The Veterans and Active Duty Military Psychotherapy Progress Notes Planner E-Book

Arthur E. Jongsma

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Practice Planners
• Sprache: Englisch
• Veröffentlichungsjahr: 2010

Seitenzahl: 719

Beschreibung

The Veterans and Active Duty Military Psychotherapy Progress Notes Planner contains complete prewritten session and patient presentation descriptions for each behavioral problem in The Veterans and Active Duty Military Psychotherapy Treatment Planner. The prewritten progress notes can be easily and quickly adapted to fit a particular client need or treatment situation. * Saves you hours of time-consuming paperwork, yet offers the freedom to develop customized progress notes * Organized around 39 behaviorally based presenting problems, including nightmares, post- deployment reintegration, combat and operational stress reaction, amputation and/or loss of mobility, adjustment to killing, and depression * Features over 1,000 prewritten progress notes (summarizing patient presentation, themes of session, and treatment delivered) * Provides an array of treatment approaches that correspond with the behavioral problems and DSM-IV-TR diagnostic categories in The Veterans and Active Duty Military Psychotherapy Treatment Planner * Offers sample progress notes that conform to the requirements of most third-party payors and accrediting agencies, including CARF, The Joint Commission (TJC), COA, and the NCQA * Presents new and updated information on the role of evidence-based practice in progress notes writing and the special status of progress notes under HIPAA

Leseprobe

Table of Contents

PracticePlanners ® Series

Title Page

Copyright Page

Dedication

PRACTICEPLANNERS SERIES PREFACE

Introduction

ABOUT PRACTICEPLANNERS PROGRESS NOTES

HOW TO USE THIS PROGRESS NOTES PLANNER

A FINAL NOTE ABOUT PROGRESS NOTES AND HIPAA

ADJUSTMENT TO KILLING

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

ADJUSTMENT TO THE MILITARY CULTURE

SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

AMPUTATION, LOSS OF MOBILITY, DISFIGUREMENT

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

ANGER MANAGEMENT AND DOMESTIC VIOLENCE

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

ANTISOCIAL BEHAVIOR IN THE MILITARY

SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

ANXIETY

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

ATTENTION AND CONCENTRATION DEFICITS

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

BEREAVEMENT DUE TO THE LOSS OF A COMRADE

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

BORDERLINE PERSONALITY

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

BRIEF REACTIVE PSYCHOTIC EPISODE

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

CHRONIC PAIN AFTER INJURY

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

COMBAT AND OPERATIONAL STRESS REACTION

SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

CONFLICT WITH COMRADES

SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

DEPRESSION

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

DIVERSITY ACCEPTANCE

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

FINANCIAL DIFFICULTIES

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

HOMESICKNESS/LONELINESS

SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

INSOMNIA

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

MILD TRAUMATIC BRAIN INJURY

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

NIGHTMARES

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

OPIOID DEPENDENCE

CLIENT PRESENTATION

INTERVENTIONS IMPLEMENTED

PANIC/AGORAPHOBIA

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

PARENTING PROBLEMS RELATED TO DEPLOYMENT

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

PERFORMANCE-ENHANCING SUPPLEMENT USE

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

PHOBIA

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

PHYSIOLOGICAL STRESS RESPONSE—ACUTE

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

POST-DEPLOYMENT REINTEGRATION PROBLEMS

SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

POSTTRAUMATIC STRESS DISORDER (PTSD)

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

PRE-DEPLOYMENT STRESS

SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

SEPARATION AND DIVORCE

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

SEXUAL ASSAULT BY ANOTHER SERVICE MEMBER

SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

SHIFT WORK SLEEP DISORDER

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

SOCIAL DISCOMFORT

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

SPIRITUAL AND RELIGIOUS ISSUES

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

SUBSTANCE ABUSE/DEPENDENCE

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

SUICIDAL IDEATION

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

SURVIVOR’S GUILT

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

TOBACCO USE

VETERAN/SERVICE MEMBER PRESENTATION

INTERVENTIONS IMPLEMENTED

PracticePlanners ® Series

Treatment Planners

The Complete Adult Psychotherapy Treatment Planner, Fourth Edition The Child Psychotherapy Treatment Planner, Fourth Edition The Adolescent Psychotherapy Treatment Planner, Fourth Edition The Addiction Treatment Planner, Fourth Edition The Continuum of Care Treatment Planner The Couples Psychotherapy Treatment Planner The Employee Assistance Treatment Planner The Pastoral Counseling Treatment Planner The Older Adult Psychotherapy Treatment Planner The Behavioral Medicine Treatment Planner The Group Therapy Treatment Planner The Gay and Lesbian Psychotherapy Treatment Planner The Family Therapy Treatment Planner The Severe and Persistent Mental Illness Treatment Planner, Second Edition The Mental Retardation and Developmental Disability Treatment Planner The Social Work and Human Services Treatment Planner The Crisis Counseling and Traumatic Events Treatment Planner The Personality Disorders Treatment Planner The Rehabilitation Psychology Treatment Planner The Special Education Treatment Planner The Juvenile Justice and Residential Care Treatment Planner The School Counseling and School Social Work Treatment Planner The Sexual Abuse Victim and Sexual Offender Treatment Planner The Probation and Parole Treatment Planner The Psychopharmacology Treatment Planner The Speech-Language Pathology Treatment Planner The Suicide and Homicide Treatment Planner The College Student Counseling Treatment Planner The Parenting Skills Treatment Planner The Early Childhood Intervention Treatment Planner The Co-Occurring Disorders Treatment Planner The Complete Women’s Psychotherapy Treatment Planner The Veterans and Active Duty Military Psychotherapy Treatment Planner

Progress Notes Planners

The Child Psychotherapy Progress Notes Planner, Third Edition The Adolescent Psychotherapy Progress Notes Planner, Third Edition The Adult Psychotherapy Progress Notes Planner, Third Edition The Addiction Progress Notes Planner, Third Edition The Severe and Persistent Mental Illness Progress Notes Planner. Second Edition The Couples Psychotherapy Progress Notes Planner The Family Therapy Progress Notes Planner The Veterans and Active Duty Military Psychotherapy Progress Notes Planner

Homework Planners

Brief Couples Therapy Homework Planner Brief Family Therapy Homework Planner Grief Counseling Homework Planner Group Therapy Homework Planner Divorce Counseling Homework Planner School Counseling and School Social Work Homework Planner Child Therapy Activity and Homework Planner Addiction Treatment Homework Planner, Fourth Edition Adolescent Psychotherapy Homework Planner II Adolescent Psychotherapy Homework Planner, Second Edition Adult Psychotherapy Homework Planner, Second Edition Child Psychotherapy Homework Planner, Second Edition Parenting Skills Homework Planner

Client Education Handout Planners

Adult Client Education Handout Planner Child and Adolescent Client Education Handout Planner Couples and Family Client Education Handout Planner

Complete Planners

The Complete Depression Treatment and Homework Planner The Complete Anxiety Treatment and Homework Planner

This book is printed on acid-free paper.

