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Re-entry and transition factors for returning Canadian Forces military members from overseas deployments Sorsdahl, Michael Neil 2010

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 RE-ENTRY AND TRANSITION FACTORS FOR RETURNING CANADIAN FORCES MILITARY MEMBERS FROM OVERSEAS DEPLOYMENTS  by  Michael Neil Sorsdahl B.Sc., University of Victoria, 2002 M.A., University of Victoria, 2005  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF  DOCTOR OF PHILOSOPHY in The Faculty of Graduate Studies (Cross-Faculty Inquiry in Education)  THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) September 2010     © Michael Neil Sorsdahl, 2010 ii ABSTRACT  This study investigated the factors that affect the re-entry process of military members returning from overseas deployments, using the Critical Incident Technique method. To date, no other study has adequately investigated to this degree and focus, looking at what factors helped and hindered the successful reintegration process. This study expands the understanding of what is desired by military members on return from overseas deployments. It also presents an adaptation of a new theoretical model of re- entry. Fifteen participants were selected through their response to a „call for volunteers‟ letter sent to military personnel in the vicinity who were either known by the researcher, known through the Veterans Transition Program coordinated by Dr. Marv Westwood, or known through those solicited persons above to have returned from overseas deployment over a year ago. The incident categories were rated by thirteen of the fifteen study participants as well as two external persons (one with military background and the other with no military background). The ratings of the categories resulted in over 90% concurrence through placing a random selection of incidents into the investigator-created categories. A total of 445 critical incidents were gathered, with 5 categories that helped the re-entry process, and 6 categories that hindered the re-entry process. The findings of this study are consistent with previous literature pertaining to military members who have returned from deployments, but also expand the information discussed in the literature. The unique findings of this study propose changes to the current programs available to military members and a adapted model of re-entry for military members. These new programs include adaptations to the military decompression program, the use of group iii therapy composed of other military members, the essential need to talk to others as an instrumental component of successful reintegration, and also an adapted model of re- entry for military members is proposed.                                         iv PREFACE  This research was reviewed and approved by the Behaviour Research Ethics Board, UBC BREB Certificate number is H09-02940.                            v TABLE OF CONTENTS  ABSTRACT ....................................................................................................................... ii PREFACE ......................................................................................................................... iv TABLE OF CONTENTS ..................................................................................................v LIST OF TABLES ......................................................................................................... viii ACKNOWLEDGEMENTS ............................................................................................ ix DEDICATION....................................................................................................................x 1     INTRODUCTION.......................................................................................................1 1.1     Background to the Study ........................................................................................1 1.2     Categories of Re-entry Issues .................................................................................4 1.3     Important Terms .....................................................................................................5 1.4     Positionality ............................................................................................................5 1.5     The Research Problem ...........................................................................................7 1.6     The Research Question ...........................................................................................8 2     LITERATURE REVIEW ..........................................................................................9 2.1     Military Culture ....................................................................................................10 2.2      Theoretical Perspectives ......................................................................................15 2.3      Re-integration Issues ...........................................................................................22 2.3.1     Family ............................................................................................................23 2.3.1     Social Issues ..................................................................................................24 2.3.1     Psychological Issues ......................................................................................25 2.3.1     Physical Health Issues ...................................................................................28 2.4      Existing Therapy and Programs for Returning Military Members .....................28 3     METHODS ................................................................................................................34 3.1      Critical Realism ...................................................................................................34 3.2      Methodology .......................................................................................................36 3.3      Appropriateness of the Methodology for the Question .......................................38 3.4      Rationale for Choosing Critical Incident Technique ...........................................38 3.5      Participants ..........................................................................................................38 3.6      The Method .........................................................................................................39 vi 3.7      Data Collection ....................................................................................................43 3.8      Data Analysis ......................................................................................................43 3.9      Ethics ...................................................................................................................45 3.10    Credibility and Convergence of Categories ........................................................45 4     RESULTS ..................................................................................................................47 4.1     Critical Incident Categories that Helped Re-entry ...............................................52 4.2     Critical Incident Categories that Hindered Re-entry ............................................58 5     DISCUSSION AND CONCLUSIONS ....................................................................66 5.1     Connections to Current Literature ........................................................................66 5.1.1     Acceptance and Positive Interest by Others ..................................................66 5.1.2     Transition and Reconnection Process ............................................................68 5.1.3     Current Military Support Systems .................................................................68 5.1.4     General Acknowledgement and Recognition ................................................70 5.1.5     Psychological Assistance...............................................................................70 5.1.6     Lack of Effective Military Systems and Recognition ...................................71 5.1.7     Psychological/Emotional Challenges and Reactions .....................................72 5.1.8     Lack of Public and Family Recognition ........................................................73 5.1.9     Disconnection with Home Society ................................................................74 5.1.10   Reluctance to Relate ......................................................................................76 5.1.11   Chronic Pain and Physical Dysfunction ........................................................76 5.2      Unique Findings of the Study ..............................................................................77 5.3      Strengths and Limitations of the Study ...............................................................81 5.4      Implications for Future Programs/Re-entry Transition Models ..........................83 5.4.1     Model of Re-entry .........................................................................................83 5.4.2     New Insights into Programs ..........................................................................86 5.4.3     New Decompression Program .......................................................................88 5.5      Concluding Statement .........................................................................................91 REFERENCES .................................................................................................................92 APPENDICES ................................................................................................................100 Appendix A Volunteer Request Letter .........................................................................100 Appendix B Telephone Script ......................................................................................102 vii Appendix C Interview Introduction .............................................................................104 Appendix D Informed Consent Form ...........................................................................106 Appendix E Referral Sheet ...........................................................................................109 Appendix F Certificate of Ethics Approval ..................................................................110                                         viii LIST OF TABLES  Table 4.1         Summary of Critical Incident Categories ..................................................49 Table 4.1         Rating Table ...............................................................................................52                                          ix ACKNOWLEDGEMENTS This thesis has been a cornerstone in my experiences as both an academic and as a Naval Officer in the Canadian Forces. I would like to thank the members of my committee, Dr. Marv Westwood, Dr. David Kuhl and Dr. Carl Leggo, for their opinions, suggestions, and advice throughout this process. Without them I would not have had such a great learning experience. I would also like to thank my parents for their unwavering support, but most especially I would like to thank my husband, David Jensen. For all the times I put professional advancement before family, his continued dedication to our future was a constant reminder of the importance of family through it all.                           x DEDICATION  To the Men and Women of the Canadian Forces                       1 1     INTRODUCTION  This study is designed to bring forward new knowledge to an area not previously explored in this way, thus providing new insights and information that could be helpful to the Canadian Forces members who serve Canada through overseas deployments. In order to better understand what led to this study a review of some background information, the categories of re-entry issues, a list of important terms to understand, the researcher‟s positionality, the research problem and the research question must be explored. 1.1 Background to the Study  The current international political climate requires the maintenance of an armed force as part of a country‟s capability. Every country either has their own military force, or is in a position where another country provides that resource for them. As long as there is potential conflict between nations, there will be a requirement for a military. Also, as long as we send military personnel into conflict situations there will be repercussions for those actions. Canada has a military that is currently deployed in international conflicts as listed in Current Operations of Canadian Expeditionary Force Command (2009) such as the Task Forces in Afghanistan, Arabian Sea, Balkans, Cyprus, Darfur, Democratic Republic of the Congo, El Gorah, Freetown, Golan Heights, Jerusalem, Middle East, Pritina, Port-au-Prince, Sudan and Tampa. By placing military members into conflict situations they are subject to experiences that are not normally experienced by regular civilian members of our country. These experiences have consequences that may create challenges for them when they return. Recently, there has been an increased focus by the Canadian military on returning deployed members and the issues surrounding reintegration into society. 2  It is imperative that more research investigates what happens to military members when they return from overseas deployments in order to provide the required support to them when they have challenges with their re-entry. In Marin‟s (2002) report he indicated that an anticipated 50% of military members suffer from Posttraumatic Stress Disorder (PTSD) or trauma that interferes with the ability to function in many aspects of their lives. PTSD is a diagnosis in the Diagnostic Statistic Manual of Mental Disorders 4 th  Edition Text Revision (DSM IV (TR)) that occurs after exposure to an event or experience that involves actual or threatened death. There are several criterion symptoms that must be exhibited to gain this diagnosis. When people exhibit some of the symptoms but not all of them, it is referred to as a case of Posttraumatic Stress Reaction (PTSR) (Westwood, Black, & McLean, 2003). The military uses terms such as Combat Stress Reaction (CSR), or Occupational Stress Injury (OSI) to include symptoms that may or may not lead to a full diagnosis of PTSD as per the DSM IV (TR). Black, Westwood and Sorsdahl (2007) state that there are many issues that can arise from the transition into civilian life including physical and psychological injuries, health issues, substance abuse, family discord, and identity issues from their time in the military. The Canadian Forces (CF) has been looking at ways to provide support for these members, particularly in the last year (Director of Casualty Support Management, 2009; CANFORGEN 143/09). Although there has been some progress in providing services to military personal in the CF, it is not sufficient  to solely implement programs without a full understanding of what is required by military members on return from deployment. The most recent study available that investigated the experience of re-entry for military members was by Faulkner and McGaw (1977), who focused on the process for Vietnam veterans returning 3 to the U.S. Times have changed, the experience of conflict has changed, and the cultures from which military members are drawn have changed since that study was conducted. It is time that more research is conducted into what is both required and accepted by military members who return from overseas deployments. The results of these studies will allow us to develop and design interventions and programs that address the challenges of military personnel in successfully reintegrating into society.  The literature discusses military members having transition issues surrounding family, social, psychological and physical health areas, the specifics of which will be addressed shortly. Most of the research that has been done in the recent past has been focused on the concern for PTSD, PTSR, and CSR for combat-experienced veterans. Although they are not the only concern, PTSD and related psychological injuries, as noted above, are a major concern for both the currently enlisted returning military members as well as veterans who returned decades ago. Blais, Thompson, and McCreary (2009) found that there was very little published research on what the process of reintegration was for CF returning members, but that the literature and studies suggest that re-entry after a deployment was associated with negativity, disruption, and stress at the personal, family and work levels. Trauma reactions can also affect social and family circles thereby creating stress and challenges with re-entry to both members and family members (McLean, 2008). When a person moves into a different culture and then returns home, challenges associated with cultural identification also occur (Walling, Eriksson, Meese, Ciovica & Gorton, 2006). Knowing what the current challenges are and what support networks are provided to returning military members is the first step in helping to 4 understand their re-entry experience and serves as a cornerstone for creating needed support networks. 1.2 Categories of Re-entry Issues  The factors that affect the re-entry process of returning military members need to be clarified. Military members are likely to experience both physical and psychological challenges when returning to Canada. For the purposes of this study, physical health issues include such experiences as loss of a limb, diseases, disorders, and degradation of senses. Basically any changes that occur to a military member physically can be included in the category of physical health. Psychological challenges are any issues around psychological health. This category includes PTSD, PTSR, CSR, OSI, Depression and its variants, as well as other psychological disorders and diagnosis found in the DSM IV (TR).  Other categories that are important to understand during the re-entry process are what these military members return to. These include both social and family circles in which the military members were engaged prior to deployment and are required to return to after the overseas deployments. For this study, family includes all members that are blood relations as well as those entered into through marriage contract, common law, or long term cohabitation, or adoption. Social circles include clubs and organizations that military members belong to before and after deployment, as well as circles of friends, and work environments. Social factors can also include government organizations, military organization support structures, and general social groups.   5 1.3 Important Terms The terms used throughout this dissertation may be foreign to some readers; therefore, a summary of these terms with brief definitions is provided: Military: although this term is difficult to define, for the purposes of this study, the term military refers to the group of people that belong to a recognized military force serving a country for both internal and external conflicts Canadian Forces (CF): the military organization for Canada CF Member: any person that is currently serving in the Canadian Forces Military Member: any person that is currently serving in a country‟s military force Veteran: any person that has been released from the military Civilian: any person that has never served for the Canadian Forces or other military force Deployed: sent out of country on behalf of the country for a military mission Overseas: any mission that occurs outside of North America Regular Force: members of the CF that are on full time service and sign a contract for a specific engagement of service Reserve Force: members of the CF that are generally on part time service and can work full time for specific contracts and then return to part time service 1.4 Positionality  It is important to look at the researcher‟s positionality when conducting research in order to understand how the researcher relates to the researched subject. The principal researcher is currently serving as a Naval Officer with the Canadian Forces (CF) and has done so since 1994. After joining the Navy at the age of 18, the principal researcher belonged to the Regular and the Reserve Force and has been deployed overseas and 6 employed in domestic operations. The experiences faced upon re-entry by the researcher were profound and unexpected, resulting in an interest to better understand how and what happens to others who return from deployments. The researcher was also raised as a dependent of a military member.  As the researcher comes from within the military culture, he has a unique perspective as a researcher, allowing for shared experiences and understandings with prospective participants in the study. Combining the experiences by the principal researcher of the culture that is being researched and the experience and knowledge gained by the principal researcher through academia provides a perspective that may allow for a deeper understanding of what occurs for the participating military members. The passion of the principal researcher requires explanation to help understand the reason why the military culture and their experiences are important and why the principal researcher wants to provide that information to the civilian community. During this research project it has been essential to realize that focusing on the military as a unique category reifies that category within society. By reifying this category, a concern may be raised about whether it is a valid category to be created and researched. Isolating the members of this constructed category as different from others could cause concern through “othering” or marginalization. The primary researcher believes that it is essential to first categorize this community as separate in order to better understand the effects of the employment on them, thus enabling society to better reintegrate them when they return without too much resistance in the process. Labelling all military members as a categorized people that have challenges on re-entry could create a situation where they are avoided by regular civilian members of that society. 7 This concern can be managed through monitoring how the data is used to ensure that this does not occur. This research is meant to be beneficial to both mainstream society and to the military members that are affected by the re-entry process. 1.5 The Research Problem  In conducting the literature review through EbscoHost using the databases of Academic Search Complete, CINAHL, Education Research Complete, ERIC, Family and Society Studies Worldwide, MEDLINE, Military and Government Collection, PsycArticles, PsycBOOKS, PsycCRITIQUES, PsycEXTRA, PsycINFO, Social Work Abstracts, SocINDEX, and Academic Search Premiere, very little published research on Canadian Military personnel returning from overseas deployments and their experiences of that re-entry process was found. There is an abundance of research that discussed PTSD and other psychological challenges by military members in the U.S. and other countries as an issue that must be addressed (Manderscheid, 2007; Casey, Kaloupek, Schumm, Marshall, Panuzio, King & Keane; Marin, 2002). There is also a concern that due to the large numbers of CF members deployed to Afghanistan and other foreign locations, there is and will be an increasing number of members returning who are suffering and will need help, not only from the psychological damage from being in those areas, but also in the act of re-entry (Walling et al., 2006). Another concern exists, namely that there are insufficient people who understand the exact challenges faced by returning military members, let alone what is required to help them.  