A FAITH IN QUESTION 1
A Faith in Question
Jennifer Hitchcock
School of Behavioral Sciences, Liberty University
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A Faith in Question
Introductory Statement
Life is not simple, easy adventure. It is a windy, hilly trail like those often found during
the creepy nights of Halloween.*The journey is started with high expectations of fun and
adventure, good times mixed with enjoyable scares. Frights are seen by the travelers, advancing
towards but giving with enough time to prepare. Other times, though, there is no warning. The
scares and dangers simply come out of nowhere, catching even the most courageous of heart
unaware. It is times like this that can leave a person feeling lost, scared, or alone. It can take the
strongest in our society and make them feel as though their very core has been stripped away or
twisted into something no longer recognizable. This is what happened to Lt. John Michaels, a 29-
year-old active-duty soldier who has survived three combat tours. During this paper, we will
travel into the life and family structure in a short vignette. We will gather information concerning
why Lt. Michaels was referred for services, explore what factors led to his concerns, and
determine what services, strategies, and resources are available for both the patient.
Exploration
* * * * * *Lt. John Michaels was self-referred. He is currently an active duty 29-year-old male of
Caucasian descent. Lt. Michaels enlisted at the age of 18, immediately upon graduating from
high school.*He spent several years working at the base clinic. After his first enlistment, Lt.
Michaels chose to participate in the NECP program where he earned his degree in nursing. Since
then, he has served three combat tours in Afghanistan, each lasting approximately 9 months.
During the last tour, he served diligently as a Special Operations Surgical Teams (SOST). He
states that during this time, the support of his wife, Angela, was invaluable, that he could not
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have gotten his degree nor survived the experiences of war without knowing she was waiting for
him.**
* * * * * *Lt. Michaels states that both he and his wife are extremely religious and actively involved
in their church. Lt. Michaelson participates as a daily greeter for visitors and members while his
wife works with a program designed to help young and new mothers. They have listed
themselves as non-denominational.*
* * * * * *Lt. Michaels and his wife have been married for approximately four years.*
They met six years ago in Kansas, where Lt. Michaels was station at McConnell AFB. He had
already served one tour in Afghanistan and states he may have had mild PTSD but never
attempted to get a diagnosis nor treatment.* *
* * * * * *Lt. Michaels states one of the reasons he has chosen to seek out therapy is the continual
disillusionment of his marriage. As previously stated, the couple met after Lt. Michael’s first
tour.*The relationship continued through a second tour where, per Lt. Michaels, the symptoms of
PTSD did not lessen, but instead, appeared to worsen. He stated that he would often struggle to
sleep and would frequently spend time away from home, preferring to be in the company of his
unit. Eventually, things improved and Lt. Michaels married.
Depression did begin to set in during the time his relationship struggled. Lt. Michaels
opted to enter into therapy and resiliency training through the base programs available to him.
While this helped at the time, Lt. Michaels stated that he continued to struggle with thoughts of
friends and fellow soldiers lost under his care.
Approximately two and a half years after he and Mrs. Michaels married, Lt. Michaels was
deployed for a third tour.*It was during this tour that Lt. Michaels experienced his first major loss
in his unit. His company was ambushed by insurgents and multiple members did not survive.
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Once he completed his training at NECP, Lt Michaels applied for and was accepted to a
program that would train him to become a critical care nurse for a Special Operations Surgical
Teams (SOST). In this position, he worked behind special forces teams, offering critical care to
Special Operations Team members injured in the line duty. It was during this time that Lt.
Michaels states he saw the deaths of many soldiers he considered personal friends, both on the
Special Ops Teams as well as a few who were part of his medical team. Lt. Michaels also
recounted two times where he was required to utilize his weapon for safety reasons. One resulted
in the death of a minor child who was firing upon his SOST. The other resulted in the death of a
female insurgent who was also firing upon his SOST. Both times, Lt. Michaels recounts feelings
of guilt and shame for what occurred.**
After returning from this time, Lt. Michaels states the symptoms of PTSD previously
stated returned: lack of sleep, intrusive thoughts, inability to enjoy time with his spouse, and an
intense desire to be away from things he states were priorly enjoyable to him.*
Despite repeating some of the actions he was required to do in his prior treatment, he states he
did not improve this time. Instead, things continued to deteriorate.**
To help with these ongoing emotions and concerns, Lt. Michaels chose to begin attending
church again.*During his last visit, the preacher gave a sermon entitled*A Just God in a World of
Suffering and Evil. He states that he does not understand how God can be just and righteous
when there is so much suffering in this world. He has begun to question his faith.