Copyright © 2010 by David J. Berghuis and Arthur E. Jongsma, Jr. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.

Published simultaneously in Canada.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750- 8400, fax [phone], or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, [phone], fax [phone].

Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering professional services. If legal, accounting, medical, psychological or any other expert assistance is required, the services of a competent professional person should be sought.

Designations used by companies to distinguish their products are often claimed as trademarks. In all instances where John Wiley & Sons, Inc. is aware of a claim, the product names appear in initial capital or all capital letters. Readers, however, should contact the appropriate companies for more complete information regarding trademarks and registration.

For general information on our other products and services please contact our Customer Care Department within the U.S. at [phone], outside the United States at [phone] or fax [phone].

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. For more information about Wiley products, visit our website at www.wiley.com.

Library of Congress Cataloging-in-Publication Data

Berghuis, David J.

The veterans and active duty military psychotherapy progress notes planner / by David J. Berghuis, Arthur E. Jongsma, Jr. p. cm. -- (Practiceplanners series)

Includes bibliographical references.

eISBN : 978-0-470-58607-5

1. Veterans--Mental health--United States--Handbooks, manuals, etc. 2. Soldiers--Mental health--United States--Handbooks, manuals, etc. 3. Psychotherapy--Planning--Handbooks, manuals, etc. 4. Psychology, Military--Handbooks, manuals, etc. I. Jongsma, Arthur E., 1943- II. Title.

UH629.3.B47 2010

616.85’212--dc22

2009031714

To all those who have given life and limb to hold up the lamp of liberty around the world.

- A.E.J.

With love and wishes for safety and success to my nephew, Lance Corporal Peter Van Dyken, United States Marine Corps. Your service makes your family proud.

- D.J.B.

PRACTICEPLANNERS®SERIES PREFACE

Accountability is an important dimension of the practice of psychotherapy. Treatment programs, public agencies, clinics, and practitioners must justify and document their treatment plans to outside review entities in order to be reimbursed for services. The books and software in the PracticePlanners® series are designed to help practitioners fulfill these documentation requirements efficiently and professionally.

The PracticePlanners® series includes a wide array of treatment planning books including not only the original Complete Adult Psychotherapy Treatment Planner, Child Psychotherapy Treatment Planner, and Adolescent Psychotherapy Treatment Planner, all now in their fourth editions, but also Treatment Planners targeted to specialty areas of practice, including:

• Addictions

• Co-occurring disorders

• Behavioral medicine

• College students

• Couples therapy

• Crisis counseling

• Early childhood education

• Employee assistance

• Family therapy

• Gays and lesbians

• Group therapy

• Juvenile justice and residential care

• Mental retardation and developmental disability

• Neuropsychology

• Older adults

• Parenting skills

• Pastoral counseling

• Personality disorders

• Probation and parole

• Psychopharmacology

• Rehabilitation psychology

• School counseling

• Severe and persistent mental illness

• Sexual abuse victims and offenders

• Social work and human services

• Special education

• Speech-Language pathology

• Suicide and homicide risk assessment

• Veterans and active military duty

• Women’s issues

In addition, there are three branches of companion books that can be used in conjunction with the Treatment Planners, or on their own:

• Progress Notes Planners provide a menu of progress statements that elaborate on the client’s symptom presentation and the provider’s therapeutic intervention. Each Progress Notes Planner statement is directly integrated with the behavioral definitions and therapeutic interventions from its companion Treatment Planner.

• Homework Planners include homework assignments designed around each presenting problem (such as anxiety, depression, chemical dependence, anger management, eating disorders, or panic disorder) that is the focus of a chapter in its corresponding Treatment Planner.

• Client Education Handout Planners provide brochures and handouts to help educate and inform clients on presenting problems and mental health issues as well as life skills techniques. The handouts are included on CD-ROMs for easy printing from your computer and are ideal for use in waiting rooms, at presentations, as newsletters, or as information for clients struggling with mental illness issues. The topics covered by these handouts correspond to the presenting problems in the Treatment Planners.

The series also includes:

• TheraScribe®, the #1-selling treatment planning and clinical record-keeping software system for mental health professionals. TheraScribe® allows the user to import the data from any of the Treatment Planner, Progress Notes Planner, or Homework Planner books into the software’s expandable database to simply point and click to create a detailed, organized, individualized, and customized treatment plan along with optional integrated progress notes and homework assignments.

Adjunctive books, such as The Psychotherapy Documentation Primer and The Clinical Documentation Sourcebook, contain forms and resources to aid the clinician in mental health practice management.

The goal of our series is to provide practitioners with the resources they need in order to provide high quality care in the era of accountability. To put it simply: We seek to help you spend more time on patients and less time on paperwork.

ARTHUR E. JONGSMA, JR. Grand Rapids, Michigan

PROGRESS NOTES INTRODUCTION

ABOUT PRACTICEPLANNERS®PROGRESS NOTES

Progress notes are not only the primary source for documenting the therapeutic process but also one of the main factors in determining the veteran’s/service member’s eligibility for reimbursable treatment. The purpose of the Progress Notes Planner series is to assist the practitioner in easily and quickly constructing progress notes that are thoroughly unified with the veteran’s/service member’s treatment plan.

Each Progress Notes Planner:

• Saves you hours of time-consuming paperwork.

• Offers the freedom to develop customized progress notes.

• Features over 1,000 prewritten progress notes summarizing patient presentation and treatment delivered.

• Provides an array of treatment approaches that correspond with the behavioral problems and DSM-IV diagnostic categories in the corresponding companion Treatment Planner.

• Offers sample progress notes that conform to the requirements of most third-party payors and accrediting agencies, including JCAHO, COA, CARF, and NCQA.

HOW TO USE THISPROGRESS NOTES PLANNER

This Progress Notes Planner provides a menu of sentences that can be selected for constructing progress notes based on the behavioral definitions (or client’s symptom presentation) and therapeutic interventions from its companion Treatment Planner. All progress notes must be tied to the client’s treatment plan—session notes should elaborate on the problems, symptoms, and interventions contained in the plan.

Each chapter title is a reflection of the veteran’s/service member’s potential presenting problem. The first section of the chapter, “Veteran/Service Member Presentation,” provides a detailed menu of statements that may describe how that presenting problem manifested itself in behavioral signs and symptoms. The numbers in parentheses within the “Veteran/Service Member Presentation” section correspond to the numbers of the “Behavioral Definitions” from the Treatment Planner.

