Extraction

1. Extraction Vignette Learning Points

2. Issues Raised in Vignette • A Special Forces team leader in Iraq, is ordered to extract an Iraqi • interpreter and his family by helicopter to a safe house. • The interpreter unexpectedly brings along many orphans who • cannot be accommodated in one helicopter. • He makes a split second decision for the helicopter to take off • without the orphans, resulting in the enemy killing all the children. • He is deeply disturbed and feels guilt, anger and irritability about • his decision to leave the orphans.

3. • After the Sergeant redeploys back home to his family, he struggles with PTSD symptoms including flashbacks, avoidance, isolative behavior, hyper-arousal and intrusive thoughts. • He has difficulty controlling his temper, and has angry outbursts directed at his two daughters. They become fearful of his unpredictable moods. • The Sergeant attempts to control his family by not allowing his daughters to have music or friends at home.

4. • He physically abuses and sexually batters his wife. She becomes fearful of him. • The wife and daughters seek the assistance of a family therapist to deal with the Sergeant’s angry outbursts. • His wife admits to the family therapist, feeling ashamed, that her husband has sexually battered her during intercourse; requiring medical treatment. • When the Sergeant experiences flashbacks while driving, he is arrested by sheriff deputies for erratic and unsafe driving, and is put in jail.

5. • He decompensates while in jail, and becomes emotionally distraught, irritable, and agitated, and is placed in restraints. • Served with a restraining order and separated from his family, he withdraws and is isolated from his family members, spending extended periods of time sitting alone in trees or parts of his house. • With the realization that he has lost his family and his peace of mind, the Sergeant decides to begin therapy.

6. Issues Addressed in Therapy • Family therapy: • • Family members are encouraged to openly communicate feelings • of fear and loss, validating the feelings of all family members. • • His wife and children are fearful of his angry outbursts and violent • behaviors. • • The entire family is anxious and frustrated about the destabilizing • changes in their family and home.

7. • The Sergeant bottles up and denies his feelings. • He feels that his wife and daughters have the “problem,” and denies having any problems himself.

8. b. Individual Therapy: Wife: • She feels sadness and pain, and grieves the uncertain and hopefully temporary change of her loving and previously stable husband. • She is fearful of her husband’s violent and erratic behaviors. • She is ashamed, embarrassed, and physically injured from his aggressive sexual behavior. • She feels obligated to protect her children, self and family by filing a restraining order.

9. Husband: • The Sergeant is depressed, hyper-vigilant, and feels guilty and unable to control his angry impulses. He has been temporarily separated from his family by a court order. • He seeks individual therapy with Dr. Jones, who provides him with empathy and an opportunity to express his feelings of guilt and shame. • The Sergeant begins EMDR, and responds well to the therapist’s ability to help him expose and identify his feelings.

10. • He successfully responds to cognitive reframing; going from “I was responsible” to “I saved some people.” • The Sergeant responds well to therapy (Exposure Techniques), and begins the extinction of uncomfortable feelings. • She encourages him to normalize his life and reconnect with his wife and two daughters, and eventually the family reunites.

11. Questions • What were the turning points that allowed him to progress through the Stages of Change? • What could have been done differently? • What would the prognosis be if his family wasn’t supportive?