The information available is vague, and does not look at recent conflicts nor does it focus on Canadian experiences specifically. Due to the current political climate and the 8 presence of Canadian military members in conflicts overseas, it is imperative that research be focused on these members. 1.6 The Research Question  Due to the lack of current research in an area of exploration that affects an entire culture within Canada, it is important to put some effort into investigating this area. In order to understand how re-entry occurs for military members after completing overseas deployments, it is essential to investigate the following research question: “What are the specific social, family, psychological and physical health factors that facilitate and hinder the successful re-entry of Canadian Forces members who have completed and returned from overseas deployments?” Once these factors are understood, insight into developing models that outline the re-entry process and how to augment current programs designed to help military members with their re-entry process may emerge.            9 2     LITERATURE REVIEW  The purpose of this chapter is to provide an overview of the research and literature that relates directly to the research question. The review is divided into the following sections: Military Culture, Theoretical Perspectives, Re-integration Issues, and Current Programs that exist for returning CF members. As alluded to in the introduction, the concept of „military‟ is not an easy one to define. It is similar to being asked to define any specific culture that exists; like being asked to define a Canadian. Being in the military is not just a job; it is a way of life. Understanding the culture from which the CF members live and work provides an important perspective that needs to be addressed when dealing with them as a specified group. When military members return from overseas deployments, they re-enter Canadian society after being separated from it for varying degrees of time. Looking into theory that can expand and explore our understanding of what happens on re-entry is essential. Although minimal published research and theory directly address this phenomenon, research into acculturation, identity formation and transition processes aid in a greater understanding of re-entry. The military has existed for a long time, and due to that, there has been ample opportunity to look at the issues that arise when military members return from overseas deployments. A discussion of the issues that have been experienced by military members upon return from deployments in our history will orient the reader to what could be expected by our CF members when they return from deployments. Challenges of reintegration of our CF members have been investigated before; therefore the programs that have been implemented to assist in the transition of returning CF members must be investigated. 10  In conducting the review of literature on these topics, it was clear that there is a plethora of research that focuses on the psychological challenges experienced by military members when they return from deployment, but little literature available on what both helps and hinders that reintegration process specifically. Due to the lack of public information, elements of military culture will be brought forward from the author‟s experiences as an active serving Naval Officer in the CF. 2.1 Military Culture  It is not easy to understand military culture if you are not within it. Societies are inundated with fictitious stories through books and film that portray military culture in a way that does not reflect the reality of it (Harper, 2001). Due to this misrepresentation, many assumptions are made and are imposed on the culture. This gap in understanding the military culture by civilians is exacerbated by the aging of our veterans who have successfully left the military and the limited number of currently serving members that leave the military into civilian occupations (Collins, 1998). This lack of familiarity and exposure to military culture creates an atmosphere of mystery and concern about what it actually means to be in the military in today‟s global climate. With this lack of familiarity and growing concern of our military‟s purpose, feelings of fear about the military are engendered, which further isolates the culture from the civilian world (Collins, 1998).  A text on military culture defines it as the attitudes, beliefs and behaviours of those personnel wearing a service uniform in support of their country (Krueger, 2000). This culture includes the families that support them and participate in the organizational structures that surround them, helping to develop a common mindset. Common bonds form between service personnel through shared experiences and training programs, 11 lifestyle expectations, camaraderie, esprit de corps, group cohesiveness and a series of regulated tenets laid out by the military specifically designed for inclusive membership. The author‟s experience of military culture allows for a precise conceptual analysis on what is military about military culture. The military culture is created through intense training, indoctrination, and learned social experiences that enhance the ability for people to defend with arms a strategic goal or to attack others when directed to do so. This culture moves beyond the action of work, and into what some call a „brotherhood of men‟ that transcends civilian connections and friendships. How this „brotherhood of men‟ concept relates to women in the military is unknown at this time, and is worth further inquiry to understand the differences that women in combat arms trades bring to a traditionally male-based camaraderie. Sorsdahl (2005) found that there is a bond and connection through interpersonal trust development that is unlike any other found in the civilian world. It is a bond that forces you to trust the person next to you with the most important thing in the world, your life, and possibly not trust them to pay you back money they have borrowed. This formulation of obscure trust bonds is not easily understood by civilians, and creates a unique cultural experience for military members.  Harrison (2006) provided some statistics of the CF which is composed of approximately 60,174 members that include both regular and reserve force members. Approximately 86.6% of all CF personnel are men and 67% of all members are married. The military culture includes spouses and dependents that live with active service personnel, and so that increases the membership of this culture (Baker, 2005). With the majority of CF membership being men, it is not uncommon to see the culture as hypermasculinized. Rosen, Knudson and Fancher (2003) explain the bonding that occurs 12 in male only peer groups that can cause some negative social consequences such as aggression. It is also suggested by Rosen et al. (2003) that both the inclusion of women in the CF and spouses has minimized the large negative social consequences associated with stereotypically exaggerated violent behaviours. The military culture includes members, spouses, and dependents, creating an environment that is inclusive to those members and exclusive to everyone else. As the family support unit is very important to military culture, support programs and services for military families have been developed for their well-being, as well as for the service personnel themselves.  King (2006) discusses British military culture in an anthropological way that speculates that the culture is brought about through doctrines that regulate the behaviour and activity of military actions. These doctrines are writings that explain exactly how to deal with almost all possible eventualities, providing a structure and rigid decision matrix that creates similarity and control in a very specific way. Through the implementation of these doctrines, the culture emerges in a way that supports the required behaviours of its members. King further argued that if we wrote these doctrines down and provided them to the civilian public, then the military culture might be better understood by the civilian public. He also believes that through combined operations with other militaries, a more cohesive international military culture is inevitable to a certain extent. To further the understanding of the institutional nature of military culture, Danderker (2001) explains that through legitimized violence and the unlimited liability of a military member‟s employment contract, the written regulations and strict rules, or doctrine, is the only way to control the result of those leniencies in people‟s behaviour. 13  Civilian organizations also utilize elements of military culture in the effective techniques of management (Garsombke, 1988). Enhancing discipline within their members, promoting group solidarity and group cohesion to achieve better labour results, and emphasizing the military value of efficiency have all been used to improve the work ethos of civilian organizations. There is also the concern of some undesirable characteristics of military culture in civilian agencies, including a win-lose dichotomy, and a top-down communication style (Garsombke, 1988). Garsombke cites Skjelsbaek‟s critique of military culture which he claims supports the development of ideologies that view human life as cheap and dispensable, understand human nature as weak and evil, condone violence against outside groups, regard revenge as acceptable, and support threats based on fear as acceptable behaviours to control others. This perspective supports the writings of Collins (1998) that the civilian elite are losing their capacity to relate to military culture on a personal level. Historically, the military culture was synonymous with concepts of honour, pride and respect. These adjectives are no longer thought of when thinking of military culture. Dandeker (2001) discusses the connection of the military to politicians, whereby the military is directed what to do by the society or country that they serve. To move a society beyond the need of a military, and therefore its culture, requires more than an attack on the military itself. The general actions and behaviours of the military are at the direction of the current governing agency, providing an opportunity for the powerful civilian elite to utilize the military to their own ends. The military generates a culture that does exactly what is asked of them, and nothing more (Warren, 1999). 14  The culture that is generated emerges from the acts and behaviours that are required of our CF members in the execution of their duties. To do these acts requires a specific way of being, which becomes a culture, that bears consequences. Eisen, Neuman, Goldberg, True, Rice, Scherrer and Lyons (1998) conducted a study that shows the connection between the psychological trauma experienced by military members and an increase in physical ailments upon their return from deployments. Langston, Gould and Greenberg (2007) explain that military personnel are an at risk group who are vulnerable to psychological distress and mental health problems including PTSD, depression, family violence, substance abuse and occupational functionality. To belong to this culture creates an inherent risk of affliction with family, social, psychological and physical health challenges.  The military has not focused on researching the military as a culture, although they do prescribe to the idea that it is a culture. The Canadian Military does not have any uniformed military psychologists, only Personnel Selection Officers that study the psychological testing of applicants to determine their suitability to specific trades (Prociuk, 1988). The U.S.‟s military has generated entire training plans and procedures to equip military psychologists with the tools needed to handle multicultural experiences of their service members (Kennedy, Jones, & Arita, 2007). Canada has not focused on identifying cultural elements of physical, emotional and psychological distress and resiliency. Field (2005) wrote an article about the three elements of successful leadership. These elements were to establish a vision, consider the culture you are working in, and to surround yourself with capable people. The most salient point is to consider the culture in which you are working. It is important to focus on the larger military culture since it 15 comes with certain elements that must be understood in order to better help the members of that culture. 2.2 Theoretical Perspectives  Theoretical explanations may provide further insight into the experiences of military members returning from deployments. However, with the exception of Faulkner and McGraw (1977) there is limited research addressing military culture specifically. In order to better understand what may be happening at a theoretical level, a look at acculturation, cultural identity and transition processes in general is conducted. From these areas of transition, a more comprehensive understanding of what may be happening to military members on re-entry will be expanded upon. Once the military is viewed as its own unique culture, the transition from military culture into the larger societal culture in which it exists is seen as more important. Rudmin (2003) outlines a history of acculturation theories that have emerged over time and culminates with the fourfold theory that will be considered. Acculturation has been understood since the first theories were posited by Thomas & Znaniecki in 1918 that put forward three typologies of acculturation to include the Bohemian, Philistine and Creative. The Bohemian type was the kind of person that took on new cultural behaviours and let go of the original to fit in. The Philistine is the type of person that held onto the main belief and discarded the new emergent culture. Finally, there was the Creative type of person that both held onto the original main cultural beliefs but included the new emerging culture. Rudmin (2003) goes on to explain the development of other typologies of acculturation up to the most recent posited by Berry, Kim, Power, Young and Bujaki in 1984 called the fourfold theory. This theory posits four types of 16 acculturation: assimilation, separation, integration and marginalization. Assimilation is where the person takes on the dominant cultural beliefs entirely and discards their original cultural beliefs. Separation is where the person holds true to their original cultural beliefs and separates themselves from the dominant cultural beliefs in which they find themselves. Integration is where the person holds onto their original cultural beliefs, but integrates elements of the dominant cultural beliefs in which they find themselves. Marginalization is where the person loses their original cultural beliefs, but also does not take on the dominant cultural beliefs.  The fourfold theory of acculturation will serve to explain aspects of military transition or re-entry into the original society after being deployed for a period of time. As explained before, joining the military brings with it an indoctrination into the military culture. Through military training, people become assimilated into the beliefs and values held within that culture. When military personnel are deployed overseas, they are completely removed from the societal culture and inculcated within the military culture in order to survive. As an example, the military members are restricted into a base camp the entire time they are deployed with very limited time away from that camp. They follow a rigid routine from the time they are awake to the time they go to sleep, constantly required to follow the rules and regulations in place in order to ensure safety for all personnel living at that camp. They also dress completely identical showing complete uniformity. Constantly alert, they must be ready to react at all times, and so the idea that they are inculcated within the military culture to survive seems appropriate in this circumstance. While deployed, these members are also influenced by the culture where they are deployed. Upon return, members of the military are likely to follow the 17 acculturation process back into the larger dominant society in which they are situated. According to the fourfold theory, these members could experience this re-entry differently depending on which typology most closely defines them. This unique experience aligns with the Adlerian belief of identity development that posits that each individual must be seen as a holistic self therefore allowing people to see differences within one culture or across cultures (Cheung & Leung, 2006). The Adlerian belief around how cultural belonging influences the development of the identity of an individual seems to fit well in understanding the identities of members of the military. Being a part of the military impacts the development of oneself, and therefore the part of the individual‟s identity is formed through that association. Furthermore Cheung and Leung (2006) explain that Adlerian theory believes that culture also plays an important role in shaping an individual‟s personality. Culture is formed through the groups one chooses to associate with, which means that through acculturation into a different culture even in adulthood, our identity is still changed and formed. Furthermore, Allen (2000) explains that the influences of the family influences personality development. As the military becomes a form of family, this indicates that the military would also have influence on the personality or identity development of the individual. Quintana (2007) explains that racial-ethnic identity exploration occurs during adolescence, and through discrimination, in-group affiliation, and defense development against discrimination the identity is created. As the military spends a great deal of time and energy indoctrinating members, normally from when they are an adolescent or young adult, in order to create a sense of family and in-group belonging, it follows that a cultural identity through belonging to the military would be formed. 18  There are many critiques to this theory of acculturation. Rudmin (2003) argues that these critiques include the lack of development by theorists from original theory work to present theories of acculturation, and the belief that integration is a beneficial and adaptive style of acculturation. The larger concern and stronger critique is how typing people and their experiences minimize the individual experiences of people. Investigating how different types of people acculturate, and focusing on what helps and hinders them irrespective of the type they belong to, can only assist in discovering the challenges to the re-entry process for military members. By doing this we remain with the Adlerian theoretical beliefs of identity formation through culture. Walling et al. (2006) discuss the cultural identity and re-entry process for short- term student missionaries which may provide insight into the experience of military members upon re-entering their home society. There is a cultural adaptation that occurs when an individual or group goes from their home culture into a new one for a short period of time. These people adapt to different roles, different routines, and unfamiliar social norms which bring about an altered global perspective. Upon return to the home culture, the re-entry process is not simple and may be more difficult than going into the new culture to begin with (Walling et al., 2006). It may be that the changes that are experienced by people in the new culture result in the travelers not feeling that they “fit in” in their home culture. The results from Walling et al.‟s study confirmed that anger and other negative reactions towards the home culture are common during re-entry. Additionally, the returning participants experience changes in their cultural identity. This lends credence to the theory that identity is at least in part formed through cultural affiliations. Similar findings were reported by Sussman (2000) and Raschio (1987). 19  Black, Westwood, and Sorsdahl (2007) found that the transition from the military culture back into the civilian society is very much cross-cultural. Black (2009) focuses on the transition of military members upon release from the military into the civilian society, resulting in its own challenges. The challenges that appear similar are problems with relating to the civilian world (Westwood, Black, & McLean, 2002). These social challenges can be a source of negative emotion and stress during the re-entry process.  Re-entry theory has been investigated by previous researchers, focussing on Vietnam Veteran re-entry in the U.S. Faulkner and McGaw (1977) conducted a study that included discussions with U.S. Vietnam Veterans returning to the U.S. and their experiences in the re-entry process. The focus of re-entry has diminished in recent years, most likely due to the lack of a focused war or event that brought the concern to light. Instead of wars, our current culture has Operations like DESERT STORM in 1991 and the proverbial “WAR ON TERRORISM” that we are currently involved with in Afghanistan. A move away from research that focuses on re-entry towards research that focuses on PTSD and programs that deal with PTSD and Combat Stress has occurred.  Faulkner and McGaw (1977) outlined three areas of transition and re-entry experienced by Vietnam Veterans. The disengagement phase occurs when the military member needs to separate themselves from the experience of being on deployment. Falkner and McGaw explain that for Vietnam Veterans, participating in the war was so central to their lives, that returning home was an extremely foreign experience. Their family had been replaced by the military, and their lives were structured in a specific way during their deployment. They were changed by the experiences that they had during the war with the other military personnel with whom they served. A disengagement from the 20 military family has to occur in order to move towards the next phase. This disengagement phase can be seen in current deployments of CF members as well, even though the deployments are only 6 months compared to 2 years. Faulkner and McGaw discuss 3 aspects of loss that Vietnam Veterans had to cope with through disengagement. These include the loss of time from their civilian experiences, loss of a part of themselves like naivety, and a loss of others when they lost friends. It appears that current soldiers returning from overseas may also have to move through these areas of loss.  