The second section of each chapter, “Interventions Implemented,” provides a menu of statements related to the action that was taken within the session to assist the client in making progress. The numbering of the items in the “Interventions Implemented” section follows exactly the numbering of “Therapeutic Intervention” items in the corresponding Treatment Planner.

All item lists begin with a few keywords. These words are meant to convey the theme or content of the sentences that are contained in that listing. The clinician may peruse the list of keywords to find content that matches the client’s presentation and the clinician’s intervention.

It is expected that the clinician may modify the prewritten statements contained in this book to fit the exact circumstances of the client’s presentation and treatment. To maintain complete client records, in addition to progress note statements that may be selected and individualized from this book, the date, time, and length of a session; those present during the session; the provider; provider’s credentials; and a signature must be entered in the client’s record.

A FINAL NOTE ABOUT PROGRESS NOTES AND HIPAA

Federal regulations under the Health Insurance Portability and Accountability Act (HIPAA) govern the privacy of a client’s psychotherapy notes as well as other protected health information (PHI). PHI and psychotherapy notes must be kept secure, and the client must sign a specific authorization to release this confidential information to anyone beyond the client’s therapist or treatment team. Further, psychotherapy notes receive other special treatment under HIPAA; for example, they may not be altered after they are initially drafted. Instead, the clinician must create and file formal amendments to the notes if he or she wishes to expand, delete, or otherwise change them. Our TheraScribeTM software provides functionality to help clinicians maintain the proper rules concerning handling PHI, by giving the ability to lock progress notes once they are created, to acknowledge client consent for the release of PHI, and to track amendments to psychotherapy notes over time.

Does the information contained in this book, when entered into a client’s record as a progress note, qualify as a “psychotherapy note” and therefore merit confidential protection under HIPAA regulations? If the progress note that is created by selecting sentences from the database contained in this book is kept in a location separate from the client’s PHI data, then the note could qualify as psychotherapy note data that is more protected than general PHI. However, because the sentences contained in this book convey generic information regarding the client’s progress, the clinician may decide to keep the notes mixed in with the client’s PHI and not consider it psychotherapy note data. In short, how you treat the information (separated from or integrated with PHI) can determine if this progress note planner data is psychotherapy note information. If you modify or edit these generic sentences to reflect more personal information about the client or if you add sentences that contain confidential information, the argument for keeping these notes separate from PHI and treating them as psychotherapy notes becomes stronger. For some therapists, our sentences alone reflect enough personal information to qualify as psychotherapy notes, and they will keep these notes separate from the client’s PHI and require specific authorization from the client to share them with a clearly identified recipient for a clearly identified purpose.

ADJUSTMENT TO KILLING

VETERAN/SERVICE MEMBER PRESENTATION

1. Negative Emotional Reaction to Killing (1)1

a. The veteran/service member displays frequent and intense emotions related to killing another human.

b. The veteran/service member displays guilt, remorse, and shame about his/her participation in killing another human.

c. The veteran/service member displays sadness about his/her involvement in killing another human.

d. The veteran/service member displays anger about his/her involvement in killing another human.

e. As treatment has progressed, the veteran’s/service member’s emotional reactions to killing have become less frequent and less intense.

f. The veteran/service member reports that he/she has come to be at peace with his/her military involvement related to taking the life of another person.

2. Ruminations about Killing (2)

a. The veteran/service member reports constant ruminations about his/her participation in killing another human.

b. The veteran/service member reports that he/she has frequent thoughts about his/her participation in killing another human.

c. As treatment has progressed, the veteran’s/service member’s ruminations about killing and harming others have decreased.

3. Avoids Future Killing Situations (3)

a. The service member avoids activities that might lead to having to kill another human again.

b. The service member has avoided combat missions in an effort to keep from having to kill another human.

c. The service member has broken military protocol and defied orders in order to avoid situations that might lead to killing another human.

d. As treatment has progressed, the service member has been willing to accept his/her duty that may involve taking of another human life.

4. Avoids Reminders of Killing (4)

a. The service member avoids activities that serve as reminders of killing.

b. The service member has declined activities such as shooting a weapon during training because of the association with his/her experiences of killing another human.

c. As treatment has progressed, the service member’s anxiety with activities that remind him/her of taking the life of another has decreased.

d. The service member reports that he/she is able to engage in all expected activities, regardless of whether these serve as a reminder of his/her experience related to killing another human.

5. Spiritual and Moral Conflicts (5)

a. The service member reports that he/she has been experiencing spiritual and moral conflicts related to killing others.

b. The service member is contemplating conscientious objector status.

c. The service member is struggling to reconcile his/her religious beliefs with his/her expectations and actions within the military.

d. As treatment has progressed, the service member has resolved his/her spiritual and moral conflicts.

6. Sleep Disturbance (6)

a. Since the traumatic killing event occurred, the veteran/service member has experienced a desire to sleep much more than normal.

b. Since the traumatic killing event occurred, the veteran/service member has found it very difficult to initiate and maintain sleep.

c. Since the traumatic killing event occurred, the veteran/service member has had a fear of sleeping.

d. The veteran’s/service member’s sleep disturbance has terminated and he/she has returned to a normal sleep pattern.

7. Alcohol/Drug Abuse (7)

a. Since the traumatic experience, the veteran/service member has engaged in a pattern of alcohol and/or drug abuse as a maladaptive coping mechanism.

b. The veteran’s/service member’s alcohol and/or drug abuse has diminished as he/she has worked through the traumatic killing event.

c. The veteran/service member reported no longer engaging in any alcohol or drug abuse.

8. Suicidal Thoughts (8)

a. The veteran/service member reported experiencing suicidal thoughts since the onset of posttraumatic stress disorder (PTSD).

b. The veteran’s/service member’s suicidal thoughts have become less intense and less frequent.

c. The veteran/service member reported no longer experiencing any suicidal thoughts.

INTERVENTIONS IMPLEMENTED

1. Assess Emotions (1)2

a. The veteran/service member was assessed in regard to the different types of emotions associated with killing another human.

b. Active listening, support, and empathy were provided during the clinical interview as the veteran/service member described his/her feelings of shame, guilt, anxiety, anger, and fear.

c. The veteran/service member was provided with support as he/she was quite emotional and forthcoming about his/her reaction to killing another human.

d. The veteran/service member was quite stoic and denied any significant emotions associated with killing another human, and was encouraged to express his/her emotions as they become more apparent.

