Interpersonal circumplex theory in the treatment of operational stress and trauma
Abstract: When clients with a background in the military or policing are asked what brought them to treatment, they often reference a desire to improve relationships damaged by service-related changes in their interpersonal functioning. These changes frequently involve a more distant, irritable, sometimes explosive style, and by the time people come for help, they often describe feeling hopelessly stuck in their current interaction patterns. Clinicians and their military and police clientele would benefit from a broad, intuitively accessible framework for conceptualizing the nature, functions, and persistence of interpersonal changes resulting from lengthy exposure to high-stress operational environments—a framework that clarifies and helps explain interpersonal patterns while stimulating feelings of hope and agency regarding possibilities for change. In this pilot study, an interview-based study conducted with a small (n = 15) group of male service personnel living with posttraumatic stress disorder (PTSD), we explore the clinical utility of using interpersonal circumplex theory (IPC; e.g., Carson, 1969; Kiesler, 1983) for this purpose. Participants were given a brief overview of IPC and asked about their characteristic interpersonal styles before, during, and after exposure to high-intensity operational environments. Interviews explored the perceived functions of stylistic shifts on deployment, as well as factors interfering with a return to predeployment interpersonal functioning. Practical implications for the treatment of operational stress and trauma are discussed.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.