The second phase described by Faulkner and McGaw (1977) was the Re-entry phase. This phase was centralized around readjustment of the member‟s perspectives of how the world works back at home. The Vietnam Veterans found re-entry difficult due to a discontinuity of relevant systems of behaviours that once worked during wartime, the inability to share their war experiences with civilians, and the feeling of exclusion from their home society. Having to return into the rules of society without adequate support during that transition was found to be challenging. The violent impulses that became normal and required during wartime were no longer valid or desirable in their home society. A feeling of separateness from the civilian society around them created an inability to feel a connection with other people, resulting in minimal support networks. The home that the Vietnam Veterans remembered was not the same as it was experienced after the war, because it changed over time just as they had changed from their experiences. This phase seems very appropriate and probable with modern day military members returning from deployment as they too must re-enter into society after being completely separated from it for a period of time. Whether it is 6 months or 2 years, the changes are just as dramatic, owing to the changes in the society that they left, and the 21 changes that they go through from the experiences the members were exposed to during their deployment.  The last phase proposed by Faulkner and McGraw (1977) was the reintegration phase. This phase moved the Vietnam Veteran from challenges of re-entry into processes that assisted them in integrating back into society. Some veterans were successful at this integration, while others were not. These differences may be the result of personality types or acculturation types that deal with integration differently. Faulkner and McGraw focused this phase on general opportunities for reaffirmation of the Vietnam Veteran‟s identity. These opportunities included peer group relationships that look at responsibility and encourage acceptable self-image by shifting perspectives, cumulative acquisition of valuable skills that increase their commitments to the social world, and the presence of other Vietnam Veterans at various stages of reintegration, providing a role model of success. This phase can also be seen as useful to our current military members that return from deployments in their re-entry process as they too could utilize these opportunities to immerse themselves in the civilian world that they return to. Reintegration is still found to be important today as seen through Blais et al.‟s (2009) creation of a Post-Deployment Reintegration scale to use with Canadian soldiers who return from overseas deployments.  After a systematic literature search, it became apparent that there is limited research that focuses on military re-entry with our modern military experiences of deployments in Canada. Using the U.S. re-entry theory from 1977 by Faulkner and McGraw, it appears re-entry does occur in stages, and that there are some challenges that have been experienced by veterans during this transition. As our current Canadian Military has not been involved with a war to the magnitude of Vietnam recently, the 22 experiences of our members may be different. It is important to investigate the experiences of our CF members on return from our current deployments to amend the re- entry theory that exists in order to provide programs that focus on those challenges. 2.3 Reintegration Issues  Although the theory behind the specific re-entry process is lacking, there is no lack of research focusing on the challenges experienced by military members when they return from overseas deployments. Investigating the family, social, psychological and physical health issues shown through research experienced by our returning CF members will aid in providing a structure to elicit the current factors that help and hinder the re- entry process back to society after overseas deployments. Manderscheid (2007) looked at how to help U.S. veterans of Afghanistan and Iraq conflicts reintegrate back into the community. Strategies looking at psychological injuries, substance abuse, and physical injuries have been implemented and programs have been developed for those issues. Blais and Thompson (2004) developed a multidimensional measure of post deployment reintegration. They explain their concern around the minimal decompression of CF members that return from overseas deployments whom return home too quickly to the regular roles and activities in personal, family and organizational levels. This fast reintegration can be a significant stressor. King, King, Vogt, Knight and Samper (2006) looked at developing a risk and resilience inventory for use in understanding the experiences of military members and veterans. They found that combat exposure was linked to an array of negative health issues including PTSD, depression, substance abuse, and other aspects of physical health. These issues emphasize the broad spectrum of factors that can influence the re-entry process. Furthermore King et al. (2006) indicate 23 that research on veteran psychological adjustment on return from deployments was improved with social support. Taft, Kaloupek, Schumm, Marshall, Panuzio, King and Keane (2007) indicate that those members with PTSD diagnosis have increased aggression connected with alcoholism and dissociative symptoms that hinder the social acceptance of the members upon return from deployments. As the conflicts change, and the demands on our military members shift, the issues that are experienced upon re-entry would also presumably shift. Understanding historical issues provides a framework in which we can structure the current issues experienced by CF members. 2.3.1 Family  The home family is what the military member returns to and that is where reintegration begins. One‟s family includes spouses, children, parents and sometimes close friends. This family is what the military members leave when they are sent overseas, and what the military culture and family replace for the period of time they are deployed. For this reason, it seems the family could be a great source of support, or a great source of challenge, depending on the reintegration experience. Mateczun (1996) indicated that military members return, readjust and reintegrate into their family first. He termed them the „3 R‟s of reunion. McLean (2006) conducted research on the effects of military members with PTSD returning home, and the experiences of spouses on reintegration. Vicarious trauma and other challenges such as physical abuse were experienced by spouses and children, the latter having a great impact on the family relationships.  Burrel, Durand and Fortado (2003) found that the more integrated a family was into the military, the more those family members endorsed the member being in the 24 military. This family integration is seen through family members having a full understanding of what the military members experience and knowing what services are available to them through the military. Also, that the military member‟s family members are in contact with other military families in the area, therefore becoming more connected to the culture of the military through those associations. Furthermore, they found that when there was no family support or integration in the military, those military members experienced increased physical, behavioural and psychological health issues on return from deployments. It seems that family connection and understanding through military integration is important in creating a social network for military members to return to. This social network appears to provide structure and support for those returning from overseas. Figley (1993) reported that secondary trauma experienced by returning members and their families after they returned from deployments was greatly overlooked. This secondary trauma for the members was experienced through having to deal with the reactions and challenges of the family members to their primary trauma reactions. Coping methods for returning members utilized many family-based support activities in order to help them adjustment back into civilian societies. 2.3.2 Social Issues  Leading from family issues, the larger contextual social reintegration by military members returning from overseas deployments must also be addressed. Acceptance by the society in which the military member is defending when overseas is an important element when they return (Sorsdahl, 2005). Benedek and Grieger (2006) along with Killgore, Cotting, Thomas, Cox, McGurk, Vo, Castro and Hoge (2008) reported that military members who return from deployments after being exposed to war zone type 25 experiences have challenges in dealing with the general public. Killgore et al. (2008) identified that returning service members take increasing risks through unsafe behaviour. This study was conducted on U.S. Army soldiers immediately returning from combat deployment during the American Operation IRAQI FREEDOM. They were found to engage in more high risk activities and were more likely to indulge in greater alcohol consumption and increased verbal and physical aggression to members of the public. Benedeck and Grieger (2006) reported a greater amount of post-deployment violence in some of the Vietnam veterans that they interviewed.  Manderscheid (2007) discussed the challenges that occur for military members through a lack of linkage to the civilian culture. He believes that it is this lack of connection to the civilian culture while they are deployed that leads to the difficulty in reintegration upon return. Social support and networks designed to assist in the reintegration of CF members is required by societies to help with the productive transition of these members. Social support networks by both military and civilian members have not been researched as a possible approach in assisting in the reintegration process. It seems that with the challenges experienced by military members integrating with the civilian society, it may be more useful to create connections with both military and civilian organizations during this re-entry phase. 2.3.3 Psychological Issues  The most well known factors that occur to military members that return from overseas deployments are the psychological ones. More specifically, the issue of PTSD has been researched and investigated at an increasing rate as seen by the amount of research on that subject. However, the known psychological issues are not only PTSD, 26 but also include Major Depressive Disorder (MDD) and addiction issues (Bliese, Wright, Adler, Thomas & Hoge, 2007). Most of the research available focuses on the development of PTSD by military members and how that affects them once they return home. Lamerson and Kelloway (1996) indicate that military members experience both combat and contextual stressors that affect the experience of traumatic reactions and make it different than civilian traumas. Combat stressors may include repeated exposure to threats to life, death of friends, and the death of other people. Contextual stressors may include family or spousal issues, financial issues, and separation anxiety issues. The combination of ongoing combat and contextual stressors create an environment for compounded traumas that may lead to more serious stress reactions.  Dobreva-Martinova, Villeneuve, Strickland and Matheson (2002) found that the higher the occupational stress is for members of the CF the lower the feelings of well being occur. Psychological challenges on re-entry to the civilian society will happen to many military members, and they need to be dealt with effectively to help members deal with those issues.  When military members return from overseas, it has been shown that a very small percentage of them actually report their issues (Britt, 2000; Fikretoglu, Brunet, Guay & Pedlar, 2007). Britt indicated that one of the causes of this failure for military members to report their psychological issues is due to the negative stigma attached to being perceived with a psychological problem by the military. If people do not report their psychological problems the system assumes that there is no support needed and subsequently no support is offered. Fikretoglu et al. (2007) found that one-third of CF members with PTSD failed to seek any form of treatment in their lifetime. Bliese et al. (2007) also found that psychological distress was higher when measured after 120 days of re-entry as compared 27 to immediately upon return from the deployment. This is likely due to the time it takes to go through the re-integration process into general civilian society and also to move beyond the sense of happiness of returning home. After these initial feelings of contentedness of being home have had time to dissipate, the actual challenges and issues associated with PTSD begin to emerge.  PTSD has its effects on marriage and family life through issues with vicarious trauma (Silverstein, 1994; McLean, 2006). Silverstein discusses the increased psychological issues of military members from the perspective of Erikson‟s identity development. This theory argues that due to the identity formation that occurs in adolescents when military members are recruited, a greater amount of guilt results after traumatisation. This idea of guilt through identity development is linked to Adlerian theory as well as Erikson‟s. Since the identity of the military member is partially formed through the military culture, when a person is unable to perform the tasks required within the spectrum of their identity, guilt and shame can ensue. A loss of self, and a belief that they have failed as a person can result in extreme shame and guilt. Furthermore, trauma reactions in military members have found to be detrimental to surveys on marriage satisfaction by both military members and their spouses (Goff, Crow, Reisbig & Hamilton, 2007). PTSD can have vast effects including sexual dysfunction, sleep disturbances, marriage dissatisfaction and socially aggressive behaviour (Goff et al, 2007). PTSD, depression, addictions and other psychological issues can be far reaching and are important to be considered when dealing with military member‟s re-entry and reintegration process.  28 2.3.4 Physical Health Issues  Physical health issues experienced by military members who return from overseas have included sexual dysfunction, sleep disturbances, brain trauma, limb-loss, hearing loss and other physical limitations (Trudel, Nidiffer & Barth, 2007; DaVanzo, 2006; Hasenauer, 2006). These issues have an effect on how some members deal with reintegration due to a change in physical status and abilities. There is also the added challenge of being released from the military for several physical health challenges on a medical pension and then being without a job or purpose. Trudel et al. (2007) have shown that Traumatic Brain Injury (TBI) is a major health issue with military and veteran populations. There is a lack of research on physical health issues by military members other than brain injuries, amputations, or broken limbs. Some of the physical issues experienced could be part of the symptoms associated with psychological issues like sexual dysfunction. More research is required investigating what other physical ailments occur to returning military members and how that affects them. 2.4 Existing Therapy and Programs for Returning Military Members  The existence of therapeutic techniques and programs designed to help military members when they return from overseas deployments are essential in providing the support required for a successful re-entry. Numerous agencies have provided a variety of therapeutic techniques; both military and civilian. The military has created systems such as decompression programs and multi-faceted re-entry programs designed for U.S. soldiers. Dr. Marv Westwood has created a program out of The University of British Columbia funded by the Royal Canadian Legion called the Veteran Transition Program that is also designed to assist military members and veterans in re-entry into Canadian 29 society and the reintegration into the civilian world (Westwood, McLean, Cave, Borgen & Slakov (2010). Richardson, Darte, Grenier, English and Sharpe (2008) indicate the existence of the occupational stress and injury support networks that the CF provides for returning members as part of their new Mental Health awareness program in the military. It is designed to help those that have any stress reactions on re-entry to gain assistance when required through a series of clinics designed to provide support. This program has been around for approximately 10 years, but recently has been expanding and given additional funding in order to provide awareness and assistance for military members suffering from OSI.  Doyle and Peterson (2005) outline the programs that exist for the U.S. military members that return from overseas. These programs include many different modalities of therapy including one-to-one support, cognitive behavioural therapies and group therapies (including post-deployment adjustment, interpersonal processes, depression, and adjustment to military life, general life skills and anger management). Doyle and Peterson indicate the greatest issue that the U.S. military is facing for reintegration of their members from deployments are those that belong to the Reserve or Guardsman. These members experience immediate demobilization into their civilian lives without the benefit of an active military unit to assist them through the process. As Reservists, many fear the loss of their civilian jobs, required closing of personal businesses and a lack of support from their civilian employment agencies when difficulty in transition occurs. This also occurs in Canada, as we have a large number of Reserve force members deployed overseas. Although there are programs designed to assist with the liaison between civilian employers and reservists in Canada, called the Canadian Forces Liaison 30 Council (CFLC), it does not always help employers understand what their employees are experiencing upon their return. The CFLC is designed to assist in getting the reserve force members time off civilian work to participate in operations and training.  Hughes, Earnshaw, Greenberg, Eldridge, Fear, French, Deahl and Wessely (2008) discuss the use and importance of the decompression program for military members returning from operational environments. This decompression is designed to help service personnel adapt to their home environments gradually in an attempt to minimize problematic adjustment issues. Hughes et al. (2008) have indicated that there is research that claims that decompression time is needed for the return but not always provided to returning members from these deployments. Different countries have different decompression programs for their returning military members that vary on the amount of time and what location they do it in. Hughes et al. discuss the American military process as occurring in a separate location other than the deployed location and the military member‟s home location. This third location is ideal in that it provides an opportunity for military members to discuss issues with other military members and unwind from their combat tour prior to being placed into a civilian environment with their family. According to Hughes et al.‟s review, Canada utilizes a five day decompression period from operations. There is little empirical evidence on the benefit of decompression; however, anecdotal evidence suggests that it is useful. The allocated time for decompression has also been criticized as it takes away from the time the members could be reuniting with their family. Hughes et al. (2008) indicate the need to utilize the decompression program appropriately for an appropriate amount of time depending on the specific people, length of tour, and exposure to combat. A “one size fits all” 31 decompression program may cause more problems than the challenges it wishes to overcome.  McCaughey (2001), Galloucis and Kaufman (1988), and Scurfield, Corker, Gongla and Hough (1984) have all conducted research that reveals group psychotherapy programs assist military members with trauma reactions and re-entry adjustment issues. Group therapy has been found as a beneficial mode of therapy for military members that can explore the issues that must be dealt with, discuss the challenges that are experienced from returning members, and possibly brainstorm ways to assist in the member‟s reintegration process alongside other military members. Programs that seem to combine both psychological healing and skills for re-entry and reintegration may be more highly utilized by the military compared to therapy treatments that are solely psychologically based. Fikretoglu et al. (2007) and Fikretoglu, Brunet, Schmitz, Guay and Pedlar (2006) found that help seeking behaviour of Canadian military members is complex and requires varied approaches to get different groups of people to seek help. CF Military members are most likely to seek help when they are suffering from severe PTSD combined with MDD, and even then would only consult a military psychiatrist, medical doctor, or social worker for a brief period of time. Those CF members that do seek help from a psychologist or psychotherapist continued seeing them for prolonged periods of time. Westwood, Black and McLean (2002) outline the Military Transition Program as it has evolved over the years. The program was designed to assist members with military backgrounds; both psychologically through interventions designed to assist with past traumas experienced during their military career, and assist them in career transition after returning from peacekeeping missions or after being released from the military 32 (Westwood, Black, & McLean, 2002). Westwood et al. (2002) further explain that many peacekeeping soldiers return home from their military experiences suffering stresses that occur with any re-entry experience combined with unresolved issues and stress reactions associated specifically with their peacekeeping experiences. Post-deployment stress reactions, including high anxiety, depression, restlessness, and insomnia, may very likely present the greatest health risk that military personnel have to face as they experience peacekeeping missions.  