2. Assess Severity of Emotional Impact (2)

a. The impact of the emotions on the veteran’s/service member’s current functioning was assessed through the use of clinical interview techniques.

b. The level of impact of the veteran’s/service member’s emotional functioning on his/her current functioning was assessed though the use of psychological testing.

c. It was reflected to the veteran/service member that he/she experiences a mild impact of the emotional reaction to killing on his/her current functioning.

d. It was reflected to the veteran/service member that he/she experiences a moderate impact of the emotional reaction to killing on his/her current functioning.

e. It was reflected to the veteran/service member that he/she experiences a severe impact of the emotional reaction to killing on his/her current functioning.

3. Teach about Negative Emotion Awareness (3)

a. The veteran/service member was taught techniques about how to become more aware of negative emotions.

b. The veteran/service member was taught to scan his/her body for physiological cues linked to his/her emotions.

c. The veteran/service member was provided with examples of physiological cues linked to his/her emotions (e.g., a tightening in the stomach to signal anxiety; balled fists to signal anger).

d. The veteran/service member was reinforced for his/her clear understanding of the physiological cues linked to negative emotions.

e. The veteran/service member has struggled to identify his/her negative emotions and was provided with remedial feedback about how to monitor for such emotions.

4. Assist with Labeling of Emotions (4)

a. The veteran/service member was assisted with correctly labeling his/her emotions.

b. The veteran/service member was supported as he/she sought to correctly label his/her emotions.

c. The veteran/service member was directed to use more descriptive terms for his/her emotions (e.g., breaking “mad” down into more descriptive terms such as “enraged,” “frustrated,” or “irritated”).

d. The veteran/service member struggled to correctly label his/her emotions and was provided with remedial feedback in this area.

5. Explain Thoughts Impacting Emotions (5)

a. The veteran/service member was taught about the concepts of how thoughts impact emotions.

b. The veteran/service member was provided with several examples of the connections between cognition and feelings.

c. The veteran/service member was reinforced as he/she displayed a clear understanding of how thoughts impact emotions.

d. The veteran/service member provided specific examples of how his/her thoughts impact his/her emotions.

e. The veteran/service member struggled to understand the concept of how thoughts impact emotions, and was provided with remedial feedback in this area.

6. Teach about Automatic Thoughts (6)

a. The veteran/service member was taught the role of distorted thinking in precipitating emotional responses.

b. The veteran/service member was assisted in identifying the distorted schemas and related automatic thoughts that mediate PTSD responses.

c. The veteran/service member was reinforced as he/she verbalized an understanding of the cognitive beliefs and messages that mediate his/her PTSD responses.

d. The veteran/service member was assisted in replacing distorted messages with positive, realistic cognitions.

e. The veteran/service member failed to identify his/her distorted thoughts and cognitions and was provided with tentative examples in this area.

7. Assign Automatic Thought Record/Journal (7)

a. The veteran/service member was requested to keep a daily journal that lists each situation associated with automatic thoughts.

b. The Socratic method was used to challenge the veteran’s/service member’s dysfunctional thoughts and replace them with positive, reality-based thoughts.

c. The veteran/service member was reinforced for instances of successful replacement of negative automatic thoughts with more realistic, positive thinking.

d. The veteran/service member has not kept his/her record of automatic thoughts and was redirected to do so.

8. Teach about Cognitive Errors (8)

a. The veteran/service member was taught about common cognitive errors.

b. The veteran/service member was taught about cognitive errors such as judging, catastrophizing, labeling, all-or-nothing thinking, self-blaming, etc.

c. The veteran/service member was assisted in connecting his/her cognitive errors to his/her thoughts about the traumatic events.

d. The veteran/service member was assigned “Negative Thoughts Trigger Negative Feelings” from the Adult Psychotherapy Homework Planner, 2nd ed. (Jongsma).

e. The veteran/service member was reinforced for his/her understanding about cognitive errors.

f. The veteran/service member struggled to identify his/her cognitive errors and was provided with remedial feedback in this area.

9. Conduct Behavioral Experiments (9)

a. The veteran/service member was encouraged to do “behavioral experiments” in which negative automatic thoughts are treated as hypotheses/predictions and are tested against reality-based alternative hypotheses.

b. The veteran’s/service member’s automatic negative thoughts were tested against the veteran’s/service member’s past, present, and/or future experiences.

c. The veteran/service member was directed to talk with other veteran/service members about their thoughts and beliefs about killing.

d. The veteran/service member was assisted in processing the outcome of his/her behavioral experiences.

e. The veteran/service member was encouraged by his/her experience of the more reality-based hypotheses/predictions; this progress was reinforced.

f. The veteran/service member continues to focus on negative automatic thoughts and was redirected toward the behavioral evidence of the more reality-based alternative hypotheses.

10. Replace Negative Thoughts with Adaptive Thoughts (10)

a. The veteran/service member was assisted with replacing negative thoughts with more adaptive thoughts.

b. The veteran/service member was assisted in developing more adaptive thoughts through his/her experience of reality testing experiments, therapeutic computation, and sporadic questioning.

c. The veteran/service member was reinforced for developing more adaptive thoughts to replace his/her negative ruminations.

d. The veteran/service member has struggled to replace negative thoughts and ruminations with more adaptive thoughts, and was provided with more specific examples in this area.

11. Reinforce Positive Self-Talk (11)

a. The veteran/service member was reinforced for any successful replacement of distorted negative thinking with positive, reality-based cognitive messages.

b. It was noted that the veteran/service member has been engaging in positive, reality-based thinking that has enhanced his/her self-confidence and increased adaptive action.

c. The veteran/service member was assigned to complete the “Positive Self-Talk” assignment from the Adult Psychotherapy Homework Planner, 2nd ed. (Jongsma).

12. Review Possible Outcomes for Future Missions (12)

a. In an effort to reduce anxiety and prepare emotionally for future combat/training missions, the service member was requested to identify the possible scenarios regarding future missions.

b. The service member was asked to theorize about the worst-case scenarios regarding future missions.

c. The service member was requested to identify the best-case scenarios regarding future missions.

d. The service member was asked to identify the most likely case scenarios regarding future missions.

e. The service member was assisted in comparing and contrasting the likely scenarios regarding future missions.

13. Instill Confidence in Capability (13)

a. In an effort to instill a sense of confidence and capability in the veteran/service member, his/her past training and successful performance were reviewed and processed.

b. The veteran/service member was reinforced as he/she identified his/her experience of past training and successful performance.

c. The veteran/service member struggled to identify his/her past successes and was provided with specific examples in this area.

14. Teach Relaxation Techniques (14)

a. The veteran/service member was trained in a variety of relaxation techniques to reduce anxiety.

b. The veteran/service member was taught about the use of deep muscle relaxation.

c. The veteran/service member was taught about the use of visual imagery.

d. The veteran/service member was taught about deep breathing exercises.

e. The veteran/service member has regularly used relaxation techniques, and their benefits were reviewed.

f. The veteran/service member has not regularly used relaxation techniques and was redirected to do so.