Identify and Discuss Personal and Professional Reasons*
I chose to take on this case for a variety of reasons.*Lt. Michaels has received prior
treatment for a condition known as PTSD or Post Traumatic Stress Disorder. While his treatment
worked in the past, it is not working now. I believe that while Lt. Michaelson may have been and
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could still be dealing with PTSD, he is currently dealing with another, a similar condition known
as Moral Injury. This condition is defined by Litz et al (2009) as “lasting psychological,
biological, spiritual, behavioral, and social impact” (p. 697) that results from “perpetrating,
failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral
beliefs and expectations” (p. 700) and resulting in “the inability to contextualize or justify
personal actions or the actions of others and the unsuccessful accommodation of these . . .
experiences into pre-existing moral schemas” (p. 705). Lt. Michaelson witnessed and
participated in multiple experiences that could have resulted in just such a concern.
Having experience with multiple vets who suffer from both disorders, this condition is
important to me. Veterans who suffer from Moral Injury often struggle with coping with what
occurred while in combat. Those I know have suffered from items such as aligning what
occurred with their moral and spiritual beliefs. An inability to cope properly and a lack of proper
treatment for them have also resulted in both physical and emotional lashing out with spouses
and families and the ultimate dissolution of relationships. For some of them, this has also
resulted in an inability to reconcile their religious beliefs with their actions.
Summarization of Primary Concerns
* * * * * *As previously stated, Lt. Michaels is struggling with multiple concerns. First, he is
struggling with two conditions: PTSD from prior deployments and Moral Injury from his most
previous one. His struggle to cope with the experiences of combat and to reconcile his actions
and those of his friends with his moral beliefs.
Lt. Michaels is also struggling in his marriage. Again, this is due to an inability to
reconcile things with his moral beliefs. This dissolution has resulted also resulted in the chipping
away at his faith, and, ultimately, a questioning of who and what God is. In the end, Lt. Michaels
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is desiring help to understand what he is going through and how God could allow the things that
he has witnessed to happen.*His prior resiliency training and help for PTSD has not transitioned
well as he continues to struggle.
Intervention and Support
* * * * * *Counseling the concerns that Lt. Michaels has requires a distinct plan of action. It is
recommended that Lt. Michaels attend weekly sessions to begin bearing in mind the frequency
may need to be changed. He will work on treatment for his PTSD, Moral Injury (MI), as well as
couples therapy to help rebuild his relationship with his spouse, who was contacted to determine
if she was willing to do so (with the permission of Lt. Michaels).**
Resiliency Solutions and Resources
While many counselors know about PTSD, Moral Injury (MI) is not as widely known. Its
treatments are less available due to the fact many counselors are still working on plans that
effectively treat it. However, without treatment, trauma conditions such as MI will get worse
(Norman et al, 2014).
More often than not, MI is comorbid with PTSD and depression.*Its effects can
exacerbate PTSD in veterans. Due to these facts, it is felt that this is the primary concern and
should have treatment initiated first. To combat this concern, Lt. Michaels will be participating
in Trauma-informed Guilt Reduction Therapy (TrIGR). This therapy is considered a cognitive-
behavioral psychotherapy that has been successful thus far in treating combat veterans with
Moral Injury. The idea is that veterans who are suffering from MI should reassess their guilt and
work on reidentifying and reengaging with their values before the event. As Norman et al (2019)
stated in their article:
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“TrIGR consists of four modules: (1) psychoeducation regarding the role of guilt
in posttraumatic distress and common types of combat-related guilt; (2) appraisal
of hindsight-bias, responsibility, justification, and wrongdoing, and helping the
patient recall the fuller, more accurate context of what occurred; (3) helping
individuals identify important values, both ones that may have been violated
during the trauma and ones important to the individual now; and (4)
collaboratively developing a plan that will allow the patient to live in-line with
important values going forward. The therapy can be administered during four to
seven 90-minute sessions” (pp.80).
While Lt. Michaels does have a religious belief and faith in God, he has also expressed a
desire to understand where He was in all this and how God could be a just one. While Lt.
