Identity and Trust Vignette Learning Points

Barika experiences PTSD symptoms, including flashbacks of dead soldiers and body parts, sleeplessness, nightmares, and placing her young child at risk. She is overwhelmed with memories of her service in Iraq in the morgue. The Army has paid for her advanced training in DNA work and as she feared she is recalled to active duty, which might lead to the break up of her family. Back in Iraq, Jenn, a Warrant Officer and co-worker in Mortuary Affairs, has experienced sexual harassment from a superior officer. She seeks advice and intervention from Chaplain Kelly who promises to help. The Chaplain tries, but fails to speak truth to power.

Issues Raised in Vignette While on a nighttime body part pick up run, Jenn is injured by an IED blast while substituting for Barika. Feeling survivor guilt, Barika hurries to the hospital to be at Jenn’s side. Michael, Barika’s husband, calls her from home. Stressed at being a single parent as well as a police detective, he suspects that their light skinned baby may have been fathered by Barika’s ex-boyfriend. She is outraged by Michael’s accusation of infidelity.

She requests and receives emergency leave. Michael greets her with the good news of a DNA test confirming his fatherhood. Barika explodes at his distrust. Though Michael protests, they go to a therapist to try to rescue their marriage. The therapist identifies their issues. Their strained marriage is caused by separation, conflict, stress, and lack of parenting skills. Barika is sad about missing her child’s developmental milestones. Michael worries that he has no experience raising a child, and on his job he witnesses all kinds of horrors caused by bad parenting. Barika expresses sadness about being an absentee parent, and it becomes clear to the therapist that, with work, the marriage can survive.

Issues Raised in Therapy: a.Individual Therapy Barika addresses her flashbacks, intrusive thoughts, difficulty sleeping, and other PTSD symptoms. The therapist coaches her on how to calm herself (Grounding Techniques) and to focus her thinking. They discuss her fears, validate her feelings and reactions to trauma. Multiple deployments are identified as causing difficulty resolving initial treatment for PTSD. The therapist makes a referral for medicine and group therapy.

Marital Therapy The therapist addresses trust issues, reframes their mutual and un-healthy reaction to stress and fears, and encourages mutual support and understanding. He reframes their conflict and communication, encouraging them to verbalize feelings with acceptance and respect. The therapist also validates their mutual stress and pressures, and directs the couple toward accepting and supporting one another more openly.

He clarifies that ‘fixing the problem’ cannot be done in one session, but is a process, and discusses their options, including individual therapy, education, and supports, and other resources. The therapist encourages both spouses to learn to develop effective listening skills and increase empathy for each other’s new roles.

Questions What are the turning points in the therapy sessions? What would you plan next in the therapy sessions?