VOCATIONAL ADJUSTMENT FOLLOWING SEPARATION FROM MILITARY SERVICE: A QUALITATIVE INVESTIGATION OF WORK INTEGRATION CHALLENGES FOR GULF WAR-ERA II VETRANS WITH PTSD _______________ A Thesis Presented to the Faculty of San Diego State University _______________ In Partial Fulfillment of the Requirements for the Degree Master of Science in Rehabilitation Counseling _______________ by Paul J. Hayes Summer 2013 iii Copyright © 2013 by Paul J. Hayes All Rights Reserved iv DEDICATION This study is dedicated to United States military veterans who continue their struggles with the silent wounds of post-traumatic stress disorder. To those who returned from wars and were diagnosed with emotional trauma, have been treated, or are receiving treatment for psychological injuries, I salute you. v Great deeds are usually wrought at great risks. -Herodotus vi ABSTRACT OF THE THESIS Vocational Adjustment Following Separation from Military Service: A Qualitative Investigation of Work Integration Challenges for Gulf War-Era II Vetrans with PTSD by Paul J. Hayes Master of Science in Rehabilitation Counseling San Diego State University, 2013 Post-traumatic stress disorder (PTSD) among Gulf War-era II veterans has resulted in psychological wounds attributed to military duty in Afghanistan and Iraq warzones. In the U.S., PTSD is now in fifth place trailing in prevalence more common psychological disorders of depression, attention-deficit/hyperactivity disorder, specific phobia, and social phobia as ranked in previous surveys, with social service and societal costs soaring into the billions of dollars. Many veterans returning from these wars are transitioning to civilian life after military separation without trauma stressor mitigation or jobs. Warzone-related stress disorders among veterans are sometimes responsible for struggles experienced with entering or reentering the workforce often requiring appropriate work adjustment and work integration. The conceptual framework for this study was derived from three three sequentially developing interactive specific subsystem components that comprise the model of work adjustment. The model was chosen to examine the work personalities, work competencies, and work goals of homeless and unemployed Gulf War-era II veterans with PTSD in relation to successful work adjustment and work integration. The purposes of the present investigation were to address the following questions (1) How do veterans with PTSD view their work competencies?, (2) What significant work integration and work adjustment challenges do veterans with PTSD experience?, and (3) To what extent have veteran’ work goals changed from pre- to post-military service? Participants were 10 Gulf War-era veterans with PTSD, separated from military service at a minimum of one year preceding the investigation, and living in a southwestern city residential substance addiction treatment facility. The research consisted of 12 open-ended or semi-structured questions asked of the participants. Data revealed five emergent themes of: (a) veterans PTSD experiences; (b) overcoming homelessness; (c) motivation to change; (d) family support and quality of life; and (e) rehabilitation counseling, education, and career preparation strategies, resulting in 19 sub-themes. The sub-themes indicated congruence between each other and the participants’ perceptions, thoughts, and beliefs. Also strongly indicated were the participants’ employment capabilities after work adjustment, worth as viable assets in the workforce, ability to restore their work identities, re-establish self-sufficiency, and ability to attain an ample quality of life. Study results emphasize the significance of recognizing and treating the effects of PTSD on veterans seeking workforce inclusion. Future research should incorporate more vii sample population diversity and assess veteran PTSD barriers to employment from a longitudinal perspective. viii TABLE OF CONTENTS PAGE ABSTRACT ............................................................................................................................. vi LIST OF TABLES .................................................................................................................. xii ACKNOWLEDGEMENTS ................................................................................................... xiii CHAPTER 1 INTRODUCTION .........................................................................................................1  Context of Research .................................................................................................2  Research Problem and Significance .........................................................................4  Research Questions ..................................................................................................6  Definition of Terms..................................................................................................7  2 LITERATURE REVIEW ..............................................................................................9  PTSD Symptoms in the General Public and Gulf War-Era II Veterans ................10  PTSD Stressor Criteria .....................................................................................12  PTSD Paradigm Shift .......................................................................................13  Overview of Gulf War-Era II and Vietnam Veteran Cohorts with PTSD .............15  Life Course Disruption ....................................................................................16  The Vietnam Legacy ........................................................................................17  Lessons for Gulf War-Era II Veterans .............................................................18  Stigma and Mental Health Concerns ...............................................................20  Help Seeking ....................................................................................................22  Post-War Adjustment Challenges Faced by Gulf War-Era II PTSD Veterans .................................................................................................................23  Social and Interpersonal Functioning ..............................................................24  Marriage and Family Relationships .................................................................26  Employment Challenges ..................................................................................31  Perspectives on Career Development Theories ...............................................31  Szymanski’s Ecological Theory ......................................................................33  Hershenson’s Model of Work Adjustment ......................................................34 ix Work Adjustment