Training at APsaA Meeting for National Outreach Program to Military Families

SOFAR, Strategic Outreach to Families of All Reservists, working with president-elect Lynne Moritz, is offering members of the American Psychoanalytic Association access to participation in a program that provides pro bono mental health services to families of Army Reservists and National Guard deployed in Afghanistan, Iraq, and Kuwait. The program was initiated by gaining the support of the Commanding General of the New England Reserves, who requested that the Judge Advocate General's (JAG) office of the New England Reserve, develop a working relationship with SOFAR.

Bridges had to be built between two cultures: the military structure and the Psychoanalytic Couple and Family Institute of New England, which launched the program. The program now involves three psychoanalytic institutes in Boston: the Boston Psychoanalytic Society and Institute, the Psychoanalytic Institute of New England, and the Massachusetts Institute for Psychoanalysis.

The JAG senior commander turned over his responsibility to the director of Family Readiness, who began to serve as a crucial liaison to the families and to the SOFAR teams created to assist them pro bono. SOFAR hoped to address the emotional difficulties family members were experiencing, to work with the children in these families to prevent psychic difficulties and to build resilience in these stressed families. SOFAR's goal was simple: provide top-notch services to families of Army Reservists who had limited options from which to choose. No civilian program had worked with the Army Reserves in this way, so each step required thought, discussion, and negotiation. By piggybacking on the relationships and procedures SOFAR has developed, members of APsaA interested in participating in the program can bypass those painstaking early steps.

These families function as single parent families as their loved ones become deployed and struggle with ambiguity and uncertainty as to their families' future. SOFAR presents psychoanalysts with the opportunity to build resilience, to acquaint a large population with the benefits of mental health services, and to disseminate information to teachers and pediatricians whom SOFAR considers first responders in the lives of children. One-third of the family population is under the age of 18. The emphasis on families and on preventing the intergenerational transmission of trauma are unique aspects of the program.

Between October 2001 and January 2006, nearly 1.5 million troops have been deployed to Iraq and Afghanistan. Predictions are that 40 percent of the returning soldiers will suffer from some psychological difficulties. No studies exist on how many family members may have problems, whether or not their soldiers come home with psychological difficulties.

Building Resilience

SOFAR builds resilience by addressing the predisposing issues, providing and expanding coping skills via support services, direct therapy services, psychoeducation, and outreach to teachers.

Originally, SOFAR planned that the bulk of its services would take place in the volunteers' offices. As SOFAR became acquainted with the military culture and the families, the prioritizing of services changed. The military are distrustful of outsiders; this includes mental health professionals, with whom families had little prior contact. Seeking psychological help is often stigmatized. Further, despite reassurances of confidentiality and SOFAR's independence from the Army Reserves, the families feared negative repercussions on their soldiers' careers if they sought help. Participation in support groups held no such risk.

Support groups provide relief to family members because their experiences are named and normalized. Psychoanalysts often fail to appreciate how frightening it is for family members to deal with their ambivalent feelings. One might feel fear when one learns about casualties in Iraq, relief when one learns one's loved one is safe, and then guilt and remorse at the feeling of relief coming at the expense of another family's suffering. Parents worry their children aren't talking to them about their feelings about the deployed parent, not realizing the child is trying to protect the parent who remains at home from the added stress of the child's distress. The families utilized the support groups to deal with these issues and to begin to identify SOFAR volunteers as safe people with whom to talk. SOFAR has had contact with approximately 2000 family members and military personnel via support groups.

Pro Bono Help

In the pilot project, individual and family therapy were available from any of 70 licensed mental health professionals recruited from the three local psychoanalytic institutes who committed themselves to volunteering at least one pro bono hour of psychotherapy per week. Service requests were received and funneled to the program's intake worker via a SOFAR phone line. Clients are self-referred, sometimes with encouragement from a member of the support group. SOFAR's current mandate is to offer psychotherapy services beginning at alert, when members of a unit are notified they will be deployed, through mobilization, when the unit is sent for training in the United States, through deployment when the soldiers go to Afghanistan, Iraq, or Kuwait, and during the first four months of reunion/reintegration when the soldier returns home. The program is willing to modify these parameters as their usefulness is tested. SOFAR will not offer services to anyone who is already in therapy or whose psychopathology is too severe to be treated on an entirely outpatient basis. Families have been slow to make use of these services. But SOFAR has found the number of referrals grows as families have informal contacts with volunteers. As soldiers get closer to the date of reunion, SOFAR anticipates a large increase in families requesting therapy services.

The first phase of the prevention effort is completed; a pamphlet, compiled by a group of educators, The SOFAR Guide for Helping Children and Youth Cope with the Deployment of a Parent in the Military Reserves, is currently being distributed electronically to teachers and pediatricians (available for free download at . or ).

These educators will also develop workshops to train teachers to identify children at risk in this population. In New York post 9/11 the importance of training teachers to recognize and deal with trauma has been seen. In Louisiana and Alabama post Katrina psychoanalysts have trained teachers in that work.

At the upcoming June 2006 APsaA Meeting, Moritz has made it possible for SOFAR to brief members on how to make connections with the Reserve and Guard groups. Institutes will be provided with training materials, including a presentation on trauma by a VA psychologist, an orientation to the military culture by a group of reservists, and a briefing by a director of Family Readiness Services, all on DVD. Digitized copies of relevant readings will also be distributed.

SOFAR will work with APsaA to help alter the public perception of analysts as detached, elitist, serving the wealthy, and isolated from the real world. Analysts have the opportunity to introduce analytic thinking to a population who know little about it and who need what psychoanalysis has to teach.