences in Narratives .................................................................................................103

Researcher Position ..........................................................................................................106

Member Checks and External Audit ................................................................................107

Conclusion .......................................................................................................................108

Chapter Five: Conclusion ............................................................................................................110

Summary of Results .........................................................................................................110

Recommendations for Counselors ...................................................................................116

Limitations .......................................................................................................................122

Future Research ...............................................................................................................123

Conclusion .......................................................................................................................123

Appendices...................................................................................................................................125

viii

References ....................................................................................................................................135

Vita

ix

LIST OF TABLES

Table 1 Participants Demographics ....................................................................................62

1

CHAPTER ONE: INTRODUCTION

Military spouses are key members of a military family. Spouses of service members hold

an important role in military life and culture. Spouses often assume the primary roles and

responsibilities related to household management and child rearing (Lara-Cinisomo et al., 2012;

MacDermid Wadsworth & Southwell, 2011). In the post 9-11 era military life and culture

changed significantly (Lincoln et al., 2008). The lives of military spouses also changed

significantly. Many spouses became the caregivers for their injured service member spouses

upon re-deployment. The stories of these women however were seldom reported in the media or

became the topics of research inquiry.

The vast majority of military spouses are women (U.S. Department of Defense, Office of

the Deputy Under Secretary of Defense, 2012). Discussions about military spouses should

differentiate between male and female spouses since the experiences of male and female military

spouses differ. Researchers often do no differentiate between genders in their research reports

regarding military spouses although sample sizes are predominantly one gender (Fields, Nichols,

Martindale-Adams, Zuber, & Graney, 2012). The current study focused on female spouses. The

stories of caregiver wives of combat inured Army enlisted services members are presented.

Overview of Current Military Related Research

Scholars devoted significant attention on topics related to the United States (U.S.)

military service members over the last decade (Asbury & Martin, 2012; Eaton et al., 2008).

These topics included: (a) aspects of deployment such as prolonged separation and reintegration;

(b) posttraumatic stress disorder (PTSD); (c) rehabilitation of wounded warriors; (d) traumatic

brain injury; (e) substance abuse and addiction; and (f) sexual harassment, violence, and trauma.

This heightened attention was due in part to increasing and repeated deployment of military

2

service members to war zones in Iraq and Afghanistan since 2001. These deployments resulted

in service members overwhelmingly facing environmental, physical, cognitive, and emotional

stressors (Jordan, 2011).

Research concerning these stressors and the effects of deployment increased since 2003

(Jordan, 2011; Weiss, Coll, Gerbauer, Smiley, & Carillo, 2010). Most of these research studies

focused on the post-deployment symptoms experienced by service members (Warner,

Appenzeller, Warner, & Grieger, 2009). The mental health effects of combat deployment on

service members garnished an unprecedented amount of public attention (Warner et al., 2009).

There was a continued need for considerable attention and research for this population. It was

notable for example, that service members presenting with symptoms of PTSD or combat

traumatic stress disorder (CTSD) were more likely to commit suicide (Jordan, 2011). Service

members returning from deployments in Afghanistan and Iraq, additionally had increased

diagnoses of a substance use disorder and major depression (Shen, Arkes, Williams, & 2012).

Numerous combat service members dealt with the effects of traumatic brain injuries post-

deployment (Jordan, 2011). Few researchers however, considered the effects of these and other

post-deployment related scenarios on military family members (De Burgh, White, Fear, &

Iversen, 2011).

Significant attention and resources particularly by scholars were afforded to service

members (Jordan, 2011; Warner et al., 2009). Numerous U.S. government committees and

commissions were established to address the issues faced by seriously wounded, ill, or injured

service members (Christensen & Clinton, 2013; Tanielian et al., 2013). Far fewer resources were

devoted to their families (Jordan, 2011; Warner et al., 2009). When service members deployed

however, their families also deployed (Jordan, 2011). Further research and educational ventures

3

should have included issues pertinent to spouses, children, and parents of service members. One

group that warranted further attention was the wives of military service members who sustained

combat related injuries during recent deployments.

Military spouses were at a high risk for experiencing high levels of stress while their

spouses were deployed and also when the deployed spouse returned home (Fields et al., 2012).

Spouses reportedly experienced similar rates of major depressive disorder and generalized

anxiety disorder (Hoge & Castro, 2005). These rates were similar to the post-deployment

experiences of service members (Hoge & Castro, 2005).

Rates of depression, anxiety, and marital instability may be significantly higher for a

military wife who is the caregiver of a combat injured service member. Women, younger

caregivers, and caregivers who care for individuals with severe cognitive, emotional, and

behavioral changes experienced the most negative consequences from their roles as caregivers

(van de Heuvel, de Witte, Schure, Sanderman, & Meyboom-de Jong, 2000). Caregiving women

reported higher levels of care recipient’s behavior problems, more caregiving tasks, more hours

of care provision, lower levels of physical health and subjective well-being, and higher levels of

caregiver burden and depression in comparison to caregiving men (Pinquart & Sorenson, 2006).

Research needed to be devoted to understanding the stories of military wives whose husbands

became functionally disabled as a result of injuries sustained during recent combat operations.

Need for the Study

Caregivers of service members and veterans bare the short and long term cost of war

(Tanielian et al., 2013). These military caregivers provide care and assistance to aid in the

recovery of current and former service members (Tanielian et al., 2013). Military caregivers are

spouses, children, parents, relatives, and friends of service members and veterans (Tanielian et

4

al., 2013). Researchers who undertook a recent study about military caregivers noted that these

individuals disappropriately suffered from emotional and mental health problems (Tanielian et

al., 2013). This ground breaking study however did not differentiate between the experiences of

male and female caregivers, category of caregivers (i.e. spouses, children, friends, parents, and

other relatives), service member military status (i.e. active duty, reserved, or veteran), and

service member rank (i.e. enlisted or commissioned officer).

There was a significant need for understanding the overall wellbeing and life satisfaction

of caregiver wives of combat injured active duty service members (Tanielian et al., 2013).

Wives of deployed service members experienced similar rates of anxiety and depression to

service members during the post-deployment stage (Hoge & Castro, 2005). Caregiver wives as

mentioned above, experienced more negative consequences in comparison to caregiver men (van

de Heuvel et al., 2000). The mental health of these women was important since their status had

an effect on their family and also their marital partners (De Burgh et al., 2011). These women

seldom had their own needs recognized and addressed effectively (Tanielian et al., 2013).

Military wives are somewhat of a forgotten group within the contexts of research about

military families and the military (Aducci, Baptist, George, Barros, & Goff, 2011). Researchers

began to consider the impact of deployment on soldier’s families only recently (Asbury &

Martin, 2012). The research however, was slow (Aducci et al., 2011) and the needs of caregivers

were largely overlooked (Tanielian et al., 2013).

Mental health professionals are seeing increasing numbers of military populations in their

work (Weiss et al., 2010). It is imperative to allocate financial resources, time, and research

towards understanding issues such as the post-deployment experiences of military caregiver

wives. Mental health professionals that are educated about military families, the culture, and

5

lifestyle are instrumental in facilitating the therapeutic relationship with military families

(Hollingsworth, 2011).

Mental health professionals, particularly counselors can effectively assist this population

of military wives through therapeutic interventions. Counselors for example, can assist caregiver

wives to mobilize their available social supports in ways that are satisfactory to them (van de

Heuvel et al., 2000). These interventions can bolster a wife’s daily functioning and overall

wellbeing. This population therefore warranted consideration and assistance for possible impacts

of deployment such as psychological impairments, as is afforded to service members. Mental

health professionals can play a significant role in this process.

Purpose of the Study

The purpose of this study was to describe, analyze, and restory the narratives of Army

wives whose active duty enlisted husbands sustained a combat related functional disability. The

narratives of these women following the husband’s injury where the wife became the husband’s

caregiver or non-medical attendant were examined. Another purpose of this study was to

understand the significant adjustments these women experienced following their husband’s

injury. The strengths and the challenges these women experienced in their new roles was

considered.

These women were offered a unique opportunity to share their stories. A qualitative

approach was utilized in this process. A qualitative approach was employed since data was

collected with great sensitivity to the people that were being studied (Creswell, 2013). A

qualitative approach also allowed for inductive and deductive data analysis and the establishment

of patterns and themes (Creswell, 2013). This inquiry also allowed me to share my position as a

military spouse, a licensed professional counselor, and a researcher involved in this process

6

(Creswell, 2013). The qualitative inquiry also facilitated the call for further consideration of this

population by counselors (Creswell, 2013).

A narrative research design furthermore was employed based on the specific approaches

utilized for the research inquiry (Creswell, 2013). Both the researcher and the research

participants took an active role in the process of conducting narrative research. It was a

collaborative venture (Creswell, 2013). The narrative approach mirrored the counseling process

in that it allowed the individual to share their experience in the form of a story and to convey

meaning (Hays & Wood, 2011). I then took an active role to ‘restory’ the stories into a

framework that was coherent, in my role as the researcher (Creswell, 2013). Narrative approach

was appropriate for this research inquiry because I was seeking to capture the detailed stories of

a small number of individuals (Creswell, 2013). It was my hope that this study would provide a

platform where these women can share their stories about becoming caregivers for their combat

injured husbands. This information as offered directly from these women, given their own

perspectives, was invaluable. Counselors and this population of women hopefully can work

collaboratively towards the overall wellbeing of this underserved community.

Research Questions

It is difficult to obtain and understand the stories of Army caregiver wives of enlisted

functionally disabled service members. The narrative interviews were designed to elicit

responses for the following research questions: (1) What are the stories of Army caregiver wives

whose enlisted husbands experienced a functional disability in combat? (2) How does the story

of becoming the caregivers or nonmedical attendants for functionally disabled enlisted Army

husbands impact the lives of these women? (3) What new roles do these wives assume while

functioning as caregivers or nonmedical attendants for their enlisted Army husbands?

7

Researcher Position in the Study

I was guided by a social constructivist framework in this research project. I approached

this research as a collaborative process where the researcher and participants developed elements

of autonomy, reflectivity, and engagement. “The goal of research…is to rely as much as

possible on the participants’ views of the situations” (Creswell, 2013, pp. 24-25). There was also

the recognition that the subjective meanings which participants shared about their situations were

“…formed through interactions with others…” (Creswell, 2013, p. 25).

It is important to note my personal and professional connection to this research study. I

am a military spouse. I celebrated and grieved with couples and families as we experienced the

various stages of deployment. Collectively we grieved when our loved ones deployed and we

celebrated their return home. We grieved when our loved ones sustained bodily injuries,

returned home in coffins, or returned differently than when they initially departed. I journeyed

with many military families working through post-deployment adjustments in my role of a

professional counselor. Many couples struggled to reconnect and continue their lives together as

a direct result of prolonged separations, combat experiences, and individual changes experienced

during the period of deployment.

I formed some assumptions about this subject matter. These assumptions were based on

my personal and professional experiences and interactions with this population. One assumption

was that the role of caregiver wife or non-medical attendant significantly altered a military wife’s

life. Another assumption was that this change significantly impacted this woman’s sense of self

and overall wellbeing. Some women would become resilient while others would experience

significant negative outcomes.

8

Limitations

This research study incorporated the stories of caregiver wives through one-on-one

interviews. Participants may not have been completely forthright. Participants may have been

cautious about sharing their stories with me, a stranger. I may have been perceived as

intimidating since I earned two graduate degrees and I was working towards another. I was also

the wife of a commissioned officer and interacted on an intimate level with wives of enlisted

Army service members. This may have been a limitation considering the military hierarchical

rank structure between commissioned officers and enlisted personnel (U.S. Department of

Defense, n.d.) and the protocol of controlled interactions between enlisted personnel and

commissioned officers (Segal, 1986). There is no restriction for family members to interact

among the ranks (Segal, 1986). Some believe however, that families informally carry the rank of

their service members (Segal, 1986). Family members cannot be held to many military customs

but they are expected to follow a degree of socialization (Segal, 1986).

Another limitation concerned self-reported data. Data collection was dependent on

participants’ ability to discern and report information from their own experiences through the use

of language and symbols (Polkinghorne, 2005). This was a limitation because participants are

likely to not have shared every detail of their experiences with the researcher. The researcher

could have missed some information which was necessary to fully understand the participants’

experiences.

There were also limitations with regard to narrative narratology. Polkinghorne (2007)

noted that in narrative research validity threats arise based on language. The language that

participants use to describe “…their experienced meaning is not a mirrored reflection of [the]

meaning” (Polkinghorne, 2007, p. 480). This issue with language and validity arise since (a)

9

there are limits in language to “capture the complexity and depth of experienced meaning”, (b)

“the limits of reflection to bring notice to the layers of meaning that are present outside of

awareness”, (c) “the resistance of people because of social desirability to reveal fully the entire

complexities of the felt meanings of which they are aware”, and (d) “the complexity caused by

the fact that texts are often a creation of the interviewer and participant” (Polkinghorne, 2007, p.

480). These four issues of validity are comparable to threats to external validity or

generalizability that are notable in quantitative research (Polkinghorne, 2007). Polkinghorne

offered various suggestions to guard against these threats. These suggestions were incorporated

into the data analysis as presented in chapter 4.

Definition of Terms

Functional Disability

“Functional disability refers to limitations in performing independent living tasks…”

(Spector & Fleishman, 1998, p. S46). This term is further divided into two components (a)

activities of daily living (ADLs) and (b) instrumental activities of daily living (IADLs; Spector &

Fleishman, 1998). ADLs include activities such as bathing, toileting, walking, and climbing

stairs (Spector & Fleishman, 1998). IADLs include shopping, meal preparation, housekeeping,

and managing finances (Spector & Fleishman, 1998).

Military Caregiver

A caregiver is an individual who is largely responsible for assisting another individual

with daily needs. A military caregiver furthermore “…is a family member, friend, or other

acquaintance who provides a broad range of care and assistance for, or manages the care of, a

current or former military service member with a disabling injury or illness [physical or mental]

10

that was incurred during military service” (Tanielian, et al., 2013). A caregiver is not

responsible for meeting the primary medical care of the person who is being assisted.

Non-medical Attendant (NMA)

A person designated by a seriously wounded, ill, and injured soldier to provide additional

support as the soldier recovers, rehabilitates, and transitions (U.S Army Warrior Transition

Command, 2014). This support may include driving the soldier to appointments, providing a

safe home environment, assisting with shopping, assisting with medication management, or

assisting with managing medical and administrative paperwork (U.S Army Warrior Transition

Command, 2014). A soldier’s eligibility for an NMA is determined by the soldier’s primary care

manager and approved by the soldier’s commander (U.S Army Warrior Transition Command,

2014). NMA’s receive official military orders (U.S Army Warrior Transition Command, 2014).

11

CHAPTER TWO: LITERATURE REVIEW

I conducted a literature review to gain a better understanding of the impact of deployment

on military families. I also conducted the literature review to understand the associations

between functional disability, social support, marital functioning, or psychological distress.

Many of these issues are currently at the forefront for military families because of the recent U.S.

military combat operations.

I utilized the computerized search process at the University of Texas at San Antonio to

obtain articles from several databases related to psychology and social sciences. All articles

were limited to scholarly and peer- reviewed, peer reviewed, and English language journal

publications. The publication date for each article was from March 1st, 2003- November 30th,

2014. Several keywords were utilized in the literature search process. These keywords included:

military family; combat injury; caregivers; and functional disability. A complete list of the

keywords utilized in the literature search is listed in Appendix A. I also engaged in a hand

searching process. I retrieved selected papers from bibliographies of other articles. The hand

search process was completed to look for other relevant articles. The publication dates for the

hand searched articles varied.

The Military

There are five branches of the United States Military. These are the Army, Navy, Marine

Corps, Air Force, and the Coast Guard (Petrovich, 2012). The Army is the largest branch

followed by the Air Force, the Navy, the Marine Corps, and the Coast Guard, respectively

(Petrovich, 2012). Each branch of the military has its distinct history, tragedies, triumphs,

rivalries, traditions, values, vocabulary, practices, and overall its own mission (Petrovich, 2012).

12

Personnel

Military personnel are classified as active duty or reservist (Petrovich, 2012). Active

duty members serve full time and reservists typically do not serve fulltime (Petrovich, 2012).

The Reserve components of the U.S. military include the Army National Guard of the United

States, the Army Reserve, the Navy Reserve, the Marine Corps Reserve, the Air National Guard

of the United States, the Air Force Reserve, and the Coast Guard Reserve (Knapp & Torreon,

2014). All Reserve and National Guard members are assigned to the Ready Reserve, the

Standby Reserve, or the Retired Reserve (U.S. Department of Defense, Office of the Deputy

Under Secretary of Defense, 2012). The Ready Reserves is further broken down into the

Selected Reserve, the Individual Ready Reserve, and the Inactive National Guard (U.S.

Department of Defense, Office of the Deputy Under Secretary of Defense, 2012). Reserve

components are federal entities and the National Guard components are both federal and state

entities (Knapp & Torreon, 2014).

Reservists serve a minimum number of days each year (Petrovich, 2012). The number

of days that a reservist serves each year depends on the reserve component category to which

they belong (Knapp & Torreon, 2014). Selected Reserve personnel train throughout the year and

engage in training with active duty personnel at least once a year (U.S. Department of Defense,

Office of the Deputy Under Secretary of Defense, 2012). Selected Reserve personal usually are

required to undergo one weekend of training each month and two weeks of training each year

(Knapp & Torreon, 2014). The two weeks of training typically occurs during the summer

months (Knapp & Torreon, 2014). Active Guard and Reserve (AGR) personnel are an exception

to the typical Reserve component training schedule. AGR personnel may serve up to 180

consecutive days or more (Knapp & Torreon, 2014). National Guard members serve both the

13

state and the country (United States Army National Guard, 2014). They can be called up to

serve by their respective state governor or the president of the U.S. (United States Army National

Guard, 2014).

Large numbers of reservists and National Guard members were called up to active duty

status in support of the U.S. military combat operations in Iraq and Afghanistan over the last few

years (Petrovich, 2012; Wiles & Nelson, 2009). Reservists can be ordered to serve on an active

duty status for a variety of reasons (Petrovich, 2012). AGR personnel for example, can be

ordered to active duty to assist with organization, recruiting, training reserve components, or to

serve as instructors (Knapp & Torreon, 2014). In the post-Cold War era Reserve components

were regarded as an integral partner with the active duty components in defending the interests

of the United States (Knapp & Torreon, 2014). The post-911 period propelled this policy to the

forefront with the mobilization and deployment of large numbers of Reserve personnel.

Military personnel across the five branches are furthermore classified as commissioned

officers/officers or enlisted service members (U.S. Department of Defense, n.d.). This

classification is reflective of the strict hierarchy which is unique to military culture. Service

members are grouped according to a rank structure. This rank structure ensures that service

members have a clear sense of their responsibilities and the individuals who are in leadership

positions.

Rank

The rank structure allows service members to be classified as commissioned officers,

warrant officers, or enlisted personnel (Hall, 2008; U.S. Department of Defense, n.d.). Enlisted

personnel are on the low end of the rank structure and officers are on the high end. Warrant

officers in this classification system are in between commissioned officers and enlisted personnel

14

(Hall, 2008). The Air Force is the only branch of the military that does not have personnel in the

ranks of warrant officers (U.S. Department of Defense, n.d.).

Officers typically have college degrees (Clever & Segal, 2013; Hall, 2008).

Commissioned officers are individuals who attended and attained a degree from one of the three

U.S. military academies (i.e. the Air Force Academy, the United States Military Academy, the

United States Naval Academy) or the Virginia Military Institute, attended Officer Training

School (OTS), or have a college Reserved Officer Training Corps (ROTC) commission (Hall,

2008).

Enlisted service members have high school diplomas or the equivalent (Clever & Segal,

2013; Hall, 2008). Individuals who wear the rank of warrant officers are formerly enlisted

personnel who became experts or specialist in certain military capabilities or technologies (Hall,

2008; U.S. Department of Defense, n.d.).

The rank structure classification is further divided among commissioned officers and

enlisted personnel. Enlisted personnel ranks range from E-1 to E-9 (U.S. Department of

Defense, n.d.). Junior enlisted personnel are classified within the ranks of E-1 to E-4 (U.S.

Department of Defense, n.d.). Mid-level enlisted personnel are classified within the ranks of E-5

to E-7, and senior enlisted leaders are classified within the ranks of E-8 to E-9 (U.S. Department

of Defense, n.d.). Enlisted personnel who wear the ranks of E-5 and up are classified as non-

commissioned officers (NCO; i.e. Army, Air Force, and Marines) or petty officers (i.e. Navy and

Coast Guard; U.S. Department of Defense, n.d.). Warrant officer ranks range from W-1 to W-5

(U.S. Department of Defense, n.d.). Both NCOs and warrant officers remain in the ranks of the

enlisted culture rather than the officer culture (Hall, 2008).

15

Commissioned officers also have hierarchical distinctions within their ranks.

Commissioned officer ranks range from O-1 to O-10 (U.S. Department of Defense, n.d.). Army,

Air Force, and Marine Corps officers who wear the O-1 to O-3 ranks are classified as company

grade officers (U.S. Department of Defense, n.d.). Officers who wear the ranks of O-4 to O-6

are classified as field grade officers and officers in the ranks of O-7 to O-10 are classified as

general officers (U.S. Department of Defense, n.d.). Navy and Coast Guard officers with the

equivalent ranks as the Army, Air Force, and Marine Corps officers are classified as junior

grade, mid-grade, and flag officers respectively (U.S. Department of Defense, n.d.).

Demographics

The majority of service members are enlisted personnel (U.S. Department of Defense,

Office of the Deputy Under Secretary of Defense, 2012). About 83.4 percent of active duty

service members are enlisted personnel and about 16.6 percent are officers (Clever & Segal,

2013). Officers who serve in the Ready Reserve comprise about 14.5% of the Reserve

population and enlisted Ready Reserve personnel comprise about 85.5% of the Reserve

population (U.S. Department of Defense, Office of the Deputy Under Secretary of Defense,

2012).

Gender. Women comprise about 14.6% of the active duty ranks whereas men comprise

about 85.4% of the active duty population (U.S. Department of Defense, Office of the Deputy

Under Secretary of Defense, 2012). Women within the Selected Reserve component ranks

comprise about 18.2% of the population and men comprise about 81.8% of this population (U.S.

Department of Defense, Office of the Deputy Under Secretary of Defense, 2012). The number

of active duty female officers increased in the last twelve years whereas the number of active

duty enlisted service members decreased in the last twelve years (U.S. Department of Defense,

16

Office of the Deputy Under Secretary of Defense, 2012). The number of women in the Selected

Reserve increased over the last twelve years (U.S. Department of Defense, Office of the Deputy

Under Secretary of Defense, 2012).

