A SHATTERED TRADITION

Vignette Learning Points

Issues Raised in Vignette • Captain Jessica Andrews is a West Point graduate in charge of a platoon searching caves for weapons in Afghanistan. During a cave search, one of her men trips a wire causing an explosion which kills her men.

• She survives, but sustains serious injuries.

• CPT Andrews undergoes life threatening surgery and awakens to find that she has facial nerve damage and that her reproductive organs were removed.

• She experiences survivor guilt.

• Upon her return home, CPT Andrews learns that her parents were mistakenly informed that she was killed in action.

• In their grief, they were killed while driving when they lost control of their vehicle.

• She mourns the tragic loss of her parents with whom she maintained a close bond, as they both graduated from West Point.

• CPT Andrews has lost the ability to smile or show emotion due to facial nerve damage.

• Confronted by the county to take away her ranch and build a highway, she responds by kicking off the surveyor from her ranch and vows to fight the county.

• Jessica refuses the help of a county social worker, a Veteran, who pays her a home visit.

• She feels deep sadness and despair, self-hatred, depression and suicidal thoughts.

• In the evenings, she displays PTSD symptoms of hyper-vigilance.

• Jessica seeks therapy with a psychiatrist for the treatment of depression and suicidal ideations.

• She copes with her altered body image by horseback riding, running and yoga.

• Jessica begins to give horseback riding lessons on her ranch to two young girls.

• She develops a mutually rewarding relationship with the two young girls and their mother.

• Jessica regains a positive affect and begins to develop a hopeful perspective about herself and her future.

Issues Addressed in Therapy• CPT Jessica Andrews experiences multiple devastating

losses, including her parents, men in her platoon, a permanently altered self-image, her reproductive ability and her military career.

• She talks about her feelings of anger and self-hatred, sadness and depression, as well as survivor guilt.

• The therapist monitors her suicidal ideations.

Issues Addressed in Therapy• She no longer is able to show on her face what she is

feeling.

• Jessica learns to cope with her altered body image by horseback riding, yoga and running.

• She discovers a sense of personal competency when she regains a limited ability to express her emotions.

• Jessica regains her self-worth and a sense of belongingness through the supportive relationship she develops with two students and their mother.

Questions• What worked?

• What didn’t?

• What would have done differently?