There is no further evidence of physical withdrawal symptoms. Persistent Desire to Reduce Opioid Use A. The veteran/service member frequently indicates that he/she would like to decrease or discontinue his/her opioid use. The veteran/service member acknowledged that he/she has frequently attempted to terminate his/her use of opioids but found that he/she has been unable to follow through. The veteran/service member acknowledged that despite the negative consequences and a desire to terminate opioid use, he/she has been unable to do so. As the veteran/service member has participated in a total recovery program, he/she has been able to maintain abstinence from opioid use. Excessive Time Investment A. The veteran/service member described expending an excessive investment of time and effort in order to obtain, use, or recover from the use of opioids.
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Teach Self-Control Strategies A. The veteran/service member was taught meditational and self-control strategies to delay gratification and reduce impulsivity. The veteran/service member was instructed to use a “stop, Sparky app think, react” technique as a way to decrease his/her impulsive acting out. The veteran/service member was assigned the “Impulsive Behavior Journal” exercise from the Adult Psychotherapy Homework Planner, 2nd ed.
As Dickens began writing Great Expectations, he undertook a series of hugely popular and remunerative reading tours. His domestic life had, however, disintegrated in the late 1850s and he had separated from his wife, Catherine Dickens, and was having a secret affair with the much younger Ellen Ternan. It has been suggested that the icy teasing of the character Estella is based on Ellen Ternan’s reluctance to become Dickens’s mistress. Bentley Drummle, a coarse, unintelligent young man from a wealthy noble family being “the next heir but one to a baronetcy”. Pip meets him at Mr Pocket’s house, as Drummle is also to be trained in gentlemanly skills. Drummle is hostile to Pip and everyone else.
The veteran/service member has been prescribed antidepressant medication. The veteran/service member has refused the prescription of psychotropic medication prescribed by the physician. Impaired Speech/ Muteness A. The service member presents as being unable to speak. The service member is able to produce some speech, but his/her functioning is significantly impaired.
Practice the Time-out Technique A. The partners were directed to practice using time-out while discussing an emotional topic in session. Support and feedback were provided to the partners as they practiced using time-out. The partners’ ongoing use of time-out during emotional discussions was reviewed and processed. Spiritual Conflict A. One partner has identified experiencing spiritual conflict due to the breaking of the marriage vows. Both partners describe spiritual conflict regarding breaking of the marriage vows. The partners have resolved their spiritual conflict by resolving the problems within the marriage.
The partners were helped to process the content of how the military has impacted the relationship considering each other’s prospective. The partners were assisted in using problem-solving problems techniques to address the impact of military service on the relationship. Identify Personal Responsibility A. Each partner was asked to turn to the other and identify his or her own personal contributions to the downfall of the relationship. Each partner was asked to turn to the other and express personal attempts to make the relationship work. Each partner was reinforced for taking significant responsibility for the relationship.
Assess Sleep Hygiene Practices The veteran/service member was assessed in regard to appropriate sleep hygiene practices. The veteran/service member was assessed about his/her food and drink intake pattern. The veteran/service member was assessed in regard to activities directly before bedtime.
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The veteran/service member has engaged in self-mutilating behavior on several occasions. The veteran/service member made a commitment to terminate suicidal gestures and threats. The veteran/service member agreed to stop the pattern of self-mutilating behavior.
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The veteran/service member refused to participate in an exercise program and would not accept a referral to such a program. The veteran/service member postponed participation in the development of an exercise program and was encouraged to follow-through on this when he/she is able to do so. Discuss Physical Training Alterations A. The service member was encouraged to discuss alterations in his/her current unit physical training program based on his/her limitations.