Age. Active duty officers’ average age is 34.7 and active duty enlisted personnel’s

average age is 27.4 (U.S. Department of Defense, Office of the Deputy Under Secretary of

Defense, 2012). The average age for Selected Reserve component personnel is slightly higher

than they active duty counterparts. Officers’ average age in this group is 39.6 and enlisted

personnel’s is 30.7 (U.S. Department of Defense, Office of the Deputy Under Secretary of

Defense, 2012).

Race/Ethnicity. Less than one-third (30.3%) of active duty service members identity as

a racial or ethnic minority (i.e., Black or African American, Asian, American Indian or Alaska

Native, Native Hawaiian or other Pacific Islander, multi-racial, or other/unknown; U.S.

Department of Defense, Office of the Deputy Under Secretary of Defense, 2012). Among the

Selected Reserve component ranks about one-quarter (24.5%) of service members identify as a

racial or ethnic minority (U.S. Department of Defense, Office of the Deputy Under Secretary of

Defense, 2012). The number of minority officers in the Selected Reserve component increased

in the last 17 years whereas the number of enlisted personnel in the Selected Reserve component

decreased in the last 17 years (U.S. Department of Defense, Office of the Deputy Under

Secretary of Defense, 2012).

Culture

There are other components of military culture in addition to the clear rank structure,

which differentiates it from civilian society and culture. The military operates with a

collectivistic approach that encourages interdependence, group orientation, and group cohesion

17

(Petrovich, 2012). This is an orderly institution, one that is stoic and employs a conformist

approach (Petrovich, 2012). The military culture is paternalistic (Lawrence, 2006) and above all

it is mission oriented (Petrovich, 2012).

When an individual first joins a branch of the military they engage in a group basic

training which is commonly referred to as boot camp (Petrovich, 2012). This process is engaged

to transform individuals from civilians to military personnel (Petrovich, 2012). Each branch of

the military has its own basic training process (Petrovich, 2012). The initial training process is

eight weeks long for the Navy, Coast Guard, and Air Force, nine weeks long for the Army, and

twelve weeks long for the Marine Corps (Petrovich, 2012). The overall goal of basic training is

to transform individuals into group oriented and mission focused personnel (Petrovich, 2012).

Military Life

Military culture, training, and protocol extend beyond the initial training experience and

permeate every aspect of a service member’s life (MacDermid Wadsworth & Southwell, 2011).

Protocols affect service members’ personal and professional conduct (MacDermid Wadsworth &

Southwell, 2011). Service members need to adhere to rigorous standards for work and personal

conduct (MacDermid Wadsworth & Southwell, 2011). They undergo random drug testing,

engage in periodic assessments for height and weight requirements, and need to avoid

questionable behavior related to their finances, drug and alcohol use, and sexual behavior

(MacDermid Wadsworth & Southwell, 2011).

Service members are on duty 24 hours per day, 7 days during the week and are expected

to report with no advanced notice (MacDermid Wadsworth & Southwell, 2011). Military duties

may demand a substantial amount of time, requiring members to remain at their posts until the

job is complete (MacDermid Wadsworth & Southwell, 2011). Failure to adhere to these and

18

other expectations can result in disciplinary action (MacDermid Wadsworth & Southwell, 2011).

Family members are also influenced by military codes of conduct (MacDermid Wadsworth &

Southwell, 2011).

Military Family

Family is an important component of military life and culture (Weiss, Coll, Gerbauer,

Smiley, & Carillo, 2010). Parenthood and marriage are common identifiers among all ranks of

the five military service branches (Clever & Segal, 2013). More than half of all military service

members have dependent spouses and children (MacDermid Wadsworth & Southwell, 2011). A

military dependent is someone who is under the care of an active duty service member (Lowe,

Adams, Browne, & Hinkle, 2012). Dependents reside in the home of the service member full

time or part time. Parents and stepchildren who reside with the service member may also be

classified as dependents (Lowe et al., 2012). The Defense Enrollment Eligibility Reporting

System (DEERS) is the official reporting system for military personnel and their families.

DEERS regards military dependents as “…spouses and unmarried children (including

stepchildren) under the age of 21 (or 23 if attending school full-time)…, of service members”

(Military OneSource, n. d.). There are more military connected family members than military

personnel (MacDermid Wadsworth & Southwell, 2011). Compared to the number of service

members both in the active duty and Reserve component, there are approximately 57.9% of

dependents in the total military population (Department of Defense, Office of the Deputy Under


Military wives. About 56.2% of service members are married (Department of Defense,

Office of the Deputy Under Secretary of Defense, 2012). Service member spouses are

predominantly women (Department of Defense, Office of the Deputy Under Secretary of

19

Defense, 2012). Approximately 93% of active duty spouses are women and appropriately 87.7%

of Selected Reserve spouses are women (Department of Defense, Office of the Deputy Under

Secretary of Defense, 2012). About 46.2% of spouses in both the active duty and the Reserve

components are age 30 and younger (Department of Defense, Office of the Deputy Under


Military wives assume numerous roles in their family (Eubanks, 2013). These roles are

endless and ever changing (Eubanks, 2013). These role changes range from locating new

housing in a foreign country, functioning as a dual parent when the service member deploys or is

away at training exercises, and other tasks relating to supporting their husband’s readiness

(Eubanks, 2013). Many military wives are also active volunteers in their local community and

within military related organizations (Eubanks, 2013).

Today’s military wife, particularly a wife of a service member who served in recent

combat operations, assumes a great deal of responsibility in her husband’s absence (Aducci et

al., 2011). These women continue serving even when their husbands return home. Military

wives assist their husbands in transitioning back to life outside of a combat zone by informally

providing support services (Aducci et al., 2011). Often service members who served in combat

operations do no seek counseling services upon their return. These husbands, unbeknownst to

the couple, rely on their wives to help them process their deployment experiences (Aducci et al.,

2011). Some military wives believe it is their responsibility to serve as a therapist for their

husbands (Tanielian et al., 2013) and neglect their own personal and emotional wellbeing

(Aducci et al., 2011). Military wives therefore are an integral component of military life and

culture.

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Family members. Family members also are expected to refrain from disrupting their

service member’s readiness and performance (MacDermid Wadsworth & Southwell, 2011).

Family members therefore are expected to assume familial role changes such as home

maintenance, emotional support, and caregiving responsibilities in the absence of the service

member (MacDermid Wadsworth & Southwell, 2011). Service members must ensure that their

family members adhere to formal and informal behavior prescription (Segal, 1986). These

formal and informal behavioral prescriptions are closely aligned to the service member’s rank or

leadership position and work related responsibilities (MacDermid Wadsworth & Southwell,

2011; Segal, 1986). Family members informally wear the rank of their service member sponsor

(Segal, 1986). Family members for example, are expected to follow a degree of military

socialization (Segal, 1986). Family members however, cannot be held to military customs and

protocols. There are other distinct areas where military culture directly affects families.

Relocation

The determination regarding a service member’s job location is an area where military

life and culture directly affects the family (Lincoln, Swift, & Shorteno-Fraser, 2008). The

average military family moves once every two to three years (Clever & Segal, 2013). These

moves are referred to as permanent change of station (PCS) assignments (Martinez, 2007).

Families make the decision to move with their service member or the service member

reports to the new duty station unaccompanied. Families that decide to move with the service

member repeatedly adjust to new and unfamiliar environments (Lowe et al., 2012). Families who

accompany their service member overseas face even greater stresses. These families are faced

with adjusting to a new culture (Eaton et al., 2008) in addition to other PCS related stressors.

Many military spouses shoulder the bulk of the burden related to PCS changes for the family.

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Spouses often are largely responsible for coordinating the moving of household goods, finding

housing in a new location, maintaining effective family communications, and limiting overall

family stressors (Eubanks, 2013).

Spouses experience difficulties completing educational degrees, transferring licenses and

certifications, maintaining employment, and pursuing careers (Eubanks, 2013; MacDermid

Wadsworth & Southwell, 2011). Military spouses are less likely than their civilian counterparts

to work fulltime (MacDermid Wadsworth & Southwell, 2011). Military spouses in comparison

to their civilian counterparts are more likely to be unemployed or underemployed (Clever &

Segal, 2013). There is a 2 percent decline in a military spouse’s annual income that is associated

with each PCS move (Clever & Segal, 2013).

Children may experience social and emotional challenges as a result of frequent

relocations (MacDermid Wadsworth & Southwell, 2011). Children may also experience

educational challenges such as non-equivalent educational programming, disruptions in

instructional and behavioral interventions, and a lapse in their individual education plans (Lowe

et al., 2012). Children additionally may experience separation from their parents, extended

family, disruptions in their friendships, discontinuity in health care, and the loss of opportunities

at a particular place (Masten, 2013).

Deployment

Deployment is another aspect of military culture which presents significant challenges for

military connected families. Deployment is when a military service member is sent away or

activated for military duty (Gambardella, 2008). It is a temporary movement of military

personnel from their family, their local work site, and their resources in order to accomplish a

task or a mission (Siegel, Davis, & The Committee on the Psychological Aspects of Child and

22

Family Health and Section on Uniform Services, 2013). A service member can be deployed

between three to fifteen months (Siegel et al., 2012). Deployments generally are classified as

peacetime or wartime.

Peacetime deployments usually are short travels to relatively safe locations (Siegel et al.,

2012). Service members involved in peacetime deployments enjoy a period of rest and recovery

during the deployment (Siegel et al., 2012). Wartime deployment however involves service

members working in dangerous and hostile locations for long periods of time (Siegel et al.,

2012). The United States’ current military operations are largely wartime deployments.

About 2.4 million military personnel deployed to Afghanistan and Iraq after the

September 11, 2001 terrorist attacks on U.S. soil (Spelman, Hunt, Seal, & Burgo-Black, 2012).

Over 793,000 of these two million plus service members deployed more than once (Tan, 2009).

Some service members deployed up to four times (Jordan, 2011). Many service members

received orders to deploy another time even before returning from a current deployment (Jordan,

2011). Some service members experienced extended deployments of 12-18 months at a time and

many began training for temporary duty (TDY) assignments soon after returning from a

deployment (Jordan, 2011). This was considerably different from previous deployment periods.

Military culture surrounding deployment changed significantly since the Iraqi and

Afghani conflicts emerged (Lincoln et al., 2008). Deployment was an aspect of military culture

which was relatively predicable (Lincoln et al., 2008). Today there are many uncertainties

relating to deployment and typical deployment rotations changed significantly (Lincoln et al.,

2008). This resulted in changes in service members’ work and family lives (MacDermid

Wadsworth & Southwell, 2011). Some of these changes include alternative child care

arrangements, custody battles relating to location of primary caregivers for children, financial

23

burdens related to relocation cost and loss of secondary income, unemployment or

underemployment, change in primary residence location, access to medical providers due to

relocation during deployment of a service member, and marital and family conflicts (MacDermid

Wadsworth & Southwell, 2011). Deployment is a substantial stressor for military families

(Lowe et al., 2012). The latest wartime deployment cycle has many implications for military

families. Families experience emotional, cognitive, and role changes before during, and after

these combat deployments (Lowe et al., 2012; Siegel et al., 2013)

Cycle of Deployment

Researchers identified specific stage changes associated with the deployment process.

These identifiable changes are categorized as the cycle of deployment. Five stages are identified

in this cycle (Gambardella, 2008). They are (a) pre-deployment; (b) deployment (experienced

during the first month away); (c) sustainment (experienced during months 2-5); (d) re-

deployment (experienced during the last month); and (e) post-deployment (experienced 3-6

months following the service member’s return home) (Gambardella, 2008). The sustainment

stage in the updated cycle of deployment was extended to 13 months (Siegel et al., 2012). This

was in light of the cycle of deployment lasting up to 15 months for some service members.

Unique emotional challenges are associated with the cycle of deployment (Gambardella, 2008).

Pre-deployment

The deployment process is “…inherently stressful for military families” (Lowe et al.,

(2012), p. 17). Families may experience an underlying level of anxiety during the pre-

deployment stage (Lowe et al., 2012). This occurs while the family continues to engage in

routine operations (Lowe et al., 2012). Service members and their families may live with the

constant stress of knowing that deployment is imminent (Lowe et al., 2012), and resolve that it is

24

just a matter time. Children may experience feelings of worry, fear, excitement, denial, and

anger (Siegel et al., 2013). Emotional withdrawal among family members is not uncommon

during pre-deployment (Siegel et al., 2013). This is especially true for the service member who

is training for the deployment and becomes mission focused. Units engage in extensive trainings

which require long hours or days away from the home in the months leading up to the

deployment (Siegel et al., 2013).

Pre-deployment preparation often includes financial organization, childcare contingencies

and scheduling, and legal matters such as the preparation of a will and power of attorney (Lowe

et al., 2012). Discussions and decisions about caring for sick children, financial adjustments, and

careers may result in at home spouses quitting their jobs (Siegel et al., 2013). The pre-

deployment tasks are many. The family additionally must prepare to say goodbye for a while or

forever.

Deployment and Sustainment

Family members may experience a series of ebbs and flows of emotions (Lowe et al.,

2012) during the deployment and sustainment stage. They may experience a period of loss,

abandonment, and emptiness (Siegel et al., 2013). There generally is a fear among families of

deployed service members that their loved one may not return home alive (Aducci et al., 2011).

Mansfield et al. (2010) noted that “increased stress among military family members before,

during, and after deployment is a potential mechanism for the development of mental health

problems” (p. 102).

Spouses. Many military spouses are comforted and honored by the modern interpretation

of the last line of John Milton’s poem On His Blindness. The last line of Milton’s poem is:

“They also serve who only stand and waite” (Sonnet Central, n.d.). Military spouses understand

25

first hand that those who wait also serve (K. Brindle, personal communication, April 12, 2009).

Military wives often feel that their deployment experiences go unnoticed (Aducci et al., 2011).

Deployment for some military wives is a disenfranchised experience (Aducci et al., 2011). In a

qualitative study of wives of deployed soldiers, these women felt that they were not allowed to

display their emotions, vulnerability, dependence, and worry (Aducci et al., 2011). These

women believed they were supposed to maintain a persona of stoicism, independence, and

strength (Aducci et al., 2011). These women believed that their deployment experiences were

not acknowledged or publicly recognized (Aducci et al., 2011). It appears that the perception

and experiences of military spouses is that they too actively participate in deployment. This

perception and overall experience of these women is seemingly supported in several scientific

inquires (Aducci et al., 2011; Jordan, 2011).

Military spouses were at a great risk for experiencing high levels of stress while their

spouse was deployed and also when the deployed spouse returned home (Fields, Nichols,

Martindale-Adams, Zuber, & Graney, 2012). Incidences of one or more mental health diagnosis

for military wives whose spouses were deployed was higher than military wives whose spouses

were not deployed (Mansfield et al., 2010.) This phenomenon was noted in a study conducted

by Mansfield and her colleagues (Mansfield et al., 2010.). Depression, anxiety, sleep disorder,

acute stress reaction, and adjustment disorder were the most common diagnoses for these wives

(Mansfield et al., 2010).

Spouses reportedly experienced similar rates of major depressive disorder and

generalized anxiety disorder as service members experienced during the post-deployment stage

(Hoge & Castro, 2005). Non-deployed parents may particularly experience this as they try to

effectively function in the role of sole caregiver for children (Lowe et al., 2012). This is

26

especially likely if other family members and friends are not close by to assist (Lowe et al.,

2012). Dependent spouses that are new to the military culture may also experience increased

levels of parental distress during a deployment (Lowe et al., 2012). This was notable in a study

of Air Force spouses who had weaker parent-child communication skills (Lowe et al., 2012).

The Air Force spouse participants in this study who were associated with the military longer

indicated less stress within the parent-child relationship (Lowe et al., 2012). These parental

issues experienced during deployment may also affect children negatively.

Children. A study was conducted to examine the impact of the cumulative length of

deployments to combat theater locations. The participant sample was comprised of 171 families

with children ages 6 to 12 years old (Manos, 2010). One parent was on active duty status and

was deployed to Afghanistan or Iraq at least twice (Manos, 2010). Researchers concluded that

cumulative length of parental increased deployment and the parental distress of the non-deployed

parent correlated with an increased risk of depression and externalizing symptoms in children,

respective of these families (Manos, 2010).

Children may communicate their feelings through behavior because they lack the

required communication skills to act otherwise (Lowe et al., 2012). Children between the ages

of three and five seemed to be especially vulnerable to behavioral problems (Chandra et al.,

2010). Children ages seven and older whose parents were deployed for extended periods of time

were likely to experience difficulty at home, school, and with their peers (Chandra et al., 2010).

This was particularly notable in girls (Chandra et al., 2010). Girls were more likely to exhibit

behavioral problems related to the deployment of an active duty parent (Manos, 2010). The

difficulties experienced by girls may be related to the roles, such as helping with household

chores, they assumed when their parent was deployed (Chandra et al., 2011). Teenage girls with

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fathers who deploy may have the added difficulty of connecting emotionally with these men

(Chandra et al., 2011).

Relational attachment between non-deployed parents and children seemed to be

negatively impacted by greater lengths of deployment times (Lowe et al., 2012). Lowe, Adams,

Browne, and Hinkle (2012) postulated that attachment problems between non-deployed parents

may stem from the daily responsibilities and stress, which compete with the child for the parent’s

attention. Attachment bonds may become more insecure when a parent becomes unavailable or

unresponsive (Lowe et al., 2012). This was true for both the deployed and the non-deployed

parent’s individual attachment bonds with the child (Lowe et al., 2012).

Romantic relationships. Deployment stressors and subsequent impairments in

psychological functioning also affect intimate partner relationships. An empirical study

conducted by Asbury and Martin (2012) examined the relationship between marital discord and

psychological functioning. Researchers assessed the rates of depression, anxiety, isolation, and

marital discord between wives of deployed service members and their civilian counterparts

(Asbury & Martin, 2012). Asbury and Martin (2012) concluded that 80% of military spouses

frequently considered divorce compared to 17% of their civilian counterparts (Asbury & Martin,

2012). The rates of divorce among service members may therefore be higher than in the general

population.

The rate of divorce among combat service members was 53% when compared with the

rate of divorce among the general population which was 49% (Jordan, 2011). Divorce rates of

enlisted soldiers and marines reached a 16 year high in the fiscal year 2008 (Gomulka, 2010).

Marines and soldiers are the group of service members who extensively deployed to Iraq and

28

Afghanistan (Gomulka, 2010). There were 1000 more divorces in 2008 than in 2007 among

enlisted soldiers (Gomulka, 2010).

A study conducted by Karney, Loughran, and Pollard (2012) appears to contradict the

information presented by Gomulka (2010). Karney, Loughran, and Pollard noted that the rates

of divorce among the military and civilian populations are comparable although military

personnel are more likely to marry than their civilian counterparts (Karney et al., 2012). They

argued that the patterns of marriage and divorce among service members have not changed

considerably since the onset of the current U.S. military combat operations (Karney et al., 2012).

De Burgh, White, Fear, and Iversen (2011) noted that, “research on the effect of

deployment on marital health is conflicting and the interaction between deployment, combat

exposure, and homecoming and marital health is complex” (p. 193). Likewise the research

related to marital functioning and the effect of deployment is conflicting (De Burgh et al., 2011).

Relational functioning during the cycle of deployment may be a significant issue for many

couples. About 53.1 percent of enlisted soldiers are married and about 70.1 percent of active

duty officers are married (Lutton, 2011). Substantial time apart for couples is not likely to

mitigate any negative effects of deployment on their marriage.

Rest and recuperation. Service members at times may be granted a short break from

the war zone. Rest and recuperation (R&R) or mid-tour leave is granted to service members

whose deployment orders span over 365 days. Service members leave the war zone for two

weeks (Siegel et al., 2013). Some service members return home during this time (Siegel et al.,

2013). Some families rendezvous with their service member during R&R in various locations

around the world to enjoy this brief leisure time (Siegel et al., 2013).

29

R&R can be a difficult time for children since the time may not coincide with a school

break. Children may become distracted with excitement and anticipation for this short visitation

period (Siegel et al., 2013). At the end of the two week break families again say goodbye to their

loved ones (Siegel et al., 2013). Once again there is the acknowledgement that this may be a

permanent goodbye if the service member dies in combat.

Re-deployment

Re-deployment is the time period when family members prepare for the return of the

combat service member (Lowe et al., 2012). This time is marked by family members busying

themselves to organize the home and their children (Lowe et al., 2012). This is a period of

transition for the entire family.

Children. Children may be expected to assume more personal responsibility since their

caregiver is unable to devote as much attention to them as in times past (Lowe et al., 2010).

Children may experience a spectrum of emotions when the formerly deployed parent returns

home (Rossen & Carter, 2011). These children may wonder whether their re-deployed parent

will remember or love them (Rossen & Carter, 2011). Girls may also experience difficulty

reconnecting with their absent parent, who usually is a father (Chandra et al., 2011).

Spouses. Spouses similarly are busy preparing for the return of their husbands. These

individuals are in a state of transition and vulnerability (Marnocha, 2012). Spouses may busy

themselves to the point of exhaustion (Lowe et al., 2012). Some spouses during this time period

and other times in the deployment cycle place the needs of others before their own (Aducci et al.,

2011). Spouses may actively consider how they can ease the transition for their service member

as they return home.

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Post-deployment

This time begins with a honeymoon period for many families (Siegel et al., 2013).

Families try to get reacquainted and there is a sense that problems can be solved and families can

return to normal (Siegel et al., 2013). Service members typically are granted leave time called

‘block leave’ (Siegel et al., p. e2006, 2013). Block leave is about 2 to 4 weeks of vacation time

(Siegel et al., 2013). The block leave time frame may not correspond with the awaiting family

members’ availability from work and school (Siegel et al., 2013).

Reintegration may be a challenging time for the service member and their families.

Negative long term effects can be notable in the stability of the family unit if the re-deployment

period is not properly undertaken (Lowe et al., 2012). Researchers Asbury and Martin, (2012)

concluded that “…a caring and nurturing environment is vital to recovery from major stressors”

experienced during deployment (p. 45). The home environment for a re-deployed service

member should not have additional major stressors (Asbury & Martin, 2012).

The transition from a combat environment to their pre-deployment life for many service

members is not smooth nor is there a decrease in stressors which they and their families

experienced (Jordan, 2011). Soldiers may feel less at home and may even have a desire to return

to combat (Lambert & Morgan, 2009). This can be hurtful and confusing to the soldier’s family

(Lambert & Morgan, 2009).

Post Deployment Stressors

Inherent in the cycle of deployment are a host of changes for military families. Some

changes are characteristic of particular stages in the cycle of deployment. Families may

experience points of strength and points of challenge. Each family will progress through the

various stages in unique ways. Some families may not experience significant changes and

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lasting effects at the different junctures. Many military families however, experience elements

of physical, psychological, and emotional stressors post-deployment. Some of these families

experience a home environment which is delineated by depression, anxiety, and confusion

(Asbury & Martin, 2012). Some service members may return home with physical injuries.