15. Use Imaginal Exposure (15)

a. The veteran/service member was asked to describe a traumatic experience at an increasing, but client-chosen, level of detail.

b. The veteran/service member was asked to continue to describe his/her traumatic experience at his/her own chosen level of detail until the associated anxiety reduces and stabilizes.

c. The veteran/service member was provided with recordings of the session and was asked to listen to it between sessions.

d. The veteran/service member was reinforced for his/her progress in imaginal exposure.

e. The veteran/service member was assisted in problem-solving obstacles to his/her imaginal exposure.

16. Assess Sleep Pattern (16)

a. The exact nature of the veteran’s/service member’s sleep disturbance was assessed, including his/her bedtime routine, activity level while awake, nutritional habits, napping practice, actual sleep time, rhythm of time for being awake versus sleeping, and so on.

b. The effect of the killing incident on the veteran’s/service member’s sleep pattern was assessed.

c. The assessment of the veteran’s/service member’s sleep disturbance found a chronic history of this problem, which becomes exacerbated at times of high stress.

d. The assessment of the veteran’s/service member’s sleep disturbance found that he/she does not practice behavioral habits that are conducive to a good sleep-wake routine.

17. Instruct on Sleep Hygiene (17)

a. The veteran/service member was instructed on appropriate sleep hygiene practices.

b. The veteran/service member was advised about restricting excessive liquid intake, spicy late-night snacks, or heavy evening meals.

c. The veteran/service member was encouraged to exercise regularly but not directly before bedtime.

d. The veteran/service member was taught about minimizing or avoiding caffeine, alcohol, tobacco, or other stimulant intake.

e. The veteran/service member was directed to use the “Sleep Pattern Record” from the Adult Psychotherapy Homework Planner, 2nd ed. (Jongsma).

f. The veteran/service member was reinforced for his/her regular use of sleep hygiene techniques.

g. The veteran/service member has not regularly used sleep hygiene practices and was redirected to do so.

18. Refer for Physician Evaluation (18)

a. The veteran/service member was referred to his/her physician to rule out any physical and/or pharmacological causes for his/her sleep disturbance.

b. The veteran/service member was referred to his/her physician to evaluate whether psychotropic medications might be helpful to induce sleep.

c. The veteran/service member was referred for sleep lab studies.

d. The physician has indicated that physical organic causes for the veteran’s/service member’s sleep disturbance have been found, and a regimen of treatment for these problems has been initiated.

e. The physician ruled out any physical/organic or medication side effect as the cause for the veteran’s/service member’s sleep disturbance.

f. The physician has ordered sleep-enhancing medications to help the veteran/service member return to a normal sleep pattern.

g. The veteran/service member has not followed through on the referral to his/her physician and was redirected to complete this task.

19. Monitor Medication Compliance (19)

a. The veteran/service member was noted to be consistently taking the antidepressant medication and stated that it was effective at increasing normal sleep routines.

b. The veteran/service member reported taking the antidepressant medication on a consistent basis but has not noted any positive effect on his/her sleep; he/she was directed to review this with the prescribing clinician.

c. The veteran/service member reported not consistently taking his/her antidepressant prescription and was encouraged to do so.

20. Normalize Spiritual and Moral Conflicts (20)

a. The veteran/service member was provided with empathetic listening as he/she verbalized his/her current spiritual and moral conflicts.

b. The veteran/service member was advised that his/her spiritual and moral conflicts are quite typical for an individual in his/her situation.

c. The veteran/service member was reinforced as he/she appeared more at ease with his/her emotional struggles.

21. Refer to Chaplain (21)

a. The veteran/service member was referred to a chaplain.

b. The veteran/service member was referred to spiritual and moral leaders associated with the military.

c. The veteran/service member has followed up on the referral to his/her chaplain, and the benefits of this opportunity were reviewed.

d. The veteran/service member has not contacted his/her chaplain and was reminded to do so.

22. Assign Reading Material about Killing (22)

a. The veteran/service member was assigned to read the book On Killing (Lieutenant Colonel Dave Grossman).

b. The veteran/service member has read the assigned material about killing in the military, and his/her reaction to the material was processed.

c. The veteran/service member has not read the assigned material on killing and was redirected to do so.

23. Normalize Apprehension and Anxiety (23)

a. Active listening was used as the service member talked about his/her apprehension and anxiety about going on future combat/training missions.

b. The service member’s apprehension and anxiety about future combat/training missions was normalized.

c. Specific examples of how others have struggled with similar apprehension and anxiety about future combat/training missions were reviewed.

24. Acknowledge Weapon Discomfort (24)

a. The service member’s discomfort with maintaining a weapon was acknowledged.

b. The service member was assisted in exploring his/her reasons behind the discomfort with maintaining a weapon.

c. Active listening and support were provided as the service member talked about his/her discomfort with maintaining a weapon.

d. The service member was very stoic about his/her discomfort with maintaining a weapon and was urged to talk about this as he/she feels more comfortable.

25. Encourage Continued Weapons Practice (25)

a. The service member was encouraged to participate in shooting range practice.

b. The service member was encouraged to continue to spend time and cleaning his/her weapon.

c. The service member has continued difficult practices regarding weapon use, and his/her experience was processed.

d. The service member continues to avoid anything to do with weapons and was provided with additional treatment in this area.

26. Teach about Impact of Conflicted Thoughts (26)

a. The veteran/service member was taught about how conflicted thoughts can affect emotions.

b. The veteran/service member was taught about how conflicted thoughts can affect physiological functioning.

c. The veteran/service member was assisted in applying the effects of conflicted thoughts to his/her experience.

d. The veteran/service member was supported as he/she identified the effects that his/her conflicted thoughts have had on his/her emotional and physiological functioning.

e. The veteran/service member denied any impact of his/her conflicted thoughts on emotional and physiological functioning and was urged to remain open to these concepts.

27. Refer for Substance Use Evaluation (27)

a. The veteran/service member was asked to describe his/her use of alcohol and/or drugs as a means of escape from negative emotions.

b. The veteran/service member was referred for an in-depth substance abuse evaluation.

c. The veteran/service member was supported as he/she acknowledged that he/she has abused alcohol and/or drugs as a means of coping with the negative consequences associated with the traumatic killing event.

d. The veteran/service member was quite defensive about giving information regarding his/her substance abuse history and minimized any such behavior; this was reflected to him/her and he/she was urged to be more open.

