PTSD and the family

What is couple therapy?

If you and your partner are having trouble getting along or feeling close, couples therapy may be helpful.

In this type of therapy, the therapist can help the two of you:

• understand where your difficulties are coming from
• learn ways to cope with relationship stress
• develop skills to communicate and solve problems better
• build trust and feel closer

A health care provider, chaplain, or social services organization can help you find a couple therapist.

What is family therapy?

If your family is having trouble communicating or getting along, consider family therapy.

In this type of therapy, the therapist helps you and your family:

• communicate better
• develop and maintain good relationships
• cope with upsetting emotions, and
• understand and cope with PTSD

A health care provider, chaplain, or social services organization can help you find a family therapist.

Reconnecting with your partner

Relationships may feel strained if one partner is struggling with PTSD. Here are some tips to help you become closer again.

• Feeling emotionally numb can make it hard to express love and care. You can start with appreciating concrete things your partner does (such as "thank you for doing the dishes," or "I appreciate you changing the oil in the car.")
• Talk to your partner about how PTSD has affected you and what you need. They can support you better if they know what’s going on.
• Ask questions and listen to your loved one’s feelings and needs. Do your best to stay open and put yourself in their shoes when they speak.
• If you tend to withdraw under stress, make an effort to move toward your loved one instead with small favors, little touches, or a few kind words.
• Avoid saying hurtful things or becoming physically violent. Instead, take a Time Out to calm yourself. You can find this tool in the Manage Symptoms section of this app.
• With the stress of PTSD, sexual intimacy may be off the table for a while. This may also and particularly be the case for those who have experienced sexual trauma. If so, try to focus on other ways of being close, like spending fun time together, holding hands, hugging, and kissing.
• Understand that PTSD may lead you to feel more distant or irritable. Try to keep your expectations and self-criticism in check—you’re only human, and healing takes time!
• Seek help from a couple therapist if needed.
• Explore options with your partner as to the support they may also need emotionally and with daily chores.

Fighting fair

Conflict will always exist in relationships. If you are irritable or have a “short fuse” it can make it even more challenging. Here are some tips for “fighting fair”:

• Think before you speak. Keeping a cool head goes a long way toward resolving problems.
• When you speak, use statements starting with "I," such as "I think" or "I feel." Using "you" statements can sound accusing.
• Take "small bites." Focus on one issue at a time.
• Be positive- Clearly request what you want or need. Blame and negativity won't help resolve things.
• Put your feelings into words. Your loved one may not know you are sad or frustrated unless you say so.
• During a confrontation, allow the other person equal time to speak his/her mind.
• When the other person is talking, listen to what he/she has to say without interrupting. Ask questions and repeat back what they said to be sure you understand.
• Don't give advice unless you are asked.
• Don’t hit “below the belt” with comments about sensitive topics. Stick to the issues at hand.
• Never argue in bed. Use a neutral room, and affirm your love often.
• Work as a team to solve problems. You can get a lot more done this way than you can as rivals.
• Avoid saying "I told you so." Remember that a problem solved is a win for you both.
• If things are getting too heated, take a time out, but agree to continue the discussion when things cool off.

Impact of PTSD on children

Adjusting to living with a parent with PTSD can be challenging for children and teens especially if symptoms are severe. While many children adjust well, others may respond in problematic ways, including:

• Acting like their parent, perhaps as a way of trying to establish a closer connection with them. These children might show some of the same symptoms as the parent with PTSD, such as being irritable or complaining of sleep problems.
• Taking on adult roles and responsibilities to “fill in” for the parent with PTSD. These children may act too grown-up for their age. This can be overwhelming for the children, and can keep them from living like the kids they are.
• Acting younger than they are (such as bed wetting, temper tantrums).
• Thinking that they are the problem, or that they are responsible for the behavior of the parent with PTSD (such as “he wouldn’t get so mad if I could be quieter.”).
• Needing emotional help for their worries, fears or depression.
• Showing problems at school or in relationships with friends.

Research shows that children of Veterans suffering from PTSD may have:

• More aggressive or violent behaviors
• More behavior problems (hyperactivity, attention problems)
• More school problems
• More relationship problems with friends and family
• Higher risk for depression and anxiety
• “Secondary traumatic stress”: symptoms like their parent’s, and emotional upset about their parent’s trauma/PTSD

Children’s responses to PTSD symptoms

A parent’s reactions to a past trauma can affect children in different ways:

If: Parent has upsetting nightmares or overwhelming memories/ flashbacks

Children might:

• Feel confused about what is happening and why
• Feel scared if they see or hear the parent in a very upset or frightened state
• Worry about their parent's well-being
• Worry that their parent cannot properly care for them

If: Parent avoids going out or isolates him/herself

Children might:

• Take it personally and worry that their parent does not care about them, about spending time with them, or about being involved in their lives (such as school sports games, family outings)
• Feel neglected
• Have hurt feelings, or feel frustrated

If: Parent is withdrawn, numb, or uninterested

Children might:

• Think that the parent is not interested in them or doesn’t love them, even if the parent’s words say otherwise
• Feel worried that their parent will leave them or the family.