The program was designed to give aid to military veterans who experience these stress reactions, and who are trying to adjust to civilian life upon return from operations overseas. The program attempts to assist military members or veterans in having a more productive experience in the world of work and family and is run in small groups of six to eight members. The groups meets for two 4-day weekend periods, with a follow up 2 day session held outside of the military establishment in the hope that this will reduce the fears behind self-disclosure of injuries that normally would lead to the end of the member‟s military career (Personal communication with Marv Westwood, 2009). The intense 4 day weekends start on Thursday evening, and then move into the formal group from the Friday morning to the Monday afternoon. The 2 day follow up is designed to check in with the participants during their process of reintegration and trauma recovery. Westwood et al. (2002) explain that the program is structured into four phases including the initial group sessions, life review writing exercises, therapeutic enactment, and consolidation. The initial sessions focus on developing group cohesiveness, establishing trust and establishing safety. The life review writing exercises are a group- based intervention wherein participants write aspects of their life story at home and then 33 share their stories to the group in a confidential setting. Therapeutic enactment is a group- based therapeutic intervention that focuses on the “acting out” of a participant‟s critical incidents from the past, present or future. The purpose of this intervention is for catharsis and cognitive re-integration of the experience to occur for the client. The catharsis is the release of feelings that underlie unresolved personal issues (Westwood et al. 2002). The final group phase focuses on the consolidation of learning from the previous sessions and on forming new goals and objectives for the future. It is at this stage that career counselling and assistance are offered, and where recognition and integration of the newly transferable skills occurs.  The program also uses Peer Helpers as part of the leadership team. These Peer Helpers are members of the military that have completed the program previously, and have a desire to help future group members. They are used to demonstrate skills and provide support to the members in the overnight evening periods. The program is designed to be an effective means for helping military members reach their personal and professional-related goals. A safe environment is created whereby military members can receive support from other military members that understand what they have been through. According to Westwood et al. (2002), the program helps participants normalize their experiences on missions and share difficulties of re-entry into civilian life. Westwood et al. (2010) showed what the participants found beneficial about the program and what could be included to make it better. The life review process and therapeutic enactment assist the members in dealing with stress related issues arising from their experiences so that they are able to cope with those issues in their future.  34 3   METHOD  In order to understand what kind of knowledge is being created through this research, a review of the epistemological assumptions and theory that this knowledge is understood through is required. The perspective taken to understand what knowledge is gained through this research is Critical Realism first discussed by Bhaskar in 1988 (Bhaskar, Archer, Collier, Lawson and Norrie, 1998). 3.1 Critical Realism According to Scott (2005), Critical Realism is founded on six principles : 1) it is not possible to describe the world in an infinite number of ways because reality acts as a constraint as to how it can be described; 2) there are objects in the world that exist whether they are known by anyone or not; 3) there is a need to focus on social practices that are not predetermined by social structures since human beings are knowledgeable agents with powers to make a difference and thus have the capacity to monitor their actions and change the practical setting; 4) a notion of error is accepted in relation to the possibility of providing a correct view of reality; 5) epistemological and ontological emergence occurs; and 6) epistemological transivity exists. These principles are what underlie the assumptions made within this perspective and within the interpretation of the results gathered through the Critical Incident Technique (CIT). Generally these principles are straight forward; however a couple of them are more complex requiring further explanation. The transivity of epistemology refers to the idea that through Critical Realism, all ways of knowing are valued including Objectivism, Constructionism, and Subjectivism. 35 In understanding reality, there are two dimensions to investigate; the intransitive and the transitive dimension. Bhaskar et al. (1998) explain that the intransitive dimension in Critical Realism is the basic reduction of the reality of being, while the transitive dimension is the relativity of our knowledge of being. There is an intransitive dimension which is what is “real” and would be explained through universal truths, and a transitive dimension described by how we currently explain or closely approximate those intransitive truths from our limited view due to historical learning. This transitive realm is where you would find the constructionist and relativist perspectives being explained by Critical Realists. What this means is that when we conduct research on the transitive realm, we are trying to find the closest approximations of truth so that we can further understand the subject being looked at and use that knowledge to make generalizations that could be used in future situations. As more knowledge becomes known, adaptations of past theory are created making a kind of „living‟ document of understanding.  For the purposes of this study, the selected epistemological stance of Critical realism is to focus on the transitive dimension, which is the closest approximation of truth when it comes to a certain phenomenon. Studying how Canadian military members re-enter and reintegrate into Canadian society and looking at what events helped or hindered that experience is a constructed reality that is assumed to be similar for all military members. For that reason, this study remains epistemologically sound and congruent with the assumptions that are required within this framework of understanding.  There were no explicit philosophical assumptions outlined by Flanagan (1954) in CIT. Even though this method is supported by the assumptions of Critical Realism, it is important to look at some additional implicit assumptions that are required by this 36 method. One of the assumptions required to support this technique is to assume that critical incidents do occur and are observable by others that can report it. It is also an implicit assumption that a critical incident will be understood to have occurred by the reporting person. The other inherent assumption that underlies the critical incident technique is that of the understanding of words and what the researcher is looking for. As an example, if CIT is being used to measure the “performance” of a member, then the reporting individuals must understand a concrete definition of the term performance. What performance means for one person does not necessarily mean the same thing for another. For this reason, the technique relies on the concept of constructed realities of understanding among people. Finally, it is important to note that an assumption underlying CIT is the accuracy of participants‟ recollection of events. The researcher must believe that individuals that are asked to report on behaviours of other people will indeed remember accurately what happened for them. 3.2 Methodology CIT was used for this research project. The research question is, “What are the specific social, family, psychological and physical health factors that facilitate and hinder the successful re-entry of Canadian Forces members who have completed and returned from overseas deployments?” CIT was first formally introduced by Flanagan (1954) and consists of a set of procedures designed to collect direct observations of human behaviour or experiences in order to solve practical problems that may lead to the development of psychological principles. An incident includes specific experiences that are witnessed by one self or by others. In order to be critical, the incident has to occur in a situation where the purpose or intent of the act (event) is clear to the observer, leaving little doubt 37 concerning its effects. CIT is a process for gathering certain important facts concerning behaviour or events in defined situations. As people have been making observations on other people for centuries, this technique is not new to science, although it was not made into a formal set of procedures until 1954. The incidents in this research are focused on behaviours or acts known by members through memory that relate to experiences surrounding the 4 areas of interest. CIT is one of the most referenced methods available in all research at this time (Twelker, 2003).  The primary features of this technique are that only simple types of judgments are required of the observer, reports from only qualified observers are included, and all observations are evaluated by the observer in terms of an agreed upon statement of the purpose of the activity (Flanagan, 1954; Twelker, 2003).  The five main steps of CIT as described by both Flanagan (1954) and Twelker (2003) are: 1. General Aims:  This is where the general aims of the study are chosen. The general aim of the study and the system of interest are investigated 2. Plans and Specifications: Precise instructions must be given to the observers. It is necessary that these instructions be as specific as possible with respect to the standards to be used in evaluation and classification. Some specifications that should be established are the situations observed, relevance to the general aim, extent of effect on the general aim, and persons to make the observations. 3. Collecting Data:  All the behaviours or results observed must be evaluated, classified, and recorded. Interviews can be useful to gather this data. 4. Analyzing the Data 38 5. Interpreting and Reporting 3.3 Appropriateness of the Methodology for the Question  When conducting the research to answer a question, a model of collection and analysis must fit the data, and produce the results that will answer the posed question. Rogosa (1995) indicates that the model used to analyze the data must fit the data it is analyzing and the data gathered will be dictated by the question that the researcher asks. The model used in this study is directly related to the question being asked, producing the results that are appropriate for the determination of the answer that was sought. The question posed determined that CIT be used to analyze the data gathered in order to answer the question that was asked. 3.4 Rationale for choosing Critical Incident Technique  As the question being asked is looking at what factors helped or hindered a certain phenomenon, CIT created data that allows for an analysis that directly provided answers to that very question. Other methodological techniques could have been used to look into this phenomenon, like phenomenology or a grounded study. Neither of those two methodologies allowed for such a direct and coherent result that allowed direct discussion and analysis of the specific question that was asked as CIT does in this case. 3.5 Participants  The participants of this study were selected from people that responded to a call for volunteers put out to known members that have returned from overseas deployments. These possible volunteers were canvassed from graduates of the Veteran Transition Program and through advertising at military units within BC known by the researcher. Those participants that responded to the letter were asked to contact the researcher 39 directly by phone or by email, or asked if it was appropriate to forward their contact information to the researcher for them to be contacted. An introductory telephone script was used to explain the study each time a potential participant was spoken to by the researcher. The participants that volunteered were selected on a first come first selected basis up to the total of 15. These participants ranged from the ages of 28 to 72 from both reserve and regular force military and comprised of 13 male and 2 female participants. 3.6 The Method  Twelker‟s (2004) manual for employing CIT outlines how to plan and implement this technique in a variety of settings. Twelker takes the researcher through all the steps that make a concise study using CIT as the method of choice. The following are the steps that were followed for the current study: 1. Step 1 - Identify the system of interest, suprasystem, and subsystems: 1)  The system of interest was the re-entry process of Canadian military members returning from overseas deployments.   2)  The suprasystem was support for military members. 3)  The subsystems of this study were 1) military members, 2) Canadian Forces, 3) Canadian social structures, and 4) military spouses, dependent(s) and family. 2. Step 2 - General aim of interest (what will you tell the observers is the aim) 1)  The general aim of the system of interest was to identify what factors helped the re-entry process and what factors hindered the re-entry process upon returning from overseas deployments. 3. Step 3- Instructions to observer (Use CAPP acronym) 40 C – Conditions:  Any specific experiences (factors or events) that occurred upon return from overseas deployments until now that helped or hindered the re-entry process into Canadian society. A – Activities: any activities that helped the re-entry process and any activities that hindered the re-entry process. P – Persons: reported on own experiences only. P – Place: these activities occurred in any place or location after completion of the deployment, which included the transit home. 4. Step 4 - What are some things that were stated to focus the observer 1)  You are to describe events, behaviours or actions, rather than an individual or quality 2)  Focus on an event which occurred and not on an individual 3)  Limit your descriptions to those events which made a difference with respect to the general aim (helped the re-entry process or hindered the re- entry process) 5. Step 5 - Cruciality 1)  Also, why the event was particularly effective in helping the re-entry process or why the event was particularly ineffective in helping the re- entry process was reported. 2)   What events may have been more (or less) effective in this situation? 3)    How important do you believe this event was in your re-entry process? 41 Rate the behaviour on a scale? – covert or overt. Used this technique to determine impact. 6. Step 6 – Specifications for the Survey Audience 1)  The subsystems that were involved were the military members returning from deployments, and their interaction with family, military members and Canadian society. 2) As the experiences of specific events that helped or hindered the military member‟s re-entry process are from memory, any military member that returned from a deployment meets the selection criteria, allowing for a greater number of possible participants. 3) Data was collected in person only. As a Canadian Certified Counsellor with the Canadian Counselling and Psychotherapy Association, the researcher had received training in basic listening skills and was able to focus the member on the observations that pertained to the study. Other possibilities, such as questionnaires or group interviews, were less desirable due to location of randomly selected participants, thus the group interview would limit options of members and would prove to be more costly than in person interviews to get all personnel in one place at one time as they were from different cities in BC. A questionnaire could be misinterpreted by participants in this study, and as there were 15 participants, it was less desirable to have problematic results from misinterpretation. An individual interview allowed for a deeper exploration and confirmation of the incidents reported to ensure the 42 accuracy of the information gathered and its direct ability to relate the answers to the question being asked. 4) No more than 50 critical incidents per participant were collected to ensure manageability of data when analysis was required. As this was a one-time data collecting interview, the interviewer collected as many critical incidents up to the max number from each participant. Saturation was found within this limit. This allowed for the greatest amount of data collection to reach saturation and to determine the various critical events or factors, but yet not put forward any minimum restriction. 5)  Further instructions that were given to the participants:  The study was sponsored by The University of British Columbia  This study was designed to increase the research on the experiences of Canadian Forces military personnel when they return from deployments as they reintegrate with Canadian society. In this way a more modern model of re-entry may be created with specific events that either helped or hindered the process, allowing for more robust re-entry assistance programs to be developed in the future.  No names in this study were released, and all data was kept in strictest confidence. The interview tapes and notes were stored by number code that only the researcher had access too, and all data was reported by the number code only and not by the name during analysis. 43  During this study, we looked at events that helped or hindered the re-entry process of CF members after deployments. The events that were focused on are those that occurred from the moment they return from deployment until the time of the interview.  The general aim is to identify events or factors that the member found helped their re-entry process after deployment and events or factors that hindered their re-entry process. By gaining this data, future programs designed to assist military members reintegrate after deployments may emerge. 3.7 Data Collection  Each participant was interviewed in person, signed an informed consent form, and was then asked a series of questions as indicated in Appendix C. Further clarification was elicited on completion of the interview to confirm that all incidents written in the notes adequately represented everything the participant wanted to impart. A referral sheet was made available in case any distressing reactions occurred from the process of the interview. 3.8 Data Analysis  The information from each participant was anonymous and was categorized into groups in order to generate clear indications of events (or factors) that were believed to be helpful to the re-entry process and those events (or factors) that were believed to hinder the re-entry process. Twelker (2004) describes the purpose of analyzing the data from a CIT perspective as the requirement to summarize and describe the data in such a way that will allow the researcher to detect events (or factors) experienced by military 44 members that are being studied that either helped or hindered the process in some way. The notes and transcripts of the interviews were reviewed to create all of the critical incidents in this study.  The critical incidents were gathered and were categorized into groups by the researcher. It is important to note that incident saturation was reached with each participant, where no one participant gave more than 48 incidents in total. Once these categories were tentatively selected, each category was defined more concretely, and any shifts that were required in the definitions of those categories in order to accommodate all the incidents were made. Once all the incidents were classified into the broad categories, it was decided that no further sub categorization was required because all incidents fell nicely into one of the selected categories. The categories were then reviewed by Dr. Marv Westwood for appropriateness of the categories and definitions. He was selected to do this initial check of the categories as the supervisor of the study and also because of his knowledge of military culture through his clinical work with military members. Once this was completed, a second interview was set-up with the participants for the purpose of rating the categories for accuracy of incident inclusion. Thirteen of the fifteen participants agreed to the second interview and initialled the researcher‟s copy of the consent form to indicate their continued willingness to continue participating. During this interview, the participants were asked to place a randomly selected sample of 66 incidents out of all the 445 critical incidents collected into the categories selected by the researcher to the best of their ability. In addition to the participants, two external volunteers, one military and one civilian, not involved in the study were asked to place the random selection of all the incidents into the categories selected.  By following this 45 procedure, an accurate reflection of the categories and their contents was created.  This also provided a semblance of inter-rater reliability to the categories to a certain degree. The data is reported by category in Chapter 4, and are defined by the incidents that fell within them (Twelker, 2004). 3.9 Ethics  Confidentiality of participants was maintained throughout the gathering of data. Several steps were put in place to ensure this occurred.  First, all interviews were scheduled with at least one hour between participants, ensuring no chance meetings between participants occurred. Second, no names are used on data paperwork; only numbers were used to identify the participant‟s information. Finally, results provided in this study are given by categories created by the researcher, so only a few specific incidents were provided as examples to the categories.  Other ethical considerations made for participants in this study were to ensure that participants were fully informed of the possible risks in participating in this study. As the study uses participants that have possibly experienced trauma, this aspect of safety for the participants was essential. Interviews focused on events (or factors) of re-entry without focusing on the participants‟ experiences in the actual deployment, thus seeking to minimize the chance of disturbing traumatic memories being remembered during the interviews. Finally, the researcher as a certified counsellor was prepared to provide immediate assistance in case of any emotional reactions and had a referral sheet on hand should the participants require support. 46 3.10 Credibility and Convergence of Categories  To ensure the results were credible and reported results were truthful, each of the participants was asked to clarify the incident and agree that what was written down was what they had meant to say. In addition, the categories were rated through placement of incidents into the category by thirteen of fifteen participants and two other volunteers not involved in the study to ensure that the categories were as accurate as possible.                                   