1. Point Blank Vignette Learning Points

2. Issues Raised in Vignette The Hamilton’s are a military couple who are both exposed to traumatic combat experiences in Iraq. Captain Kate Hamilton is wounded when the vehicle she is driving explodes, hit by an IED. Driving in from another area of operations, Lieutenant Colonel Ben Hamilton rushes into the Combat Support Hospital, and comforts his wounded wife as she comes out from under anesthesia.

3. Ben hurriedly leaves to return to his area of operations where he attempts to control angry Iraqi villagers, upset that his unit has taken four Iraqi women in for questioning. The villagers suspect exploitation. He attempts to calm the angry crowd through a translator who uses a bullhorn, but as he returns to his vehicle, he is shot several times by an insurgent, resulting in a life threatening injury and ultimately a spinal injury and paralysis from the neck down. Ben is flown for treatment from Iraq to a Regional Medical Center, to Walter Reed Army Hospital and is finally discharged to his home.

4. Depressed, angry and paralyzed, Ben Hamilton wishes he had the means to commit suicide. His wife Kate, now working as a college instructor, is the sole financial support for the two of them. Ben tells her that he feels useless and wants to be placed in a long term VA care facility so that she can live her life without the burden of caring for him. Kate tells him that she loves him and wants him to stay at home. Kate takes Jeff to a physical therapy clinic appointment and learns from the therapist how to carry on Ben’s in-home course of rehabilitation. Ben is a large man, and the strain of performing physical therapy on her husband is taxing.

5. The couple seek marital therapy. Ben tells the therapist that he feels irrelevant and wants Gen to set him free. Gen reassures him that she loves him and is determined that they will stay together as a couple. Ben seeks individual therapy with a compassionate psychiatrist and tells him he is feeling hopeless and wants to die. Dr. Chau explains to Jeff that he will treat his depression and PTSD. Kate’s persistence, commitment, and resilience is a powerful recovery force.

6. One day, Ben regains movement in his right hand, which brings more options and hope. They are excited at the prospects for his greater independence. Dr. Chau learns in a counseling session that Ben plans to purchase a motorized wheelchair. Kate also tells of her husband had a wet dream, and asks the psychiatrist if they could start a family. The psychiatrist expresses his support and refers them to a fertility therapist. Ben acquires a motorized wheelchair, and begins to feel the return of independence.

7. Employed as a docent at a children’s science museum, Ben discovers it is enjoyable teaching children. As he leaves the job, Kate informs him that she has been to her doctor and learned she is pregnant. Their future as a family now begins.

8. Physical Therapy Kate is trained to provide in-home physical therapy. Individual Therapy Ben feels helpless and wants to die. The psychiatrist suggests treatment for depression and PTSD symptoms with medication and group therapy. Issues Addressed in Therapy

9. Couples Therapy Ben s feelings of depression, despair, and irrelevance are discussed and validated. Ben states his desire to be placed in a long term care facility. Kate reassures her husband that she loves him and wants him to stay at home. The therapist guides the couple to freely express their different expectations, accept each other’s feelings and attempt to achieve mutual understanding. They both share with the psychiatrist the news that Ben has feeling restored in his right hand and that he wants to purchase a motorized wheelchair. The psychiatrist encourages Ben’s quest for self-reliance.

10. Ben’s wet dream and their desire to start a family is discussed. The psychiatrist is supportive, and refers them to a fertility therapist. Dr. Chau explains to Ben the importance of PTSD relapse prevention. He educates Ben to identify his psychological triggers and to learn coping skills.

11. Other Therapy Issues When assisting physically disabled war veterans, behavioral health providers could consider referring clients to Veterans Administration Polytrauma Units. It is important to assess current physical functioning, family assets for coping, importance of requesting medical records, develop treatment planning, and set therapeutic and recovery goals. Combat Veterans have up to two years medical and behavioral healthcare through TRICARE coverage after their return from the war. Health Care Providers must assess the family expectations when helping disabled soldiers.

12. Questions What are the turning points in the Stages of Change? What would you do next in therapy?