Other service members may return home with no visible wounds however; they may be dealing

with the effects of a traumatic brain injury (TBI) or mental health problems (Jordan, 2011).

Psychological Stressors

Psychological stressors include issues relating to the psychological or mental health of an

individual. Psychological stressors may affect the service member as well as other members of

the family. Stressors such as a traumatic brain injury and post-traumatic stress disorder

significantly impact the life of the person faced with these stressors. The impact of each stressor

on the family is related to the severity of the stressor and also the degree of resiliency the family

possesses.

Traumatic brain injury. Traumatic brain injury (TBI) is regarded as one of the two

signature injuries of the Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF)

campaigns (Tanielian & Jaycox 2008). The severity of a TBI is determined by the duration of

the loss of consciousness and post-traumatic amnesia (Okie, 2005). Many service members

return home with mild-to moderate traumatic brain injuries (Jordan, 2011). A mild TBI is

associated with the loss of consciousness for less than 1 hour or amnesia lasting less than 24

hours (Okie, 2005). A moderate TBI is associated with the loss of consciousness for 1 to 24

hours or amnesia for 1 to 7 days (Okie, 2005). A severe TBI is diagnosed if the person loses

consciousness for more than 24 hours or has amnesia for more than a week (Okie, 2005).

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Researchers estimate that tens of thousands of service members are dealing with mild-to-

moderate TBIs (Jordan, 2011). Service members with TBIs may experience changes in brain

functioning (Okie, 2005). These changes can be accompanied by headaches, sleep disturbances,

and sensitivity to light and noise (Okie, 2005). They may experience cognitive changes such as

disturbances in memory, attention, language, and delays in reaction times during problem

solving (Okie, 2005). Service members may also experience issues with balance, irritability,

depression, and a lack of awareness of their impairment (Jordan, 2011). Changes in mood, the

presence of depression, anxiety, impulsivity, inappropriate laughter, and emotional outburst are

some of the most troubling TBI behavioral symptoms that service members experience (Okie,

2005). Many service members may be misdiagnosed with PTSD or mood disorders since TBI

symptomology can mimic these other diagnosis (Jordan, 2011).

Posttraumatic stress disorder. Posttraumatic stress disorder (PTSD; American

Psychiatric Association, 2000) is the other signature disorder of OIF and OEF (Tanielian &

Jaycox 2008). Approximately one-in-five service members return home from an OIF or OEF

deployment with PTSD (Asbury & Martin, 2012). Service members however may develop

PTSD symptoms months after they re-deployed (Matsakis, 2007).

Soldiers with PTSD may have higher symptoms of depression, anxiety, anger, sleep

disturbances, somatization, substance abuse, dissociation, and sexual problems (Nelson Goff,

Crow, Reisbig, & Hamilton, 2007). Incidences of PTSD and depression among combat service

members rose since the beginning of the wars in Iraq and Afghanistan (Warner et al., 2009).

Rates of PTSD and depression among service members rose to 10-20% in the post-deployment

stage (Warner et al., 2009). Soldiers may also experience horror, fear, and helplessness

(Lambert & Morgan, 2009). The latter symptoms may not be frequently reported by soldiers

33

because of reduced awareness of these emotions (Lambert & Morgan, 2009). Soldiers

additionally may wish to avoid any stigma associated with showing distress and seeking mental

health assistance (Lambert & Morgan, 2009).

The propensity for reduced reporting of PTSD symptoms may also be related to a service

member’s rank. Active duty enlisted parents enrolled in a study by Lester et al. (2010) were

more likely to report symptoms of PTSD than officer active duty parents. A similar reporting

pattern was also notable among the at home care taker spouses of service members also enrolled

in the study (Lester et al., 2010). The children in these households were more likely to

demonstrate externalizing behavior (Lester et al., 2010). These children did not usually exhibit

internalized behavior or depressive symptoms (Lester et al., 2010). The parents seemed to

underreport symptoms in the household but the same was not true for the children. Adults likely

are more cognizant of the stigma and try to defend against the consequences of reporting these

symptoms outside of the household. Service members who underreport PTSD symptoms could

also be motivated to protect against the shame of other issues experienced in their home such as

poor marital functioning.

Service members returning home with PTSD and who experience a disrupted

reintegration period may also experience poor marital functioning (De Burgh et al., 2011).

Married service members with strong coping skills within their relationship are likely to recover

quickly from feelings of anxiety and stress (Asbury & Martin, 2012). This is in contrast to a

married service member struggling with PTSD who does not have the benefit of strong coping

skills within his/her marriage. Avoidance of effectively addressing PTSD symptoms however

may eventually lead to more serious matters of life and death.

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Suicide. Suicidal attempts and completed suicides by service men and women increased

(Manos, 2010; Siegel et al., 2012). Recent numbers indicted an 80% increase in completed

suicides from the year 2003 when major combat troop deployment began in Iraq and Afghanistan

(Siegel et al., 2012). Today the rate of suicides and psychiatric illness for the military population

is higher than their civilian counterparts (Manos, 2010). The inverse was true in the past

(Manos, 2010). Rates in the military population may be double those in the civilian population

(MacDermid Wadsworth & Southwell, 2011). The rates of completed suicides among military

personnel for the first time in over two decades climbed to 20.2 per 100,000 among active duty

service members when compared demographically to their civilian counterparts (Manos, 2010).

There is speculation that the increased rate of completed suicides among service members is due

to the continued strain on the military (Manos, 2010). Relationship issues also are implicated

with increased completed suicides (MacDermid Wadsworth & Southwell, 2011). This statistical

information however does not incorporate the higher rates of suicide among veterans after they

leave the armed services (Gomulka, 2010).

Physical Stressors

Physical stressors include injuries sustained during combat involvement. Service

members with combat injuries may engage in substance abuse, intimate partner and familial

violence, and experience mental health impairments (Weiss et al., 2010). Soldiers with severe

combat injuries are likely to later meet diagnosis criteria for depression and PTSD (Grieger et al.,

2006).

Many soldiers who survive injuries sustained in conjunction with combat deployments

“…face serious long-term consequences such as amputations, spinal cord injuries, and traumatic

brain injuries” (Spelman et al., 2012, p. 1201). These injuries are lasting and result in loss of

35

function and disfigurement (Grieger et al., 2006). Technological advancements resulted in a

decrease in combat related mortality (Devore et al., 2011). The incidences of morbidity

experienced by wounded service members nevertheless, are increasing (Devore et al., 2011;

Spelman et al., 2012). With the decreased mortality there is an increase in severity and difficulty

of treatment of wounds (Devore et al., 2011).

Combat injuries. The vast majority of battlefield physical injuries sustained by service

members are to their extremities (Devore et al., 2011). Most wounded service members

experience polytraumatic injuries of approximately 2.3 extremity wounds (Devore et al., 2011),

where the physical injuries impact two or more organ systems (Department of Veterans Affairs,

2005). Combat service members and veterans who experience limb loss are generally assisted in

the recovery and rehabilitation process (McFarland, Choppa, Betz, Pruden, & Reiber, 2010).

The rehabilitative process for these injured service members often involves families.

Family members often require mental health interventions during this time of adjustment

(Sayer et al., 2009). The level of services needed by many family members requires a

considerable level of skills from mental health experts (Sayer et al., 2009). Families of combat

injured service members are likely to receive exceptional medical treatment and services to cope

with their new normal in the post-deployment stage. This often includes technological and other

provisions afforded to service members.

Emotional Stressors

Emotional stressors include relationship issues, unhealthy family dynamics, and role

changes. The impact of an emotional stressor varies among families. Some of the physical and

emotional stressors such as PTSD symptoms, TBI related changes, and depression may be

intertwined in the resulting emotional stressors experienced by families.

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Vicarious traumatization. Spouses and family members may experience vicarious

traumatization if their service member returns from a deployment with PTSD (Lambert &

Morgan, 2009). Vicarious traumatization is also referred to as secondary traumatization and

compassion fatigue (Lambert & Morgan, 2009). Individuals who experience this condition

report feeling distress as a result of their loved ones direct experience of a traumatic event

(Lambert & Morgan, 2009). Romantic partners of peacekeepers with PTSD were noted to have

sleep problems, somatic problems and negative social support (Lambert & Morgan, 2009). A

study involving the use of the Couple Adaptation to Traumatic Stress Model indicated that

secondary trauma symptoms in a spouse may in turn intensify symptoms of primary trauma in

their spouse (Nelson et al., 2007). The individual symptoms experienced by the primary trauma

survivor and the secondary partner likely affects the couple’s relationship functioning. This

phenomenon is not documented among family members of recently deployed service members.

It is possible however that it may be present among this population of families.

Home environment. It is important to note that the home environment during the

reintegration process should not present with additional major stressors (Asbury & Martin,

2012). Issues such as marital instability exacerbated by psychological distress experienced by

both spouses, does not foster an environment conducive towards the recovery of both

individuals. Marital functioning, psychopathology, functional disability, and social support are

some common variables documented in the literature which significantly impact military

families as a result of recent combat deployment. There are far reaching consequences for

military families when their active duty service member returns home emotionally instable

(Gibbons, Barnett, & Hickling, 2012).

37

Marital functioning and psychopathology. There is an association between marital

functioning and psychopathology (Papp, Goeke-Morey, & Cummings, 2007). A study was

conducted with 100 heterosexual married couples. The study involved dyadic data analysis with

a series of multilevel multivariate models. Researchers indicated that there was a positive

relationship between psychopathology and marital conflict expressions (i.e. strategies that

husbands and wives used during conflict interactions; Papp et al., 2007). Psychopathology and

martial satisfaction was explored in another study (Whisman, Uebelacker, & Weinstock, 2004).

Researchers specifically assessed anxiety and depression both for the husband and the wife

(Whisman et al., 2004). Two data-analytic strategies, a path analysis and hierarchical linear

modeling were utilized (Whisman et al., 2004). Eight hundred forty one couples participated in

the study (Whisman et al., 2004). Participants were mixed-gender spouses (Whisman et al.,

2004). Anxiety and depression were significantly correlated within the couple relationship with

marital satisfaction (Whisman et al., 2004).

Functional Disability

Many of the emotional, physical, and psychological post-deployment stressors are related

to a functional disability experienced by the service member (Brininger, Antczak, & Breland,

2008; Okie, 2005). A functional disability is likely to affect the family functioning (Sayer et al.,

2009). Family members are likely to experience long term to permanent role changes in the face

of their service member’s impairments. Children may experience poor parent child relationships

(Tanielian & Jaycox, 2008). The marital relationship may also suffer as a result of the service

member’s disability status (Mancini & Bonanno, 2006).

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Marital Closeness and Psychopathology

Functional disability can influence the degree of marital satisfaction in the presence of

psychopathology. Researchers Mancini and Bonanno (2006) conducted a study to assess

socioemotional selective theory with regard to marital closeness, functional disability, and the

association with depression, anxiety, and self-esteem. The participants in the study were older

couples who were at least age 65 years old. High levels of marital closeness and high levels of

functional disability were associated with less of an increase in depression, and anxiety (Mancini

& Bonanno, 2006). Marital closeness accounted for a substantial portion of the variance

explained for all of the dependent variables (Mancini & Bonanno, 2006). Beta coefficients for

reduced depression was = -.30, -.16 for reduced anxiety, and-.29 for increased self-esteem. The

interaction effect for marital closeness and functional disability was significant with depression

yielding a beta coefficient = -.27, anxiety with a beta coefficient = -.29, and self-esteem with a

beta coefficient = .34.

Social Support

Social support is also associated with functional disability and psychopathology. The

presence of social support can ease the negative psychological effects associated with a

functional disability (Mancini & Bonanno, 2006). Researchers noted that social support could be

a potential benefit to a person with a functional disability (Mancini & Bonanno, 2006). It may

be important to differentiate the type of social support. Researchers noted that it is particularly

the social support within the context of the marriage that the individual receives (Mancini &

Bonanno, 2006). Mancini and Bonanno (2006) also discussed the importance of measuring the

multidimensional dimensions of social support, which is supported extensively throughout the

literature. Social support is also associated with fewer levels of depression and anxiety (Frazier,

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Tix, Klein, & Arikian, 2000). Social support was also shown to be instrumental in mediating

stressful life events (Heitzmann & Kaplan, 1988). Emotional support received from others in a

caregiver’s social network also had a positive impact on marital satisfaction (Wright & Aquilino,

1998).

Current Considerations for Military Families

A wartime deployment can easily facilitate the presence of functional disability,

psychological impairment, and marital instability for today’s military family. Family members

need their own support even as they assist combat veterans in their healing process (Sniezek,

2012). A combat injury sustained by a military service member that results in the need for

continuous assistance by a spouse is likely to perpetuate and even increase the negative mental

health components experienced by a spouse. This type of couple is faced with common issues of

reintegration such as role modifications precipitated by personal and environmental factors

(Gambardella, 2008). The couple additionally has to negotiate the consequences of the physical

injury sustained by the combat service member (Gambardella, 2008). How then does this couple

progress in light of these and other stressors?

Stress Coping

Etiology. People who are stressed first appraise the severity of the consequences of the

stressor (van den Heuvel et al., 2000). This is in accordance with the stress coping theory which

was proposed by Lazarus and Folkman (van den Heuvel et al., 2000). The individual secondly

will assess for available resources and possible coping strategies (van den Heuvel et al., 2000).

These primary and secondary assessments influence each other and subsequently determine the

amount of stress the individual experiences (van den Heuvel et al., 2000). As the individual

employs a coping strategy, be it passive or active, the effectiveness of the strategy and

40

assessment influences the individual’s social functioning, mental well-being, and physical health

(van den Heuvel et al., 2000).

This response to stress generally is critical yet not detrimental to the individual’s

wellbeing (Siegel et al., 2012). The selected response is dependent on previous experiences with

stress; the meaning ascribed to the specific stress; the context of the current stress experienced;

and the inherent and external resources available to cope with the stress (Siegel et al., 2012).

Mental health assistance. Some military families seek professional assistance to cope

with many of their stressors. There is an increased seeking of mental health services by military

families to cope with significant population specific, situational, and maturational changes

(Weiss et al., 2010). These changes are largely due to the United States’ military combat

assignments of service members to Iraq and Afghanistan, in conjunction with OIF, OEF, or

Operation New Dawn (OND) (Spelman et al., 2012).

Service members and military families who seek mental health assistance may experience

positive changes in their relationship (Hollingsworth, 2011; Jordan, 2011). These families

additionally may become more resilient (Weiss et al., 2010). Numerous topics are likely to arise

in counseling with military families dealing with post-deployment challenges (Jordan, 2011).

Mental health counselors need to have knowledge and significant understanding of the research

regarding the foremost issues respective of this population. Counselors who are assisting

military families working through the residual effects of war should especially be familiar with

the secondary implications for military caregivers.

Caregivers Burden

Women, younger caregivers, caregivers who are not in good physical health, and

caregivers taking care of someone with severe emotional, cognitive, and behavioral concerns,

41

experience the most negative consequences in their role as a caregiver (van den Heuvel et al.,

2000). This was the conclusion made by Elisabeth van den Heuvel and her colleagues who

engaged in a study about the risk factors for burnout among caregivers (van den Heuvel et al.,

2000). This study was related to the direct care of a loved one who sustained a stroke. There

may be implications for military families where the caregiver is a woman, young, or also

involved in a situation where the injured service member is experiencing cognitive deficits, and

behavioral changes.

A study by Wright and Aquilino (1998) examined the interrelationships among elderly

couples, reciprocity of emotional support, the experience of caregiving wives for husbands with

disabilities, and wives’ marital satisfaction. Researchers concluded that the act of caregiving can

move marital satisfaction towards unbalanced exchanges of emotional support between the

couple (Wright & Aquilino, 1998). Wives provided more emotional support to their husbands

who in turn provided less emotional support to their wives (Wright & Aquilino, 1998).

Providing care for other people in addition to a husband can increase a caregiver’s burden while

also decreasing marital satisfaction (Wright & Aquilino, 1998). This is a threat to the well-being

of a wife who is the caregiver to a husband that is disabled (Wright & Aquilino, 1998). This

may have significant implications for military caregiver wives who also are caregivers to

children.

Conclusion

Multiple areas are affected for military families due to combat deployments. It is not

only the combat service member who experiences negative changes following a deployment to

the war zones of Iraq or Afghanistan (Manos, 2010). Military spouses may continue to

experience elevated rates of depression, anxiety, and marital instability post deployment in the

42

absence of adequate spousal support from the service member. These issues necessitate further

research and interest.

The impact on deployment on wives who are the caregivers of functionally disabled

active duty service members is not sufficiently examined. Information particularly about

caregivers to service members that were injured in recent combat operations is scarce. The

questions regarding the coping strategies, developmental changes, and life outcomes of these

caregivers remain. It is imperative that further research be devoted to understanding and

supporting the overall well-being of Army caregiver wives whose husband’s combat injury

resulted in a functional disability.

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CHAPTER THREE: METHOD

I present the research methodology in this chapter. The theoretical framework which

supported the methodology and measures utilized to ensure requirements for research rigor are

satisfied are also included in this chapter. These are followed by the research questions, criteria

for participation in the current study, recruitment methods, a rationale for study participants,

instruments, data collection procedure, the informed consent process, and data analysis. The last

section denotes steps taken to address trustworthiness or goodness of the research.

Theoretical Framework

Qualitative Research

Qualitative research methods were utilized in this research study. Qualitative research

methods are broad empirical procedures which are utilized to describe and interpret the

experiences of people participating in a research study (Denzin & Lincoln 2000). The

experiences of these individuals as described in the study are presented from a context specific

setting (Denzin & Lincoln 2000). Polkinghorne (2005) noted that, “the experiential life of

people is the area qualitative methods are designed to study” (p. 138).

Qualitative research is distinguishable from other research methodologies given a few

characteristics. Qualitative research is conducted in a natural setting (Creswell, 2013). That is

the place where participants experience the issue or problem (Creswell, 2013). Other

components of qualitative research include (a) the use of multiple methods of data collection; (b)

the researcher themselves collecting data; (c) both inductive and deductive logic are used to

stimulate complex reasoning to build patterns, categories, and themes; (d) the focus is to learn

the meanings that participants expound about a particular issue or problem; (e) the research

design and the research plan can change when the researcher enters the field; (f) the researcher

44

utilizes reflexivity and presents their own background and explains how it informs their

interpretation of the information in the study; and (g) employs a holistic account to report

multiple perspectives, identify the many factors involved in the situation, and identifying the

complex interactions in the situation (Creswell, 2013).

Interpretative Frameworks

There are several interpretative frameworks which qualitative researchers can employ

(Creswell, 2013). These include postpositivism, social constructivism, transformative

frameworks, postmodern perspectives, pragmatism, and feminist theories, to name a few

(Creswell, 2013). Each interpretative framework incorporates the philosophical assumptions of

qualitative research (Creswell, 2013). That is the ontological, epistemology, axiology, and

methodology assumptions (Creswell, 2013). The interpretative frameworks essentially are

theories reflective of various disciplines which are employed to serve a myriad of purposes (i.e.

social justice, advocacy, or to give voice to underrepresented or marginalized groups; Creswell,

2013).

Social constructivism. This research study was guided by a social constructivist

framework or stance. The constructivist or interpretivist paradigm generally is an alternative to

the traditional received view or positivist paradigm (Ponterotto, 2005). Social constructivism

acknowledges the construction of knowledge from people who in turn construct their society

(Sullivan, 2009). Knowledge is constructed by individual and collective action (Sullivan, 2009).

The social constructivist framework, in analysis of others, views individuals as seeking

understanding of their world (Creswell, 2013). People try to develop or forge subjective

meanings of their lived experiences (Creswell, 2013). Meaning however, may be varied and

multiple (Creswell, 2013).

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The influence of the social, political, cultural, and historical context of the accumulated

narrative are recognized in the social constructivist framework (Hays & Wood, 2011). These

factors significantly influence the overall meanings obtained from the shared stories (Hays &

Wood, 2011). It is likely that several of these contexts influenced the individual narratives of the

current study’s participants. Researchers also recognize that their own backgrounds influence

their interpretations of these meanings. I was therefore cognizant that my positon and

experiences as an Army spouse of a service member who served in multiple combat operations

was likely to influence my interpretation of the research findings. The goal of research given a

social constructivist stance is to rely as much as possible on the views of the participants who are

describing the situation (Creswell, 2013). Meaning is developed through interactions or

discussions with other people (Creswell, 2013).

Narrative research design. A narrative design was employed as this most appropriately

supported the research focus, research questions, and subsequent analytical strategies. In a

narratological tradition, the goal of qualitative research “…is to understand the human

experience through narrative forms of qualitative research data” (Hays & Wood, 2011, p. 293).

Narrative design is appropriate to gather the stories of one or two individuals, to report their

individual experiences, and chronologically order the meanings of those experiences (Creswell,

Hanson, Clark Plano, & Morales, 2007). The researcher then is able to analyze these stories and

‘restory’ them chronologically (Creswell et al., 2007). This is a unique feature of narrative

methodology (Creswell et al., 2007).

Narratives, like novels, have a beginning, middle, and an end (Creswell, 2013).

Narratives similarly involve a predicament or struggle, a main character or protagonist, and a

sequence with implied causality during which there is some resolution to the predicament

46

(Creswell, 2013). Some scholars refer to three elements of the narrative during the analysis.

These are the orientation, the complicating action, and the resolution/coda (Hays & Wood,

2011). Dialogue that establishes the context of the narrative is the orientation (Hays & Wood,

2011). The plot or central tension of the story is the complicating action and the resolution or

coda is the conclusion of the story (Hays & Wood, 2011).

A narrative methodology was best suited to gather and relay the stories of Army

caregiver wives whose husbands sustained a functional disability related to a combat operation.

These women retold their story noting their life before their husband’s injury, the nature of their

life when the injury occurred, and their life following the injury. The chronicle of their

individual stories and meaning making process was effectively analyzed using the narrative

design. Narrative inquiry facilitated the process of getting to know these women and their

individual stories much like the counseling process (Hays & Wood, 2011)

Research Questions

Research questions which are guided by the social constructivist framework are general

and broad and offer participants the opportunity to contrast meaning of a situation (Creswell,

2013). The following research questions guide this study.

Research Question 1

What are the stories of Army caregiver wives whose enlisted husbands experienced a

functional disability in combat?

Research Question 2

How does the story of becoming the caregivers or nonmedical attendants for functionally

disabled enlisted Army husbands impact the lives of these women?

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Research Question 3

What new roles do these wives assume while functioning as caregivers or nonmedical

attendants for their enlisted Army husbands?