47 4   RESULTS   The categories contained in the following section represent the results of the analyzed critical incidents that came from the interviews conducted with the participants. The participants ranged from the ages of 27 to 72 and were comprised of 13 males and 2 females. All were Caucasian and came from both regular force and reserve force from all three services (Navy, Army and Air). Participants included both officers and non- commissioned members and had been deployed to such locations as Cyprus, the Gulf War, Haiti, Bosnia, Golan Heights, Croatia and Afghanistan. These deployments ranged from around 2 years ago to 50 years ago, providing a full spread of information. The results shown are listed as either categories that helped in the successful re-entry process to Canada or categories that hindered the successful re-entry process to Canada following an overseas deployment. Table 4.1 indicates how many incidents fell within each category, the number of participants that put incidents into each category, the range of the importance ratings chosen by the participant, and the average importance rating score of all the incidents in the category. The categories are listed in order of the number of critical incidents that were placed in each category, since using the importance rating alone may be misleading in providing the actual strength of the category. As an example, if only one participant gave several incidents in the same category rating them all very high, it could skew the results giving an inaccurate high number to the importance by all participants to the category. The idea is to look at all the information about the categories including number of incidents, number of participants that put incidents into that category, range of importance scores, and average of importance scores within the category. 48 In total, 445 critical incidents were collected from all 15 participants that were interviewed. Saturation of incidents occurred to each participants, never reaching the maximum number of 50 incidents. Each incident that was recorded and used in this study was checked by the participant to ensure that the information in the incident was accurate. There were 5 categories created from the 238 incidents that helped the successful re-entry of participants and 6 categories created from the 207 incidents that hindered the successful re-entry of participants into Canada.  During the interviews, each participant was asked to rate the incident on a scale from 1 – 10 where 1 represented very little importance and 10 represented extreme importance in its effect on their re-entry process. The results are shown in the two columns on the far right of Table 4.1, giving the number of incidents (CI) in the category, the number of participants that had incidents in that category (Part), the range of the different importance scores (Range) in each category and the average score (x) of the importance ratings of all incidents found in that category. A more complete explanation of the categories, including examples of incidents that fall within that category is explained after the tables. Table 4.1 also outlines the names of the categories and the definitions used during the rating process. Initial support of the categories took place with Dr. Marv Westwood, the supervisor for the study, before ratings through placement of incidents by other individuals occurred. The rating results for the categories are outlined in Table 4.2. Sixty-six incidents were randomly selected for the rating process. Overall, there was 90% or better concurrence of the placement of incidents into categories by all raters, which included: 13 of 15 military participants; an individual with military experience who did not participate in the study; and an individual with no military experience at all who did not participate in the study. 49 Table 4.1  Summary of Critical Incident Categories Category Definition CI Part Range x Helped Re-entry Experience  Acceptance and Positive Interest by Others Just being around and also talking at own pace to military members, family members and civilians about the deployment who were able to listen and showed interest. 98 14 4-10 8.6 Transition and Reconnection Process On completion of deployment, members needed time to return home with military members and decompress, connect with family and loved ones on return, and then start working again to feel productive within Canadian Society. 58    12 5-10 8.3 Current Military Support Systems and Services Current systems and services put in place by the CF including programs available on return or release, continued medical support, and the ability to remain in contact with people at home during deployment and transit home. 35 15 3-10 8.4 50 Category Definition CI Part Range x General Acknowledgement and Recognition Military and public positively acknowledging the return of CF members to Canada, the usefulness of their knowledge to instruct others, and general positive public support of the CF and their missions. 33 13 4-10 8.4 Psychological Assistance Psychological assistance provided to CF members through group and individual counselling/therapy. 14 3 2-10 8.7 Hindered Re-entry Experience  Lack of Effective Military Systems and Recognition Military systems currently in place do not properly meet the needs of the member or do not exist. Military does not acknowledge experiences of returning members and creates an inadequate environment for members to seek needed assistance. 63 15 2-10 6.7 Psychological/ Emotional Challenges and Reactions Feelings of grief, depression, sadness, anger, frustration, boredom, experiencing PTSD or OSI symptoms, substance abuse and challenges in getting appropriate help. 48 13 4-10 7.7 51 Category Definition CI Part Range x Lack of Public and Family Recognition Military members not being recognized for their experiences, knowledge or their actual return to Canada. A lacking of positive support and understanding by the public or family about the deployment or member. Inaccuracies published by the media on their return. 40 11 4-10 7.7 Disconnection with Home Society Changes that occur in society during deployment, changes in family situations and changes in self due to experiences from the deployment. 24 9 3-10 6.4 Reluctance to Relate The member feels different from others around them and is reluctant to talk to or cannot relate to others about their deployments experiences. 20 12 1-10 6.5 Chronic Pain and Physical Dysfunction Challenges experienced through physical ailments and dysfunctions on return from deployment. 12 9 2-9 5.1  Note. CI = Number of Critical Incidents; Part = # of participants that had an incident in that category; Range = Range of Importance Rating Scores; x = Average Importance Rating Score     52  Table 4.2 Rating Table  Rater Concurrence Rater Concurrence Rater Concurrence Rater Concurrence PI 66/66 (100%) Rp1 63/66 (92%) Rp2 61/66 (92%) Rp3 60/66 (91%) Rp4 60/66 (91%) Rp5 61/66 (92%) Rp6 65/66 (98%) Rp7 63/66 (95%) Rp8 62/66 (94%) Rp9 65/66 (98%) Rp10 63/66 (95%) Rp11 63/66 (95% Rp12 64/66 (97%) Rp13 64/66 (97%) Rm14 62/66 (94%) Rnm15 61/66 (92%)  Note. thirteen of fifteen military participants were used as raters, as well as one military rater that was not part of the study, and one non-military rater. Percentage indicates concurrence rate with original Investigator‟s incident placement. PI = Principal Researcher; R = rater; p = military participant; and m = military member that was not a participant in the study; nm = non-military.  4.1 Critical Incident Categories that Helped Re-entry  The following categories more fully explain the categories of incidents that participants found to help the successful re-entry process on return to Canada: 1) Acceptance and Positive Interest by Others.  In this category, events include when CF members slowly start to be involved with military and civilian groups in many different venues, and also spend time with their family. These activities include sports, social functions, and vacations with civilians that are unaware that the member is military. Incidents include volunteering in society and spending time with military friends, civilian friends and family members regularly. In addition to just being around these people, the act of talking with family members (spouse, partner, siblings, parents, and children) who showed interest and were able to listen about the deployment at the member‟s desired pace was found to assist the re-entry process. It was also helpful when the family members knew the military culture and lifestyle and accepted it. Other incidents in this category include talking with civilians who are willing to listen, talking and asking questions to members about their deployment and the CF member‟s experiences. A member telling their story and experiences to the media, civilian groups 53 and organizations and to civilian friends are included here. Telling and listening to stories about deployments with other military members who are willing to listen and share their own experiences was found to assist in returning home. This contact with military members includes remaining in communication with other members from the deployment, talking with CF members who were on similar deployments and also talking to those that have not been on deployment at all. This category contained 98 incidents with the range of importance ratings between 4 and 10 and an average of 8.6. There were 14 participants that provided incidents into this category. Example 1 – Participant 170 It was helpful when my family listened and talked about the deployment whenever I wanted to talk about it, never pushing for answers. Example 2 – Participant 250 I found it very helpful that my parents asked questions focused on the present and the future, never dwelling on questions from the past. Example 3 – Participant 210 The fact that my wife knew the military culture very well from being in it, made coming home so much easier as she knew the language and could talk with me about things.  2) Transition and Reconnection Processes. This category includes taking time to return from deployment through coordinated, stress-free stopovers in different cities with people from the same deployment. This return process over time allowed for members to spend time together and also to have some time alone. It was found that having a limited amount of time off directly on return from deployment to re-connect 54 with family was also very useful in assisting with member‟s re-entry process. The military allowing some flexibility around attendance on return from deployment in order for members to look after returning and reconnecting to their family and friends, but also requiring them to be back at work and stay connected with the military are included in this category. This category also includes the need by members to be both productive and remain busy after returning from deployment. Starting some kind of work or school (civilian or military) that is meaningful and focuses on the present and future was found to be helpful to the member in returning home. There were 35 incidents that fit into this category with an importance rating range between 5 and 10 and an average of 8.3. A total of 12 participants had incidents that fit within this category. Example 1 – Participant 180 When I returned to Canada I had some time off to spend quality time with my family and get to know them again.  Example 2 – Participant 200 On return I started to look for a purpose in life, something meaningful to do, something more than what I did before I left. This helped me move on.  Example 3 – Participant 190 It really helped being around other guys from the deployment on the way back during decompression in Cyprus. It gave me some time to adjust. 3) Current Military Support Systems and Services. This category contains the ability to contact loved ones at home through videoconferencing and by telephone throughout deployment and transit home, which was found to be important for the re- entry process. The Military Family Resource Centre (MFRC) providing family-based 55 assistance whenever required and allowing all military families to access contact to the deployed CF member during transit home helped the member‟s re-entry experience. This category includes events such as CF members being given the opportunity to call/contact home liberally during transit home. General Military Support Systems that exist to support military members like MFRC, Occupational Stress and Injury System (OSIS), the Decompression program for returning members, the Second Career Assistance Network (SCAN) and other programs that are designed to provide support and assistance to members were all found to be helpful to returning members. Also, the physical and psychological assistance provided through the military medical system to returning CF members was found to be accessible which helped the re-entry process. Information about Posttraumatic Stress Disorder (PTSD), information about Occupational Stress Injury (OSI) symptoms, Veterans Affairs (VA) medical pensions, and supportive referrals to civilian medical agencies when required are all included in this category. There were 35 incidents found in this category with an importance rating range between 3 and 10 and an average of 8.4. All 15 participants had incidents that fell within this category. Example 1 – Participant 240 MFRC was amazing, they looked after my family while I was gone, coordinated a video teleconference so I could see my children, and put on a big celebration for when we got home. Example 2 – Participant 140 OSIS was good, they were available during decompression and also when I got home. The program is helpful when things aren‟t going right at home. 56  Example 3 – Participant 190 The fact that I already knew what was going on at home because I had access to email and the phone while I was coming home was great. I felt that I kind of knew what to expect. 4) General Acknowledgement and Recognition. This category looks at positive public perception where the general Canadian public, including all media, were supportive and positive towards the CF and the deployment. Comments like „thank-you‟, special incentives by businesses given to CF members, and supportively framed press releases on the members and the deployment were all helpful incidents found in this category. Also, this category specifically acknowledges the importance of being greeted by friends, family, military and the general public in person on return to Canada. Events like „Welcome home celebrations‟ and having loved ones at the airport on arrival were all incidents that were found to be helpful in this category on the member‟s return to Canada. Finally, having the CF utilize the knowledge, experience and skills gained by deployed CF members to instruct other CF members in Canada was helpful to the re-entry experience. Home units in Canada (Regular force and Reserve force) asking members to instruct others and maintaining a mission-focus in their training by using deployed member‟s knowledge in their curriculum and lesson plans are found in this category. There were 33 incidents in this category with an importance rating range between 4 and 10 and an average of 8.4. There were 13 participants with incidents in this category. Example 1 – Participant 110 57 I went into Subway and found out that they give a discount to military members, just for being military members. That was great because I felt that people recognized what we do. Example 2 – Participant 220 When I arrived back home there was a band on the jetty, lots of people cheering, the admiral was there too I think. I just felt like I was home and everyone was happy I was there.  Example 3 – Participant 160 I remember walking down the street in my uniform and someone just came up to me, grabbed my hand and shook it, saying „thank-you, for everything‟. I felt touched, and honoured. 5) Psychological Assistance. This category includes psychotherapy itself, as well as the exploration and learned skills gained through psychotherapy to deal with any psychological challenges on return. Group therapy with other military members, individual counselling with therapists that understand military life and communication skills to assist in talking about experiences with others were all found to be important in helping with the successful re-entry to Canada and part of this category. There were 14 incidents in this category with an importance rating range between 2 and 10 and an average of 8.7. There were only 3 participants that had incidents in this category. Example 1 – Participant 130 After I started getting some counselling, I felt it helped me with my issues. That was important to me and my family as it wasn‟t easy.  Example 2 – Participant 140 58 The most helpful thing I experienced was when I attended therapy with other soldiers and got to be around military guys again who understood me.  Example 3 – Participant 150 What helped me the most was when I got to help other soldiers deal with their shit and move on with their lives. I felt like I was helping myself by helping them. 4.2 Critical Incident Categories that Hindered Re-entry  The following are categories that were created to capture the incidents that were found to hinder the successful re-entry by the participants into Canada:  1) Lack of Effective Military Systems and Recognition. This category looks at the lack of military acknowledgment and support to returning members through the lack of coordinated assistance by the military on return to Canada. Incidents in this category include members being left on their own to seek help if they felt they needed it, a home unit not using knowledge/skills of returning members to instruct others, and sometimes discounted their experiences all together as not having occurred. Other incidents include the military not recognizing all members that are deployed with medals and the decompression program currently used was limited in its benefit because it only focused on PTSD and OSI challenges and nothing else about returning home. Further incidents included events around the decompression program lacking good coordination and all the activities put on for members cost money to participate in therefore reducing its effectiveness. Members felt forced to talk about their deployment, too quickly, and with people that did not know each other which hindered the re-entry experience back to 59 Canada. Also, the military belief that to be a good CF member nothing should bother you, that you should be unemotional, and that one must “soldier on” was found to hinder the re-entry process. These features are included in this category. There were 63 incidents in this category with an importance rating range between 2 and 10 and an average of 6.7. All 15 participants had incidents within this category.  Example 1 – Participant 230 After I got home no one in the military asked me how I was doing at all, they just went along with their lives and didn‟t seem to care what happened to me.  Example 2 – Participant 180 After I got back, the military denied that there was any combat or anything on my deployment, which was bullshit. What I went through was crap, and the least they could do was admit it happened.  Example 3 – Participant 160 I flew back to Canada and when I arrived there was no one there to meet me. My own wife didn‟t even know I was coming because no one told her.  2) Psychological/Emotional Challenges and Reactions. The experience of depression, grief and sadness around the loss of connection to people on deployment when it is over, or loss of connection to military through release are included in this category. Other incidents including the experience of PTSD and OSI symptoms like anxiety, stress, shame and unwanted memories or reactions surrounding aspects of the deployment experiences or the experience coming home is challenging for re-entry. Inappropriate outbursts of anger to normal everyday experiences and general frustration 60 with the Canadian public about common societal complaints compared to the experiences of the member on deployment hindered successful re-entry into Canada. Incidents like the use of substances including elicit drugs or alcohol to escape or numb psychological issues and a feeling of boredom and loss of purpose on return from the deployment are found in this category that hindered successful re-entry. Also, incidents that indicate challenges in getting therapy through the military and then having challenges in relating to a therapist once lined up with a one are included here. There were 48 incidents found in this category with an importance rating range between 4 and 10 and an average of 7.7. A total of 13 participants had incidents in this category.  Example 1 – Participant 200 I was so angry at everyone all the time. Like when I was in a grocery store listening to someone bitch about the loss of 2 cents while I had to watch children starve or beg for food. What was wrong with these people?  Example 2 – Participant 130 I would get drunk every night so I didn‟t have to think about what happened, and so I could feel a little bit more normal in a group of people.  Example 3 – Participant 220 After I got back, I didn‟t get to see anyone from the deployment again. We all just moved on to other cities and our own lives. It felt like I lost my family; which sucked.  3) Lack of Public and Family Recognition. Incidents around negative publicity and inaccurate accounts of the CF or the deployment including incidents of the public blaming military personnel for actions by the military without knowing the entire story 61 are included in this category. When civilian organizations singled out military members as different or as people automatically afflicted with PTSD or OSI diagnoses and symptoms was found to be unhelpful on return to Canada. Other incidents included in this category are the lack of civilian equivalencies for military courses and experiences by the academic community as well as the disregard of the member‟s military experiences as valid by civilian organizations. Incidents around not having a welcome home celebration or anyone to pick up the member on return to Canada are found in this category. Friends and family members that did not listen or did not relate to the member‟s deployment, spouses that break up with the member on return or the member having superficial relationships with family were all included in this category of what hindered successful re-entry. There were 40 incidents in this category with an importance rating range between 4 and 10 and an average of 7.7. There were 11 participants with incidents in this category.  Example 1 – Participant 220 I couldn‟t believe it, I went back to my civi[lian] job and my boss pulled me aside and asked me to get help for PTSD so there wouldn‟t be any problems. Just because I was deployed, he figured I had PTSD.  Example 2 – Participant 110 I arrived back home by plane and had to take a taxi home. It was like no one knew I left or came back at all.  