28. Refer for Medical Evaluation (28)

a. The veteran/service member was referred for a medical evaluation because substance dependence is suspected.

b. The veteran/service member has received the medical evaluation, but no substance dependence was identified.

c. The veteran/service member has received the medical evaluation, and substance dependence is confirmed.

29. Refer to Chemical Dependence Treatment (29)

a. The veteran/service member was referred for chemical dependence treatment.

b. The veteran/service member consented to chemical dependence treatment referral, as he/she has acknowledged it as a significant problem.

c. The veteran/service member refused to accept a referral for chemical dependence treatment and continued to deny that substance abuse is a problem.

d. The veteran/service member was reinforced for following through on obtaining chemical dependence treatment.

e. The veteran’s/service member’s treatment focus was switched to his/her chemical dependence problem.

30. Tell the Story of the Killing (30)

a. The veteran/service member was gently encouraged to tell the entire story of the traumatic event.

b. The veteran/service member was given the opportunity to share what he/she recalls about the traumatic event.

c. Today’s therapy session explored the sequence of events before, during, and after the traumatic event.

31. List Regrets (31)

a. The veteran/service member was asked to develop a list of all the regrets he/she has concerning the killing.

b. The veteran/service member was provided with empathetic listening and assistance in verbalizing his/her thoughts about the regrets that he/she has concerning the killing.

c. The veteran/service member was assisted in processing the list of regrets related to the killing in which he/she has participated.

32. Use Rational Emotive Approach (32)

a. A rational emotive approach was used to confront the veteran’s/service member’s statements of responsibility for the killing.

b. The veteran/service member was encouraged to consider the reality-based facts surrounding the killing and his/her distortion of those facts in accepting responsibility for the loss irrationally.

c. The veteran/service member was reinforced as he/she has decreased his/her statements and feelings of being responsible for the killing.

33. Treat/Explain Regarding Grief (33)

a. The veteran’s/service member’s experience was treated as one of grieving.

b. The veteran/service member was assisted in understanding the stages of grief.

c. The veteran/service member was assisted in identifying his/her current stage of grief.

d. The veteran/service member was taught about how to cope with, manage, and move through the stages of grief.

34. Assess Suicide Risk (34)

a. The veteran’s/service member’s experience of suicidal urges and his/her history of suicidal behavior were explored.

b. It was noted that the veteran/service member has stated that he/she does experience suicidal urges but feels that they are clearly under his/her control and that there is no risk of engagement in suicidal behavior.

c. The veteran/service member identified suicidal urges as being present but contracted to contact others if the urges became strong.

d. Because the veteran’s/service member’s suicidal urges were assessed to be very serious, immediate referral to a more intensive supervised level of care was made.

e. Due to the veteran’s/service member’s suicidal urges and his/her unwillingness to voluntarily admit himself/herself to a more intensive, supervised level of care, involuntary commitment procedures were begun.

f. The service member’s chain of command was notified of the service member’s suicide ideation and was asked to form a 24-hour suicide watch until the service member’s crisis subsides.

35. Restrict Access to Weapons (35)

a. Support and supervisory people were contacted and told to remove weapons from the living environment of the veteran/service member.

b. A recommendation was made to the service member’s chain of command that the service member be limited to low risk training.

c. The veteran/service member understood and agreed with the actions taken to restrict his/her access to weapons that he/she could use for self-injury.

36. Encourage Time with Supports (36)

a. The veteran/service member was encouraged to spend more time with family and friends.

b. The veteran’s/service member’s tendency to isolate himself/herself was monitored.

c. The veteran/service member was reinforced for his/her regular involvement with friends and family.

d. The veteran/service member has not regularly maintained involvement with extended family and was reminded to do so.

ADJUSTMENT TO THE MILITARY CULTURE

SERVICE MEMBER PRESENTATION

1. Difficulty Following Rules and Orders (1)3

a. The service member reported difficulty adjusting to following the many rules of the military culture.

b. The service member has difficulty accepting orders from others.

c. The service member’s problems with following rules and orders have resulted in disciplinary action.

d. As treatment has progressed, the service member has adjusted to following rules, orders, and other military expectations, and this progress has been reinforced.

2. Emotional Reaction to Loss of Independence (2)

a. The service member focused on his/her sense of loss of autonomy and independence as he/she has entered the military culture.

b. The service member reports sadness, frustration, anxiety, and hopelessness due to the loss of autonomy and independence.

c. The service member has displayed erratic behavior due to his/her negative reaction to the loss of autonomy and independence.

d. As treatment has progressed, the service member has become more stable in his/her reaction to the loss of autonomy and independence.

e. The service member is now much more accepting of the loss of independence in the military culture.

3. Reprimands (3)

a. The service member identified a persistent pattern of insubordination, misconduct, disrespect, and failure to follow orders.

b. The service member does not regularly adhere to military customs and courtesies.

c. The service member has been reprimanded often for his/her failure to comply with military expectations.

d. The service member is at risk for serious reprimands for failure to follow military expectations.

e. As treatment as progressed, the service member reports increased compliance with following orders and accepting military expectations.

f. The service member has not been recently reprimanded for any insubordination, misconduct, disrespect, or failure to follow orders/expectations.

4. Failure to Meet Standards (4)

a. The service member has failed to meet the minimum standards set by the military.

b. The service member has failed to meet the minimum standards for physical fitness as expected by the military.

c. The service member has failed to meet the basic academic expectations of the military.

d. The service member has failed to meet the basic professional standards set by the military.

e. As treatment has progress, the service member has improved his/her performance in meeting military standards.

f. The service member meets all minimum physical fitness, academic, and professional standards.

5. Negative Effects of Decreased Sleep (5)

a. The service member reported a pattern of decreased sleep.

b. The service member’s mental functioning has decreased as a result of his/her decreased level of sleep.

c. The service member’s physical functioning has suffered because of his/her lack of sleep.

d. The service member’s mental and physical functioning has improved as sleep has increased.

6. Absent Without Leave (6)

a. The service member has decided to go absent without leave as a means to escape the stress of military life.

b. The service member went absent without leave and is now being disciplined.

c. Although the service member has been tempted to go absent without leave, he/she has seen the problems this may create and has declined to do so.

d. The service member acknowledged the poor judgment associated with going absent without leave.

7. Desires to Leave Military (7)

a. The service member reported a desire to leave the military and return to civilian life.

b. The service member has initiated proceedings to leave the military.

c. As treatment has progressed, the service member reports greater certainty in regard to his/her decision about remaining in the military.

d. The service member has made a clear decision to leave the military.

e. The service member has reversed his/her thinking and has made a clear decision to remain in the military.

