A group therapy approach to treating combat posttraumatic stress disorder: interpersonal reconnection through letter writing.

Many who have served in a war zone carry deep emotional wounds that go beyond the typical symptom clusters of reexperiencing, avoidance/numbing, and hyperarousal that comprise a diagnosis of posttraumatic stress disorder (PTSD). Specifically, many combatants experience unresolved grief, guilt, and shame caused by losses and traumatic experiences suffered in war, called "moral injury" by some clinicians and researchers (e.g., Litz et al., 2009; Shay, 1994). We describe the aspects of human attachment that set the stage for grief, guilt, and shame, and outline the 3-phase group therapy model we have implemented in a clinical setting to foster the reconnection of severed human bonds. Special attention is paid to killing and related phenomena that are unique to combat PTSD. The program phases include psychoeducation, trauma-focused therapy, and aftercare, which focuses on assisting the veterans in reconnecting with their families and communities. The use of letter writing as an intervention is illustrated through case examples, and clinical outcomes are anecdotally described.

Rorschach oral dependency in psychopaths, sexual homicide perpetrators, and nonviolent pedophiles.

Rorschach Oral Dependency scores (Masling, Rabie, & Blondheim, 1967) were compared among nonsexually offending psychopaths (NSOPs, n = 32), sexual homicide perpetrators (SHPs, n = 38), and non-violent pedophiles (NVPs, n = 39) as initially reported by Gacono, Meloy, and Bridges (2000). The aggressive special scores of Gacono and Meloy (1994; Gacono, unpublished doctoral dissertation, 1998) were also scored and compared with ROD scores. Consistent with theory and predictions, NVPs were found to have significantly higher levels of oral dependency scores than NSOPs or SHPs. Additionally, there was a high degree of association between oral dependency and aggression in the SHP and NSOP groups. These Rorschach differences support the validity of the ROD as an implicit measure of dependency and add to the understanding of the dynamics that fuel sexually deviant violence.

Divergent ethical perspectives on the duty-to-warn principle with HIV patients.

This article presents the case of an HIV-positive client who reported having sexual relations with an unknowing partner. The issue raised is whether the therapist was required to warn the unknowing partner, similar to the Tarasoff mandate that is imposed on therapists. The case is analyzed from an ethical framework similar to that presented by Beauchamp and Childress (1994). Two opinions are presented, each leading to different conclusions about whether the therapist should inform the unknowing partner. It is concluded that although such analysis is valuable in aiding the therapist in his or her decision-making process, no clear professional standard for the management of the problem is evident.