Theory Applied to Gulf War-Era II Veterans with PTSD ......................................................................................................................36  Quality of Life Significance.............................................................................36  Work Adjustment Significance ........................................................................37  Work Adjustment Fulfillment ..........................................................................38  Work Adjustment and Vocational Success ......................................................38  3 METHODOLOGY ......................................................................................................40  Research Design .....................................................................................................40  Grounded Theory .............................................................................................40  Research Questions ..........................................................................................41  Data Collection ......................................................................................................42  Recruitment ......................................................................................................42  Participants .......................................................................................................43  Data Extraction ................................................................................................45  Trauma Exposure Substantiation .....................................................................45  PTSD Substantiation ..................................................................................45  Participant Questionnaire ..........................................................................46  Interview Procedure ...............................................................................................46  Data Analysis ...................................................................................................49  Member Check .................................................................................................52  4 RESULTS ....................................................................................................................54  Introduction to the Themes ....................................................................................54  Veterans PTSD Experience....................................................................................54  War-Induced Trauma Coping ..........................................................................54  Co-existing Health Conditions .........................................................................57  Affirming Healthy Behaviors ..........................................................................58  Overcoming Homelessness ....................................................................................58  The Effects of Substance Abuse ......................................................................59  Family Disruption ............................................................................................62  Motivation to Change ............................................................................................63  Identification and Acknowledgement of Personal Values ...............................63  Modifying Beliefs and Attitudes ......................................................................64 x Personal Development Awareness ...................................................................66  Family Support and Quality of Life .......................................................................67  Positive Family Support ...................................................................................67  Reestablishing Relationships ...........................................................................68  Treatment Outcomes ........................................................................................70  Transition to Community, Interpersonal Relationships, and Belonging..........71  Current Economic Concerns ............................................................................72  Societal Contributions ......................................................................................73  Rehabilitation Counseling, Education, and Career Preparation Strategies ............74  Rehabilitation Support .....................................................................................74  Personal Role in Rehabilitation .......................................................................75  Prioritizing and Focusing on Work and School ...............................................76  Decision Making Difficulty .............................................................................77  Developing Knowledge Through Skills...........................................................78  5 DISCUSSION ..............................................................................................................80  Adaptation of Hershenson’s Work Adjustment Model to this Study ....................80  Relationship to Previous Research...................................................................81  Post-deployment Adjustment Challenges ........................................................81  Interpersonal Functioning and Social Adjustment ...........................................82  Relationship and Family Adjustment ...............................................................83  Employment Adjustment Challenges ..............................................................85  Work Adjustment Significance, Fulfillment, and Success ..............................87  Findings of the Present Study ................................................................................88  Interactive Theme Analysis ...................................................................................89  Achieving Successful Outcomes ............................................................................89  Rehabilitation Counseling Implications .................................................................92  Limitations .............................................................................................................95  Implications for Further Research .........................................................................97  Conclusion .............................................................................................................99  REFERENCES ......................................................................................................................102 APPENDIX A INFORMED CONSENT ...........................................................................................113