Clients Background:
Client, Chris Kyle, is a 39 year-old Caucasian male, married with two children, an 11 year-old son and 7 year-old daughter. He is a high-school graduate with highly specialized military training. He was employed by the Navy as a Navy Seal Sniper from 1999 until August 12, 2013. He was awarded several military honors and served four separate tours of duty to the Middle East during the War in Iraq. Client has not been treated for mental illnesses or disorders in the past. His wife recommended that he come in for treatment based on significant differences in his behavior, after he returned home from the war where heserved over 1000 days in Iraq with 160 confirmed enemy kills, and how be responded at the cook-out.
When Taya was nine months pregnant, she asked Chris to share his feelings. She was concerned because he was not leaving the house at all. The first time he left his home, upon return from his first tour in Iraq, was for her last OB check up before their son was born. Client could not understand how the world was “continuing on as if there was no war. They were talking on their cell phones and carrying on like normal.” He felt like he “should not have been heading to the mall” when he really “should have been fighting in the war”.
Client was quick tempered after his second tour. He reported yelling and punching his fists against the nursery glass window when he felt his newborn daughter was not attended to as he requested from the nursing staff. Taya expressed that she was hurt by his absence and that she was “making memories” by herself. She informed Chris that she hated the “Teams” because they pulled him away from his family; that he was her husband. She also felt that Chris didn’t think the war was changing him but he was wrong. She felt that he could only “circle the flames” for so long. Chris felt that the “Teams” couldn’t wait for his help and his family could.
After the Client’s third tour, he returned home to bury his colleague, Mark. Client felt that he needed to return to Iraq to avenge the sniper shot that injured, Biggles’ face, his friend and team mate. He informed Taya the he felt she would find someone else if anything happened to him and that he was fighting the war for her because he
“could never live with himself if he did not go back”. Taya shared that she has felt abandoned, left to raise their children with-out a father and that she needed him home with her and the kids.
Client felt that he was emotionally unable to return home directly after his fourth and final tour. He felt that he needed to take some time to feel better before returning to his family. He was concerned about feeling depressed and struggled to stop the tears that came to his eyes.
Taya was concerned because that was the first time that he had not called home or informed his family that he was back in the US. He chose to go out drinking at a bar instead of reuniting with his family. After all his other tours of duty, he notified his family immediately when he was home and they met him on the flight line. It was very out of character for him to be so distant and removed from his family.
Client reported feeling depressed, disconnected, heard the sound of war while he tried to watch television and felt irritable. He completed the Beck’s Depression Inventory, upon initial intake and scored a 43 which indicated a case of severe depression. Client’s mood was assessed with the BDI that revealed the client’s feelings as follows: “sense of failure, guilt, irritability and socially withdrawn”. Due to the severity of the client’s numerous high risk attributes the client was assessed for suicide risk due to the following: severity of his depression, access to guns, knowledge and skill with weapons, his gender, increased alcohol usage, cognitive distortions and negative self thoughts. He completed the SAD PERSONS Scale and is not a suicide risk at this time. He will be re-assessed with the SAD PERSONS Scale, prior to release from in-patient care, to ensure the client’s safety. Client has expressed several cognitive distortions including the following: All or Nothing thinking, Discounting the Positive, Labeling and Mislabeling, Catastrophizing, Overgeneralizing, Personalizing, Using Should Statements, and Having Tunnel Vision.
Client is unaware of how the experiences he encountered during the war may be having some negative impacts on his behavior and his cognitive processes. He doesn’t feel that the numerous kills he made, as a sniper, are impacting him in anyway. He reported only feeling “haunted” by the soldiers that he could not save. Some negative self statements that the client has made include the following: “I am no hero; I quit, I am here and I should be there fighting in the war”, “I shot 8 people that day but they got one of us. I failed to shoot what I couldn’t see” and “I am failing my fellow soldiers by being here and not being there to save them”.
Questions example, must be included.
Miracle Question
Here is a clear example of how to administer the miracle question. It should be delivered deliberately. When done so, it allows the client to imagine the miracle occurring.
“Now, I want to ask you a strange question. Suppose that while you are sleeping tonight and the entire house is quiet, a miracle happens. The miracle is that the problem which brought you here is solved. However, because you are sleeping, you don’t know that the miracle has happened. So, when you wake up tomorrow morning, what will be different that will tell you that a miracle has happened and the problem which brought you here is solved?” (de Shazer, 1988)
2. Presupposing change questions
A practitioner of solution-focused therapy asks questions in an approach derived way.
Here are a few examples of presupposing change questions:
“What stopped complete disaster from occurring?”
“How did you avoid falling apart.”
“What kept you from unraveling?”
3. Exception Questions
Examples of exception questions include:
1. Tell me about times when you don’t get angry.
2. Tell me about times you felt the happiest.
3. When was the last time that you felt you had a better day?
4. Was there ever a time when you felt happy in your relationship?
5. What was it about that day that made it a better day?
6. Can you think of a time when the problem was not present in your life?
4. Scaling Questions
These are questions that allow a client to rate their experience. They also allow for a client to evaluate their motivation to change their experience. Scaling questions allow for a practitioner to add a follow-up question that is in the positive as well.
An example of a scaling question:
“On a scale of 1-10, with 10 representing the best it can be and one the worst, where would you say you are today?”
A follow-up question:
“ Why a four and not a five?”
Questions like these allow the client to explore the positive, as well as their commitment to the changes that need to occur.
5. Coping Questions
These types of questions open clients up to their resiliency. Clients are experts in their life experience. Helping them see what works, allows them to grow from a place of strength.
“How have you managed so far?”
“What have you done to stay afloat?”
“What is working?”