Michaels is struggling in his faith, his recent attendance at church suggests he has not given up
his faith completely. Working collaboratively with the Chaplin will provide a bio-psycho-social-
spiritual approach to moral injury. Due to this, his TrIGR sessions will be completed with the
base chaplain, who has experience working with veterans with conditions such as MI.**
Throughout the TrIGR, Lt. Michaels will also participate in Pastoral Narrative Disclosure or
PND.* PND is designed to be a multidisciplinary approach where a pastor offers spiritual
interventions along with a trained counselor. It will consist of 8 60–90 min sessions, presented in
sequential order. The phases are Rapport, Reflection, Review, Reconstruction, Restoration,
Ritual, Renewal, and Reconnection (Carey & Hodgson, 2018).
Once Lt. Michaels completes his treatment for Moral Injury, he will begin treatment for
the prolonged symptoms of PTSD. Lt. Michaels has expressed that his marriage is currently
failing. As part of his treatment, it is believed that a treatment plan involving his spouse would
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be beneficial. Studies have shown time and again that veterans often prefer treatments for PTSD
with participation from their spouse. More recently, a study has shown that CBCT or Couples
Based Cognitive Therapy (Malaktaris et al, 2019). CBCT was chosen from a variety of potential
treatment plans that incorporate spousal support due to the empirical evidence showing it to be
fairly successful (Kugler et al, 2019).*It will incorporate both a treatment for PTSD as well as
goals to help improve Lt. Michaels marriage.
The final portion of Lt. Michael’s treatment plan will address his inability to understand
how resiliency plays a role in his recovery. After having recently attended a training in
resiliency, Lt. Michaels still is not understanding how it fits in with what is going on in his life.
He is unable to put the pieces of the puzzle together so to speak. PTSD patients often benefit
from a dual approach of both individual and group therapy (Holgersen et al, 2020). During this
time, Lt. Michaels will be able to connect with other survivors of trauma. He will continue to
work on understanding and promoting post-traumatic growth in a format that utilizes Solution-
Focused Brief Therapy, which has been shown to help promote post-traumatic growth (Zhang et
al, 2014). By working in a group, Lt. Michaels will be able to see how resilience has helped other
survivors to grow after experiencing trauma.
Biblical Insights and Principles
Lt. Michaels is struggling to understand why he has gone through what he did and
incorporate it into his moral worldview. This concern is not that uncommon when soldiers are
exposed to or perpetuate events that are against their current moral code. Guilt and anger can
overwhelm (Dees, 2011). It can become difficult to understand what God’s overall plan is or the
reasoning behind why one survived when others did not during wartime.**
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One of the insights that are common through the bible is the presence of evil. In Genesis
3:6, Adam and Eve brought sin into the world with their initial sin: disobedience of God’s
commands. With the introduction of sin came evil. Through evil and sin, Satan can pain and
death (Dees, 2011). War exposes our soldiers to both times and again, traumatizing them in ways
many cannot understand.
Another principle integrated throughout the bible is that faith will not prevent pain. Being
a Christian does not exempt a person from suffering. In many ways, it can guarantee it. In
Matthew 5, Christ gives what is called the Beatitudes. Multiple items such as pain and suffering
are mentioned as something to be thankful for. Further along in 2 Corinthians 1: 3-4, Paul tells us
“ Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God
of all comfort, 4 who comforts us in all our troubles, so that we can comfort those in any trouble
with the comfort we ourselves receive from God.”**
These two beliefs are important to Lt. Michaels treatment. Understanding that ultimately
evil is responsible for what occurred during war, not God nor himself, can help Lt. Michaels
begin to reconcile and heal. Once he begins the healing process, helping Lt. Michaels to see that
his pain can be utilized to help others heal is an important part of his treatment plan. It has been
my experience that helping others when hurting yourself can help one to heal.
Application
* * * * * *Creating a case study is not simple. It is a long process full of both inspecting the patient
and his/her concerns, but the introspection of the therapist as well.*
Understanding your limitations and taking the time to continue to research empirical data is
essential.*Learning never stops.**
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* * * * * *Over the past few years, several studies have been conducted to try and determine how to
best treat soldiers experiencing various disorders. Often, these disorders do not come alone. They
are paired up with other comorbid conditions that create a complex situation.*
Learning how to treat these conditions both separately and in conjunction with each other is
complicated and very involved.
What you Have Learned
* * * * * *As stated above, learning never stops. This class made that extremely evident for me.*
One of the major things I learned in this course is that conditions such as moral injury are
extremely complex. Trying to understand it well enough to develop a treatment plan was intense.
