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B. The veteran/service member was referred to his/her physician to evaluate whether psychotropic medications might be helpful to induce sleep. The veteran/service member was referred for sleep lab studies. The physician ruled out any physical/organic or medication side effect as the cause for the veteran’s/service member’s sleep disturbance. The physician has ordered psychotropic medications to help the veteran/service member return to a normal sleep pattern.

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The psychological test results indicate that the veteran’s/service member’s depression level has decreased significantly and the suicide risk is minimal. The service member’s chain of command was advised about his/her suicide potential. The follow-through of significant others in providing supervision of the veteran/service member during this suicide crisis was monitored. Significant others were contacted to make sure that the veteran/service member was receiving adequate supervision. Identify Immediate Help A. The veteran/service member was asked to identify a clear plan for seeking help if he/she feels suicidal prior to the next appointment. The veteran/service member was directed to contact his/her immediate supervisor, relative, or friend if his/her suicide thoughts become overwhelming.

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Teach Forgiveness A. The service member was taught the value of forgiveness as a means of overcoming pain and hurt rather than holding on to it and acting out the anger that results from it. The service member was asked to list those parental figures from his/her childhood who have caused him/her pain and suffering. The service member was assisted in developing a list of benefits of beginning a process of forgiveness toward those perpetrators of pain in his/her childhood.

As the partners have attempted to place the therapist in the role of mediator or judge, they were redirected. Recognize Gradations of Anger A. The partners were taught to recognize the gradations of anger. The partners were taught about when they need to take steps to cool down before selfcontrol becomes eroded. The partners were taught cool-down techniques (e.g., relaxation and deep breathing exercises, take time-out for 15 minutes, go for a walk). The partners were assessed for their understanding of the gradations of anger and when they need to take steps to cool down.

The veteran/service member was assisted in identifying losses that have contributed to feelings of grief that have not been resolved. The veteran’s/service member’s unresolved feelings of grief are noted to be contributing to current feelings of depression and were provided a special focus. 20. Using role-playing, modeling, and behavioral rehearsal, the veteran/service member was taught how to implement conflict resolution skills. The veteran/service member reported implementation of conflict resolution skills in his/her daily life and was reinforced for this utilization.

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Emphasize Go now of Chaos in Combat A. It was noted that the events related to the veteran’s/service member’s actions or lack of actions related to the loss was a chaotic combat situation. A discussion was held about the accidents that happen during the stress and chaos of combat. It was reflected to the veteran/service member that the extreme circumstances of combat can negatively impact decision making. The veteran/service member was assisted in processing the issues related to how the stress and chaos affected his/her actions or lack of actions. Emphasize Routine A. The veteran/service member was educated about how following a routine promotes familiarity, contentment, and predictability.

Decreased Social and Occupational Functioning A. The veteran/service member reports decreased social involvement subsequent to the loss of a comrade. The veteran/service member reports that his/her occupational functioning has decreased subsequent to the loss of a comrade. The veteran/service member noted that he/she is less interested and motivated in regard to social and occupational needs since the loss of the comrade. As treatment has progressed, the veteran/service member reports increased social and occupational functioning. Guilt Feelings A. The veteran/service member reports that he/she feels responsible for the death of a comrade.

The service member was expected to be in sight of a peer 24 hours a day. The service member has been compliant with the safety plan as developed. The service member has not been compliant with the safety plan and was reminded to continue this for his/her own safety. The service member has not been compliant with the safety plan, and a more restrictive setting was initiated. Lethargy/Apathy A. The veteran/service member reported no longer having the energy for or the interest in activities that he/she formerly found challenging and rewarding. Death Preoccupation The veteran/service member reported recurrent thoughts of his/her own death.

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The veteran/service member identified how his/her psychiatric concerns may contribute to his/her sleep problems. The veteran/service member denied any psychiatric concerns that would contribute to his/her elevated arousal. B. The “Applying Problem-Solving to Interpersonal Conflict” assignment from the Adult Psychotherapy Homework Planner, 2nd ed.

The veteran/service member was advised that moderate social, occupational, and interpersonal functioning effects were noted. The veteran/service member was advised that significant, social, occupational, and interpersonal functioning effects were noted. The veteran/service member was urged to take responsibility for routine activities in order to overcome depression symptoms. The veteran/service member was reinforced for his/her increased self-reliance.

An example was provided of how someone with a fear of needles may react during the initial inoculation process in basic training. The veteran/service member was taught about factors that interact to maintain the problem phobia from information in Mastery of Your Specific Phobia—Therapist’s Guide . The veteran/service member was taught about factors that interact to maintain phobic fear from information in Specific Phobias . The veteran/service member was provided with examples of how changing thought patterns can decrease phobic reactions. Develop Peer Pressure Resistance A. The veteran/service member was assisted in developing methods to combat peer pressure. The veteran/service member was directed to combat peer pressure in specific ways (e.g., create a new social network; learn to anticipate peer pressure before it happens).