The primary purpose of these questions was to determine what if any types of social

support these women utilized in their new role as caregivers or nonmedical attendants. The

responses to this question provided information to frame best practices for counselors in their

work with the caregiver wives or nonmedical attendants of Army enlisted functionally disabled

soldiers.

Participants

All study participants were married women whose husbands were active duty enlisted

Army soldiers. Soldiers and marines were the primary fighters in the wars in Iraq and

Afghanistan (Gomulka, 2010). Recruitment was conducted among Army families and not

among other service branches. Each branch has its own distinct subculture (Petrovich, 2012).

The participants’ husbands were deployed and directly involved in at least one of three recent

U.S. military combat campaigns (a) Operation Iraqi Freedom (OIF); (b) Operation Enduring

Freedom (OEF); (3) or Operation New Dawn (OND).

I sought to recruit six to eight women to participate in this study. There is no prescribed

number of participants for a narrative design (Santos, 2013). This is unlike other forms of

qualitative research traditions such as grounded theory, phenomenology, and consensual

qualitative research (Hays & Wood, 2011). Narrative research has no recommended sample size

(Hays & Wood, 2011). Narrative research is best suited to capture the stories of one individual

to a small number of individuals (Creswell, 2013). Six to eight therefore was selected in order to

obtain sufficient rich stories for analysis. Eight women expressed interest in participating in the

48

research study. Only seven women however, engaged in the participant aspect of the research

study.

It should be noted that the eighth woman was unsure if she met criteria as a caregiver to

participate in the research study. This was a sentiment expressed by two of the seven women

that participated in the study. I presented the definition of a military caregiver and provided

examples of tasks to these three women. Two of the women realized they were functioning in a

caregiver role and agreed to share their narratives. The eighth woman however, ceased

communication with me after three occasions. This woman shared that she was dealing with

several family issues during our communications. She therefore may not have had the time to

fully commit to sharing her narrative at that time.

The enlisted service member sustained an injury during a combat deployment of OIF,

OEF, or OND. This injury immediately or gradually resulted in a functional disability to the

soldier. The wife functioned in the role of caregiver or non-medical attendant for the injured

service member. The wife was not functioning in the capacity of caregiver for any other

individual other than minor children. All study participants were past the post-deployment stage

of 3-6 months at home. The service member returned from combat at least six months ago.

The time frame of six months or more was chosen noting that this is past the post-

deployment period (Lowe et al., 2012). Even military families that did not experience the injury

of a service member could feasibly be undergoing normal post-deployment related stressors such

as role negotiation during the 3-6 month post-deployment time period (Lowe et al., 2012). Many

military wives whose active duty husband served in combat could present with typical post-

deployment challenges during the first six months of post-deployment. These challenges may

include significant levels of depression, anxiety, and marital instability. Families however, who

49

are not faced with a functional disability, are likely to have moved towards successful

reintegration during the 3-6 month post-deployment period. The same may not be true for

families faced with a functional disability sustained by the re-deployed service member. Wives

respective of the latter family may still experience significant levels of depression, anxiety, and

marital instability past the 3-6 month post-deployment period.

Methods of Recruitment

Participates were recruited from families stationed at two U.S. military installations in the

southern portion of the United States. Military personnel at one of these installations are part of

a joint base command comprised primarily of Army and Air Force service members. Personnel

from all branches of the military, (i.e. the Army, the Air Force, the Navy, the Marine Corps, and

the Coast Guard), and also among the active duty and Reserve components, serve in some

capacity at this installation. Military personnel at the second installation are primarily Army

service members. However, there is a substantial amount of personnel who serve in the Air

Force also stationed at this installation.

A variety of purposeful selection methods were utilized in this study (Polkinghorne,

2005). This is a methodological approach for participant recruitment which is in line with a

narrative design (Hays & Wood, 2011). A stratified purposeful and snowball sample was

employed (Noy, 2008; Sandelowski, 1995). These sampling techniques were utilized because it

is fairly difficult to access members of this population in the absence of referrals and personal

contacts. This situation is related to the military culture which cultivates an environment of

secrecy and a mistrust of outside sources (Hall, 2008). I established substantial contacts at these

two military installations however the recruitment process was challenging. It is possible that

because I am the wife of an officer it was more difficult to access wives of enlisted service

50

members. Because of the military rank structure family members of enlisted and officer service

members do not readily associate in similar circles. I therefore relied heavily on professional

contacts rather than personal social contacts.

Participants were recruited for the study through direct personal contacts, flyers, and

electronic mail. Several key individuals were contacted near and on these installations to elicit

guidance regarding other key personnel, organizations, offices, and contact information of

potential study participants. Recruitment of study participants was initiated following the

approval of the study from the Institutional Review Board (IRB) at The University of Texas at

San Antonio.

Why Study These Women?

Little research exists about the experiences of military families post deployment.

Minimum information to date was obtained from caregiver wives of combat injured service

members. Only one research study was conducted which sought to gain an understating of

military caregivers (Tanielian et al., 2014) at the execution of the present research study.

However, this study by Tanielian et al., (2014) was not exclusive to caregiver wives.

Additionally, the research study by Tanielian and her colleague (2014) did not examine the

individual narratives of caregiver wives of Army service members.

Insight into the narratives of caregiver wives can be instrumental to counselors in their

continued work with military families. De Burgh and colleagues (2011) concluded their research

article noting that it is important to address the effects of military deployment on spouses. These

researchers wrote that the mental wellbeing of this group of military spouses not only affects

these women but also their partners and their families (De Burgh et al., 2011). Counselors may

be ill equipped to assist these women and their families in the absence of these personal

51

narratives. It is therefore possible that in the absence of the current study researchers and mental

health professional continue to lack information specific to supporting Army caregiver wives in

their roles, their sense of self, and their overall wellbeing. The current narrative research injury

has the potential to validate the knowledge of these ordinary people (Fraser, 2004), the caregiver

wives, whose stories are seldom heard.

Data Collection

In the following section I described the data collection procedures which were utilized in

the research. The purpose of data gathering in qualitative research is to provide evidence for the

experience under investigation (Polkinghorne, 2005). The data collection procedures were

significantly influenced by my social constructivist framework and narrative methodology. The

specific instruments utilized for this process are also described in detail.

Instruments

Researchers that utilize narrative methodology utilize interviews and documents

primarily for data collection (Creswell, 2013). These are the instruments for inquiry. The

instruments which were utilized in this study are an information sheet, a demographics

questionnaire, semi-structured interviews, and field notes and memos. An information sheet was

provided to each participant as approved by The University of Texas at San Antonio IRB. This

sheet was in lieu of an informed consent form. The Demographics Questionnaire was utilized to

elicit specific information about the participant and their family for data analysis. The semi-

structured interviews were used to obtain the participants’ individual stories. The field notes and

memos were utilized to support the holistic approach and document other contextual factors in

the participants’ story. The process in which each instrument was utilized is detailed below.

52

Information sheet. All mechanisms of recruitment emphasized the voluntary nature of

the study. Participants were provided with an information sheet about the research study.

Participants were not required to sign an informed consent to further ensure participant

anonymity. The participants were given information about the purpose of the study and

information about the methods which were employed to ensure participant anonymity. A copy

of the Participant Information Sheet is included in Appendix F.

Participants additionally were provided with my contact information. I informed

participants to contact me if they had questions related to the study or desired to obtain study

results when they become available. I also shared with each participant my personal connection

to the research topic. Participants were encouraged to ask questions of me before or after

interviews were completed (DiCicco-Bloom & Crabtree, 2006). This step was completed with

the recognition that I possessed a significant amount of power in these interactions (DiCicco-

Bloom & Crabtree, 2006).

Participants were asked to provide a pseudonym which would replace their names on

interview transcripts. De-identified data included the demographic data and the interview

recordings. This data was transferred to a password protected electronic file on an external

storage device. This device was stored in a separate locked safe. A Microsoft Excel spreadsheet

was created which matched participants’ pseudo names and proper names. This was an

important component during the facilitation of member checks and further data analysis. This

spreadsheet was stored on a password protected electronic file on an external storage device.

Demographics questionnaire. All participants were asked to complete a demographics

questionnaire. This questionnaire was developed to elicit pertinent information about the

participants and their respective stories. It was important that I develop the questionnaire rather

53

than relying on a questionnaire which was developed otherwise. This is a data collection method

which is in accordance with qualitative research methodologies (Creswell, 2013). Information

such as age, number of years married, husband’s number of years in service, number of combat

deployment experiences, duration of husband’s functional disability, husband’s military

occupation during deployment, and number of children was solicited through this questionnaire.

A copy of the Demographics Questionnaire is included in Appendix G.

Identification. Participants were asked to verbally verify their status as a caregiver or a

non-medical attendant. Participants could have chosen to provide paperwork which

demonstrated their current or expired status as a non-medical attendant. All participants were

required to demonstrate their status as the wife of an active duty enlisted service member.

Participants were asked to show their current dependent identification card. Displaying a

dependent identification card is an ever present component of military culture and serves to

verify a person’s legitimate military connection.

Interview Methods

The women were interviewed using a semi-structured interview guide. Use of a semi-

structured interview guide facilitated the inclusion of emergent ideas during the interview

process (DiCicco-Bloom & Crabtree, 2006). One interview was conducted with each woman

separately. The interviews were about thirty minutes to two hours in duration. Interviews were

the primary source of data collection. Data was supplemented by documents, visual media, etc.

as provided by the participants and my personal observations during the interview (Hays &

Wood, 2011). All interviews were video or audio recorded. Interviews were not conducted

within the military system.

54

Interviews. A semi-structured in-depth interview guide was utilized as the primary

mode of data collection (DiCicco-Bloom & Crabtree, 2006). The questions listed on the

Interview Guide were comprised to answer the three research questions outlined above. I

developed the Interview Guide which is in line with qualitative research methodologies

(Creswell, 2013). The questions were open-ended. A copy of the Interview Guide is included in

Appendix H. The use of a semi-structured interview guide allowed for additional questions to be

asked of participants during the interview process (DiCicco-Bloom & Crabtree, 2006).

Interviews were conducted at several locations both public and private. The determination for

which location to utilize was based on the location which was most convenient for the individual

participants. Factors such as proximity to participants, their work schedules, their husbands’

appointment schedules, and child care locations were considered. The determination was made

for which location was best suited for the interview through discussion with each participant

individually.

Field notes and memos. Reflective and descriptive field notes were recorded. These

field notes were recorded in order to preserve contextual information and other observations.

This instrument added to the holistic perspective of qualitative research (Creswell, 2013). Field

notes and memos were written at the completion of each interview. Information such as my

thoughts and observations during my interactions with the wives were recorded. I in turn

processed these notes at the conclusion of each interview (Polkinghorne, 2005).

Follow-up contact. Each participant was contacted after the initial interview.

Participants were provided with a copy of their individual interview transcript. The preferred

method to provide this transcript to participants was in person. Many participants however, were

unable to attend another in person session. The option to receive their individual transcripts via

55

electronic mail was therefore provided to each participant. Participants were able to provide

feedback to me via phone or electronic mail.

Follow-up contacts helped to combat some of the challenges with validity in qualitative

research. These contacts provided another opportunity for participants to be less resistant about

sharing their stories (Polkinghorne, 2007). Seidman (1991) noted that participants may be

hesitant to reveal information about themselves in one interview and lack trust in the researcher.

Follow-up interviews facilitated the process of member checking and supported research

trustworthiness. The importance of trustworthiness and the purpose of member checking are

described in detailed in the data analysis plan section.

Data Analysis Plan

Data analysis was conducted concurrently with data collection (DiCicco-Bloom &

Crabtree, 2006). It was an iterative process where I moved from data collection to analysis and

back again to data collection and analysis as needed (Polkinghorne, 2005). This process was

engaged until the description was comprehensive (Polkinghorne, 2005). The seven phases of

narrative analysis as suggested by Fraser (2004) were employed as a guide. Fraser’s (2004)

guide for data analysis include: (1) Phase One: Hearing the stories, experiencing each other’s

emotions; (2) Phase two: Transcribing the material; (3) Phase three: Interpreting the individual

transcripts; (4) Phase four: Scanning across different domains of experience; (5) Phase five:

Linking ‘the personal with the political’; (6) Phase six: Looking for commonalities and

differences among participants; and (7) Phase seven: Writing academic narrative about personal

stories (Fraser, 2004). Fraser’s (2004) phases were adopted as a guide and were modified and

reworked in light of my own research interests, experiences, and goals (Fraser, 2004).

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Trustworthiness

Four concepts are notable in qualitative research that closely corresponds to the concepts

of validity and reliability which are noted in quantitative research methods (Creswell, 2013).

These four concepts are: credibility, transferability, dependability, and confirmability. These

four concepts should be appropriately substantiated. Polkinghorne (2007) notes that a claim,

such as the claim that a researcher makes upon the conclusion of a research study is valid if the

evidence and arguments that are presented are justified (Polkinghorne, 2007). Narrative

researchers have the task of arguing for the validity of the collected evidence and also the

validity of the interpretation that is offered (Polkinghorne, 2007).

Trustworthiness is related to validity in quantitative research (Morrow, 2005).

Qualitative researchers use various methods to demonstrate credibility, transferability,

dependability, and confirmability in order to substantiate the claim for validity and reliability.

Although these four concepts are related to concepts of validity and reliability they are not

parallel to each other (Morrow, 2005). Qualitative research renders different kinds of knowledge

than quantitative research methods (Morrow, 2005). Credibility, transferability, dependability,

and confirmability are addressed in detail in this research project.

Credibility. Credibility pertains to the confidence that the issue under study is accurately

documented. This concept is closely related to internal validity in quantitative research

approaches (Morrow, 2005). Several steps were undertaken to ensure credibility in this study.

These included triangulation and member checking. Multiple sources are utilized by researchers

to provide corroborating evidence about the subject matter through the process of triangulation

(Creswell, 2013).

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Triangulation. Triangulation was sought through multiple interactions with participants.

I initiated contact with each individual participating in this study on at least four occasions. The

first contact was to share information about myself, about the research study, answer questions

the interested person had, and to schedule a time for the interview if the person was interested in

sharing their narrative. The second encounter was initiated with each woman the day before or

the day of the interview. This was done to confirm the interview time and meeting place. The

third encounter with each participant was to conduct the interview as described above.

Field notes and memos which were utilized in the data collection stage were also

employed to further support triangulation. These served as additional data during the various

interactions with the participants. Triangulation helped to ensure that the holistic contexts of the

participants’ stories were obtained (Creswell, 2013).

Member checking. The fourth encounter with each participant was in conjunction with

member checking. Member checking was utilized to ensure credibility (Morrow, 2005).

Individual interview transcripts were provided to each participant. Participants were given the

opportunity to review and clarify their stories. Participants therefore were given the opportunity

to judge the accuracy and the credibility of the account (Creswell, 2013). These four encounters

allowed the participant wife and me to become familiar with each other and also facilitate

rapport (Polkinghorne, 2007). These encounters additionally allowed the participant to reflect on

responses given and provide deeper meaning if they found it important or necessary to do so

(Polkinghorne, 2007).

Transferability. Transferability involves the extent to which the reader can generalize

the results from a study to their respective context (Morrow, 2005). Transferability or

generalizability is related to external validity in quantitative approaches (Morrow, 2005). Thick

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description is a function of transferability and was employed in this study. Pieces of the

participants’ narratives and rich description of their experiences is presented in the analysis

section. Detail information which emerged from the data was highlighted through the data

analysis process. Rich details and revealing descriptions helped to attest to the validity of the

stories (Polkinghorne, 2007). This process was engaged such that readers may be able to transfer

the information to other personal contexts (Creswell, 2013). Readers however should not expect

to generalize these study results to other populations or settings (Morrow, 2005). Qualitative

data should not be expected to be generalizable in the same manner as quantitative data

(Morrow, 2005)

Dependability. The concept of dependability is parallel to the quantitative concept of

reliability (Morrow, 2005). The process of obtaining research findings should be explicit and

repeatable as much as possible (Morrow, 2005). An external auditor who was versed with the

methodology but not connected to this research project was utilized. This individual examined

whether the findings, conclusions, and interpretations I proposed were supported by the study

data (Creswell, 2013). Research activities and processes also were presented to this individual

(Morrow, 2005). This also incorporated the field notes and the memos. Data was presented to

the auditor in the absence of participant identifying information. Use of an external auditor is a

function of dependability.

Confirmability. Confirmability is the degree to which the results of the study are

informed by the participants rather than by the researcher (Morrow, 2005). Confirmability is

related to objectivity in quantitative approaches (Morrow, 2005). There is an acknowledgement

however that research is never objective (Morrow, 2005). The researcher however, must

integrate the data, the analytic process, and the findings such that the reader is able to confirm

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the adequacy of the research findings (Morrow, 2005). The process of triangulation can be

utilized to achieve confirmability in addition to researcher flexibility (Santos, 2013). Throughout

the data collection process I kept a journal to document my thoughts and feelings. It was

important to document my biases as they arose during this process given my personal and

professional connection to military families.

Conclusion

This chapter detailed the methods which were utilized in this study. A narrative approach

was employed to provide caregiver wives of functionally disabled enlisted Army service

members an opportunity to tell their stories of being caregivers or nonmedical attendants. Steps

for achieving trustworthiness were also provided.

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CHAPTER FOUR: DATA ANALYSIS

The results of the research study are presented in this chapter. A summary of the seven

participants is presented followed by an individual synthesis of the participant narratives. This

section is then followed by a group analysis where themes which emerged from the data are

described in detail. Data analysis was completed utilizing components of Fraser’s (2004) seven

stages of data analysis. Chapter four concludes with information about member checking, the

process of utilizing an external auditor, and the researcher’s position in the research study.

Summary of Participants

Seven wives of Army enlisted service members participated in this study. Demographic

information for each participant was obtained from the Demographics Questionnaire which is

included in Appendix G. All the information obtained from the individual Demographics

Questionnaire was self-reported. A table is included below with demographics information

about the seven participants.

Three women identified as Hispanic, two identified as White, and two women declined to

provide information about their race or ethnicity. One of the women who declined to provide

information about her racial or ethnic identification shared during her narrative that she was from

Germany.

Four women worked outside of the home. There was variability in the professions of

these four women. Two women worked at home. The women who worked at home self –

identified as either a homemaker or a domestic engineer. One woman did not provide

information about her profession.

The women ranged in ages from 23 to 46. Their specific ages were: 23, 30, 32, 38, 44,

46 and 46. The women were married from one to twenty four years. The specific years of

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marriage include 1, 4, 4, 9, 19, 23, and 24 respectively. This was the second marriage for two of

the women. Information about previous marriages however was not solicited on the

Demographics Questionnaire. It is possible that this was not the first marriage for other women

involved in the study.

Each woman was a mother. The number of children each woman had ranged from one to

three. Five of the women had three children each. One woman had two children and the seventh

woman had one child. The children collectively ranged in ages from five months to twenty three

years old. There were 18 children total among the seven women.

The individual husbands of these women wore the ranks from E-4 to E-7. One woman’s

husband wore the rank of E-4, two husbands wore the rank of E-6, and four husbands wore the

rank of E-7. The number of years each woman’s husband served ranged from seven years to

twenty four years. The individual years of service were 7, 11, 11, 11, 17, 23, and 24

respectively. The number of combat deployments each woman’s husband served in ranged from

two to four times. The individual deployments were 2, 2, 2, 2, 3, 3, and 4 respectively. Two of

the women began functioning in the role of caregiver for their husbands in 2011, three women

became caregivers for their husbands in 2012, and two became caregivers for their husbands in

2013.

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Table 1- Participants Demographics

Pseudonym Age Race/Ethnicity # of Children/Ages Years Married Spouse’s Rank Deployment#

Sarah 32 White 1/ Age: 4 4.5 E-7 2

Leah 30 White 3/ Ages: 2, 4, 4 9 E-7 4

Milcah 46 Puerto Rican 2/ Ages: 18, 23 24 E-6 2

Rachel 23 Hispanic 3/ Ages: 2, 4, 6 4 E-6 3

Ruth 46 Not provided 3/ Ages: 13, 15, 18 19 E-7 3

Hannah 38 Hispanic 3/ Ages: 5 months, 9,

13

1.5 E-4 2

Esther 44 Not provided 3/ Ages: 15, 21, 23 23 E-7 2

Table 1- Participants Demographics

Conducting the Narrative Interviews

Fraser (2004) offered several recommendations for interviewers to consider before

conducting narrative research. These included facilitating a climate of trust, allowing

participants to ask questions of their own, and “demonstrating sensitivity to the time frame of

participants as well as our own” (Fraser, p. 184, 2004). I therefore exercised great care in

scheduling and conducting each interview, consistent with Fraser’s (2004) recommendations.

Information about the interview process is included below.

Interview Location and Environment

Interviews were conducted in various locations. Each of the seven interviews was

conducted in a different location. Each woman was provided the option of meeting at the place

of their choosing. I provided information about the type of environment which was best suited to

conduct an interview. I suggested that the environment should be relatively quiet, private, and a

place where the participant would be comfortable sharing their narrative. I also provided

suggestions for interview locations such as the participant’s home, a study room at a local

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library, a local park, or another location of the participant’s choosing. Interviews were

conducted between business hours. Interview times were scheduled at the discretion of each

individual participant. I made a concerted effort to clear my calendar on various days during the

interview period in order to be available at multiple times. This was done so I would largely be

available at the time suggested by the individual participants.

The Interview

The interview protocol as presented in Chapter 3 was followed. I therefore explained and

presented a copy of the Participant Information Sheet to each participant (see Participant

Information Sheet in Appendix F). I then shared information about myself as a military spouse,

as a licensed professional counselor, and my interest and investment in the research study. I

asked each participant if she had any questions about the research study and also my work.

I then inquired of each participant about any time constraints for the interview process.

Each participant noted that they did not have any time restraints. The period of time spent with

each participant ranged from about thirty minutes to three hours. Field notes were written during

each interview. The majority of the interviews were conducted in person. One interview was

conducted via phone.

After the Interview

Each participant was assigned a pseudonym in order to maintain confidentiality. Each

woman was asked to provide a pseudonym. None of the women provided me with a pseudonym.

I therefore assigned pseudonyms to each participant. Pseudonyms were also assigned to other

individuals listed in the narratives by the participants. For example, if a participant mentioned

her husband’s name in the narrative, I assigned a pseudonym to replace the identifying

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information. Names which I favored were assigned at random to each participant and other

individuals listed in the narratives as needed.

I wrote theoretical memos about my experience after each interview. These memos

described my experience of sitting and talking with each participant. The memos also included

my feelings and thoughts about sharing an intimate space with the individual women. The field

notes which were written during each interview were reviewed when I listened to the individual

recordings.

I also listened to each audio recording soon after the interview was conducted. I wrote

notes about significant events and prominent themes which emerged from the individual stories.