If: Parent is irritable, angry, or easily frustrated

Children might:

• Question their parent's love
• Walk on eggshells around their parent, or feel tense and anxious
• Lose respect for their parent

If: Parent is vigilant, sensitive to danger, or startles easily

Children might:

• Develop levels of vigilance similar to their parent and feel very stressed
• Feel more on edge and wary of danger

Can children get PTSD from their parents?

While it is not common, it is possible for children of people with PTSD to show signs of PTSD, too. This is called “secondary traumatic stress.”

Here’s how it can happen:

• When a family teaches a child never to talk about disturbing events, thoughts, or feelings, the child's anxiety may get worse. He may worry about causing the parent's symptoms, make up his own story about what happened.
• Sometimes parents share too many details about the events. Children may start to have their own stress and PTSD symptoms in response.
• A child may begin to share in her parent's symptoms as a way to connect with the parent.
• Children may also re-enact or re-do some aspect of the trauma their parent experienced. It is difficult at times for children to separate the past trauma from the present moment.

Helping children cope

When PTSD impacts the family:

• Explain the reasons for the difficulties. Knowing what is happening, and why, helps children feel safer.
• However, be careful not to share too many details of the event(s) with the child. How much you say depends on your child's age and maturity level.
• Help them see that PTSD symptoms and trauma reactions are not their fault.
• Talk about related events and experiences together. Listen to their concerns and accept their feelings.
• Recognize that change is stressful for children just as it is for adults, and be patient.
• Remember that they may have mixed feelings about you and your PTSD. They may feel loving, concerned, and protective, and also resentful, anxious, or angry at times.
• Help them learn tools to better manage stress. Examples include:
  • Running or exercising to blow off steam
  • Drawing or writing for self-expression
  • Taking deep breaths to relax
• Give them a journal to keep about these events and their feelings and experiences.
• Involve them in decisions that affect them whenever possible.

Parenting tips

Here are some tips for parenting children who are adjusting to living with someone suffering from PTSD.

Educate Yourselves

• Both parents should learn about how PTSD can impact children, and about children’s common responses to having a parent with PTSD.
• Be aware that children may need extra care, attention, and closeness during this time.

Provide Support

• Make time to do activities and talk together. Both parents should listen to their children’s feelings and concerns, and take them seriously.
• Provide reassurance and support for their questions and worries.
• Give kids information at a level they can understand about PTSD and about the experiences and changes of their parent suffering from PTSD to ease the confusion and fear of the unknown.
• Encourage and organize activities (moving around to blow off steam, drawing and writing to express themselves, etc.) that help kids to express themselves and manage stress.

Be Loving and Have Clear Limits

• Be loving, patient and attentive, while also holding clear, consistent limits.
• Understand kids may act out and misbehave at times, and give them some slack for this. Acting out is a normal response to stress, as long as it doesn’t become frequent or cause bigger problems.
• Praise their positive behavior and healthy ways of coping. Always keep your focus on what you appreciate about them.
• If you are the parent suffering from PTSD, focus on quality and fun time with kids and delay getting involved in disciplining, especially if you have been moody or irritable lately.

Keep Things Ordinary

• Maintain basic family routines like dinnertime and bedtime rituals.
• Make sure children keep attending school and other regular activities.

Include Them

• Involve kids in family activities. Keep weekends fun with kid-friendly activities.
• Stay as involved as possible in your kids’ school and social activities.
• Ask about their interests and listen without judging or teasing.

Are my kids ok? When to seek outside help

If you have concerns about the way your child or teenager seems to be handling the situation, don't hesitate to contact your doctor or a mental health professional for support. Here are some things to watch out for:

• Trouble concentrating or engaging in school assignments and activities
• Intense emotional responses, such as continued crying, intense sadness or moodiness
• Depression, or acting withdrawn and uncommunicative
• Expressing violent or depressed feelings in "dark" drawings or writings
• Significant weight loss or gain, or lack of attention to hygiene
• Big changes in social activities or friendships
• Drug or alcohol use

Please seek help immediately if your child intentionally hurts or cuts himself, seems at risk of hurting others, or expresses suicidal thoughts.

Should my child have individual psychotherapy?

Children may benefit from individual psychotherapy or family therapy.

Family therapy helps family members learn how to cope, communicate, and get along when they are under stress.

Individual psychotherapy offers a private place for kids to talk about and learn to cope with their experiences.