PTSD/Substance Abuse Committee Update January/February 2018

Thomas C. Hall, Ph. D., PTSD/Substance Abuse Committee Chair


There is an old film on family therapy, The Family Trap, by family counselor and therapist Sharon Wegscheider-Cruse. In it, she is approached by a young boy. She asks him how he’s doing. He says that his family is in treatment to help his dad. She asks him if his father is getting better and he thinks for a moment.

Then he replies, “Well, when you’ve been wetting the bed as long as I can remember and now I’ve gone a whole week without wetting the bed, I would say that things are getting better, wouldn’t you?”

PTSD and substance abuse can have devastating impacts. Veterans with PTSD may improve with Cognitive Behavioral Therapy, Exposure Therapy, or Eye Movement Desensitization and Reprocessing. These have been recognized by the National Academy of Medicine (formerly the Institute of Medicine) and the National Center for PTSD as being effective in significantly reducing PTSD symptoms. Individual treatment also can help people abstain from abusing alcohol and drugs.

In each of these treatments, the individual often experiences a reduction in symptoms. However, this improvement is not experienced in a vacuum. Individual therapy often excludes the family: The family does not know what’s going on; they’re confused; they lash out at themselves or others. The family often does not even perceive any improvement in their loved one’s condition.

In family therapy, the entire network of relationships and interpersonal systems—along with the history of relationships—is taken into account. Unfortunately, some people avoid participating in this therapy because they think the family will be blamed for the struggles of the person afflicted with PTSD or substance abuse.

But the family deserves attention in the rebuilding of a veteran’s mental and emotional environment. Family members benefit by understanding the challenges associated with the disorder. Everyone has something to gain by reclaiming emotional and psychological trust in frayed relationships. Disrupting PTSD or substance abuse as a family can lower the risk of future generations developing secondary PTSD and substance abuse.

The veteran benefits by having loved ones understand the challenges and struggles, some related directly to the veteran’s issues and others unrelated to those struggles. This can enable family members to develop healthy problem-solving and coping skills and clarify their understanding of their lives and roles in the family. They can learn and move on from their hurt and anguish by identifying what is important for their own mental health—and how to ask for and get what they need.

Family therapy is complex yet simple. It’s complex because families are complex; it’s simple in that the health of each family member has a good chance of improving. Someone trained and certified in family therapy can be very effective in helping members of a family navigate their thoughts, feelings, and current circumstances. And the veteran comes to appreciate that he or she no longer feels alone or defective, and comprehends how difficult change can be for everyone.

All of these spoken and unspoken realities take away the burden of isolation and self-recrimination. Everyone in the family can move on to feelings of trust, belonging, love, and meaning.

While all this sounds good, building trust is hard work. All family members have their own concerns and fears, because opening a closed system in which feelings have been twisted and used against one another can seem risky. Learning how to let others deal with how you feel can leave you feeling vulnerable; at times, this process of reconciliation will be painful. There is no miracle cure. Painful memories of hurtful interactions don’t just go away.

Although family therapy is not a magic bullet, it is a start. Ask your local VA and Vet Center to recruit family therapists, then support and retain them. Make their presence known and available to our brothers- and sisters-in-arms.

Remember the little boy who no longer wet his bed? He could be joined by his parents and other members of his family who will no longer feel they have to walk on eggshells to avoid conflict and eruptions of anger as they try to cope with their own pain, anger, and guilt.

The veteran finally has a chance—a life-saving chance—to manage negative emotions and regain a positive role in the family. The family, an informed team of loved ones, may now manage together what no one did well alone.

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