Each interview was transcribed and the individual transcriptions were carefully reviewed. I then

reviewed the transcripts while listening to the respective recordings.

Individual Narratives and Analysis

Sarah

Listening to the narrative. Sarah was thirty two years old. She was a graphic designer

and was employed fulltime outside of the home. Sarah and her husband were married for over

four years. This was Sarah’s second marriage. Her current husband served in the Army for over

eleven years and experienced two combat deployments since 2001. Sarah reported that her

husband was a NCO or a mid-level enlisted service member. He received training as a combat

medic. This couple had one child, a preschooler who resided with them.

Sarah was the first woman I interviewed for this research project. This interview was

video recorded. We met at her home. Sarah and I sat and talked at her dining room table. The

dining room was the first room one entered from the front door. I did not venture into any other

rooms in Sarah’s home. Sarah sat in a chair at one of the ends of the table and turned her chair

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facing into towards me. I sat in a chair which was next to Sarah’s. We sat facing each other. I

spent over three hours talking with Sarah. I did not realize the amount of time we spent together

until I left her home. The semi-structured interview was about one hour and forty minutes. Our

time was spent building rapport before and after the semi-structured interview component. I

quickly realized how sharing a personal narrative could be an intimate and time consuming

process.

It seemed very important to Sarah to start at the beginning and share as many details of

her story. Sarah asked “…can I start at the beginning?” Later she shared, “I have to tell you all

the facts, right [laughs]?” I was delighted that Sarah wanted to share her story with me in great

detail. I recognized I was in a place of privilege. I did not know what she would share but I was

ready and eager to hear her story. Her story was captivating. I wanted her to take as much time

as she needed to share her story.

Sarah’s story evoked numerous feelings and thoughts within me. During the interview I

felt significant empathy for Sarah and her family. I struggled with my role as a researcher and a

counselor as I listened to her story. I wondered if it would be appropriate to offer minimal

encouragers, if I should verbally express empathy, or if I should only demonstrate active

listening in my body language and eye contact. Sarah’s story was moving and I wanted to offer

her more than a listening ear and a gift card at the conclusion of our time together.

I wrote in a journal after the interview about my feelings. I was confused after hearing

her narrative. I wondered, What was my role as a researcher? What was my role as a military

spouse sister? What else could I do to support Sarah in her journey? I believe my feelings and

thoughts were largely felt because this was the first opportunity for me to listen to the narrative

of an Army caregiver wife. Overall, I was overjoyed to complete one interview.

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Interpreting individual transcript. Sarah began her narrative describing how she and

her husband met. The couple met in high school and had several mutual friends. Sarah shared

that she and her husband were always good friends but never dated. She went on to share about

starting a romantic relationship with her friend, now husband. She talked about moving to live

with her boyfriend, her pregnancy and giving birth, becoming an Army partner, getting married,

completing a PCS move, re-deployment, and post-deployment.

Sarah’s narrative contained several stories. This stories included, meeting her husband,

starting a romantic relationship with her husband, her new life as a military wife, living through

the couple’s first deployment together, post-deployment, Sarah’s first PCS move, her husband’s

change in religious values, her husband’s mental health diagnosis, child rearing, and her life

today.

Turning points. Sarah shared three turning points in her story which appeared to signal

the beginning, middle, and end of her narrative. The first turning point was related to Sarah’s

story of starting a romantic relationship with her friend, now husband. She shared:

So I was in Florida, and I’m like if we’re gonna do this we’re gonna do it. We can’t do it

– long distance is not gonna work for either one of us so we both committed and basically

because of all of our friendships, and our best friends, we’re part of their family, too. We

both go to their family functions. These are our deep, deep friends, and we’re like we

can’t screw this up. If we’re gonna do it, we’re gonna do it all the way.

And we’re both kinda crazy and we’re both really spontaneous and sometimes

that’s good and sometimes that’s bad. So anyway, so I moved to D.C. in December of

2009 and pretty much everything was fine and everything was going great, and [David's]

best friend [Jacob] – he calls him his brother, and that’s my best friend’s brother – he

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lived there too and they were flipping this house that he had purchased with his ex-wife,

so I moved up there…

Sarah’s second turning point was related to her story of when her husband returned home

for R&R during his last deployment. Sarah shared, “so he comes home for R&R and that was a

nightmare”. “He also was very weird towards my family, didn't want guests and all this stuff, so

it was very weird”. She went on to say:

So we were kind of doing those things but he would want to go and hang out with

[Jacob], just go off with [Jacob]. I’m like you're only here for two weeks and you want

to go off with your best friend and not see your baby? It did not make any sense to me or

anyone around me that he wasn’t gonna be with his family. He’s gonna go to the mall

with his buddy. So that was very stressful and didn't make any sense.

Sarah’s third turning point was related to her story of her life today with her son and her

husband David. Sarah shared:

Well, he has told me leave me alone. So I say okay, fine. We’ve checked out – this

year’s probably been the most peaceful ‘cause we just do our own thing now, or I try to

meet [David’s] expectations in all areas of life.

She additionally shared, “I mean I’m not saying our story’s over. I think our story’s in a weird

transitional place right now”.

Leah

Listening to the narrative. Leah was the second woman that was interviewed in

conjunction with the present research study. Leah’s interview was conducted via phone and

audio recorded. Leah and I were unable to meet in person for the interview. We were unable to

meet and talk on the date originally scheduled. Leah’s children were ill on the day we scheduled

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to talk initially. The children were unable to go to their regular childcare provider because of

their illness. Leah therefore requested that we reschedule our appointment since she had no

alternate childcare arrangements. Leah’s husband was deployed at the time of the interview.

Leah was apologetic for needing to reschedule our appointment. I was empathetic and

we seemed to do a dance of being very apologetic, compassionate, and understanding with each

other. Her situation reminded me of my own life experience of being the sole provider for a

minor child, especially a sick child. I felt connected to Leah. I believe this connection is what

facilitated our dance of compassion and empathy which we expressed to each other in words and

phrases such as ‘aww’, ‘I’m so sorry’, and ‘I understand’.

Leah and I talked via phone twice and communicated via electronic mail once before our

interview. I believe these communications in addition to our shared experience of being the care

provider for minor children facilitated rapport building and a level of comfort with each other

even before Leah shared her narrative. These communications also may have eased Leah’s

concern for confidentiality and possible adverse effects to her husband’s career. These were two

areas of concern for Leah.

Leah inquired about the limits to confidentiality considering what she may share in the

narrative. I made a concerted effort to re-review and explain in greater detail about the limits to

confidentiality to Leah. Leah seemed satisfied with my explanation and offered verbal consent

to participate in the research study.

Leah was thirty years old, identified as White, and was employed as a nurse at a medical

facility. She and her husband were married for over nine years and had three children. All the

children were preschoolers and resided with the couple. Leah’s husband was a NCO and served

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in the military for over eleven years. Leah’s husband served as a medical sergeant. Leah

reported that her husband experienced four combat deployments since 2001.

Leah seemed eager to share her story. She however, was unsure if her story was valuable

or beneficial to my research. I assured her that her story was valuable and that I was eager to

hear her story. Leah furthermore did not know if she was a military caregiver and qualified to

participate in the research study. I presented the definition of a military caregiver and Leah

decided that she was a military caregiver. Leah and I talked for about forty minutes.

Interpreting individual transcript. Leah began her narrative sharing about her

husband’s combat injuries over the years. She listed some minor injuries he sustained and noted

the injury she believed was most significant for her husband and subsequently their relationship.

She talked about her husband returning from a deployment and not knowing “anything was

wrong” until her husband expressed that he “wanted to move out and get his own apartment”.

Leah shared about her reaction to her husband possibly wanting a divorce. She said “…I cried

and cried, and I didn't know why”.

She also shared about her husband’s confession regarding “multiple affairs”, and the

noticeable change in his demeanor during the post-deployment period. Leah also shared about

the process of seeking counseling to “figure out how to co-parent at least and come up with a

plan” and moving from separation to actively working to continue in the marriage. Leah also

shared about the challenge of being the sole caregiver to three preschoolers, the strengths she

realized in herself, and her faith in God.

Turning points. Leah seemed to have two turning points which signaled the change

from the beginning, to the middle, and the end of her story. Her first turning point was

experienced when her husband returned from deployment. Leah said:

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…then the next day he told me that he thought he wanted to live separately. He wanted

to move out and get his own apartment. Our kids were in there and everything. They

heard him say this, and I don't think they understood what he was saying. I called the

nanny before we even discussed the issue, and she came and got them – and got them out

of the house ‘cause obviously I was really upset.

I asked if he was talking – I didn’t understand if he wanted a divorce or he just

expected to stay married and live together. He said he didn’t really know, but he thought

he wanted a divorce. Of course I cried and cried, and I didn’t know why. He didn’t even

look fazed. He didn’t look remotely concerned. I was upset. He wasn’t at all upset. He

just was acting really weird.

Leah’s second turning point was experienced after going to counseling with her husband.

Initially the couple sought counseling to learn how to co-parent effectively. Leah and her

husband decided to work on preserving the marriage during the course of the counseling process.

This second turning point which moved from the middle of the story to the end is reflected in

Leah’s words:

After that, it got better. Right now, even though he is gone, it feels generally better.

Before he left, it was much better. He actually treats me a lot better. He says he loves

me. It just feels a lot better.

Milcah

Milcah was the third woman I interviewed. Milcah and I met in an office of a mutual

associate who was located close to Milcah’s home. Milcah was forty six years old and worked at

home as a domestic engineer. She self-identified as Puerto Rican. Milcah and her husband were

married for over twenty four years. Her husband was a NCO and served in the Army for over

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seventeen years as an engineer. Milcah reported that her husband experienced at least two

combat deployments since 2001. This couple had two adult children. The youngest child

resided with Milcah and her husband. The second child lived away at college.

Listening to the narrative. Milcah and I talked for about one hour and forty five

minutes. This interview was audio recorded. We sat in two separate office chairs directly facing

each other. We sat close to each other. I experienced Milcah as warm, friendly, and as an active

caregiver for her husband and her children. It seemed like Milcah’s identity was integrally tied

to being a caregiver. When answering the questions on the Demographics Questionnaire, Milcah

joked that she became a caregiver to her husband over twenty four years ago. She shared “…in

my case it was the minute I said ‘I do.’ Her identity as a caregiver furthermore, was noted in that

she affectionately referred to her adult daughter as her “little girl”. Her caregiver identity was

also demonstrated when Milcah shared that she and her husband financially supported their adult

son.

Milcah’s identity as a caregiver may be closely related to her cultural identity. However

she recognized the difference between her personal culture and military culture. She shared,

“well I guess for military purposes I became a caregiver once he became injured...”.

Milcah spoke in a soft voice, changed her tone and pattern of speech rapidly to connote

feelings, and utilized colloquial terms from time to time. Milcah grew up in the northeastern part

of the United States as I did. I felt connected to Milcah as her story incorporated the importance

of family and community. I believe this connection was fostered by my sense of sharing similar

values and components of a common culture with Milcah.

Interpreting individual transcript. Milcah began her narrative setting the scene for her

life before her husband was injured. She talked about being a fulltime student and working on

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her homework when she was notified that her husband was injured. She then moved on to share

about being in the hospital, the numerous surgeries her husband underwent, and relying on

family and friends for prayer and support. Milcah shared about the ongoing support she received

from her loved ones and also “the military”. She concluded her story sharing about the

challenges she and her family experienced and continue to experience as a result of her

husband’s injury.

Turning points. Milcah’s narrative seemed to contain two turning points. The first

turning point occurred when Milcah learned that her husband was injured. She shared, “…my

whole world just fell out from under me”. This was a life-changing moment for Milcah where

her role as a caregiver for her husband changed dramatically.

Her second turning point signaled her life today. Milcah said, “To go from dealing with

his frustrations of him being able to do everything for himself to now us having to do everything

for him; that was – those were some trying times”. She also shared:

It’s been interesting to see in situations like this how all the roles in the home actually all

kind of mix and mingle together and they all intertwine and you still, even though you’re

playing role reversal with a lot of the members of the family being that my kids are

older; it still all kind of works. You’re still a family unit, you’re still all working

together, you’re still all working towards the same goal, you’re still there for each other.

In our situation its brought our family even closer.

Rachel

Rachel was a twenty three year old, self-identified Hispanic female. Rachel was

employed as a leasing agent. She and her husband were married for over four years. The couple

had three children. One child was enrolled in elementary school and the two other children were

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preschoolers. All three children resided with the couple. Rachel’s husband served in the Army

for over seven years and experienced three combat deployments since 2001. He was a NCO.

Rachel’s husband served as an infantryman and achieved the badge as an Army Ranger. Army

Rangers are an elite group of soldiers who are trained to be “always combat ready” (U.S. Army,

n.d.).

Rachel was the fourth woman who shared her narrative in conjunction with the present

research study. We met at her place of work. We utilized a lounge area for the interview. The

space was open and fairly quiet. People, namely Rachel’s co-workers and other hired

professionals, walked around the lounge area from time to time.

Listening to the narrative. Rachel and I talked for about one hour and fifteen minutes.

This interview was audio recorded. I experienced Rachel as energetic with a bubbly personality.

She spoke rapidly and continuously. She and I spoke once on the phone and communicated via

text message before our interview. Rachel seemed to be very open about sharing her story.

There were other people in the office area during our interview. This experience was different as

I met the previous three ladies in a private space.

Rachel and I talked about her morning prior to beginning the interview. She shared

briefly about the number of tasks she completed before 9:00 a.m. that day. I certainly

empathized with her noting her numerous tasks in the role of a mother and primary caregiver for

her children.

During the interview Rachel shared in greater detail about the challenges of being a

mother and also working fulltime. I felt more empathy as I listened to these specific components

of her narrative. I furthermore reflected on my experience as a professional counselor where I

worked with service members who were injured in combat. As Rachel shared her experience as

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a caregiver wife noting challenges and questions she had about her husband’s behavior, I

reflected on the stories of service members who shared their own challenges and resulting

behaviors. I tried to integrate the two perspectives, that of the wife and that of the service

member husband, as I listened to Rachel’s story. I felt empathy for Rachel, for the other

caregiver wives I encountered, for Rachel’s husband, and for the other husbands I encountered in

my professional clinical practice.

Interpreting individual transcript. Rachel began her narrative reflecting on the

beginning of her relationship with her husband. She shared about when they met but not the

specific circumstances. Rachel instead shared about what life was like for the couple in the

beginning of their relationship. Rachel then moved on to share her experience of life with her

husband when he experienced war related nightmares. She also shared about her husband’s

numerous surgeries, medication management, changes in her husband’s demeanor, and the

challenges she and her family experienced and continue to experience. Rachel concluded her

narrative noting the people and organization which were helpful to her during this process.

Turning points. Rachel had two turning points in her narrative. Her first turning point

was experienced soon after her courtship with her husband. Rachel noted:

So then there was this one time when I was pregnant, I was maybe almost due, and I

guess he was having a really bad dream so he punched me right in the stomach and it

woke me up and I’m like, ‘Oh my god, why did you hit me?’ just because the entire time

he had been I guess okay but I guess he had just gotten off the medicine or something so

he was acting kind of crazy.

And then there was another time when again he was having another dream and I

was awake but he had his hand wrapped around me so he was like, ‘Don’t move,’ he was

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telling me and I’m like, ‘Oh my god, I’m not moving. What do you mean?’ so I just

stayed there and I didn’t move and then I barely tried to move to get his arm from – like

move it around me and then he said, ‘I told you don’t move,’ and he was really serious

but he was asleep so I was like this is scaring me because he’s never done anything like

this.

Life with her husband changed significantly. Rachel’s husband began to exhibit a change in

behavior and this was jarring for Rachel physically and emotionally.

Rachel’s second turning point which signaled the end of her story was related to her life

today. She recounted the loss of her husband’s brother and the resulting destabilization in her

family. She noted:

Yeah, so like the last couple of weeks have been even harder just because he doesn’t

want to do anything and he doesn’t want to eat or talk or nothing, like really nothing at

all. So it’s been really hard just because when he is on medicine even though I know it’s

not him it’s who I know as him. Keeping how he stays in a certain mood, then if when he

doesn’t have it it’s totally different and then seeing him now with the whole thing that

happened with his brother I can tell – I don’t think I’ve ever seen him ever at a point how

he is now. So I know that this kind of – I felt like we were ten steps better and now I feel

like it threw us a whole bunch of steps back because it just feels like we have to start all

over again with everything just because now he’s like, “You know I really want to go

home and maybe I should just go and be with my mom”, and to me it just hurts because I

feel like your mom hasn’t been here this entire time. I have and I’ve been the one taking

care of you. (Crying) Sorry.

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It seems like life for Rachel and her family changed once again. At the time of the interview, her

husband’s seventeen year old brother died three weeks before, from injuries sustained in a car

accident. Rachel’s family again was undergoing a period of disequilibrium.

This disequilibrium resulted in a change in her husband’s mood and also a change in

Rachel’s caregiving duties. Rachel had to assume more caregiving tasks as her husband

expected her for instance to schedule his appointments. She shared:

So now that he’s going to have his knee surgery I had to set up an MRI for him so as I’m

here at work I’m like, ‘Okay, I’m going to take my lunch so I can call the hotline to

schedule him an appointment,’ and he’ll call me, ‘Oh, well did you set my appointment?’

and I’m like, ‘You're at home. You can call them if you really want to,’ but he just

expects so much from me and sometimes I just feel like I don’t have any more to give.

She also assumed more caregiving tasks for her children. Rachel shared:

So for instance the other day I got home and she was still wearing the clothes from the

day before. She hadn’t been showered and I told her, ‘Why didn’t daddy change your

clothes?’ and she said, ‘I don’t know.’ And I said, ‘Did you eat anything?’ and she’s

like, ‘Yeah, daddy gave me chips,’ but because he doesn’t want to eat I guess he just

forgets that she needs to eat. So he has lost a couple of pounds since the accident of his

brother and I just felt like it did – I felt like right before this happened we were at a really

good point.

This turning point is essentially where Rachel started mentally when we met on the day

of the interview and engaged in casual conversation. During the interview she expanded on this

saying, “For instance this morning it’s 9:00 and I felt like I have done so much stuff just today

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and it’s like, ‘Oh my god, is the day almost over because I’m exhausted already.’” Rachel was

in the midst of transition when we met.

Ruth

Ruth was forty six years old. She did not provide information about her profession or

race/ethnicity. She and her husband were married for over nineteen years. Ruth’s husband was

an NCO, he served in the military for over twenty three years, and he held MOSs as an

infantryman and a career counselor. Ruth reported that her husband served in three combat

deployments since 2001. The couple had three children. One child was an adult and the other

children were teenagers. The couple’s three children resided with them.

Listening to the narrative. Ruth was the fifth woman I interviewed for this research

study. Ruth and I communicated via phone once and two times via text message prior to the

interview. Ruth also followed-up with me via text message four days after our interview to

provide specific months and years for her husband’s three deployments, as promised. Ruth and I

met at a local library. We initially met at the front of the building and then moved to the

courtyard of the library to talk. I was punctual however, when I arrived at the library Ruth was

already waiting on a bench at the front of the building. I approached her, smiled, introduced

myself, and inquired if she was Ruth. She confirmed her identity and we exchanged greetings.

There were several benches in the courtyard. The courtyard was surrounded by trees and

was beautified with several flower beds. I invited Ruth to select the bench where she preferred

us to sit and talk. We sat next to each other with my research material (papers and recording

device) between us. I sat turned in to face Ruth and Ruth sat looking straight ahead. Ruth

occasionally looked at me when she spoke as if to see if I was listening or to receive further

prompting from me. At the conclusion of the interview Ruth and I walked to the parking lot

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together. Ruth apologized for possibly not providing much or valuable information to me for my

research study. I assured Ruth that the information she shared was indeed helpful. I again

expressed my gratitude for Ruth’s willingness to share her narrative with me. We exchanged

goodbyes and proceeded to our separate vehicles.

Ruth’s narrative was short. The semi-structured interview component was approximately

thirteen minutes and was audio recorded. We met for about thirty minutes. Ruth was soft

spoken, reserved, and did not initiate conversation. She however was kind and willing to share

her story. Ruth was interested in the nature of the research project, my intentions after data

collection, and the end results of the study. I was excited about her detailed interest in the study

and my work. Ruth asked detailed questions about my work unlike the other women I

interviewed. I was happy to share with Ruth. I wanted her to feel comfortable sharing her story.

I believed my transparency would assist in building rapport and help Ruth to feel comfortable as

we inevitably discussed intimate details of her life.

I experienced Ruth’s sharing of her narrative in a calm yet powerful manner. I

experienced her as tired and maybe even hopeless. She did not exhibit a booming personality

filled with energy and a fighting spirit. Ruth was holding on. As Ruth shared I gained further

clarity and context on her behavioral presentation. I believed I understood her even in the

absence of flowing words. Ruth furthermore shared that she was originally from a mid-western

state during her narrative. This bit of information allowed me to feel more connected to her as I

previously lived in a mid-western state for four years. I believed this afforded us to have a

commonality, a shared cultural understanding.

Ruth’s presentation could be misconstrued by others as unfriendly or distant. As I

listened to her story however, her initial presentation made sense. There was lots of sadness in

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her story which initially she masked with aloofness and anger. I wanted to hug Ruth to assure

her that life could be better. However, I refrained from doing so. I did not want to invade her

personal space or to facilitate an uncomfortable space for Ruth. I thought, “would this hug be for

me or for Ruth?” I wavered between my roles as a fellow military wife and considered my role

as a counselor and also my role as a researcher.

Interpreting individual transcript. Ruth’s narrative began with her account of getting

married and her husband enlisting in the Army. Ruth shared that military life was new to her.

She said, “it was all very new to me because I’m from [a mid-western state] and they don’t even

have ROTC in the high schools”. She moved on to talk about her husband’s deployments

particularly the deployment where his injuries resulted in a functional disability. Ruth shared

about the challenges she experienced both past and present such as the “constants stress” she

experienced. She shared about her change in demeanor and also about the impact that her

husband’s functional disability had on her family to include her children. Ruth concluded her

narrative making mention of her current life situation.

Turning points. Ruth’s narrative included two turning points. Her first turning point

was experienced when her husband sustained a combat related injury. She noted “…it was the

one when we were living in [the mid-west] that was the worst…”

Ruth’s second turning point occurred when her family moved to their current duty

station. Ruth shared:

I felt good up until we moved here because it was like, okay, we got through this

deployment and we’re doing good. And it’s just like we came here and it just kind of all

fell apart. Like I don’t know, we just kind of broke.

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Ruth went on to share that “there’s really no end to how it’s going to get better...”. “This might

be it” referring to the present state of her life.

