Extraction
Vignette Learning Points
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.
• 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.
• 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.
• 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.
Issues Addressed in Therapy
a. 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.
• The Sergeant bottles up and denies his
feelings.
• He feels that his wife and daughters have the
“problem,” and denies having any problems
himself.
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.
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.
• 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.
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?