OneOp (MFLN) Family Transitions concentration area recognizes that military families experience an endless number of changes or transition points throughout their service commitment. Few of these transitions impact families more, than when a service member returns home with a physical or psychological wound. OneOp Family Transitions recently had an opportunity to visit with Michelle Sherman who develops family education programs and resources to support adults who care about someone living with mental illness or PTSD. Michelle is a licensed clinical psychologist who has worked in the VA system for over 17 years, providing a range of mental health services to veterans and their families. She is currently a research scientist at the Center for Research and Outreach (REACH) at the University of Minnesota. This interview focuses on a new resource Michelle has developed to help military families speak with their children about PTSD.
OneOp Family Transitions (MFLN-FT): You recently published a new resource, A Veteran’s Guide to Talking With Kids About PTSD. How would you describe this guide for those that haven’t seen it yet?
Michelle Sherman (MS): Funded by the VA South Central Mental Illness Research, Education, and Clinical Center (MIRECC), we conducted a 3-site mixed methods research project. We interviewed veteran parents living with PTSD and asked about their motivations for talking with their children about PTSD, barriers to sharing, positive outcomes of disclosure, experience at VA as a parent, and desired VA services.
Based on our findings, we developed a 25-page interactive pamphlet for military parents entitled “A Veteran’s Guide to Talking With Kids About PTSD.” The pamphlet can be used independently by a service member/veteran or in conjunction with a therapist as part of a therapy group, class, or workshop.
The pamphlet is organized in the following sections:
- What Do You Enjoy About Parenting?
- How Can PTSD Affect Families?
- Should I Tell My Kids About PTSD?
- How Might I Prepare To Have These Conversations With My Kids?
- How Might I Approach the Discussion?
- What Should I Tell My Kids?
- What Should I Do If I Get Upset When Talking With My Kids About PTSD?
- What Should I Do If My Child Becomes Upset During the Discussion?
- How Do I Deal With Questions My Child Asks?
- How Can I Be an Effective Parent?
- Resource List
MFLN-FT: Have you had personal experiences working with this topic?
MS: Yes, I directed the Family Mental Health Program at the Oklahoma City VA Medical Center for over 15 years. I provided clinical care to veterans and their families, many of whom were managing PTSD in one or both parents. I also continue to perform research on family issues related to PTSD, deployment, and mental illness.
MFLN-FT: Why is this topic so important?
MS: Over 15 million people living in the United States today will develop PTSD at some point in their lives and have at least one child (Lauterbach et al., 2007; Leen-Feldner, Feldner, Bunaciu, & Blumenthal, 2011). Although precise rates of parenthood among veterans living with PTSD are unknown, many military personnel managing mental health conditions do have children. Furthermore, research has found associations between parental PTSD and difficulties in children, including both internalizing problems and general behavioral problems (Leen-Feldener et al., 2013). Parents with PTSD also report greater difficulties with parenting, lower parenting satisfaction, and poorer relationships with their children than parents without PTSD (Leen-Feldner, Feldner, Bunaciu, & Blumenthal, 2011). Therefore, it is vital to support these families to potentially minimize these negative outcomes and promote healthy family functioning. We hope that our pamphlet can be a helpful resource for military families and the mental health professionals that serve them.
MFLN-FT: What makes discussing PTSD with kids so difficult?
MS: Great question! Parents in our research project cited many barriers to talking with their kids about PTSD. For example, parents expressed shame, a need to be strong for their children, avoidance of talking about PTSD, and a desire to protect their children as reasons they avoid talking about PTSD with their children. Parents also cited fears about the consequences of disclosure on their children, including worry their kids could be upset, see the parent as weak, tell their friends, or ridicule the parent. It takes a lot of courage to talk openly about one’s mental health challenges. However, importantly, parents in our study who had confided in their children described many positive outcomes, including increased child understanding and support.
MFLN-FT: What would you say is the MOST important piece of information for veterans to know before talking with kids about PTSD?
MS: Take time to prepare! Consider talking with trusted friends or family members before talking with children. Parents may wish to write notes or practice what they plan to say. Also, remember that this is not a one-time conversation, so parents can be open to their children spontaneously raising questions and continuing the dialogue over time.
MFLN-FT: What strategy do you think is the most important in helping kids navigate this topic?
MS: It’s important for parents to start slowly, listen more than they talk, and consider the developmental age of the child in deciding what, how, and when to share information. If the child or parent becomes upset during the discussion, it’s time to take a break to calm down and hopefully resume the conversation at a later time. We offer five key messages in the pamphlet of helpful ideas military parents may wish to share.
MFLN-FT: What makes this guide unique?
MS: We are unaware of any other resources to help parents talk with their children about PTSD. The pamphlet is honest, yet gentle in encouraging veterans to consider their hopes and fears in talking with their kids about PTSD. Parents’ strengths are emphasized, and readers are encouraged to draw upon support from family members, friends, other veterans, and mental health professionals. Numerous interactive activities are offered throughout the pamphlet to encourage reflection and personalizing the information. Quotes from veteran parents shared in the research project are also included. The resource is rooted in a recovery approach and instills hope in veteran parents, both for themselves and their children
MFLN-FT: What questions do you find yourself still grappling with after finishing the guide?
MS: We still have a lot to learn! Much more research is needed in this area to inform the development of helpful clinical tools. We need to learn more about parenting with PTSD across a wide range of parents, considering mothers vs. fathers, parents with different kinds of traumas, parents from different war eras (etc.). We also need to examine the important role of the co-parent in managing parental PTSD in the family. We hope this resource helps military parents in talking with their children about PTSD, and that our research stimulates further inquiry into this important, yet long neglected area.
Michelle is a licensed clinical psychologist who has worked in the VA system for over 17 years, providing a range of mental health services to veterans and their families. She has developed family education programs to support adults who care about someone living with mental illness or PTSD, including the Support And Family Education (SAFE) Program, Operation Enduring Families, and Veteran Parenting Toolkits, all of which are available online. In her personal life, she has also written interactive books for military teens, including Finding My Way: A Teen’s Guide to Living with a Parent Who Has Experienced Trauma. She co-chaired the American Psychological Association Presidential Task Force on military service members and their families, and is a Fellow of the American Psychological Association.
Her newest publication, A Veteran’s Guide to Talking With Kids About PTSD can be found here.
For more information about her research project and findings, please see:
Lauterbach, D., Bak, C., Reiland, S., Mason, S., Lute, M.R., & Earls, L. (2007). Quality of parental relationships among persons with a lifetime history of posttraumatic stress disorder. Journal of Traumatic Stress, 20(2), 161-172. doi: 10.1002/jts.20194
Leen-Feldner, E. W., Feldner, M. T., Bunaciu, L., & Blumenthal, H. (2011). Associations between parental posttraumatic stress disorder and both offspring internalizing problems and parental aggression within the National Comorbidity Survey-Replication. Journal of Anxiety Disorders, 25, 169-175. doi: 10.1016/j.janxdis.2010.08.017
Leen-Feldner, E. W., Feldner, M. T., Knapp, A., Bunaciu, L, Blumenthal, H. & Amstadter, A.B.(2013). Offspring psychological and biological correlates of parental posttraumatic stress: Review of the literature and research agenda. Clinical Psychology Review, 33(8), 1106-1133.doi:10.1016/j.cpr.2013.09.001
Sherman, M.D., Larsen, J.L., Straits-Troster, K.A., Erbes, C., & Tassey, J. (2015). Veteran-child communication about parental PTSD: A mixed methods pilot study. Journal of Family Psychology, 29(4), 595-903.