Hannah

Hannah was a thirty eight year old Hispanic woman. She was employed by a government

agency. Hannah previously served in the Navy for nine years. She and her husband were

married for nearly two years at the time of the interview. The couple however was involved in a

romantic relationship with each other for over six years. This was Hannah’s second marriage.

The couple had three children. One child was an infant. The other two children were a teenage

son and a daughter who was elementary school age. The three children resided with the couple.

Hannah’s husband served in the military for over eleven years and experienced two combat

deployments since 2001. Hannah’s husband was a junior enlisted personnel and received

training in logistics.

Listening to the narrative. Hannah was the sixth woman I interviewed in conjunction

with this research study. The interview portion was approximately one hour and fifteen minutes.

The interview was audio recorded.

I communicated once with Hannah via phone and twice via text message before our

interview. I experienced Hannah as jovial, warm, inviting, and very open to sharing her story.

I met Hannah at her home. She greeted me at her front door on the day of the interview

with a wide smile. She held her infant son in her arms. I quickly greeted Hannah and introduced

myself. Hannah introduced herself and we shock each other’s hand. She introduced me to her

infant son and also her mother who provided child care while Hannah and I talked. Hannah’s

mother and I smiled at each other and politely said hello. Her mother quickly exited the room

with her grandson in her arms. The two went into an adjacent room and Hannah and I remained

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in the living room. Hannah and I sat on a couch. We both sat with our legs turned in and bodies

facing each other. We sat close to each other with the recording device between us.

After completing the initial components of the research protocol as documented in the

method section, I shared with Hannah about my personal and professional connection to the

present study. I invited Hannah to ask any questions of me. Hannah did not have any questions.

She seemed eager to begin the research process.

After reading the generative narrative research question Hannah readily began sharing

her story. She seemed very comfortable sharing her story. Her story did not appear to be

rehearsed but it seemed as if she previously shared her story. It is possible that Hannah was

comfortable speaking with me since I was a licensed professional counselor (LPC). I made it

known to Hannah and the other women that I was not acting in the capacity of a LPC during the

respective interviews. Hannah sought individual counseling at several points in her life. Hannah

therefore, may have been familiar with a process of sharing her story with other mental health

professionals.

I was impacted when I heard Hannah’s story. Her story was raw, intimate, and packed

with lots of emotion. I experienced Hannah as a resilient woman, one who valued hard work,

and determined that it was helpful to persevere in the face of adversity. Hannah shared:

I’m very strong-minded when it comes to family. That’s my strength, my family. That

gets me going through everything, my family, because I’ve always worked hard. I’ve

always worked hard to just do what I have to do. ‘I have my mind set on, I’m gonna get

it done. It’s a challenge for me, and a challenge that I will not fail in. I will succeed in it,

and I will get through it’.

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Interpreting individual transcript. Hannah began her narrative sharing how she and

her husband met. She shared about their courtship and noted, “It was wonderful. It was

wonderful”. She explained that she “was happy” and it seemed “everything was just falling into

place”. Hannah then shared about her husband’s deployment where he sustained several injuries

which resulted in a functional disability. She talked about the relationship her children shared

with her husband (their step-father), her faith, the re-deployment and post-deployment periods,

the various surgeries her husband endured, and her last pregnancy. Hannah shared about the

challenges she and her family faced to include suicidal attempts by her husband, her children’s

change in demeanor around their dad, and her own struggles with anxiety and depression.

Hannah also shared her thoughts about possibly ending her marriage. Hannah ended her

narrative reaffirming her dedication to her family, her dependence on her mother and especially

on God.

Turning points. Hannah shared four turning points in her narrative. Her first turning

point was reflected in her retelling of her experience of feeling overwhelmed during her

husband’s last deployment. She stated:

Some of the problems started when he started calling me every day, five times a day, and

I was okay. But then I was getting stressed out as time was going with him being

deployed. Time was going. I got so stressed out because I was like, ‘My time is just not

with you.’ I said, ‘I have two children. Because you left the house, it doesn’t stop here.’

So I was feeling a little overwhelmed. It’s like I had to be there for him because

if I didn’t, I wasn’t supportive. But then I had to be here and I had to be focused because

I have to drive everywhere. I have two children. I have to be focused. He wasn’t

understanding that, and then I couldn’t understand where he was at, ‘cause I’ve never

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been where he’s at. I can’t even imagine what he’s seen. I’ve just heard the stories, and I

know that everybody handles it differently. I didn’t understand.

Hannah’s second turning point was expressed when she shared about the re-deployment

and post-deployment periods in the aftermath of her husband’s injuries and recovery. Hannah

shared, “Our home, what used to be so peaceful, all got along just wonderful, it was falling

apart”, “that’s when all our problems just started and started”.

Hannah’s third turning point occurred when a friend encouraged her to seek help for

herself. Hannah shared:

A friend of mine saw me. She said, ‘[Hannah], go get some help.’

I said, ‘I got this. I got it.’ I just broke down crying, and I went. The following day I

went, and I went to go talk to a therapist. And ever since I went to go talk to the

therapist, I feel better. I have been handling it better.

The fourth turning point Hannah shared concerned her husband’s recovery. She shared:

Well, his motivation started getting better. He started walking. He started walking. He

started going back on his little diet again. He started painting. He started cutting the

grass without me telling him. He started doing things without me telling him. He started

doing the laundry, hanging it up, ‘cause my laundry was piled up because here I am

working, taking care of the baby, everything. Everything was going on, and he was

doing nothing. But now he’s finding the motivation.

This turning point signaled the ending of Hannah’s narrative. She went on to conclude:

So through all the talks and the fighting and the arguing and the therapy sessions that he’s

been taking, we’re looking at a little progress. So I’m hoping for more. We still have our

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trials, but for the most part I think we’re gonna be okay. I feel that way, but only time

will tell.

Esther

Esther was forty four years old and worked at home. Esther did not provide any

information about her race/ethnicity. Esther shared during her narrative that she was originally

from a western European country, Germany. She and her husband met in Germany. Esther and

her husband were married for over twenty three years. The couple had three children two of

which were adults and the other child was a teenager. Esther reported that her husband served in

the military for over twenty four years and was trained as a fire support specialist. Esther

additionally reported that her husband experienced two combat deployments since 2001.

Listening to the narrative. Esther was the seventh and final woman I interviewed in

conjunction with the current research study. The interview portion lasted about 18 minutes. The

interview was audio recorded. Esther and I communicated twice on the phone before we met for

the interview. During our first telephone conversation Esther mentioned that she needed to ask

her husband if he was comfortable with her meeting and sharing her narrative with me. I

followed- up with Esther several days later to determine if she was still interested in sharing her

narrative. Esther was still interested in participating in the research study. We scheduled a time

to meet and talk.

Esther and I met at a local park close to her home. Esther was looking at posted material

when I arrived. I approached her, smiled, introduced myself, and inquired if she was Esther.

She in turn smiled confirmed her identity and we exchanged greetings. We walked through the

park together looking for a suitable location to sit and talk. I engaged Esther in casual

conversation during this walk. We talked about the weather and how long we each lived in the

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area. I invited Esther to choose the location she wished to sit. There were several tables and

chairs in this park. We sat on two separate chairs around a table with four chairs. Esther sat first

and I sat next to her. We sat facing each other as I explained the components of the research

protocol to Esther.

Esther expressed her concern about whether she was a caregiver to her husband. I

presented the definition of a military caregiver and Esther decided that she could provide

information to me from her perspective. Esther did not have any other questions to ask of me

before we commenced on the semi-structured interview.

I experienced Esther as a private person, a woman of few words. Esther often looked

straight ahead rather than directly at me as she shared her story. I wondered why she agreed to

share her story with me. I was grateful for her willingness to share. I hoped that Esther

understood my questions and wondered if perhaps there were cultural underpinnings which could

negatively affect our relationship.

I reflected on my own racial/ethnic identity. While Esther did not list her racial/ethnic

background on the Demographics Questionnaire, there were visible differences in racial makeup

between the two of us. I also wondered how much her cultural background differed from my

own and its implications for our relationship. I wondered what things we had in common and

what differences existed between us which possibly affected our relationship.

I tried to posture myself such that my attending behavior was regarded as open and

attentive to Esther during her narrative. I felt significant empathy when I listened to Esther’s

narrative. She did not appear to possess detailed information about her husband’s injury and his

recovery process. She seemed frustrated and uninformed. I shared information at the conclusion

of our interview about mental health resources she and her children could utilize. Esther seemed

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trapped, as if she was doomed to continue living life in the absence of significant happiness. She

shared, “It’s a low point but if you don’t know the lows, you don’t appreciate the highs” and “so

little things can make you really happy, you know”? I hoped that she would continue to seek help

for her and her children even if she could not help her husband in a tangible way.

At the conclusion of the interview I expressed my gratitude to Esther for her participation

in the research study. We exchanged goodbyes and Esther swiftly exited the area of the park. I

hoped the interview was beneficial for her. I learned a lot from Esther and her journey through a

deployment and a resulting functional disability sustained by her husband.

Interpreting individual transcript. Esther’s narrative though brief contained several

stories. These stories included the emotional changes her husband experienced during

deployment and the experience of her husband post- deployment. Esther also shared about the

challenges she and her family experienced during the re-deployment and post-deployment

periods. She went on to share her feelings about terminating her marriage and her frustration

with not receiving information from any professional or military personal on how best to

navigate life given her husband’s disability. Esther concluded sharing the strength she realized

in herself and a resource that she utilized during this process.

Turning points. Esther shared three turning points. Her first turning point was

experienced when her husband deployed and seemed to be more anxious than usual. Esther

shared, “…before his deployment we, we did actually very well”.

What I do know is during the deployment he had very much excited, yes. Very much,

like if he would call home he would really work up on I really got very and I told him

why doesn’t he go seek help? I didn’t know all the services that had followed

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deployment but I thought that it could have helped him, but he didn’t go and seek out any

help right there.

Esther noticed a marked difference in her husband’s demeanor and encouraged him to seek

assistance. However when he did not seek assistance she tried to assist him. She shared,

“So what I remember is I told him do breathing exercises, calm down…”

Esther’s second turning point occurred after her husband’s deployment. She shared, “he

had a hard time doing daily, regular tasks”, “…everything became very stressful…”, and “he was

kind of like in his own world”. It seems like in the absence of knowing that her husband

experienced a combat related injury Esther nevertheless noticed changes in her husband’s

behavior when he returned home.

Esther’s third turning point occurred when she resolved how to deal with her husband’s

disability. After trying unsuccessfully to help her husband get better Esther noted, “I just kept

my distance. I just let him be”, This seemed to be the same position that Esther maintained even

at the time of our interview. She said, “So I do talk about caregiving but I don’t want to talk

about his outbursts, you know, because that would be his story to tell” and “even though he said

he doesn’t mind, I ask him before [laughter] but this is his thing, so I can only give it out of the –

you know, as a caregiver, as an observer through the whole process”.

Common Themes in Group Narratives

Looking Back/Reflecting on Personal Narrative

Many of the women shared a common theme of looking back or reflecting during their

personal narratives. These women reflected on how their lives changed due to their respective

husband’s functional disabilities. Excerpts of their reflections are included below.

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Sarah. Sarah readily talked about looking back and reflecting on her story, looking at

her life before, during the diagnosis period, and her life today. She shared:

“…every once in a while looking back, every once in a while there would be a weird

thing that would happen and I didn't understand it and I’d be like you know, that’s not

normal type of reaction – I would get a reaction from him every once in a while but they

were not normal…”

So I think he’s been dealing with PTSD since the first deployment. He even has

told me when he was with his first wife she dealt with his anger, had to do anger

management and stuff. Instances that he went through. They were in a bank one day and

it was taking too long and he screamed at everybody in the bank and she just walked out

and left him. And we’ve had similar things like that happen where it’s just

unexplainable, but obviously this explains it.

Sarah also shared what life was like when her husband returned from his last combat

deployment. She said, “when he gets home is when the crap starts so I have to remind myself

what it was before, that it wasn’t always like this”. She went on to share:

Looking back over the past five years, it made sense – all those little things as I'm reading

and learning what it is and all the symptoms and how it affects a person. I’m like oh,

okay. This has been going on for a while.

Hannah. Hannah began the process of reflecting towards the beginning of her narrative.

In her time of reflecting Hannah shared, “Well, I met my husband almost seven years ago, and it

was really, really wonderful. He wanted to get back into the military ‘cause he had been out for

a nice break in service, and so I helped him get there, not knowing that it would change our lives

completely”.

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Ruth. Ruth shared, “And so it’s really kind of just we just do what we have to do and not

really realizing until like a long time afterwards, looking back, seeing that oh, yeah, now that

makes a little more sense”.

Esther. Esther shared, “At the moment if you are active in it you cannot see it but if time

pass and you think back, you realize it a little better. ‘It was not like it was before his illness…’”

I Didn’t Know Anything was Wrong

For many of the women there was a sense that everything was fine. They did not know

their husbands were injured in combat at the time of the injury and even after their husbands

returned home from the deployment. Some of the women did not recognize their husbands

changed until their husbands exhibited significant changes in demeanor and mood. This lack of

knowing is demonstrated in the excerpts below.

Sarah. Sarah used statements such as “everything was fine”, “everything was great”,

“everything was normal” She was referring to her husband’s demeanor and their life during the

post-deployment period.

Leah. Leah shared, “I didn't even know about it until after he came home, and even then

it was because I found paperwork from the TBI clinic. I really don’t have any idea” and “I have

no idea, ‘cause he doesn't tell me anything specific. I don’t even know when, just that it

happened”. Leah furthermore shared “I did not know anything was wrong at all, really. He

sounded fine on the phone, and he sent me e-mails while he was gone like everything was

normal”.

Ruth. Ruth shared, We didn’t really realize about his PTSD and his brain injuries until

pretty much just recently”.

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Hannah. Hannah shared about her ignorance of the severity of her husband’s injuries.

She said:

I said, ‘You're fine. Look at everybody around you. They’re smiling, and they don’t

even have their legs. They’re smiling with their babies because they’re happy to be

home.’ I met so many gentlemen with disfigured faces, a gentleman that didn’t have his

ear. I was like, ‘But they are so grateful to be here. You have all your limbs.

Esther. Esther said:

…My husband is a kind of private person, so he did not share early a whole lot with me

and I’m also the kind of person if somebody don’t wanna come forward, I do not ask. So

I do not know the entire circumstances, like I’m aware about some incidents happened

that may contributed towards his diagnosis.

…at the time before his deployment we – we did actually very well. So but then

afterwards and I…saw like, you know, he was difficult to recognize, you know?

Lack of Self-Care

At least three of the women explicitly mentioned their lack of self-care in the original

interview. These women seemed to neglect their self-care in light of their dedication to their

caregiving responsibilities. Excerpts from their narratives are included below.

Milcah. Milcah shared “A lot of times as caregivers we forget about ourselves, because

we’re so busy taking care of them”. She went on to share:

When I broke my leg I was like ‘Okay, Lord, I get it. I need to stop, I need to slow

down, I need to…’ Because I was on the verge myself of – I wasn’t taking care of

myself. I wasn’t going to the doctors. I wasn’t doing what I have to do. Right now I was

supposed to do glasses in August of last year. We’re already in March and I still haven’t

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gone checked my eyes and done dental and done all of that.

But now that he’s a little better then I’m finally at the point I’m like okay, I need

to start taking care of myself. I need to go do the well-woman exam and that kind of stuff

and make sure that everything’s in order and everything’s okay, because from the stress

and from the anxiety that we don’t even realize that we’re in we end up getting sick,

because our bodies can only function at that high of a stress level for so long.

Rachel. She talked about her lack of self-care as she shared her frustrations of catering

to her husband. Rachel shared, “I get tired too. I want to take a nap too. I want to take a shower

when I get home but I just feel like a robot sometimes. I never pause”.

Hannah. Hannah shared:

I was injured, too. I fell at work. I had my knee and my ankle – I sprained my ankle

when I was pregnant, four months pregnant, when I fell at work. But I sucked it up, and I

just kept working. And then I tore my rotator cuff on my shoulder ‘cause a dog attacked

me and I fell on my shoulder.

But I’m still lifting and I’m still doing everything because I have a home. I have

kids that depend on me, and then I’m pregnant and this other little guy depends on me.

I’m trying to tell him that. It’s like, ‘Sometimes we’re hurting, but we have to put that

aside because we have a family that needs us. They didn’t ask for this. Our son didn’t

ask for this. He’s here. He needs us.’…I said, ‘I’ve got my own appointments.’ I would

cancel them. I was like, ‘The kids need me. The kids need this.’

I had no time for me, no time for me whatsoever, and so I was breaking, and I was

breaking, and I was breaking because I was trying to – I was trying to keep my family

together. Even though he was pulling us apart, I was keeping us together. I was like, ‘I

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am gonna be the glue to this. I’ve gotta hold it together. I’ve gotta hold him. I gotta get

him thinking straight.’ It was a challenge. It was like, ‘I will get him straight. I will get

him straight.’

Sarah. Sarah mentioned her need for self-care in a follow-up interview. She shared that

she recently started going back to the gym to exercise and lose weight. She also mentioned that

a friend encouraged her to “take care of [herself]” rather than catering extensively to her

husband.

Ruth. Ruth also expressed her lack of self-care in during the member checks portion of

the research study. She said, “I get caught up with what needs to be done and take care of, losing

sight of my own relationships and my own needs”.

Faith/Religion/Spirituality

Five of the seven women expressed the importance of faith, religion, or spiritualty in their

lives in their narratives. The presence of faith, religion, or spirituality seemed to be an area of

strength and support for these women. This strength or support was manifested in their lives

through conversations with God, the use of biblical Scripture, a community of like-minded

people, and family or origin values. Excerpts from their individual narratives are included

below.

Sarah. Sarah shared about her husband’s change in values which was markedly different

to their initial courtship.

During his deployment he changed a lot and he decided that he wasn’t gonna be a

Christian, which when we first got together, oh yeah he’s a Christian, we’re gonna go to

church, we’re gonna raise our children in the church… He would send me texts that said

he was praying for me and all this normal stuff…

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Now he’s like an atheist pretty much. Not even that, he’s trying to get me to turn

away and trying to prove how it’s all crazy and wrong and all this stuff …We had this

discussion during his R&R about the whole he’s not gonna be a Christian anymore or this

is when he was deciding about that. So obviously that’s a big deal to me ‘cause I grew up

in a Christian home. That’s who I am. I’m 32. That's not changing any time soon.

Leah. She shared, “I thank God that I ran into people like the chaplain”. Leah believed

that the counsel she received from one chaplain helped her to process her feelings and engage in

sound decision making.

Milcah. Milcah was perhaps the most vocal about her faith. These are some of the

quotes she shared. “God just glorified himself time and time again throughout this whole

situation”.

It was like the Bible says that peace that surpasses all understanding; that entire room was

just filled with the peace of the Lord and I literally felt like God was by my side just

hugging me at that moment. I was like ‘Okay, Lord, it’s gonna be alright.’

When God is real in your life it just doesn’t matter. When you knew – like God

was preparing me for this from way before it even happened. That I didn’t understand he

was trying to prepare me for it is one thing, but then it all became clear once it happened.

Ruth. Ruth in her response to the question of who was most helpful to her during this

process replied “Jesus, Jesus is my help; my refuge; strength”.

Hannah. Hannah shared, “I went to church every Sunday. I told God, ‘I will be there

every Sunday. I will be there every Sunday, my promise.’ She went on to say:

I’m like, ‘God, give me the strength. Give me the strength. Just give me a sign. Give

me some sign.’ I was seeing them, and God was talking to me, telling me, ‘Just hang on.’

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I was listening, and I would cry and cry in the shower. I would cry and cry. That was my

only place to cry, ‘cause I couldn’t let my children see me. I’d be in there just like, ‘Just

talk to me, God. Just keep me going. Keep me going. Keep me going.’

I told him, ‘I can't hear God anymore telling me what to do or how to do it.’ I

was losing myself. Once I couldn’t hear God anymore, I knew that I was – I was getting

lost myself, and if I got lost, then the kids – my kids need me. So now it’s like I'm back

with my whole ACTS and retreats and all that.

She concluded saying, “I have faith that things are gonna continue to get better…”

Change in Husband’s Demeanor/Mood

All the women shared about changes in their husband’s demeanor or mood. These

changes served as a signal for many of the women that life was different. These changes were

cues for some of the women who were uninformed of their husband’s injuries, that the

deployment experience was literally life changing. Their husbands no longer were the same men

they were before becoming injured.

Sarah. Sarah shared that her realization that her husband was different emerged based

on his interactions with her in various situations. She said, “I knew something was going on

because I knew his reactions were not normal. His reaction towards me was not normal…” “So

he took it as this crazy thing and shut down, and I remember that and I remember when it

happened, me thinking like that’s not normal. Normal people don’t think like that”.

Sarah also shared about changes in her husband’s communication with her. She said

“…the verbal abuse really started when he was overseas via email, so phone calls too but I have

it on email just blaming me for things or he would ask me”. She also shared about her husband’s

current disposition. She said:

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He’s obviously disconnected from his emotions, so emotions scare him. He doesn’t

understand them. He doesn’t want to deal with them. In the beginning he tried. He

would try to console me physically, hugging me, but now It’s just like please stop crying.

You’re annoying me.

Leah. Leah shared that the day after her husband returned from a previous deployment

she recognized he was different. She shared, “…he came back, and then the next day he told me

that he thought he wanted to live separately. He wanted to move out and get his own apartment”.

Leah went on to share several other points “He just stone-faced told me that he’d had multiple

affairs and that he just – he really didn’t feel anything at all”. She went on to say:

He didn’t feel not just about me, but about anything, about the kids or even the fact that

his mom had stage IV cancer and he had just found out a couple months before. He

didn’t feel anything about that, either. He said that for the past year and a half or

something, he just hadn't felt anything at all. He can’t even feel happy with the kids. He

doesn’t feel sad or happy. He just doesn’t feel anything except he said he felt mad all the

time.

…he said he didn’t feel anything for me, and he thought he had never loved me.

He was totally unrecognizable, not just what he was saying, but just the way he was

acting. He really did seem totally shut off.

Milcah. Milcah shared about her husband’s loss of interest in activities he once found

pleasurable. She shared:

If we want to go to Sea World; ‘Nah, you go.’ ‘Want to go to the mall? Nah, you go.’ I

go to Walmart he sits in the car; he doesn’t want to get out, doesn’t want to go to the

trouble of – where that wasn’t him at all. Weekends he just wants to be home.