Example 3 – Participant 230 62 What really didn‟t help was coming home to an empty house because my wife decided to leave me because she couldn‟t handle me being away as it stressed her out. 4) Disconnection with Home Society. This category includes changes in society and family functioning since leaving on deployment, as well as changes in the CF member through being away from home. Returning to the slower pace of a non-deployed environment requires adjustments that hindered the successful re-entry process. Cultural values of the member change from time being immersed in the military culture and being around other cultures during deployment which hindered the re-entry experience back into Canada. Incidents such as names of stores or restaurants in the member‟s home city had changed since the member left are included here. Changes in the member‟s family since the member left, like children growing, or new household rules that were implemented since the member‟s departure were found to be incidents in this category. There were 24 incidents in this category with an importance rating range between 3 and 10 and an average of 6.4. There were 9 participants that had incidents in this category. Example 1 – Participant 160 After being deployed where everything is fast paced and your life depended on being quick and efficient, coming home to where nothing happens quickly, everything takes forever, and no one seems to know what they are doing.  Example 2 – Participant 180 I was sitting at the table at home, and my kids went to eat their lunch in front of the TV. I got angry at them, and my wife told me to stop it, and 63 that they were allowed. All the rules changed, and I didn‟t know what they were anymore. I felt out of place in my own home.  Example 3 – Participant 240 I got home, and I realized I had to go shopping. I hadn‟t had to go shopping or make any meals in almost 8 months. I forgot what I would need to pick-up.  5) Reluctance to Relate. Incidents that are included in this category are events where members had a desire not to speak to others about the deployment because they felt that they would not understand are included here. The avoidance of people so as not to be asked obscure questions and also events where members felt they wanted to protect others from their deployed experiences are all included in this category. Incidents where participants were trying to avoid questions like “did you kill anyone?”, and also self- censoring conversations with others because they wouldn‟t understand or because members did not want to be “that guy” that always talks about “war stories” are all found in this category. There were 20 incidents in this category with an importance rating range between 3 and 10 and an average of 6.5. A total of 12 participants had incidents in this category.  Example 1 – Participant 160 After being asked several times by different people if I killed anyone, I just didn‟t want to talk to anyone anymore.  Examle 2 – Participant 140 When I hung out with my civilian friends, I kept biting my tongue on my stories from my deployment because I didn‟t want to be known as “that 64 guy who always talks about his deployment”. I felt like I shouldn‟t talk about it.  Example 3 – Participant 110 I ended up distancing myself from my family, keeping only superficial relationships with them in order to protect them from what I had to experience. I didn‟t want them to suffer and worry about me, it was my problem, not theirs. 6) Chronic Pain and Physical Dysfunction. Physical ailment incidents in this category include chronic pains in the back and knees, sexual dysfunctions, gastro- intestinal challenges from change in food, insomnia from time changes and possible future injuries due to exposure to hazardous elements during the deployment. There were 12 incidents in this category with an importance rating range between 2 and 9 and an average of 5.1. There were 9 participants that had incidents in this category. Example 1 – Participant 220 While I was deployed I hurt my shoulder and my leg doing some tasking or another. I get home and it doesn‟t completely heal. So now I feel aches and pains and I can‟t do everything I used to.  Example 2 – Participant 120 I injured myself while I was overseas, and it ended up getting in the way of me being able to have sexual relations with my wife. That was not easy, and it caused lots of problems in our relationship.  Example 3 – Participant 210 65 Where I was stationed overseas I got used to bland food without much flavour or anything else for that matter. When I got back, my body was certainly not used to the rich western food and I suffered for weeks.                     66 5   DISCUSSION AND CONCLUSIONS  In this chapter, the findings of the study will be discussed as they relate to the current literature, unique findings of this study, the strengths and limitations of the study, implications for future programs and re-entry/transition models, and possibilities for future research. 5.1 Connections to Current Literature  All the categories identified from this study in some way are consistent with the literature that was reviewed in Chapter 2. However, the categories described in the present study enhance or expand the understanding to include more concepts under the general topics discussed by the literature. To more fully understand these categories, a look at how they are similar to the available literature will be explored. Any major differences will be highlighted and explained when they occur. 5.1.1 Acceptance and Positive Interest by Others The literature by Krueger (2000), Cheung and Leung (2006), and Allen (2000) all emphasize an importance in the connection with other military members and their own families. Adlerian theory claims that culture impacts the formation of the personality, so therefore the military culture will be instrumental within the understanding of reintegration for the individual. The results of this study support the conclusion that being around and talking to other military members as well as family were important in helping the military member reintegrate back into Canada. Moreover, this study found that having a spouse who understood the military culture and was able to accept the military member‟s ways of behaviour as developed by that culture created a helpful situation to return to after a deployment. This category also coincides with the results of Burrel et 67 al.‟s (2003) study that indicated the more family members endorsed the member being in the military, the easier military members found it to return. Faulkner and McGraw‟s (1977) model of re-entry for Vietnam Veterans discussed the final phase of re-entry as the need to reintegrate back into society. Faulkner and McGraw found the integration of peer group relationships provided acceptance to the members returning, regardless of how they were adjusting, and encouraged an acceptable self-image to be developed. This specific category in this study supports the phenomenon around positive peer group relationships being very helpful in the member‟s reintegration process back to Canada. Talking and being with military members that understand the culture and accept the members for who they are and what they did was a very important category.  As much as the results of this study do support the findings of previous research regarding the importance of military members and family for the successful re-entry of military members from deployments, the category provides much more information regarding this phenomenon. It is not simply the acceptance by military members and family members that is found to be helpful for the returning CF member. Being around friends and other civilian people who also showed interest and were willing to talk with the member was found to be helpful in their process of re-entry. Being around and talking to people, regardless of military or familial connection, was found to be helpful in reintegration once home. This is the first study that addresses this phenomenon directly. This is different from the current literature where this phenomenon is not talked about at all.  68 5.1.2 Transition and Reconnection Process This category incorporates the idea of taking time to return to Canada, having time to reconnect with family and then getting back to work or getting back to something that the member feels is useful in society. One place of connection to current literature for this category is the research by Mateczun (1996) who reported that it was imperative that military members had time to reintegrate into their families on return. This category emphasizes the need for this time to reintegrate, and that the military makes an effort to provide flexibility for the members on return to have time to connect with their families. Bliese et al. (2007) indicated that military members found more challenges with their reintegration home after 120 days, which emphasizes the need to give time for military members to reintegrate home. Programs designed to be fast and immediate may not be as helpful as those that take time and allow a slower reintegration process. This category branches from the available literature as it emphasizes the need to reintegrate with the military first en route home. Unlike Mateczun‟s (1996) belief that family was the first point of reintegration for military members, the present study reveals the need to take time through decompression before returning home. According to this category in this study, the first point of reintegration is with military members during decompression. 5.1.3 Current Military Support Systems and Services There are several pieces of literature and research that look at programs available for military members on return from deployments. Some of the programs are specific to the U.S. and are not available for Canadian military, although there is research indicating their usefulness on U.S. military members. Manderscheid (2007) looked into conflicts 69 and challenges around psychological injuries, substance abuse, and physical injuries providing programs that resolve most of those for U.S. military members. Doyle and Peterson (2005) specify many other programs available to U.S. military members that deal with psychological assistance and educational information. As indicated earlier, these programs are not available to Canadian military, but there are some similarities that can be drawn between programs in the U.S. and in Canada. There have been several programs that are offered to CF members that were mentioned both in this study and in the literature as being helpful. The Occupational Stress and Injury Support Network (OSIS) was found to be useful by both the participants in this study as well as in the discussions by Richardson et al. (2008). The Veterans Transition Program (VTP) created by Marv Westwood (Westwood et al., 2005) was also identified by this study as a helpful program that is currently available for military members through funding by the Royal Canadian Legion. The other program mentioned in the literature that was specifically found to be effective was the Decompression program implemented by the CF prior to having members return home. Blais and Thompson (2004) discuss the idea about slowing down reintegration in order to reduce stress on the member and Hughes et al. (2008) specify the importance of decompression for returning military members prior to arrival back home. This category included incidents that directly relate to the usefulness of the decompression program for many CF members, thus creating an extremely useful program that has been created by the CF to help CF members. There are aspects of this program that were not found to be helpful, but those will be discussed later on under the category named Lack of Effective Military Systems and Recognition. 70 5.1.4 General Acknowledgement and Recognition Cheung and Leung (2006) indicated that according to Adlerian belief systems the identity is formed by the cultures that one is in and exposed too. To receive acknowledgement and recognition from the cultures in which CF members are involved in is to receive acknowledgement of the individual. Sorsdahl (2005) also found that acknowledgement by the community in which a CF member returns to is important for when they return. This category supports the literature in that there were several incidents in this category that emphasized the importance of this acknowledgement by the media and the Canadian public as well as supportive news and publicity towards what they have done. This category diverges from the literature in that it emphasizes more acknowledgements needed by a broader sense of public. It is not enough just for the community to acknowledge and recognize the members for what they have done, it is the entire country that needs to be aware of and acknowledge the service by these members. 5.1.5 Psychological Assistance This category has received much attention through literature and media since the enhanced understanding of PTSD for military members through the Ombudsmen report by Marin (2002) was released. The area of literature that was highly supported by this study was the inclusion of military members in a group therapy environment in order to assist in psychological challenges, such as PTSD, OSI, depression, substance abuse, life skills and anger management (Faulkner & McGraw, 2007; Manderscheid, 2007; Doyle & Peterson, 2005; McCaughey, 2001; Galloucis & Kaufman, 1988, Scrufield et al., 1984; Westwood et al., 2002). Therapy itself seems to be helpful in assisting military members 71 during their re-entry process including dealing with mental challenges but also to learn new skills that can adequately assist them in the future. There was little divergence in the literature when compared with the results of this study, only to emphasize the usefulness of group therapy in the recovery of trauma symptoms for CF members. 5.1.6 Lack of Effective Military Systems and Recognition  One of the areas where this study accords with the literature published to date is in the barrier to accessing psychological treatment due to the cultural beliefs of having to „soldier on‟ or be strong. Britt (2002) found that one of the causes for military members not to seek help was this exact reason. The cultural belief that nothing should be wrong with you and that you are a better military member if you cannot be psychologically injured does hinder the integration process when those members return to Canada and do need assistance.  Another area where literature supports this study is in regards to the decompression process that has been implemented by the CF for helping military members return after deployment. Hughes et al. (2008) and Blais and Thompson (2004) both found that when decompression is too short or made as a one size fits all, it does not help the CF members as much as it could. This study explained that the current CF decompression program focuses more on PTSD and OSI challenges and less on transition issues that could be experienced on return. It was pointed out that the CF prepares the military member over several months to get ready to be deployed, but then only provides up to 5 days to help them get ready to get back. This one size fits all decompression program hinders the re-entry process for many military members returning from deployment. 72 5.1.7 Psychological/Emotional Challenges and Reactions  Similar to the consistent findings of this study with the current literature about psychological assistance being beneficial to military members, the same can be said about there being ample literature around psychological and emotional challenges experienced by military members that hindered their re-entry experience. Langston et al (2007) found connections between psychological distress and mental health problems like PTSD, depression, substance use and other emotional reactions and the return of military members from deployments. Bliese et al. (2007) and Taft et al. (2007) found that depression and addiction issues were both found in returning military members and that the use of alcohol was used to cope with feelings of anger and frustration. The incidents found in this category support all of these findings, where members experience outbursts of anger, symptoms of PTSD and the use of illicit drugs and alcohol to cope psychological or emotional challenges and reactions on return.  Another element found in this category from this study was around the feelings of loss and grief at the end of the deployment. Falkner and McGaw (1977) spoke a little to this event in their model of re-entry where the military members had to deal with the experiences of loss of time, losing part of themselves through exposure to experiences and the loss of friends from deployment. The incidents in this study were more focused on the idea of the loss to other members on deployment due to separation and future postings, but it can be easily associated with the loss of people on deployment as well. One participant indicated that when the deployment was over if felt like a loss of their entire family. The connections that happen while on deployment are deep and meaningful, filling in for the loss of family back home during the period away. The loss 73 of this family at the end of the deployment will create feelings of grief and sadness which seems entirely valid. 5.1.8 Lack of Public and Family Recognition  The findings from this category support the current literature in many ways. Harper (2001) discussed how the understanding of the military culture by non-military personnel was through fictitious stories and movies that do not accurately portray the culture. Sensationalized understanding of the culture leads to a lack of public recognition for what the military really does, as well as who the people in the military really are. Collins (1998) indicated that feelings of fear about the military and the members on return from deployments create a separation that leads to disconnection from society on the member‟s return. Under this category it was made clear that those inaccuracies in the media or complete lack of media and knowledge of what the military members went through hindered the re-entry process. Furthermore, incidents indicating the sensationalization of movies on the military members who are inflicted with PTSD may generate the belief that all military members suffer from PTSD from their time overseas. Maderscheid (2007) also found that this lack of linkage to civilian culture would cause difficulty in reintegration, which is supported by this category of the study‟s findings.  Another finding from this study was that military members have been blamed on occasion for the actions of the military despite only acting as directed by their government. Danderker (2001) discussed a similar phenomenon of how the military is the arm of the government and yet is directly blamed for actions they are ordered to do. This again alienates military members from the general public and their families causing difficulty when they return home. 74  Lastly, although not directly supported by the findings in this study, the shift in perception about the military has changed from an organization that was synonymous with honour, pride and respect to one where the public criticizes and condemns members for actions that they were ordered to do. The function of the job may not be glamorous, but the reason for why we have a military force still remains. This creates an environment where having the recognition for what the military does by the public is very important for members returning. It seems it provides meaning and justification for the acts they are ordered to do by the very public that need them to do it. 5.1.9 Disconnection with Home Society A few similarities between the literature and the findings of this study can be made in this category. Rudmin (2003) referenced Berry et al.‟s (1984) fourfold theory of acculturation typologies that people may go through on entering into a new society. It seems that when a military member is away on deployments he becomes completely assimilated into that culture in order to survive. So when they return back to their home society they are necessarily changed in their behaviour. This category included incidents where military members often separated themselves from their home culture and remained with the behaviours and beliefs found in the military culture. This was noted as a source of challenge during the re-entry process. It seems that the members that were able to integrate both the military culture and the home culture did better during the re- entry process. Finally, when some members released from the military they lost their military culture as well as their home culture and so were more similar to Berry et al.‟s (1984) fourfold theory of the marginalized individual. This marginalization which created isolation makes it more difficult during the military member‟s re-entry process. 75 Benedek and Grieger (2006) and Killgore et al. (2008) indicated military members had problems dealing with normal public on return from deployment. This category contains incidents that support this finding as changes in the member, changes in the family and changes in the culture during the member‟s time away created dissonance and challenges during re-entry. Walling et al. (2006) found challenges for student missionaries returning home to include issues around different roles performed, different routines and changes in global perspective. This study found the same challenges were experienced by military members returning to Canada. The cultural values and even some belief systems were changed from the military member‟s time being on deployment, so that returning back to Canada provided challenges in the same areas as were found by the student missionaries. Anger and negative reactions to the general Canadian public typically due to their ignorance around other cultures and what the military is really all about were experienced by participants of this study and supports the findings by Sussman‟s (2000) and Raschio‟s (1987) studies. Finally this disconnection with home society is also discussed in the second phase of Faulkner and McGaw‟s (1977) re-entry model. They indicated difficulty by Vietnam Veterans when they returned home due to discontinuity of systems that once worked before they left, feelings of exclusion and separateness from civilians, and dealing with violent impulses that were normal when at war. These veterans changed while they were gone, and had learned to act in a certain way in order to survive. This study also found that military members who were deployed also returned with changed behaviours and beliefs and that those shifts hindered the re-entry process as they had to be dealt with 76 appropriately in order to move beyond and reintegrate back into their family, friends and the general Canadian public. 5.1.10 Reluctance to Relate The linking of this category to the literature is made through the re-entry phase in Faulkner and McGaw‟s (1977) model of re-entry. Feelings of separateness from civilian society and an inability to connect with other people, which hindered the re-entry process, occurred for them as much as it did for the participants of this study. Benedek and Grieger (2006) and Killgore et al. (2008) also found that military members had a hard time dealing with the public. Westwood, Black and McLean (2002) indicate that military members had challenges relating to the civilian world both in their family and social circles. This category is completely supportive of the literature whereas members indicated a reluctance to talk to people about their experiences for fear of judgment or even in an attempt to protect the public from the knowledge of their experiences. This study also found that hearing obscure questions about their time on deployment and also not wanting to be the person that always talked about the deployment assisted in the military member censoring their conversation and sometimes removing themselves from or even avoiding social functions entirely. All of these incidents hindered the member‟s re-entry experience as they were unable to speak to anyone about their experiences and so shame and isolating behaviour most likely followed. 