8. Homesickness and Isolation (8)

a. The service member reports strong feelings of homesickness.

b. The service member reports strong feelings of isolation and difficulty connecting with any other service members.

c. The service member reports a better connection to others within the military.

d. The service member’s feelings of homesickness have significantly decreased.

INTERVENTIONS IMPLEMENTED

1. Explore Current Stressors (1)4

a. The service member’s current military stressors were reviewed.

b. The service member was helped to make a connection between current stressors and feelings of frustration, hopelessness, depression, and anxiety.

c. The service member was reinforced for his/her acknowledgment of stressors and emotions.

d. The service member reported decreased feelings of hopelessness, depression, and anxiety, and this progress was reinforced.

2. Rank Order Stressors (2)

a. The service member was assigned to create a list of stressors contributing to his/her current situation.

b. The service member was asked to rank order the stressors from the most troubling to the least troubling.

c. The service member has completed his/her rank order list of stressors, and these were processed in the session.

d. The service member has not completed his/her rank order list of stressors and was redirected to do so.

3. Identify Similar Situations and Outcomes (3)

a. The service member was assisted in identifying several dissatisfying situations in the past that were similar to his/her current circumstance and feeling.

b. The service member was asked to identify the outcomes of the similar situations in his/her past.

c. Reasons behind both negative and positive outcomes of similar past situations were processed.

4. List Emotions (4)

a. The service member was assigned to create a list of the various emotions caused by his/her challenges in adjusting to the military culture.

b. The service member was offered a list of emotions from which to select his/her typical emotions when challenged by adjustment to the military culture.

c. The service member has identified a variety of emotions regarding his/her challenges to adjusting in the military culture, and these were accepted and processed.

d. The service member had difficulty naming emotions caused by his/her challenges in adjusting to the military culture and was provided with additional feedback in this area.

5. Explore Stigma about Emotions (5)

a. Stigma that may be associated with identifying and accepting emotions was explored with the service member.

b. Beliefs contrary to identifying and accepting emotions (e.g., “emotions make you weak”) were reviewed and processed with the service member.

c. The service member acknowledged beliefs that tend to minimize and invalidate emotions, and these were processed.

d. The service member denied any beliefs that would minimize or invalidate the identification and expression of emotions, and he/she was provided with beliefs for which he/she should be monitoring.

6. Identify Military Positives (6)

a. The service member was assigned to develop a list of what he/she likes about serving in the military.

b. The service member has created a list of reasons why he/she likes serving in the military, and this was processed within the session.

c. The service member has struggled to identify a list of what he/she likes about serving in the military and was provided with specific examples in this area.

d. The service member has not attempted to develop a list of what he/she likes about serving in the military and was redirected to do so.

7. Switch Role Play (7)

a. A role-play situation was facilitated in which the service member and the therapist switch roles, and the service member was required to convince the therapist that the military can be a positive environment.

b. As a result of the switched role play, the service member has identified ways in which the military can be a positive environment; this progress was reinforced.

c. The service member has struggled to identify ways in which the military can be a positive environment, and he/she was urged to identify possible options in this area.

8. Encourage Acting as Model Service Member (8)

a. The service member was encouraged to act or role-play (as if) he/she were a model/squared-away service member while at work.

b. The service member has attempted to present himself/herself as a model service member, and his/her experience was processed.

c. The service member has not attempted to act as if he/she were a model/squared-away service member and was redirected to practice this for a time-limited period.

9. Brainstorm Stress Management Techniques (9)

a. The service member was assisted in brainstorming healthy ways of coping with stress and improving mood.

b. The service member was encouraged to use progressive muscle relaxation techniques.

c. The service member was encouraged to replace negative thoughts with positive ones.

d. The service member has identified several healthy ways of coping with stress and improving his/her mood; his/her response and progress were monitored.

e. The service member has struggled to identify healthy ways to improve his/her mood and was provided with additional feedback in this area.

10. Teach Anger Management Techniques (10)

a. The service member was taught techniques for managing anger.

b. The service member was taught deep breathing techniques.

c. The service member was taught about taking a time-out.

d. The service member has used anger management techniques to control his/her level of frustration.

e. Through the use of the identified anger management techniques, the service member has significantly decreased his/her impulsive actions.

f. The service member has struggled to learn and utilize anger management techniques and was provided with remedial instruction in this area.

11. Apply Problem-Solving Processes (11)

a. The service member was taught how to apply the seven-step military problem-solving process to his/her current situation.

b. The service member was taught about recognizing and defining the problem as well as gathering facts and making assumptions.

c. The service member was taught about defining end states or goals and establishing criteria for success.

d. The service member was taught about developing possible solutions and analyzing and comparing possible solutions.

e. The service member was taught about selecting and implementing a solution as well as analyzing the solution for effectiveness.

f. The service member displayed a clear understanding of how to use the seven-step military problem-solving process to his/her current situation and was reinforced for this.

g. The service member struggled about how to apply the seven-step military problem-solving process to his/her current situation and was provided with remedial assistance in this area.

12. Apply Problem-Solving Process (12)

a. The service member was asked to identify a current problem on which to apply the problem-solving process.

b. The service member was assisted in identifying how he/she would utilize the problem-solving process for the identified problem.

c. The service member was assisted in developing an action plan for real-world implementation.

d. The service member was assisted in reviewing and processing the outcome of his/her problem-solving process.

13. Teach Assertiveness (13)

a. Role-playing techniques were used to teach the service member various methods for being more assertive in personal and professional situations.

b. The empty-chair technique was used to teach the service member about assertiveness.

c. Role-reversal techniques were used to practice and learn about assertiveness in personal and professional situations.

d. The service member has displayed increased understanding about assertiveness in professional and personal situations; this progress was reinforced.

e. The service member has struggled to learn about increased assertiveness and was provided with remedial feedback in this area.

14. Assign Books on Assertiveness (14)

a. The service member was assigned to read books on assertiveness.

b. The service member was assigned to read The Complete Idiot’s Guide to Assertiveness (Davidson).

c. The service member was assigned to read How to Grow a Backbone: Ten Strategies for Gaining Power and Influence at Work (Marshall).

d. The service member has read the assigned information on assertiveness, and the content was processed and applied to current life problems.

e. The service member has not read the assigned information on assertiveness and was redirected to do so.

15. Develop Pleasant Activities (15)

a. The service member was encouraged to develop activities that he/she enjoys.

b. The service member was encouraged to include activities that can be done with others or alone, if desired (i.e., hiking, fishing, and biking).

c. The service member was assigned “Identify and Schedule Pleasant Activities” from the Adult Psychotherapy Homework Planner, 2nd ed. (Jongsma).

d. The service member completed the homework assignment, and the content was processed within the session.

e. The service member has completed the assignments for developing activities, and this list was processed.

f. The service member has engaged in desired activities, and his/her experience was processed.

g. The service member has not developed or used any list of activities in which he/she can participate with others or alone and was redirected to do so.