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Weekends I was the one ‘Babe, I just want to be home.’ Now I’m like ‘Can we go

somewhere and can we do something?”… like he’s lost interest in doing a lot of things

unless it’s church related…

Rachel. Rachel shared about her husband’s change in disposition and the resulting effect

on her family. She shared:

Some days he won’t even speak to me. I will try to have a conversation with him and he

just makes really short conversations or he’ll just ignore me and I’m just like I really

can’t understand what he’s going through…

Even sometimes the kids feel like they have to tiptoe around him because you

don’t know if daddy’s going to be in a good mood or daddy’s going to be in a bad mood,

if daddy’s going to be friendly or if daddy’s going to be a jerk today.

Ruth. Ruth also shared about her husband’s change in disposition. Ruth reflected that

her husband also seemed to change from being angry to withdrawn from the family. She said,

“… at first he was really angry and so that changed the whole atmosphere. And then he went

inpatient and that helped but now he’s kind of like the other end almost”.

Hannah. Hannah shared about her husband’s change in deportment after he returned

from his last deployment. The following excerpt is her recounting of noticing the change in her

husband while he was receiving medical treatment at another installation hundreds of miles away

from their home.

I had never heard him so down, so depressed. He’s always been a chipper person and

just full of life and just go, go, go, go, go, and just always laughing and loud. He was

always loud. I can hear it in his voice where he goes, ‘I just want to go home, [Hannah].

I just want to go home.’ He would cry to me.

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Hannah also reflected on her husband’s frustration that their children seemed to no longer

respect him. She shared, “I said, ‘The respect that you want, you have to give them. You

stopped respecting them.’”

Esther. Esther noticed that her husband was easily startled which negatively influenced

the dynamics in their home. She shared, “…the smallest noises in the house…and in our case,

most of the time, the refrigerator, but it would trigger like a really bad reaction to it”.

Challenges

There were also common themes listed by several women which revolved around

challenges. These themes include (1) It’s like caring for a child, (2) Tired/Exhausted, (3) Doing

everything, and (4) Emotional changes in caregiver wife.

It’s like caring for a child. This theme was extracted from the narratives of four

women. These women shared about caring for their inured Army husbands. They explained that

in their role as caregiver wives their caregiving tasks with their respective husbands was much

like their caregiving tasks for their children.

Milcah. Milcah recounted some of the challenges she faced when her husband was

initially injured. She shared:

…When the accident happened it was just like having a newborn all over again and

you’re waking up every hour on the hour and you’re waking up every two hours and

you’re waking up every – to the point where now they think I have sleep apnea.

She went on to share that she continues to struggle with her caregiving duties although

her husband’s health improved from the initial prognosis. She shared about helping her husband

get ready for work in the morning. Milcah said, “It’s like having a little five-year-old; getting a

little five-year-old ready for school in the mornings”.

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Rachel. Rachel’s story of this theme was exemplified in her discussion of her husband’s

expectation of her.

So yeah, so he tells me, “The doctor told me to stretch and you haven’t been helping me

stretch”, and I just want to think like you are an adult. You can stretch by yourself.

You’re not a baby but then again if I don’t tell you, “Come on, let’s stretch”, you’re just

not going to stretch. So sometimes I feel like I don’t know what you would do if I was

not here because you wouldn’t do anything then. You wouldn’t eat, you wouldn’t – I

really don’t know what he would do for real because sometimes he does make me think

like are you serious? Are you being serious?

She went on to say, “so sometimes he does make me feel like he’s just another child that I have

to take care of and need for and do stuff for”.

Ruth. Ruth’s narrative of this shared theme included a simple line about her caregiving

role. She shared, “So it’s kind of like having – I mean this respectfully, but like having another

kid”.

Hannah. Hannah’s narrative likewise included a story of this theme. Hannah shared

about her frustration of her husband’s increased use of pain medication and becoming “more

crippled” every time he received a new diagnosis. She said:

Any little pain he had, it was just like the end of the world. ‘Ah, ah.’ And all the faces.

We’d just look at him and just walk around – walk around him. I didn't want to baby him

and cater to that because then he was gonna enable himself even more.

Tired/Exhausted. Another common theme which was extracted from the narratives was

the idea of the caregivers feeling physically and mentally tired or exhausted. Five of the seven

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women expressed this sentiment. Several excerpts from the individual narratives are included

below.

Leah. A story in Leah’s narrative where this theme was exemplified concerned her role as

the sole dependable provider for the couple’s children. She said:

…Helping the kids deal with it. That’s the hardest thing. When he comes and goes and

when he comes back acting weird, it’s all on me because I’m there all the time, and they

trust me. I can’t be the only parent and still live here.

Milcah. Milcah shared “It’s hard, it’s not easy. I’m not gonna sit here and lie to you and

say ‘Oh yeah it’s been a’ – no it’s not a piece of cake. It’s a lot of work”.

Rachel. In Rachel’s narrative this theme was exemplified in her recounting of life today,

after the death of her husband’s teenage brother. Rachel shared:

So I just feel like as hard as I feel like I’m trying to be there it’s like I just can’t this time.

I can’t this time. All the other times I figured out how to cater to him, how to be there for

him. Even when I was pregnant and he had surgery it was really hard because he’s 6’2”;

I’m 4’7” so he’s big compared to me so it’s hard for me to help him to get up to go to the

bathroom and to help him to take a shower and you know to make sure that he takes his

medicines, to make sure that he eats. It was really, really difficult but I felt like no matter

what I managed to do it and this time I just feel like I don’t know what to do. I don’t

know how to manage and help him get passed this or anything.

Ruth. Ruth exemplified this theme in her response to the research question of what

changed in the couple’s life when they moved to their current duty station. She shared, “I

think just the constant stress. Just you can only take so much, I guess or I don’t know.

Maybe I just didn’t take care of myself enough or I don’t know”.

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Hannah. Hannah exemplified this theme in her narrative recounting an emotionally

charged discussion with her husband. “I said, ‘I'm physically and mentally breaking

down, and you don't see it’”

Doing everything. The majority of the women shared their perception of doing

everything in their role as a caregiver. Some women reflected that they felt the need to

do everything for their children or their husbands. Excerpts from their individual

narratives representative of this theme are included below.

Sarah. Sarah shared her feeling of doing everything with regard to caregiving for her

son. She said, “so I started working here at this time and I’m doing everything, and I’m doing

everything with him, which is not normal to me…” She went on to also share, “I have the sole

responsibility of taking him to childcare every day, picking him up and feeding him, bathing

him, whatever. So I do everything”.

Leah. Leah also shared about providing care for her children. She shared, “so all their

care and everything was still on me just like when he was deployed except I was scared to go

home”.

Milcah. Milcah’s narrative excerpt was related to providing care to her husband. She

shared, “to go from dealing with his frustrations of him being able to do everything for himself to

now us having to do everything for him; that was – those were some trying times”.

Rachel. Rachel’s narrative excerpt which exemplified this theme was related to

providing care for both her husband and her children. She shared:

So it was really hard and then him being on medication, me having to drive him

everywhere, and at the time I was not working so it was a good thing and now that I am

working and I still have to take care of him and take care of the kids and do everything

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else it does get a lot harder and overwhelming sometimes

Ruth. Ruth’s narrative excerpt which exemplified this theme was related to her

caregiving responsibilities for her children and also her husband. She shared, It’s kind of like

when he was deployed I took care of everything and now he’s here and so I still have to take care

of everything but I also have to think for him almost.

Hannah. Hannah’s narrative excerpt which exemplified this theme was related to

addressing all the household needs in addition to providing care to her husband. She shared:

Every day he’d go outside and go sit on the rocker and rock. Wouldn't do anything, not

pick up a thing, not do a piece of laundry. Everything is piling up on me 'cause I'm

running around going crazy. He couldn't drive after his surgeries.

So I’m losing it, but holding it together, still trying to hold it together. I wouldn’t

make it to an appointment, and he’d be like, ‘You see? You don’t even support me. You

don’t even support me.’

Esther. Esther’s narrative excerpt which exemplified this theme was related to

providing care to her children in the absence of assistance from her husband. She shared,

“I found it really difficult because you have children, you have things to take care of and

everything is on your head because he couldn’t”.

Emotional changes in caregiver wife. An emotional change in the women’s demeanor

was another theme which emerged in the data analysis. Five of the seven women

expressed a change in their overall emotional presentation. These changes are related to

their assumed responsibilities of providing care to their husbands post injury. All of the

women were mothers so these emotional changes were also related to providing increased

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care to their children especially minor children. Some women experienced increased

stress and symptoms of anxiety and depression.

Sarah. Sarah shared:

…my husband calls me extremely emotional, although all the books I read talk

about how all the wives cry all the time, but he says I cry more than any other

person he knows and any other woman he knows, which I don’t think that’s true.

But for him, any time I cry, which is every time we argue, is extremely negative

for him. I/m like I don't know what you think, but it’s almost like I have to turn it

off but I can’t do that.

Rachel. Rachel shared, “If I just shower, just take a deep breath I’m okay instead of me

just being angry just because I feel like I don’t get the option to be angry”.

Ruth. Ruth shared, “…I’m mad all the time. Mad… I’m mad at him. I’m mad at God”.


I was so angry with him. I was like, ‘He’s not gonna kill himself. He’s just talking crap.’

I was just so mad. ‘That's all he’s doing just to reel me in.’… He’d call me on the phone,

and I’d be like, ‘What do you want? I have nothing to say to you. What do you want?’

Deep down inside, I know I love him, but it was just so much anger that I had

towards him because he couldn't see the gifts he had in front of him, his whole family,

how we were here waiting for him, supporting him…As much as he makes me angry,

something is still telling me to hang on, because things are gonna get better, even though

at times I just – I just want to quit, because it is a struggle.

Hannah went on to share, “…when I was going through all this with him… I would tell him, ‘I'm

depressed again. I am depressed.’ I would tell him”.

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Esther. Reflecting further on how her life changed as a result of her husband’s injury

Esther shared, “…I didn’t know how to cope because it could really get you emotional…”

Differences in Narratives

Strengths

None of the women readily shared about a strength they realized in themselves through

this process. While they all presented an answer to the research question I needed to directly ask

the question before a response was offered. The individual strengths offered by each woman are

included below.

Sarah. Sarah noted that her strength was realizing that she was independent. She said,

“if I were dependent on him I would be lost because he doesn’t help me in any part of life…”

Leah. Leah shared:

Oh, well, I realized that I could live without him, and that was totally new for me, ‘cause

like I said, we’ve been together since we were 15. I just always thought that – sometimes

you wonder, ‘What would I do if he died?’ He’s trying to get himself killed all the time,

and we have additional life insurance for that. But I was like, ‘If he dies, I can’t – I won’t

be able to live. My life will end, and I won’t be able to function for my kids.’

And now I know it’s not true because I really realized that I can – I can do it on

my own, and I’m not that scared of it. I’m not scared of it at all anymore because I really

faced the possibility of not having him at all. I realized it really wasn’t that bad

Milcah. Milcah’s strength was related to her role as a caregiver. She shared, “I didn’t

realize I was as strong as I am as far as the nursing him back to health”

Rachel. Rachel shared that her strength was noted in her ability to persevere in light of

all she and her family had experienced.

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Ruth. Ruth did not offer a specific strength. When asked the question, her response was

“no” noting that she did not realize a specific strength in herself through this process.


I’m very strong-minded when it comes to family. That’s my strength, my family. That

gets me going through everything, my family, because I’ve always worked hard. I’ve

always worked hard to just do what I have to do. I have my mind set on, ‘I’m gonna get

it done. It’s a challenge for me, and a challenge that I will not fail in. I will succeed in it,

and I will get through it.’

And so my strength is thinking if I wake up, that’s a strength already. I’m already

happy because I have that strength. If my kids are okay, that’s my strength to continue to

keep going. And then my therapy sessions. My therapy sessions keep me going because

I can let out so much, and I can see the next day. So those are my strengths. That’s my

strength. It’s no muscles, no nothing. It’s my mind. It’s just my family that’s keeping

me going.

Esther. Esther shared that she realized her strength was patience.

What/Who was Helpful

The answer to this question was also one I had to ask specifically of each woman. Some

women offered more detail than others in their responses. The information that the women

shared is included below.

Sarah. Sarah shared that her faith in addition to receiving support from her family and

close friends was helpful.

Leah. Leah noted that help from licensed professional counselors in addition to pastoral

counseling were helpful to her. She shared, “…the military family life consultants, that was –

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they really helped. But the most helpful person, and you'll think I’m making this up, but

Chaplain [Deborah], she helped me the most out of anybody. I didn’t even know her…”

Milcah. Milcah shared that having community support was very helpful to her and her

family during her husband’s initial recovery. She shared “it was a hard time, but it was a

wonderful time. It was a beautiful time of bringing the community together”. She went on to

say:

…all the churches would come together and all the people would gather and they were

like ‘Oh yeah, we were praying for them.’ Now this is Pentecostal, Baptist, Methodist,

Presbyterians, Catholics; you name it, it didn’t matter the denomination; …everybody

came together. We had all these denominations praying for my husband in the middle of

the town square

Milcah also shared that her own church and the military personal at a particular

installation were very helpful to her and her family during the initial recovery period. She

shared, “The military was very supportive in Fort [Somewhere]; they were there constantly

looking out for us; ‘How you doing? How’s this? How’s that? How’s the other?’”

Rachel. Rachel shared that a peer support group was helpful. She said she enjoyed

fellowship with a “…group of women”... that she could relate to and “…felt like [she was] really

not by [herself]. She said:

…We’d meet every Thursday and it was great because the people that got there at the

same time we got there it was like we had formed this bond, all these women, we formed

this bond and we all knew everything that was going on with each other.

Ruth. Ruth shared that counseling was helpful to her during this process. Additionally

she and her husband also engaged in marriage counseling.

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…My faith is what has helped me extremely, and my mother. My mother is my rock. If

it wasn’t for God and me praying, I really don’t know if we would be where we’re at

because, like I said, I would hear God talking to me on just the days I wanted to give up

and just pack it all up and just go with my kids. Even though this is our house and my

kids’ stuff is here, I was ready to pack it all up and go.

My spirituality is what got me here. That’s what keeps me going, because I don’t

see any other way. If I didn't have my spirituality, I would have given up the very first

time because I would have been like, ‘I'm not gonna deal with this’. But I know that

there is a reason why. There is a reason why, and it’s gonna – it's gonna be beautiful

Esther. Esther shared that it was helpful to be with other people from families that were

experiencing similar struggles. She was afforded this opportunity at a local center. She said, “I

did meet some great friends because of the opportunity right there and that’s where you change

out of your – you have a little relaxation or change out of your daily habits right there…”

Researcher Position

I documented components of my position as a researcher in the individual analysis.

There I included some of my initial thoughts, feelings, and experiences of engaging with the

seven women before and during our interview. This section contains further details about my

position as a researcher conducting this study.

I felt connected to all the women who participated in this research study. There was an

initial sense of connection since all the women were Army wives. Many Army and military

wives in general refer to each other as sisters. This is much like male service members who refer

to each other as brothers. When I talked more with each of the women I found that I connected

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to each of them even more on an individual basis. Each woman no longer was a random sister.

These were women who entrusted me with the intimate stories of their lives.

I connected with all of these women as mothers. I connected with some women as wives

whose husbands experienced multiple deployments. I connected with some who functioned in

the capacity of sole care providers for minor children. I felt honored that they were willing to

share their narratives. I regarded their narratives as cherished commodities.

The narratives were raw and it seemed like the majority of the women presented their

narratives with as much detail as possible. For some of these women it seemed like everything

was available for discussion. They did not hold back. I struggled as noted above with my role,

my identity. I experienced multiple intersecting identities. My role struggle revolved around

presenting as empathetic rather than sympathetic.

Therefore the task of analyzing, summarizing and reporting the results of the research

study was not easy. My feeling of connection to these women served as an increased sense of

responsibility to appropriately report the findings. It was very important that I carefully

considered the emergent themes. It was helpful to review Fraser’s (2004) suggestions for

narrative analysis on several occasions. I trust that the themes effectively presented the stories of

these caregiver wives.

Overall, I enjoyed meeting, talking, and listening to these women. I sincerely appreciated

their openness and detailed narratives. I counted it a great privileged to have shared in this

aspect of their individual journeys.

Member Checks and External Audit

Electronic copies of the respective individual transcripts were sent to each woman via

electronic mail. The majority of the women did not return the transcripts with changes or

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additives to the transcriptions. One woman returned the transcript with feedback. Her feedback

was incorporated into the data analysis section.

An external auditor familiar with qualitative research reviewed the transcripts and data

analysis. The external auditor was utilized to provide alternative perspectives and also to

confirm the themes and categories that I selected in the data analysis. The external auditor did

not express any concerns with the themes and categories I selected.

Conclusion

Gift Cards

Most of the women hesitantly accepted or outright refused the $20 gift card which I

provided as a token of appreciation. Milcah explained that she did not need the gift card. She

accepted the gift card after some convincing. Ruth explained that she did not offer much to me

as if to say she was not deserving of the gift card. Sarah accepted the gift card bashfully and

hastily put it away. Likewise Hannah and Rachel hastily put their gift cards away as if the

exchanges never occurred. Leah expressed her lack of concern for the gift card when I

mentioned it in our discussion about the research study protocol.

Gratitude

The women were grateful for the time we spent together. Each expressed their gratitude

to me for sitting and talking with them and largely for allowing them to share their narratives.

Rachel said “thank you for hearing me” at the conclusion our interview. Hannah noted that

telling her story was very helpful as if noting that it was helpful to her wellbeing. She also

expressed her gratitude to me for meeting with her in her home.

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Validation

Many of the women wondered if the information they presented was helpful to my

research goals. I assured each of the women that inquired that their narratives were indeed very

helpful. I wholeheartedly learned a lot and found great value in hearing each of the narratives.

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CHAPTER FIVE: CONCLUSION

In this chapter I provide an overall summary of the research results. This includes

participant demographics information, the two most prominent themes which emerged from the

data analysis, and differences in the narratives. Recommendations for counselors in their work

with military caregiver wives and their families are presented. This is followed by limitations of

the research study. The chapter is completed with a recommendation for future research and a

concluding discussion.

Summary of Results

Demographics Information

Seven Army caregiver wives shared their stories in conjunction with the current research

study. Demographic information provided below was self-reported by each woman. Five of the

seven women completed the Demographics Questionnaire in its entirety.

Four of the seven women were employed outside of the home. Two women identified as

a homemaker or a domestic engineer as their profession. One woman did not provide

information regarding her profession. She also did not make mention of her profession during

the semi-structured interview component.

Four women identified as Hispanic, and one woman identified as White concerning their

race/ethnicity. Two of the women declined to provide information about their racial or ethnic

identification. One of these women shared that she was from Germany. The other woman

shared the state she grew up in during her narrative. She however asked during the member

checks that this information be retracted to further protect her identity. The information

subsequently was withdrawn from the present writing at the request of the woman.

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The seven women ranged in ages from 23 to 46. The women were married between one

to twenty four years. Each woman was a mother. The number of children each woman had

ranged from one to three. The children collectively ranged in ages from five months to twenty

three years old. There were eighteen children total among the seven women.

The ranks which the husbands of the seven women wore ranged from E-4 to E-7. The

years of service completed by the husbands collectively ranged from seven years to twenty four

years. The number of combat deployments each woman’s husband served in ranged from two to

four times. Two of the women began functioning in the role of a caregiver for their husbands in

2011. Three of the seven women became caregivers for their husbands in 2012, and two of the

women became caregivers for their husbands in 2013.

Research Questions

Three research questions were posed in conjunction with the present research study. The

questions were: (1) What are the stories of Army caregiver wives whose enlisted husbands

experienced a functional disability in combat?; (2) How does the story of becoming the

caregivers or nonmedical attendants for functionally disabled enlisted Army husbands impact the

lives of these women?; and (3) What new roles do these wives assume while functioning as

caregivers or nonmedical attendants for their enlisted Army husbands? A narrative inquiry

which results in narrative data analysis was utilized to capture responses to the three research

questions.

The first research question was fulfilled by listening to the individual narratives of seven

Army caregiver wives. I met with each woman individually. A semi-structured interview guide

was utilized to elicit the stories of each woman. The overall goal of the semi-structured

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interview was for the women to share their narratives so as to provide insight into their unique

lives.

Each woman shared her story in a distinct manner. All narratives were audio or video

recorded. The time each woman took to share her narrative differed. Three women shared their

individual narratives in less than an hour. Two women shared their individual narratives using

more than one hour of time. The remaining two women shared their individual narratives closer

to the two hour mark. All the narratives were emotionally charged. Six of the seven women

wept at various times while sharing their narratives. The seventh woman did not cry while

sharing her narrative. Tears however, were noticeable in her eyes at one point and she paused

briefly as if to compose herself.

Research questions two and three were satisfied in the detailed analysis of the seven

narratives. The answers emerged from common themes recognized in the individual narratives.

Nine prominent themes were identified throughout the seven narratives. The individual themes

were not exemplified in each woman’s narrative. There however, were many similarities in the

narratives.

Themes

Themes included (1) Looking Back; (2) I Didn’t Know Anything was Wrong; (3) It’s

Like Taking Care of a Child; (4) Tired/Exhausted; (5) Doing Everything; (6)

Faith/Religion/Spirituality; (7) Lack of Self-Care; (8) Emotional Changes in Caregiver Wife; and

(9) Change in Husband’s Demeanor/Mood. Rich thick quotes were extracted from the individual

narratives to support the presentation of a prominent theme. The individual themes were

identified in at least four narratives to be classified as a prominent narrative.

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Two of the most prominent themes which emerged from the data analysis were a

noticeable Change in Husband’s Demeanor/Mood and the wife’s perception and experience of

Doing Everything. All seven narratives included various stories which exemplified these two

themes. The proceeding discussion incorporates these two themes given past research results

and the results from the current study.

Change in husband’s demeanor/mood. The narratives of the seven women included

numerous stories of a change in their individual husband’s demeanor or his mood. These

changes overwhelmingly affected the families’ lives.

Children. Ruth shared that her children got frustrated with her husband because he often

forgot things. Another caregiver wife, Hannah, shared that her children were struggling with

anxiety and depression. She shared that she believed her husband’s harsh and disrespectful

interactions with their children spurred these changes in her preadolescent and adolescent

children. Reintegration can be a difficult time for older children. These children experienced

high levels of stress and psychological symptoms such as anxiety (Chandra et al., (2011).

Yet another caregiver wife, Leah, shared that her children who were toddlers exhibited

changes in their sleep patterns (i.e. waking and crying excessively at night) when her husband

returned home from a deployment. This woman went on to share that her children did not feel

comfortable in the presence of her husband. This woman likewise attributed these changes in her

children’s behavior to her husband’s changed demeanor. Leah reported that her husband had a

mental health diagnosis of PTSD. Therefore his change in demeanor/mood may be attributed to

the difficulty he had with reconnecting with his children among other issues the family

encountered.

