USA — Center Provides Advice on Post-deployment Intimacy Issues

BETHESDA, Md., Jan. 27, 2011 — In the list of prob­lems that can con­front ser­vice mem­bers after a com­bat deploy­ment, few can be hard­er to talk about or more dev­as­tat­ing than the inabil­i­ty to resume inti­mate rela­tion­ships.
Cou­ples who have sur­vived mul­ti­ple com­bat deploy­ments know the sit­u­a­tion all too well.

“The first few years of the war, every­body thought they’d get off the plane and the hon­ey­moon would start,” Rebekah Sander­lin, an Army wife at Fort Bragg, N.C., and “Oper­a­tion Mar­riage” blog­ger, told Amer­i­can Forces Press Ser­vice. “The first two weeks are good, then it’s down­hill for sev­er­al months.

“We had a hard time just feel­ing like we knew each oth­er,” Sander­lin said of her hus­band, who has deployed sev­er­al times. “It was like there was a stranger in the house. Even if we were phys­i­cal­ly inti­mate, we real­ly did­n’t feel con­nect­ed.”

The Sander­lins are far from alone. “I haven’t met any­body who just bounces right back,” she said of rede­ployed cou­ples.

While it’s hard to quan­ti­fy the prob­lem, it is com­mon enough that psy­chi­a­trists with the Cen­ter for the Study of Trau­mat­ic Stress, part of the Uni­formed Ser­vices Uni­ver­si­ty of the Health Sci­ences here, are reach­ing out with infor­ma­tion to health care providers, coun­selors and mil­i­tary fam­i­lies to help troops re-estab­lish deep con­nec­tions -– both emo­tion­al and phys­i­cal -– upon return­ing home.

“Inti­ma­cy is an impor­tant part of post-deploy­ment health care,” Dr. Stephen J. Coz­za, asso­ciate direc­tor of the cen­ter and pro­fes­sor of psy­chi­a­try at the uni­ver­si­ty, told Amer­i­can Forces Press Ser­vice and the Pen­ta­gon Chan­nel. Any cou­ple sep­a­rat­ed for many months needs to be patient and give extra atten­tion to their rela­tion­ship after a deploy­ment, he added. But for those suf­fer­ing from the cur­rent wars’ sig­na­ture wounds of post-trau­mat­ic stress or trau­mat­ic brain injury, “those con­di­tions can have a pro­found effect on rela­tion­ships, and espe­cial­ly inti­ma­cy,” Coz­za said.

Peo­ple with post-trau­mat­ic stress some­times expe­ri­ence per­son­al­i­ty changes, become emo­tion­al­ly dis­tant or avoid peo­ple and feel­ings, he explained. TBIs can fur­ther com­pli­cate rela­tion­ships, and espe­cial­ly sex­u­al­i­ty, depend­ing on the injury, which may leave the per­son in phys­i­cal pain and cause their part­ner to dou­ble as care­giv­er, he said.

Add to that pos­si­ble side effects of med­ica­tions, impul­sive or vio­lent behav­ior, or sub­stance abuse, and many post-deploy­ment prob­lems can hin­der inti­ma­cy, Coz­za said.

All of this can be dev­as­tat­ing to cou­ples and seek­ing help can be dif­fi­cult. “How do you bring that sub­ject up?” Coz­za asked. “Often, we just don’t even have the words to express it.”

The cen­ter has devel­oped fact sheets and guid­ance for health care providers and fam­i­lies on issues of rein­te­gra­tion and inti­ma­cy. They cite inti­ma­cy as an often neglect­ed area of care and urge peo­ple to talk about their prob­lems — and for providers to bring up the issue.

Oth­er guid­ance for health care providers includes:
— Edu­cate patients and part­ners about impli­ca­tions of brain injuries, espe­cial­ly in areas that con­trol sex­u­al­i­ty, inhi­bi­tions and impuls­es;
— Encour­age com­mu­ni­ca­tion to work through rede­ploy­ment changes, includ­ing self-image; and
— Urge cre­ativ­i­ty in find­ing solu­tions to inti­ma­cy chal­lenges.

“It’s real­ly impor­tant for peo­ple to have a sex­u­al rela­tion­ship that does­n’t have to be all about sex,” Coz­za said.

Some­times ser­vice mem­bers return home more intense and aggres­sive than when they left, and they may have dif­fer­ent atti­tudes about sex, Coz­za said. Coun­selors can help them work through those changes, he added, and part­ners should refrain from sex until it’s mutu­al­ly enjoy­able.

Many cou­ples can work out their post-deploy­ment inti­ma­cy prob­lems with­in a few months of being back togeth­er, and even in the case of seri­ous injuries, inti­ma­cy usu­al­ly returns over time, Coz­za said.

The center’s tips for improv­ing inti­ma­cy include:
— Find ways to be close that do not involve sex, such as show­ing affec­tion in oth­er ways;
— Spend qual­i­ty time togeth­er;
— Talk about your feel­ings, hopes and desires when you’re both calm and ready to lis­ten;
— Respect your partner’s need for space; and
— Sched­ule inti­mate time.

Sander­lin and her hus­band dis­cov­ered that a lit­tle pro­fes­sion­al coun­sel­ing can go a long way.

“I rec­om­mend coun­sel­ing for every­body,” she said. “TRICARE pays for it, and all you have to do is call Army One­Source.” But no mat­ter how many times her hus­band deploys, Sander­lin said, rein­te­gra­tion always is a chal­lenge.

“It seems to take sev­er­al months to feel nor­mal again,” she said.

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)

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