The service member was referred for a medication evaluation to assist with depression or anxiety symptoms. The service member was reinforced as he/she agreed to follow through on the medication evaluation. The service member was strongly opposed to being placed on medication to help stabilize his/her moods and emotional distress; his/her objections were processed.

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The service member’s irritability has diminished somewhat and the intensity of the explosive outbursts has lessened. The service member reported no recent incidents of explosive, angry outbursts. Abandonment Fears A. The veteran/service member described a history of becoming very anxious whenever there is any hint of abandonment present in an established relationship. The veteran’s/service member’s hypersensitivity to abandonment has caused him/her to place excessive demands of loyalty and proof of commitment on relationships. The veteran/service member has begun to acknowledge his/her fear of abandonment as being excessive and irrational.

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Concern about Loss of Rank/Separation A. The service member is concerned that he/she will lose rank. The service member is concerned that he/she will be involuntarily separated from military service. The service member is concerned about his/her change in income due to loss of rank or involuntary separation from military service. As treatment has progressed, the service member has become more at ease regarding his/her military service status. Psychomotor Retardation A. The veteran/service member demonstrated evidence of psychomotor retardation within the session.

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The veteran/service member was redirected when he/she did not use the cognitive restructuring techniques. Continue Queries about Suicidal Ideation A. The veteran/service member was asked about possible suicidal ideation despite the apparent resolution of the suicide crisis. The veteran/service member indicated no further suicidal ideation, and this was reinforced. The veteran/service member identified some level of suicidal ideation, and treatment was focused again on resolving this suicide crisis. Explore Spiritual Support System A. The veteran’s/service member’s spiritual belief system was explored to discover whether it could be a source of reassurance, support, and peace.

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Existing research has found that traumatic events might lead to the deterioration of relationship quality and intimacy (Cohan and Cole, 2002; Marshall and Kuijer, 2017). Consequently, the intimacy and sexual life relationship of non-cohabiting couples was affected by isolation and went through a sharp change due to the pandemic. Isolation had a negative impact in terms of couple and sexual relationships, due to the difficulty of finding moments for intimacy (Lehmiller et al., 2020; de Oliveira and Carvalho, 2021). This situation has an impact on the increase in autoerotic sexuality, cybersex, cyber-pornography use, and sexting (Ibarra et al., 2020; Li et al., 2020).

The service member was assigned “Making Use of the Thought-Stopping Technique” from the Adult Psychotherapy Homework Planner, 2nd ed. The service member was monitored and encouraged in his/her use of the thought-stopping technique between sessions. Explore Prior Expectations A. The service member’s expectations about the military prior to enlisting were explored. The service member identified the specific expectations that he/she had about the military prior to enlisting, and these were processed.

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The veteran/service member reported that the medication has not been beneficial in stabilizing his/her mood; this was reported to the prescribing clinician. The veteran/service member reported side effects of the medication that he/she found intolerable; these side effects were reported to the physician. Therapeutic techniques as described in Cognitive-Behavioral Treatment of Borderline Personality were used to help the veteran/service member manage his/her symptoms.

The veteran’s/service member’s partial use of cognitive behavioral techniques was reinforced, and he/she was reminded about the more regular use of these techniques. C. The veteran/service member was assisted in replacing his/her maladaptive thoughts that promote misplaced self-blame. As the veteran’s/service member’s misplaced self-blame thoughts were identified, challenged, and replaced, he/she reports decreased guilt about the loss. The veteran/service member has failed to accept any challenge to his/her thoughts that promote misplaced self-blame and was provided with additional feedback in this area. Emphasize Effects 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.

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