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Whether the children of the caregiver wives’ behavior were as a result in a change in their

fathers’ demeanor or related to a psychological diagnosis is unknown. Their behavior however

seems to be typical of children where the re-deployed parent was gone for long periods of time

(Bradshaw, Figiel, & Deutsch, 2014; Chandra et al., 2011; Chandra et al., 2010).

Leah’s observation of the change in her children’s behavior is consistent with research on

military children and deployment. Research findings by Chandra et al., (2010) suggested that

children between the ages of three and five are especially vulnerable to behavioral problems.

Children also are more likely to communicate their feelings through their behavior because they

do not have the necessary communication skills to communicate in another manner (Lowe et al.,

2012). Preschool age children, as in the case of Leah’s children, are likely to regress in their

cognitive development and psychomotor skills during the deployment cycle (Fitzsimons &

Krause-Parello, 2009). Leah’s children were externalizing problems typical of children during

the reintegration period (Bradshaw et al., 2014). This was evident in their sleep patterns, specific

reactions to their father, and their stronger emotional attachment to their mother.

Marriage and psychopathology. A number of the husbands of the Army caregiver wives

had a diagnosis of a psychological impairment. This included post-traumatic stress disorder,

depression, and anxiety. At least six of the seven women indicated that they experienced marital

instability. It appears that marital instability was interconnected with psychopathology. This

finding is consistent with previous research findings regarding psychopathology and marital

functioning (Papp et al., 2007) and marital closeness, functional disability, and psychopathology

(Mancini & Bonanno, 2006) within military families. In the current research study the impact of

marital instability, psychopathology, functional disability, and marital closeness seemed to be

related to the overall level of functioning and wellbeing of this group of Army caregiver wives.

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Doing everything. All of the women perceived the need to or had to provide care for

their children and also their husbands. This is consistent with research by Christensen & Clinton

(2013). These researchers noted that female significant others to male service members provided

more than 40 hours of care per week for very seriously injured or seriously injured service

members (Christensen & Clinton, 2013).

In the absence of adequate spousal support from the service member caregiver wives in

the current study continued to experience depression, anxiety, significant stress, and marital

instability even past the post deployment period. This finding was consistent with research

conducted by Mancini and Bonanno (2006) about functional disability, spousal social support,

and psychopathology with military families. The present research study however, incorporated

the narratives of Army caregiver wives. It seems that these Army caregiver wives continued to

deal with depression, anxiety, stress, and marital instability indefinitely.

Likewise emotional support has a greater impact on marital satisfaction for caregiving

wives (Wright & Aquilino, 1998). Only one woman, Milcah, shared about being emotionally

supported by her husband. She shared:

He’ll just do something – I can’t stay mad at him no matter what he does, because he’ll

find a way of making me laugh and then I’m like ‘You know, I really hate you right

now.’ He’s just like ‘Yeah, but I love you…’.

This woman also did not express dissatisfaction with her marriage. She instead shared about the

experience of her husband being injured bringing her family closer together. She shared:

In our situation its brought our family even closer. We’ve had cases where it hasn’t been

– that has not been the case; where families have fallen apart... Some…[wives] don’t

think that they’re caregivers or – they’re really not. They’re still letting the soldier do

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whatever he’s gotta – you figure it out, you do what you got to do. They’re hurt, they’re

resentful, they’re going through all of that where because of our faith and because of our

spiritual walk we took it more as a blessing and let’s see what good can come out of it

It seems that emotional support from her husband and social support from her children was

instrumental in this caregiver wives’ wellbeing and also her family’s wellbeing.

Caregiver wives may also express feeling tired/exhausted in their roles. Five of the seven

women expressed feeling tired/exhausted in their caregiving roles. At times it is not the strain of

taking care of the injured spouse but lack of self-care that eventually takes a toll on the caregiver

(van den Heuvel et al., 2000). Five of the seven women expressed their lack of self-care in lieu

of their caregiver duties. Social support can mitigate feelings of being tired/exhausted and

burnout. The importance of social support will be discussed later in this chapter.

Differences in the Narratives

Important differences in the narratives were reflected in answers to the questions about

realizing personal strengths and who or what was most helpful during this process. Each

caregiver wife’s recognized strength differed. One woman indicated that she did not recognize a

strength in herself through the process of becoming an Army caregiver wife. This woman may

have failed to recognize a strength in herself due to the “constant stress” she experienced. The

other six women identified strengths such as “patience”, being independent, and “being strong-

minded”.

Recommendations for Counselors

Counseling

The majority of these women were experiencing negative consequences in their roles as

caregivers. This was consistent with the work of van de Heuvel, et al. (2000). The benefit of

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counseling to mitigate some of these negative consequences is documented in the literature

(Weiss et al., 2010).

Some of the women initiated individual and marriage counseling in the past. For many of

the women who participated in this study counseling or counselors were not regarded as the most

helpful. Perhaps some of the counselors were not well versed in military culture and did not

build rapport with these women effectively.

Counseling perhaps was not helpful to these women because counselors were not

adequately listening to the narratives and focusing on themes or topics which significantly

impacted the lives of these women. If a counselor does not address these concerns it is likely

that caregiver wives will continue to experience many of the negative consequences of

caregiving. These include depression, anxiety, stress, and marital instability.

Counselors are therefore encouraged to consider the two most prominent themes which

emerged from the current research study. These are Change in Husband’s Demeanor/Mood and

the wives’ assessment of Doing Everything. As noted above these themes have significant

implications for the wellbeing of caregiver wives, their husbands, and their entire family.

Counselors additionally are encouraged to consider the other noticeably important themes

which emerged from the narratives in the present study. These included (1) I Didn’t Know

Anything was Wrong; (2) Lack of Self-Care; (3) Faith/Religion/Spirituality; (4)

Tired/Exhausted; and (5) Emotional Change in Caregiver Wife. Five of the seven women’s

narratives contained stories representative of these four themes. Counselors for example, can

effectively assist caregiver wives in traversing the barrier of I Didn’t Know Anything was

Wrong. This can be facilitated by asking a caregiver wife to reflect on her current situation and

to consider the differences she noticed in herself, in her children, and in her spouse.

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In the present study caregiver wives recognized changes in their life when they took time

to reflect. Caregiver wives should be provided a safe space filled with empathy, unconditional

positive regard, openness, genuineness and authenticity to facilitate the reflective process. This

space was fostered time and time again in the seven interviews. It was a space where caregiver

wives were allowed to “download” their issues. Counselors certainly can provide such an

intimate and beneficial space for other caregiver wives.

If the couple presents for counseling the theme of I Didn’t Know Anything was Wrong

likewise may be effectively addressed in session. Counselors should provide an environment

where both the husband and the wife are comfortable sharing. This is a similar environment as

described above for individual counseling with the caregiver wife. In my work with caregiver

wives and combat injured service members I realized that both parties often were not fully aware

of the challenges each other faced. In the absence of open communication both the husband and

the wife were likely to persist in ignorance of each other’s feelings.

This was exemplified in one narrative where a caregiver wife, Hannah, shared that her

husband expressed his understanding of her position after a number of honest and open

communications. Towards the end of her narrative she shared, “We’re getting back on track.

It’s been a slow progress, but now I can add progress at the end of that. But it’s been a year and

a half of trials”. This couple’s conversations were explosive at times which likely resulted in

adverse effects for the pair and also their children. Counselors can mitigate the presentation of

these scenarios in session. In doing so, both husband and wife are likely to hear each other

within a shorter period of time rather than over a year and a half or more.

As the couple persists in counseling other topics could include other prominent themes

which emerged from the current data analysis. Counselors accordingly can assist the couple with

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the wife’s perception of having to do everything which results in the caregiver wife feeling tired

or exhausted. Family interventions that focus on both a patient and their spouse were associated

with a reduction in the patient’s depressive symptoms and family burden (Martire, Lustig,

Schulz, Miller, & Helgeson, 2004). These interventions can bolster the couple’s relationship and

overall wellbeing.

Counseling likewise can assist caregiver wives in emotional regulation. This can be

facilitated through couple or individual counseling. Counselors once again are charged with

providing a space where caregiver wives feel comfortable being vulnerable and actively working

towards personal care and wellness. In that space other themes which emerged in the data

analysis of the current research study are likely to be discussed. These include Lack of Self-

Care, Taking Care of a Child, and Faith/Religion/Spirituality. Faith, religion, or spirituality

another prominent theme which emerged in the data analysis section is discussed in detail below.

Faith, religion, or spirituality. Five of the seven participants discussed God, their faith,

religious practices, or other related components in their narratives. Counselors are encouraged to

explore and incorporate faith or spirituality in their work with caregiver wives. The incorporation

of religion or spirituality in counseling can result in positive aspects for the client who is

interested in such exploration (Bowen, Baetz, and D’Arcy, 2006).

Religion or spirituality furthermore, is an important component in the lives of many

clients (Shafranske & Malony, 1990), especially military connected clients (Brelsford &

Friedberg, 2011). The caregiver wives who participated in this study recognized that there was

an interconnection between their issues and their respective faith beliefs or religious practices.

This interconnection of religion/spirituality with secular issues is supported in the literature

(Brelsford & Friedberg, 2011). Some women viewed their situations as a blessing from God.

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These women accordingly recognized that their marriages were strengthened because of the

issues they traversed. Some women recognized their circumstances as something that helped

them fulfill their God inspired purpose. Others recognized their circumstances as opportunities

for them and their husbands to move closer to God.

Interventions used by the counselor may include the use of a military spiritual genogram

(Weiss et al., 2010). The genogram is a visual representation of the family’s past and present

functions in life. This tool can assist the family in recognizing intergenerational patterns to

provide context and explore connections and relationships. This tool can also be used to identify

barriers, identify strengths, and facilitate individual and family growth. The use of the genogram

by the counselor can readily support rapport building between the counselor and the family. This

tool allows both the family and the counselor to recognize a myriad of patterns and values of the

family in a short period of time. The family and the counselor may not have recognized these

familial distinctions throughout the course of the counseling process. Additionally, use of a

military spiritual genogram can build resiliency in the couple or the family since strengths are

emphasized.

For a family who values religion or spirituality the counselor could assist or encourage

the family to develop a new ritual. This can be a tangible exercise such as a ritual of healing

during various times of transition. This ritual can serve as a great coping skill. It gives the

family ownership of the process and encourages healthy functioning.

Counselors may also consider engaging couples or the family in spiritual disclosure. This

could be a helpful tool for a couple facing related issues like Sarah and her husband. This couple

seemed to hold different religious values following deployment. A spiritual disclosure could

assist couples in discussing deeply held religious/spiritual values in a safe space.

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Therapeutic Support Groups

Therapeutic support groups may be a great resource caregiver wives can utilize through

the process of dealing with the aftermath of a combat injured husband. Emotional support

received from others in a person’s social network has a positive impact on a caregiver’s marital

satisfaction (Wright & Aquilino, 2013). Support groups can provide an environment where

caregivers can receive emotional support from others in their social networks. This can be

particularly important for caregiving wives (Wright & Aquilino, 2013). Utilizing support groups

for social connections can also have a reciprocal effect on children particularly adolescents

(Mmari, Bradshaw, Sudhinaraset, & Blum, 2010).

Milcah shared that she attended a support group three times over the last year. She

shared that the group was beneficial but she was unable to attend consistently. Milcah noted that

the support group was offered during the day when her husband had appointments to which she

escorted him. Rachel shared that a local support group was beneficial to her and Esther believed

some kind of professional support would have been beneficial to her.

Social support can help prevent burnout in caregiver wives. van den Heuvel and her

colleagues (2000) concluded that social support had a positive influence on caregivers’ well-

being. None of the women involved in the study were actively participating in a support group.

Some however expressed the benefits and satisfaction they experienced when they participated

more consistently with a support group. One woman expressed weekly involvement in religious

activities with her nuclear family and also her “church family”. This was a component of her

social support network. This woman was the only one that did not share about martial

instability. It is undeterminable from the data whether this woman experienced marital

instability. It seems that her mobilization of her social support network (i.e. church

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involvement), may have served as a buffer to marital instability. This is consistent with research

with caregiver wives’ marital functioning and social support among African American women

(Chadiha, Rafferty, & Pickard, 2003). While the woman in the current study did not identify as

African American there may be implications for other caregiver wives to whom

faith/religion/spiritual practices are important components in their lives. Religious social support

can be instrumental in the well-being of these women.

Counselors are encouraged to facilitate groups at times which would be convenient to a

large number of women. This can include afterhours groups rather than only during business

hours. In the current study the majority of the women worked fulltime outside of the home.

Two of the women who were homemakers often accompanied their husbands to medical and

other appointments. It therefore was not feasible for them to attend support groups during the

day.

Counselors additionally are encouraged overall to facilitate the process where caregiver

wives can mobilize various aspects of their social support network. Components of the social

support network may include a therapeutic support group as discussed above. Other components

include a peer support group, friendships, or religious organizations.

Limitations

The women that participated in this research study were generated from key informants

in two regions. Therefore it is possible that these women were drawn from distinct subsets.

Another limitation of this study is that information was collected using interviews and self-

reports. Participants may not have offered factual information. More importantly the information

they offered could have been skewed to support their individual perspectives.

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The reader is reminded that the purpose of this study was not to obtain and report

generalizable data. The study was focused on the narratives of Army caregiver wives. The

information shared by these women sufficiently supported the research goals.

Future Research

It is equally important to assess both husbands and wives, approaching any problem faced

by one or both of the marital pair (Whisman et al., 2004). While research supports the

association of the caregiver’s appraisal as a potential predictor of marital well-being (Chadiha et

al., 2003), husbands usually serve as the barometer of marital relationship quality (Papp et al.,

2007). Thus whether evaluating a wife’s level of depression and anxiety, or a husband’s level of

depression and anxiety there is an incomplete account in the absence of the association between

wife and husband effects, the actor and partner effects (Whisman et al., 2004).

Conclusion

When we consider the military often we think only about the service member. The

reality is that spouses, children, even parents also serve. Military service influences family

schedules, housing relocation, job responsibilities, and familial roles. These conditions, to

include combat deployments, usually affect every member of the family not just the service

member.

The current research was focused on the wives of Army service members where the

service member sustained a functional disability while serving in combat. The resulting

condition was such that the service member required assistance completing activities of daily

living or instrumental activities of daily living. The wives of these injured soldiers become their

caregivers.

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There was little documented about the stories of Army caregiver wives. Researchers also

did not fully consider the challenges and strengths of caregiver wives. In the absence of research

practitioners were largely unable to provide appropriate and effective services for Army

caregiver wives and their families? The current research study is an additive to the sparse

literature concerning of Army caregiver wives.

I am overwhelmingly grateful to the women who shared their stories in conjunction with

the current research study. Their narratives were fascinating and heartbreaking. These women

were strong but struggling on a daily basis. They faced issues of depression and anxiety; they

felt lonely, discredited, unwanted, and frustrated. They desperately needed and deserved

services. It is time that help is provided to them and other caregiver wives in a tangible way.

Counselors and counselor educators can be instrumental in this process. I hope that this

discussion will encourage others to gain awareness, offer targeted support services, and engage

in advocacy towards the wellbeing of Army caregiver wives, military spouse caregivers, and

military families. May this current work inform our clinical practices, teaching, and research

emphases of evidence based practices.

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APPENDIX A

Literature Review Keywords Search

military family; combat injury; caregivers; military caregivers; military spouses; military wives; functional disability; military and deployment; military family; relationships between recent deployment; psychopathology and marital functioning; social support; and marital instability.

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APPENDIX B

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APPENDIX C

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APPENDIX D

Recruitment Letter

Hello! My name is Reneé Foyou. I am a doctoral candidate in the Counselor Education and Supervision program at the University of Texas at San Antonio. I am conducting research about the stories of wives of Army enlisted combat injured soldiers. I am working under the advisement of my dissertation chair, Thelma Duffey, Ph.D. This study is approved by the UTSA Institutional Review Board and is conducted for research purposes. I hope to gain further insight into the experiences of Army wives whose active duty enlisted husbands sustained a combat related functional disability. These wives should be caregivers to their functionally disabled husbands. My goal is that the information will facilitate the process for counselors and this population of women to work collaboratively towards the overall wellbeing of this underserved community. Individuals who participate in this study will be asked to complete a confidential individual interview in person. Interviews will be video or audio recorded and will last between one hour to two hours. If you are eligible for this study and willing to participate please contact me at (555) 123-4567 or [email protected]. If not, I would appreciate if you can share this message with any Army wife caregiver who fits my sample criteria. Thank you! Reneé Foyou Doctoral Candidate Counselor Education and Supervision The University of Texas at San Antonio

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APPENDIX E

Recruitment Flyer

Are you interested in sharing

your story? Who: Army caregiver wives of combat injured, active duty, enlisted Soldiers

Why: Understanding your experience will assist in improving counseling and support services to other caregiver wives

When: Individual interviews will be scheduled at your convenience

If interested please contact Reneé Foyou at (555) 123-4567 or [email protected]

Reneé Foyou Doctoral Candidate

Counselor Education and Supervision The University of Texas at San Antonio

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APPENDIX F

Participant Information Sheet

Title of research study: The Stories of Caregiver Wives of Combat Injured Army Service Members: A Narrative Approach Investigator: Reneé A. Foyou Purpose of the research study and reason for your participation: You are being asked to participate in a research study. This form provides you with information about the study. I am asking you to take part in a study of the deployment and post-deployment experiences of wives of combat injured Army enlisted service members. I want to learn more about your personal story before, during, and following a recent deployment. I am asking you to take part in this study because you are an Army caregiver wife who has experienced a recent combat deployment. Up to 10 participants are expected to take part in this study. Conditions surrounding your participation:

The PI will explain this research study to you. Whether or not you take part is up to you. You can choose not to take part. You can agree to take part and later change your mind. Your decision will not be held against you. You can ask all the questions you want before you decide.

Contact information: If you have questions, concerns, complaints, or think the research has harmed you, you may talk to the research team contact Reneé A. Foyou at (555)123-4567 or via email at [email protected]. This research is being overseen by the University of Texas at San Antonio Institutional Review Board (“IRB”). You may also talk to them at (210) 458-6473/6179 or [email protected] if you have questions regarding your rights as a research participant or other questions, concerns, or complaints. Participation in the research study: If you agree to participate in this research study, you will be asked to participate in one individual interview. The arrangement of the interview time will be at your convenience at one of two designated locations. The interview will be one hour to two hours in duration. All interviews will be video or audio recorded. There is no expected benefit, or cost to participate in this study. Risks and Discomforts: Risks of completing these interviews are minimal and may include mild discomfort associated with answering questions about your thoughts, feelings, and behaviors. If you feel adversely affected by the questions and want to seek counseling services, you may contact the Sarabia Family Counseling Center at UTSA at 210-458-2055.

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Participant Privacy and Research Record Confidentiality: To protect your privacy, each participant will be asked to provide a pseudo name which will be utilized on collected data. There will be a separate confidential document which will contain each participant’s legal name, pseudo name, and contact information. This file will be kept in a password protected electronic file on an external password protected storage device, apart from all data collection files. Identifiers and links to names of participants will be destroyed at the earliest time possible. All the electronic data will be stored in a password-protected file, on an external password protected storage device. Your research records will not be released without your consent unless required by law or a court order. Your records may be viewed by the Institutional Review Board, but the confidentiality of your records will be protected to the extent permitted by law. The data resulting from your participation may be used in publications or presentations but your identity will not be disclosed.

This Form is yours to keep

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APPENDIX G

Demographics Questionnaire

1. Your age: ________

2. How long have you been married to your husband? Please write number: _________ years

3. What is your husband’s grade?

Check one

E-1 ____ E-2 ____ E-3 ____ E-4 ____ E-5 _____

E-6 ____ E-7 ____ E-8 ____ E-9 ____

4. How long has your husband served on active duty status?

Please write number: ________ years

5. What is your husband’s military occupation specialty (military job)?

_____________________________________________________________________________

6. How many U.S. military combat deployments has your husband engaged in since 2001?

Please write number: _________

7. When was your husband’s most recent U.S. military combat deployment?

Please write month and year: _______/_______ to _______/_______

8. What was your husband’s military occupation specialty when he sustained a combat related

functional disability?

______________________________________________________________________________

9. When did your husband sustain a combat related functional disability?

Please write month and year of injury: ________/_________

10. When did you become your husband’s primary caregiver?

Please write month and year: _________/__________

11. Do you have children? Check one: Yes____ (continue to questions below) No_____ (stop here)

a. If yes, what are the ages of your children? __________________________________________

b. If you have children, how many live in your household? _______

c. If you have children in your household, what are their ages? ___________________________

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APPENDIX H

Interview Guide

1. Generative narrative question: Can you tell me your story about becoming a caregiver wife? Please include everything you find relevant about your experience and add as many details as you like. I am very interested in hearing your story and learning more about who you are.

2. [If not mentioned] How did your husband’s injury change your life?

3. [If not mentioned] How did your husband’s injury affect your family?

4. [If not mentioned] Are there any specific challenges you faced?

a. [If challenges, follow-up question if not mentioned] What are some of the specific

challenges you continue to face?

5. [If not mentioned] Are there any specific strengths you realized in yourself?

6. [If not mentioned] What has been helpful for you during this process?

7. [If not mentioned] Who has been helpful to you during this process?

8. Is there anything else you would like to include?

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APPENDIX I

Debriefing Statement

THE STORIES OF CAREGIVER WIVES OF COMBAT INJURED ARMY SERVICE MEMBERS: A NARRATIVE APPROACH

Conducted by Reneé A. Foyou, M.A., M.A.R. for completion of requirements for the Doctor of

Philosophy in Counselor Education and Supervision

Debriefing Statement

Thank you for your participation in this research on the stories of Caregiver wives of combat inured Army service members.

The goal of this research is to gain insight into the narratives of these women. The research question is: What are the stories of Army caregiver wives whose enlisted husbands have experienced a functional disability in combat? This information can be instrumental to counselors in their continued collaborative work with caregiver wives.

During this research you were asked to share your story of becoming a caregiver wife. You were also asked about any strengths and challenges that you experienced in this new role and what or who was helpful to you during this process. Contact Information

If you have questions right now, please ask. If you have additional questions later, you may contact me at (555) 123-4567 or [email protected]. You may also contact the faculty member who supervises this research, Dr. Thelma Duffey at (555) 123- 4567 or [email protected].

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VITA

Reneé A. Foyou is from Staten Island, NY. She studied Psychology, Sociology, and

Anthropology at Gustavus Adolphus College in Saint Peter, Minnesota. She went on to earn a

Master’s degree in Clinical/Counseling Psychology from Fairleigh Dickinson University in

Madison, New Jersey and a Master’s degree in Religion from Liberty University in Lynchburg,

Virginia. Reneé also earned a Doctoral degree in Counselor Education and Supervision from

The University of Texas at San Antonio. Her future plans include serving as a counselor

educator and working within the military community.

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