5.1.11 Chronic Pain and Physical Dysfunction  This category is fully supported by the current literature through Trudel et al. (2007), Da Vanzo (2006) and Hasenauer (2006) who all found that sexual dysfunction, sleep disturbances and other physical limitations were experienced by military members 77 returning after deployments. This study found that chronic physical pain, sexual dysfunction and sleep disturbances were all problematic for the re-entry process for returning military members.  Although this study cannot speak to how physical ailments would increase by psychological trauma as Eisen et al. (1998) does, it seems likely that this would be the case. 5.2 Unique Findings of the Study To start with, this study provided some interesting information around which categories had the most incidents and highest importance ratings. Firstly, there were more incidents found in the categories that helped the re-entry process (238) than in the categories that hindered the re-entry process (207). More than that, the incidents in the categories that helped only numbered 5 compared to the 6 different ones that indicated categories that hindered. It was interesting that more incidents were found by the participants around what helped them but fewer categories. From these results there are some very clear ways to help people transition, and those incidents came more often than the incidents that hindered. It is also interesting to note that all the categories that helped in the re-entry experience had an average around 8.5, basically indicating that all categories were equally as important in helping in the re-entry process. The categories that hindered were a little more spread out and averaged between them all around a score of 6.5 or so. So from this it follows that implementing changes focused on the categories that helped for the members would be a more important first step than dealing with the categories that hindered. When something helped, it made more of an effect on the observer. Finally, from looking at the number of incidents reported, the category of 78 Acceptance and Positive Interest by Others has the most. This indicates that the category was a very important one in helping people re-enter and reintegrate back into Canada. This category emphasizes the need for acceptance that removes shame and provides safety for the member on return. The category of Acceptance and Positive Interest by Others has provided a greater understanding around the need for this acceptance by CF members in order to successfully reintegrate after a deployment. Although acceptance by other military members and one‟s family is extremely important, it is not enough. Being around people in general, slowly being able to integrate into these groups, and having all people accept and show interest in their deployment encourages discussion, which allows the members to relate to others. This ability to relate to everyone around without restriction provides the best situation for CF members to reintegrate according to the findings of this study. This category is supported even more through the category Reluctance to Relate, as it was found that when military members were unable to talk about their experiences it hindered their successful re-entry process and caused challenges for the integration. Another unique finding from this study was that military members found reintegration easier when there was more time given to the transit home prior to having to reintegrate into family. After having some time at home to reintegrate with family and social circles, it was important for CF members to start working or doing something productive in society in order to live in the present. This is consistent with the category describing psychological/emotional challenges and reactions and the idea of boredom upon return from deployment. Staying active and busy within society on return was 79 extremely beneficial in the reintegration process, while being bored or inactive was not helpful. The category of Current Military Support Systems and the category Lack of Effective Military Systems and Recognition are opposite and have quite similar points to make. It is agreed and supported that the programs that have been created for CF members are a great beginning, but are certainly not perfected at this time. Many of the incidents in both of these categories were from participants with military experience from quite some time ago, and programs that have been recently implemented would not have been known about or reflected in their experiences. This being said, participants that were recently deployed and experienced the programs that exist now also believed that the current military systems available to help their re-entry and reintegration process require some adaptations to make them better. The main challenge found through the incidents with current military systems was the lack of coordination and usefulness of the decompression program. Many participants found that decompression could be more helpful if better organized and looked at more than just PTSD and OSI challenges. This decompression program was found to be helpful, but it could be a lot more helpful if adapted further to incorporate some different areas of focus. The category of General Acknowledgement and Recognition does not just stop at public and family acknowledgement. This study found that in addition to this, it was important that „Welcome Home‟ celebrations occurred as they were helpful in the re- entry process. These celebrations were best when they consisted of military, public and family members. Also, when the knowledge and skills gained by the military members from deployment were utilized and supported by the military units that they returned too, 80 it also helped with the re-entry process. It was a way of the military validating what the member went through and gained from the deployment. One of the systems that the military lacks is their ability to provide recognition to their members who deploy. There are medals provided, but the restrictive nature of medals and that not all operations received medals seems to indicate to military members that their deployment was less meaningful than others. A more robust recognition process in the military would be beneficial and could help members in their re-entry process. Another new finding by this study was that challenges to therapy were encountered when having to find a counsellor or therapist who understood the military culture. When dealing with therapists without knowledge of military culture, there is a tendency to not share fully the experiences and challenges due to fear that they would not understand. Although it is recognized by this study that acceptance by civilians is needed, it seems more important in the beginning to talk to someone that has some knowledge or experience with the military culture first and then move into talking with civilians. From the category of „Lack of Public and Family Recognition‟ we also found some elements that have not yet been talked about in the current literature. The lack of connectedness between the experiences and courses by the military into the civilian world creates another separation between the military member and their home culture. This makes all the time and experience from the military seem unacceptable by the public. Furthermore, not having a welcome home celebration attended by the general public and family again maintains this separation and feelings of not being accepted by the country for which they fought. Finally, general family issues that arise by spouses or significant others that do not understand or choose not to stay with the military member on return 81 creates an environment where the member does not feel recognized or understood by their own family on return. All of these types of events hinder the successful re-entry into Canada. 5.3 Strengths and Limitations of the Study  One of the important strengths of this study is that there is very little research that looks at the experience of returning military members in this way. Research has been done on challenges and issues experienced for members once returned, mostly focusing on the psychological stresses that result. Programs have been created when these challenges have come up, but no study has looked at what actually helped or hindered the member‟s re-entry experience so that a greater understanding of what needs to be changed or implemented to help with that process has been accomplished. Another aspect of this study that lends strength to its purpose is that it not only looks at what the challenges of re-entry are, but also investigates what helps that re-entry process. Balancing both what helps and what hinders provides a more complete understanding of what is needed and wanted by military members when they return from overseas deployments.  Further lending to this study‟s strengths is that it focuses specifically on incidents that occurred in order to reach understanding through saturation of incidents types, thus allowing a greater understanding of the process of re-entry to better help military members in the future. As this study looks at the co-creation of incidents between participant and facilitator within a context of constructed meaning, this creates results that provide insights that can be better generalized to the military culture. Furthermore, as the participants range in age from 28 – 72, sample both regular and reserve force 82 members, both men and women and have representation from all service elements and ranks (Navy, Army, Air Force), this research shows that similar experiences and incidents can be found across generations and types of military service, therefore lending more credence to the usefulness of the results to the entire CF. The rating of the categories through placement of random selected incidents into the categories from the incidents collected incorporated both military and civilian perspectives to ensure that the categories were appropriately titled and defined from both inside and outside the culture. Having thirteen of the fifteen participants rate the categories through placement of incidents also lends strength to the study, as their incidents were used to create the categories. Over 90% concurrence in the selecting of incidents into categories lends strength to the credibility of the categories to represent the incidents collected from the participants. This study is therefore considered quite useful to better understand the re-entry process of the Canadian military as a whole.  There are some limitations to this study that must be taken into consideration. As a study based in Critical Realism, there is an inherent limitation due to the epistemological assumptions made. Within this paradigm, co-created narratives of understanding between the participant and the researcher must be assumed. This co- created narrative found in the incidents decreases the objectivity of the incidents, as there is necessarily room for interpretation. Due to the nature of this study, it is unable to predict the exact experience of military members during re-entry, as it is only the experiences that were understood from this set of participants at this time that were identified. It is likely that if this study were duplicated, different results could be found. In keeping with this kind of study, only 15 participants were selected. The sample was 83 selected by the members who were interested in participating. Although the participants that were selected did come from a smaller population of those that were available, they were from a population that was closer in proximity to the researcher, and had to have felt comfortable contacting the researcher after receiving one letter of request for volunteers. Also, most of the incidents that were reported were reported through memory, and memory is not always entirely accurate. This lack of accuracy could be the result of broken memories due to trauma or just the inaccuracy of memory on later recollections. Although the fact that memory may not be entirely accurate, this is only a limitation, because the purpose of the study is to gain insights into what helped or hindered the successful re-entry process. Whatever the participant remembers was helpful or unhelpful to them is true for them, and therefore useful as data in this study.  5.4 Implications for Future Programs/ Re-entry Transition Models  A very important implication that comes out of this study is the need for adjustments to current programs to assist military members on return from a deployment. The CF has come a long way in helping their members with any challenges that may arise, but without knowing what helps and hinders this process the task is more onerous than need be. To first better understand how programs can be changed to better assist, a look at a new updated model of re-entry will first be outlined. 5.4.1 Model of Re-entry  From the literature the only standing model of re-entry for military members comes from Faulkner and McGaw‟s (1977) work with Vietnam Veterans. This model fit quite well for those Vietnam Veterans at that time, but some changes are needed in order to better adapt current programs to deal with military members returning from more 84 current deployments. Through the results of this study, it was noticed that the original model still fits fairly well with the current experiences of our military members, only a couple changes need to be made in order to make it suit better. With the addition of programs by the military, an emphasis on decompression has occurred. For this reason, the first phase in this adapted model is the Decompression Phase. This phase looks at helping military members move away from the deployment environment and into an environment conducive for letting go of the past. This is the phase where military members can make sense of what happened and to be listened to by other military members at their own pace in order to gain a better understanding of the experiences. This phase works best in isolation from home and family, prior to returning back to Canada. The second phase includes Faulkner and McGaw‟s first phase called the Disengagement Phase. This is where the military members have to separate themselves from each other knowing that on return the relationships will not be the same between and among each other. It is like saying good-bye and grieving for a lost family, as well as disengaging from the deployment itself. Returning home from deployment marks an end to a certain way of life, which requires attention by the member. Life can become less exciting and this transition needs to be addressed. The third phase is also in line with Faulkner and McGaw‟s second phase called the Re-Entry Phase. Although it lends itself to the same name as Faulkner and McGaw‟s model, in this model the focus is different. This is the phase where the military members first meet with their family, friends and society on return to Canada. This occurs during the first couple of months of return, where the member must move through and 85 understand all the changes that have happened at home during their deployment, including societal, family and personal changes. It is a time of disconnection and relearning what life back at home is like, and how it has changed in comparison to self. The fourth phase is the Reintegration Phase, where the member has to actually deal with and integrate back into family, friends and social circles through talking and discussions. Different from the Re-entry Phase where it is more about understanding the differences, this phase focuses on the actual process of reintegration back into all aspects of the member‟s life. This is where changes or adaptations of behaviour may be required by both the member and those around them. Psychological stressors may occur where assistance becomes necessary. Struggles of engaging the world around the member are looked at and addressed. In looking at these four phases of the adapted re-entry model, it is important to note that these phases are not experienced in the same way or in the same timeframe for everyone. Some military members are able to move through these phases faster than others, while others may become stuck in a certain phase. The phases may also overlap, meaning that even though someone is moving into reintegration at some points, they may still be dealing with components of disengagement. This model is not intended to make a strict and clear chronological explanation of what is experienced by members as they return to Canadian society, it is more to help understand that there are phases that military members go through, each with their own challenges and needs. It is also important to understand that each individual will be unique in their end result depending on how they fit within the Fourfold acculturation model, and how they end up reintegrating within Canadian society. This model encompasses many of the categories of incidents and 86 experienced explored in this study. It is designed to provide a way of looking at how military members re-enter and the common challenges that may be experienced in that process. 5.4.2 New Insights into Programs  One of the major insights that this study provides is the great need for talking by military members to others. These others seem to move from an ability to talk to other military members, to an ability to talk to family and friends, to finally an ability to talk to any civilian about the experiences that occurred overseas. It seems that the ability to talk about the experience removes the original shame and cause for separateness and isolation that the members experienced directly on return. It was found that the more members talked about their experiences with people, and the more these people understood and listened to those experiences, the better the military member‟s experience of re-entry.  Another new insight that came from this study was the difference of re-entry experience that occurred when it took longer to return to Canada from the end of deployment. The Navy requires a transit back to Canada by ship after the deployment, thus providing an extended time for military members to decompress with each other en route home. This is similar to people in historical conflicts that had to come and go by ship to the area of operation in contrast to the airlift we do for many of our modern operations. It allows for socializing with other societies during the transit back when there were stops for weekends which slowly introduce the military members to other non- military people. This slow process of re-introducing military members back to a more normal Canadian society during the transit home seemed to allow for more decompression and an ability to disengage from each other. This finding lends itself to 87 the idea that more time is needed to be focused on the decompression process than currently occurs for the majority of our army personnel who only get 5 days of a decompression program prior to returning to Canada.  Another insight from this study is specifically about the decompression process provided to returning military members who are not returning with a ship back to Canada. The decompression program is currently 5 days held in a city different from the deployment and also not in Canada. This study provides insight into some of the adaptations that need to be made to make this program more beneficial. First, this study indicates that decompression is extremely important and helpful when it occurs, compared to having nothing at all prior to return. The fact that the military provides decompression at all was found to be beneficial. It is what happens at that decompression that causes some challenges for many members according to the results of this study. Most of the participants who experienced this program felt that it focused only on PTSD and OSI symptoms, providing information about it so that members understood what was happening if they were having a psychological challenge on return to Canada. What it was missing was that it did not focus on what experiences other than PTSD and OSI symptoms that can be expected when they do return back to Canada, challenges with family, challenges with societal differences and so on. Also, this decompression program seemed to be more focused on a place for military members to blow off steam and drink alcohol than any other activity. Most of the members seem to be left on their own to coordinate activities outside of drinking alcohol, activities which cost money and never really got any attention to ensure smoothness of the process. This lack of coordination was a major drawback to what the program can provide. 88  Another major insight is the benefit that was found by all military members in this study with regards to receiving psychological assistance through group-based therapy with other military members. Some participants indicated that group psychotherapy with military members was beneficial specifically, while others indicated that being around and talking to military members about their experiences was helpful in their re-entry process. In either case, the preferred way of helping oneself re-enter is through working with military members in groups. This may be due to the cultural closeness of members, shared experiences not understood by general public, or the act of being with what some participants called “a band of brothers” where they just feel safe and comfortable. This use of group-based assistance is an extremely important finding as the fear of vicarious trauma has been discussed on several occasions in the literature. Military members train together, live together, and become injured together. It is only logical that they would be healed best together. 5.4.3 New Decompression Program  Combining a couple of insights indicated above, it may be beneficial to implement a new decompression program in the Canadian Forces that provides comprehensive services and activities focused on decompression and planning for re- entry instead of only PTSD symptoms and „blowing off steam through drinking alcohol‟. One suggested difference after looking at what is desired and the updated Re-Entry Model is to look at doing a decompression program in 3 stages. The first stage is upon leaving the deployment area and being taken to a separate location with all the people on deployment. The important point in this is to provide a fully coordinated place for military members to decompress with other members from their specific division/platoon. 