I learned to rely not only on myself but on the experiences of others. What those experiences
taught me was that it is often necessary to incorporate more than one treatment into a plan to best
help a patient.
* * * * * *Another item I learned in this course was to have faith in myself. My pain, my
experiences have value. Having gone through burnout that resulted in my hurting myself and
therapy to become stable again is something that does not need to do to waste. I can use it to help
other people going through something similar.* *
Areas for Further Development
While I did learn a lot in this course that helped me to grow, I recognize I am nowhere near
where I need to be. I have a base understanding of many counseling concepts but nothing in-
depth enough to help others. I would honestly say I know just enough to be dangerous. I need to
keep learning and growing in this area.
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I need to also learn to trust myself more. I know that my instincts are often accurate, I do
not always trust them. God gave each of us gifts to help do His will. I need to trust that God will
help me hone those skills when I use them for His purpose.
Conclusion
In this paper, we were introduced to Lt. Michaels, a young combat vet who is suffering
from a series of comorbid conditions that have resulted in him seeking therapy. His treatment
plan incorporates help with Moral Injury, PTSD, inability to understand the point of resilience, a
loss of faith, and a failing marriage.* He will receive help from both a licensed Christian
counselor who is familiar with military veterans along with the base chaplain. Together they will
partner to help Lt. Michaelson overcome his MI and loss of faith.* He will continue to work on
his PTSD in a combined therapy with his wife where they will both work on repairing their
relationship.*
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References
Carey, L. B., & Hodgson, T. J. (2018). Chaplaincy, spiritual care and moral injury:
Considerations regarding screening and treatment.*Frontiers in Psychiatry,*9.
https://doi.org/10.3389/fpsyt.2018.00619
Dees, R. F., & Huckabee, M. (2011).*Resilient warriors. San Diego, CA: Creative Team Pub.
Holgersen, K. H., Brønstad, I., Jensen, M., Brattland, H., Reitan, S. K., Hassel, A. M., Arentz,
M., Lara-Cabrera, M., & Skjervold, A. E. (2020). A combined individual and group-
based stabilization and skill training intervention versus treatment as usual for patients
with long lasting posttraumatic reactions receiving outpatient treatment in specialized
mental health care - a study protocol for a randomized controlled trial.*Trials,*21(1), 1–
13. https://doi.org/10.1186/s13063-020-04297-z
Kugler, J., Andresen, F. J., Bean, R. C., & Blais, R. K. (2019). Couple-based interventions for
PTSD among military veterans: An empirical review.*Journal of Clinical
Psychology,*75(10), 1737–1755. https://doi.org/10.1002/jclp.22822
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009).
Moral injury and moral repair in war veterans: A preliminary model and intervention
strategy. Clinical Psychology Review, 29(8), 695–706.
https://doi.org/10.1016/j.cpr.2009.07.003
Malaktaris, A. L., Buzzella, B. A., Siegel, M. E., Myers, U. S., Browne, K. C., Norman, S. B., &
Angkaw, A. C. (2019). OEF/OIF/OND Veterans Seeking PTSD Treatment: Perceptions
of Partner Involvement in Trauma-Focused Treatment.*Military Medicine,*184(3/4),
e263–e270. https://doi.org/10.1093/milmed/usy231
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New International Version (1978). The International Bible Society
Online.*https://www.biblegateway.com/passage/?search=Genesis%203&version=NIV
New International Version (1978). The International Bible Society Online.
https://www.biblegateway.com/passage/?search=Matthew+5&version=NIV
New International Version (1978). The International Bible Society
Online.*https://www.biblegateway.com/passage/?search=2+Corinthians+1&version=NIV
Norman, S. B., Wilkins, K. C., Myers, U. S., & Allard, C. B. (2014). Trauma informed guilt
reduction therapy with combat veterans.*Cognitive and Behavioral Practice,*21(1), 78–88.
https://doi.org/10.1016/j.cbpra.2013.08.001
Zhang, W., Yan, T., Du, Y., & Liu, X. (2014). Brief Report: Effects of Solution-Focused Brief
Therapy Group-Work on Promoting Post-traumatic Growth of Mothers Who Have a
Child with ASD. In*Journal of Autism & Developmental Disorders*(Vol. 44, Issue 8, pp.
2052–2056). https://doi.org/10.1007/s10803-014-2051-8
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