1. Survivor Guilt Vignette Learning Points

2. Issues Raised in Vignette While recovering in post-op, he experiences a stress reaction. In a hyper-aroused state, he climbs atop at vehicle which requires the nurses to talk him down. After he returns from Iraq, Sergeant Martinez has nightmares and hallucinates that a terrorist is walking through his house and threatening him.

3. Suffering from traumatic memories and bothered by hallucinations he sinks into isolation. Unemployed and without resources, he tries to find work, and is repeatedly told that either there are no openings, or that he is not qualified.

4. Unable to deal with the overwhelming sense of guilt and despair, having great difficulty adjusting to his daily stressors, seeing no options and feeling hopeless, Sergeant Martinez decides to end his pain through the flames.

5. Issues Addressed in Therapy Sergeant Martinez seeks treatment from a psychotherapist who conducts a mental health assessment and makes several treatment recommendations. Deciding instead to draw from his cultural background, he seeks healing from a Curandera.

6. Survivor guilt: overwhelming sense of grief and mourns the loss of his buddy. Possibility of a dual diagnosis of both PTSD and a psychotic disorder. Rejects the recommendation of inpatient hospitalization.

7. Depression and traumatic combat experiences are identified during the initial assessment. Stage of change: therapist recommends individual and group therapy and Veteran support groups. Isolation, depression, trauma and hallucinations.

8. Questions Is this an example of non-compliance issues in therapy with combat veterans or an instance of misgauging the veteran’s stage of change. What was the effect of the cuerandera and therapist dismissing each others intervention?

9. Questions What might have been done to better engage the veteran ?