89 This decompression phase can be set-up very similarly to what the military offers now, only that the lectures/classes that are provided focus not only on PTSD and OSI injuries, but on other areas that are important for the re-entry back home. Information on what can be expected on returning, maybe a look at the model of re-entry and different experiences found in each phase. Learning communication and relationship skills combined with the opportunity to talk in a facilitated group with other military members from the same platoon that know each other provides a comfortable and safe environment to talk. These classes/groups only have to last during the mornings, after which point other coordinated activities that are free to the members are put on that offer more than just alcohol as an activity. This is not to say that consumption of alcohol is to be removed from the possible activities, only that it should not be the only activity that is easily available and accessible to members.  The second stage of the decompression program would be to move the members from the site of decompression to another city for up to 10 days for planning re-entry. In addition to this move, it is also required that they bring the member‟s spouse or preferred family member to that city as part of this stage. The military already has a program called Home Leave Travel Assistance (HLTA), which could be used in a very specific way to allow military members to be slowly re-introduced to their family life in a very controlled way. During this second stage, the first 5 days can be filled with classes in the morning where the military member and their partner (whomever they brought out on this) come into classes and groups in the morning that provides education and communication instruction to the level that both the member and partner is comfortable with. In this way the military member‟s partner becomes more aware of what to expect, possible ways to 90 assist, and the partner is given a chance to practice talking with the military member about what changes they can expect when they return home. In this facilitated environment, communication starts with the members and their partners so that on return home, it is easier to talk about the experiences with them. This stage would also include other coordinated activities that the military member and their partner can go on together. Educating family and member in a neutral environment prior to re-introducing them home can greatly reduce the shock of re-entry experienced by many members on return.  The third stage is the return home to Canada. This third stage is where the Canadian military and public get together to provide a welcome home celebration for all personnel returning form overseas deployments. Friends, families and the general public are all invited to be in attendance to welcome back military personnel. It is at this stage that a coordinated effort between military and civilian organizations can be inserted to provide the recognition and acknowledgement of the returning members to Canada. This can be coordinated simply and done in advance so that everyone is aware that it is happening. This marks the celebration by society that the members returned safely and the end of the deployment entirely. This stage is important to be done for all returning members to some degree, even if they return alone from deployment.  This new decompression program could cover many aspects of both what was found by this study as helpful in the re-entry process and also removes aspects of what was found to be unhelpful. The military is certainly moving in the right direction, but adaptations to current programs to meet the needs of their military members can always be done. 91 5.5 Concluding Statement  This study has provided information and knowledge that fills the gap in literature surrounding the re-entry process for military members returning from overseas deployments. This study goes beyond the current literature that mostly focuses on psychological challenges of the returning military member, and moves into what has helped them and also what has got in their way on their return to Canada. The Critical Incident Technique methodology has provided fairly generalizable categories that can be used to adapt programs and increase understanding of what is truly needed by military members when they return to Canada. This study opens up the possibility of looking at other research into the effectiveness of current military programs within Canada and internationally. It identifies group psychotherapy as the preferred method of treatment for military members and the long term effect of military service on military members who suffer PTSD or OSI symptoms. Finally, as was mentioned earlier, Canada has not looked at the cultural elements of physical, emotional and psychological distress and resiliency, which would be helpful in further helping military members re-enter society. 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Sorsdahl, CD, MA, CCC University of British Columbia 2329 West Mall Vancouver BC  V6T 1Z4       December 2009  To  VOLUNTEER REQUEST FOR A RESEARCH STUDY ON THE RE-ENTRY EXPERIENCE OF CANADIAN MILITARY MEMBERS  A study is being conducted that looks at the re-entry experience of military members returning from overseas deployments back home to Canada.  This study concerns the exploration of specific factors that occurred to members that helped their re- entry experience and specific factors that occurred to members that hindered their re- entry experience. This letter is being sent to personnel in the Canadian Forces, serving or retired that have deployed overseas and have been back in Canada for over a year. You are being invited to participate in this study to potentially inform and enhance the current literature on the experiences of military members returning from overseas and the process of re-entry into Canadian society. The purpose of the project is to identify specific social, family, psychological and physical health factors that helped or hindered the re-entry process of Canadian military members returning from overseas deployments. There is a possibility to experience strong emotional responses and unexpected memories during the interviews as you are asked about your time during the re-entry process. You may also experience further psychological integration of your experiences through discussing this process.  Through your participation, this study may also help future clients with military experience, understand the process of re-entering civilian society and what may help or hinder that process. Participation in this study is completely voluntary, and you have the right to withdraw your consent at any time without consequence or explanation.  All information provided, including your name, will be kept completely confidential by the researcher.  In addition, the specific information that is gathered from you by the researcher throughout this study will not be shared with anyone connected to the group that you attended, the military, or myself.  Participation in this study requires two separate interviews. The first to be for approximately 1-½ hours, and the second to be for approximately 1 hr.  The total amount of time required of you for participating will be approximately 2 ½ hrs.” Michael Sorsdahl, a Graduate student with the The University of British Columbia, is conducting this study.  If you are interested in participating in this study, or 101 want to know more about it, please contact him directly.  He can explain the study more fully to you, and can make arrangements to interview you at a place and time that is most convenient for you.  Thank you for your time and consideration in this research request for volunteers.         Michael Sorsdahl, CD, MA, CCC                                  102 Appendix B  Telephone Script for Initial Principal Investigator Contact  Mike Sorsdahl’s Initial Principal Investigator Contact script (upon receipt of a phone call from a potential participant):  “Thank you for showing interest in this study in requesting more information and to possibly set-up an interview.”  “Before I answer any questions, would it be alright if I went over what this study is about and how participation would work if you agreed to participate?” [if yes, continue, if no – “what can I do for you at this time?”]  “I am conducting a study that looks at the re-entry experience of Canadian Military members upon returning from overseas deployments.  More specifically, I am looking for what specific social, family, psychological, and physical health factors that help or hinder the re-entry process. The study is being conducted by myself, Mike Sorsdahl, as part of the requirement for the degree of Doctorate of Philosophy at The University of British Columbia.  I am the principal investigator and the only researcher in this study. Participation in this study is completely voluntary, and you would have the right to withdraw your consent at any time without consequence or explanation.  All information provided, including your name, would be kept completely confidential by me. Participation in this study requires two separate interviews. The first will take approximately 1-½ hours, and the second approximately 1 hr.  The total amount of time required of you for participating will be approximately 2 ½ hrs.”  “The purpose of the project is to identify specific social, family, psychological and physical health factors that helped or hindered your re-entry process upon returning from an overseas deployment.”  “Some risks and benefits are that there is a possibility to experience strong emotional responses and unexpected memories during the interviews as you are asked about your re-entry experience. You may also experience further psychological integration of your re-entry experience through discussion.  Through your participation, this study may also help future clients with military experience re-enter into civilian society through greater awareness of the factors that affect the process. With the possible publication of this study, future models of re-entry and transition for military members may be formed that help to create programs to assist in the re-entry process.”  “Are you interested in participating in this study?” [If there are more questions, answer them, if they say yes then continue, if no – “thank you for your time, good bye]  “To give you an idea of what will happen I would like to outline the interview process that will be followed.  Upon our first meeting, I will go over a consent form with you. 103 Once you completely understand all that is involved and are still interested in participating in the study, I will have you sign the form.  You will get a copy and I will keep a copy for my records.  From there the first interview will take us through an exploration of facilitator behaviours that you remember observing during the course of the program that increased your sense of trust in the facilitator or hindered it. Up to a maximum of 100 factors will be identified, without any minimum.  This will conclude our first interview.  Once I have compiled all the data from all participants, the second interview will be scheduled and I will ask again if you are interested in continuing your participation.  If you are, we set up a second interview for about an hour, where I will go over the consent form again to ensure that you fully understand what is happening. I will have you initial the consent form to indicate that you are still interested in participating.  I will then ask you to place the incidents that you identified into pre-created categories as you see fit.  This will conclude your participation in the study.  Are there any questions?  * Time and place will be discussed and agreed upon at this point*  “Thank you for your support and cooperation in this study”                              104 Appendix C Interview introduction brief and Sample Questions  Thank-you for being a part of this study.  The general purpose is to identify some specific factors that helped and hindered your re-entry process after an overseas deployment.  As was described in the consent form signed by you earlier, we are interested in identifying specific social, family, psychological and physical health factors that helped and hindered your re-entry experience. For the study I am asking you to describe specific examples of factors or events which you have observed or experienced and which you feel to be either effective or ineffective in your re-entry experience. Social factors include any events that occur in relation to your community or work, including friends and coworkers, government, general Canadian societies etc. Family factors include any events that involve family members that include spouse, parents, children and extended family. Psychological factors include events that involve mental illness, psychological assistance, and other related events. Physical health factors include specific physical injuries, limitations of sensory faculties, and physical illnesses. Each of the factors or events you describe should be a factual description of an event which:   1) You observed or experienced; 2) Involved a particularly effective or ineffective aspect of your re-entry experience; or 3) Had a clear-cut consequence that was observable or understandable to how it helped or hindered your re-entry experience. 105 It is important to note that it is a particular kind of event and not an individual that you are describing when you are reporting this critical incident. This distinction is crucial. The focus must be on the event that occurred and not on an individual judged to have helped or hindered your experience. Limit your descriptions to those events, which “made a difference.” Your event descriptions of the factors need not be highly dramatic; however, they should focus on situations and events that occurred. In addition, it would not be unusual to find examples of both effective and ineffective events reported around the same situation.  These situations may include such events as, „the welcome home celebration was really helpful‟, but „the questions at the welcome home celebration about my experience so soon after I returned caused some challenge relating‟. Also, please indicate why the event was particularly effective in helping with your re-entry experience, or why the event was particularly ineffective in helping with your re- entry experience. General interview questions 1.   To start, could you tell me one factor or event that you felt helped your re-entry experience?  2. What it is it about the event that made you feel that it helped/hindered your re- entry experience?  3. What other possible events at that point may have been more (or less) helpful in your re-entry experience?  4. On a scale of 1 to 10, how important do you feel this event was in helping or hindering your re-entry experience, where 1 is very little, and 10 is very high?  5. On a scale of 1 to 10, one being not helpful at all and 10 being very helpful, would you rate this event?     106 Appendix D  Informed Consent Form  Project Title: Re-entry and Transition Factors for Returning Military Members from Overseas Deployments  You are being invited to participate in a study entitled “Re-entry and Transition Factors for Returning Military Members from Overseas Deployments” that is being conducted by Michael Sorsdahl.  Mike Sorsdahl is a doctoral student in the Centre for Cross Faculty Inquiry within the Faculty of Education at The University of British Columbia and you may contact him if you have further questions.  As a graduate student, I am required to conduct research as part of the requirements for a Doctor of Philosophy (PhD). It is being conducted under the supervision of Dr. Marv Westwood. You may contact my supervisors through the contact information provided below:  Dr. Marv Westwood - Professor, Counselling Psychology, Department of Educational and Counselling Psychology and Special Education, University of British Columbia.  You were selected as a potential participant as you have been deployed overseas and have returned to Canada over a year ago, providing you a unique perspective on the re-entry experience. Participation in this study is completely voluntary, and you have the right to withdrawal at any time without consequence or explanation.  If at any time there are any questions regarding the procedures of this study they will be answered in order to ensure that you fully understand what is happening.  Interviews will be audio taped and maintained until analysis is complete, upon which all materials from the interviews will be destroyed. This study has no affiliation or connection with the military or the government whatsoever.  If at any time you do not feel you wish to answer any questions, you have the right to do so.  There is a potential for strong emotional responses and unexpected memories to occur during the interviews as you are being asked about your re-entry experience.  If any distressing reactions occur during the interviews, the interview will be stopped immediately and you will be offered the support of the researcher whom is a Canadian Certified Counsellor (CCC), and a referral to other support services in your area.  The cost of support services offered by referral is not covered by this study.  There are several agencies that you may be referred to that are either free or offer a sliding scale to ensure cost is equitable.  You will be required to pay for any service that you choose that costs money. Participant Consent Form 107  Purpose of Project: The purpose of the project is to identify specific social, family, psychological and physical health factors that helped or hindered the successful re-entry of Canadian Forces members who have completed and returned from overseas deployments.  The factors or events that we are focusing on are those that occurred anytime from the completion of your deployment until now. These events may have occurred in any situation after your deployment was officially complete.  You may experience further psychological integration of your re-entry experience. Through you participation, this study may also better help future CF members in their re- entry process by informing current literature and future programs designed for military members re-entering their home society. Through this increase in knowledge, new models of re-entry and updated information on what CF members need assistance with during their re-entry can be made.  Procedures and Time Requirements: Interviews will take place at a mutually agreed upon time and location.  The first interview will last approximately 1 ½ hours, with a discussion and signing of the consent form and the collection of your memories of events from your re-entry experience. A second interview will be scheduled that will last approximately 1 hour, where we will go over the consent form again and have you initial it to indicate agreement for ongoing participation.  You will then be asked to place the identified factors or events that you remembered into categories selected by the Principal Investigator.  The total time commitment for this study will be 2 ½ hours in total.  Confidentiality: No information will be reported that could be used to identify individual participants, and all data is kept in strictest confidence. The interview tapes and notes will be stored by number code that only I will have access to, and all data will be reported by the number code and not by the name when analysis is being conducted.  The data will be published in a doctoral dissertation and possibly as a journal article in the future.  The data that would be published in both venues will not contain names of participants, only the categorical data determined through the information provided in the interview.  Questions or Concerns: You may verify the ethical approval of this study, or raise any concerns you might have, by _______[once it is received].  Right to Refuse to Participate: Each participant has the right to refuse to participate or to withdraw from the study at any time without consequence or explanation. If you do withdraw from the study your data will be destroyed and not used in the results of this study.  108 I      have a received a copy of this consent form for my own records.  Your signature below indicates that you understand the above conditions of participation in this study and that you have had the opportunity to have your questions answered by the researcher     Signature       Date: yy/mm/dd                                    109 Appendix E  Referral Sheet  Victoria BC  Dr. Athol Malcolm (R. Psych): specializes in military clients and trauma  (Costs money – MSP covers)  Citizen’s Counselling Centre: volunteer lay counselling service Contact: (250) 384-9934 (sliding scale fee depending on income)  Victoria Crisis Line: (250) 386-6323  Vancouver BC  Dr. Greg Passey MD: specializes in military clients and trauma (costs money – MSP covers)  Royal Canadian Legion Pre-doctoral Internship at UBC Counselling Services: (free) Daily drop-in sessions are available for first appointments and emergencies during the following time periods:   Mon/Tues/Thu/Fri: 9:00 – 12:00 and 1:00 – 4:00   Wed: 1:00 – 4:00 and 4:00 – 7:00  Drop-in sessions are first come first served. Availability varies on any given day depending on demand. We urge participants to come early in the drop-in period.  For follow up appointments call (604) 822-3811 or drop by Counselling Services to speak to a receptionist  Vancouver Crisis Line: (604) 872-1811 (Free)  Other Locations in BC  British Columbia Psychological Association Referral Service Contact: 1 (604) 730-0552 (RPsychs cost money – MSP covers)   The University of British Columbia 110 Appendix F   CERTIFICATE OF APPROVAL - FULL BOARD  PRINCIPAL INVESTIGATOR: INSTITUTION / DEPARTMENT: UBC BREB NUMBER: Marvin J. Westwood  UBC/Education  H09-02940 INSTITUTION(S) WHERE RESEARCH WILL BE CARRIED OUT: Institution Site UBC Vancouver (excludes UBC Hospital) Other locations where the research will be conducted: Other locations may be required, depending on the location of the participants found. In each case I would organize a space at the university or college located in that city.  CO-INVESTIGATOR(S): Michael Sorsdahl SPONSORING AGENCIES: N/A PROJECT TITLE: Re-entry and Transition Factors for Returning CF members from Overseas Deployments REB MEETING DATE: CERTIFICATE EXPIRY DATE: November 26, 2009  November 26, 2010 DOCUMENTS INCLUDED IN THIS APPROVAL: DATE APPROVED:   January 25, 2010 Document Name Version Date Protocol: Dissertation Proposal Summary  N/A November 2, 2009 Consent Forms: Consent Form 2.0 December 22, 2009 Questionnaire, Questionnaire Cover Letter, Tests: Initial Telephone Script N/A November 2, 2009 Interview Script N/A November 2, 2009 Letter of Initial Contact: Request for Volunteers N/A November 2, 2009 Other Documents: Referral Sheet N/A  November 2, 2009   The application for ethical review and the document(s) listed above have been reviewed and the procedures were found to be acceptable on ethical grounds for research involving human subjects.   Approval is issued on behalf of the Behavioural Research Ethics Board and signed electronically by one of the following:  Dr. M. Judith Lynam, Chair Dr. Ken Craig, Chair Dr. Jim Rupert, Associate Chair Dr. Laurie Ford, Associate Chair Dr. Anita Ho, Associate Chair 


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