16. Set Strict Boundaries for Time Off (16)

a. The service member was assisted in setting clear and strict boundaries when he/she has time off from work.

b. The service member was encouraged to identify the circumstances under which he/she is willing or not willing to accept additional work.

c. The service member has set clear boundaries for his/her time off from work, and his/her implementation of this was reviewed and processed.

d. The service member has struggled to maintain his/her clear boundaries about time off from work and was assisted in problem-solving these struggles.

17. Encourage Non-Military Related Activities (17)

a. The service member was encouraged to participle in non-military-related outings/activities that promote a sense of connectedness to others in the community.

b. Examples of activities that promote a sense of connectedness were provided to the service member, including attending church socials, volunteering at an animal shelter, etc.

c. The service member has begun involvement in non-military-related outings and activities, and his/her experience was processed.

d. The service member has not sought out nonmilitary activities that promote connectedness with the community and was reminded about this important resource.

18. Encourage Friendships (18)

a. The service member was encouraged to develop friendships with current and past service members.

b. The service member was encouraged to seek out social supports who understand the challenges of being in the military.

c. The service member has talked on a social basis with others who understand the challenges of being in the military, and his/her experience was processed.

d. The service member has not sought out friendships with current or past service members and was reminded to do so.

19. Encourage VFW Activities (19)

a. The service member was encouraged to attend an activity at a local Veterans of Foreign Wars (VFW) organization.

b. The service member was provided with specific information about the availability of VFW activities.

c. The service member has attended an activity at a local VFW post, and his/her experience was processed.

d. The service member has not attended a VFW activity and was redirected to do so.

20. Connect with Chaplain (20)

a. The service member was encouraged to talk with his/her unit chaplain about his/her problems adjusting to the military culture.

b. The service member has talked to the unit chaplain about his/her problems, and his/her experiences were processed.

c. The service member did not feel that his/her needs were met through the contact with the unit chaplain and was provided an alternative spiritual resource with whom to share.

d. The service member has not contacted the chaplain and was redirected to do so.

21. Assist in Contact with Base/Post Services (21)

a. The service member was assisted in making contact with local base/post services that help service members adjust to military life.

b. The service member was encouraged to get involved with base/post services, such as the single soldiers’ club.

c. The service member has made contact with the local base/post services that help service members adjust to military life, and his/her experience was processed.

d. The service member has not made contact with a base/post services and was redirected to do so.

22. Encourage Talking with Superiors (22)

a. The service member was encouraged to talk about his/her difficulty adjusting to military culture with his/her squad leader, platoon sergeant, first sergeant, or others in the chain of command whom he/she trusts.

b. The service member has talked with his/her chain of command about the current situation, and the experience was processed.

c. The service member has not informed the chain of command about his/her current adjustment difficulties and was reminded that this will be an important step.

23. Include Family (23)

a. The service member’s significant other was included in joint sessions to deal with problems that are impacting all parties involved.

b. The service member’s family was included with joint sessions to deal with problems that are impacting all parties involved.

c. The service member reported better support from his/her family members, and this progress was reviewed.

24. Encourage Physical Fitness Instruction (24)

a. The service member was encouraged to meet with a certified instructor at his/her local base/post in order to develop a physical fitness training plan.

b. The service member has started a physical fitness training regimen, and his/her experience was processed.

c. The service member reports better adjustment as he/she experiences better physical fitness; this progress was highlighted.

d. The service member has not coordinated involvement with a certified instructor at his/her local base/post and was reminded to do so.

25. Reinforce Physical Fitness Gains (25)

a. The service member was noted to have made significant physical fitness gains.

b. Encouragement was provided to the service member in regard to his/her physical fitness program.

c. Positive feedback was provided to the service member for his/her physical fitness gains.

26. Teach Imagery Techniques (26)

a. The service member was taught imagery techniques that can improve his/her performance on the required physical fitness test.

b. The service member was taught how to imagine success versus failure at fitness tasks.

c. The service member has regularly used imagery techniques, and his/her experience was processed.

d. The service member has not used the imagery techniques and was reminded about how these can be helpful.

27. Teach about the Need for Authority (27)

a. The service member was taught about the need for authority and chain of command to promote order and safety in the face of threat and chaos during an attack.

b. The service member was reinforced for his/her acceptance of the need for authority and chain of command.

c. The service member was assisted in identifying how the authority and chain-of-command issues need to occur during training, deployment, and all other times within the military, not just during the threat and chaos of an attack.

d. The service member has shown increased adjustment since his/her acceptance of the need for authority and chain of command, and this was reinforced.

e. The service member continues to resist the need for authority and chain of command and was provided with additional feedback.

28. Explore History of Resistance to Authority (28)

a. The service member’s civilian patterns of resistance to authority were reviewed.

b. Distinctions were drawn between the resistance to authority within civilian life and the need for authority and chain of command within the military setting.

c. The service member was encouraged to develop new reactions to authority within the military setting.

d. The service member was encouraged to view civilian resistance to authority as appropriate at that time but submission to authority as appropriate for this time.

29. List Negative Consequences for Resistance to Authority (29)

a. The service member was asked to list the negative consequences that will occur if a pattern of resistance to authority continues.

b. The service member was assisted in developing a list of negative consequences for resistance, including lack of promotion, possible confinement, disciplinary assignments, etc.

c. The service member has listed the negative consequences that will occur if the pattern of resistance to authority continues, and this list was processed.

d. The service member has not listed the negative consequences that will occur if a pattern of resistance to authority continues, and this resistance was processed.

30. Explore Isolation and Homesickness (30)

a. The service member’s feeling of isolation was queried and processed.

b. The service member was asked about his/her feelings of homesickness.

c. The service member identified significant feelings of isolation and homesickness, and these were accepted.

d. The service member denied any pattern of homesickness or isolation, and he/she was reminded to monitor for this.

31. Role-Play Establishing Social Contact (31)

a. Role-play situations were used for the service member to practice reaching out to others to establish social contact.

b. The service member was assigned “Restoring Socialization Comfort” from the Adult Psychotherapy Homework Planner, 2nd ed. (Jongsma).

c. The service member completed the homework assignment, and the content was processed within the session.

d. The service member has developed a greater comfort with reaching out to others to establish social contact, and this was reinforced.

e. The service member continues to struggle with how to reach out to others to establish social contact and was provided with remedial feedback in this area.

AMPUTATION, LOSS OF MOBILITY, DISFIGUREMENT

VETERAN/SERVICE MEMBER PRESENTATION

1.