Abstract
Outcome literature has shown poor treatment engagement in efficacious, evidence-based post-traumatic stress disorder (PTSD) programs among returning veterans with combat-related psychological symptoms and calls for the development of motivational, preparatory exercises that circumvent stigma-related barriers and are delivered before or during the orientation phase of treatment. The psychological states of hope, meaning, and guilt have been found to impact motivation for treatment and the development and maintenance of post-trauma pathology and symptom severity. Given a chaplain’s less stigmatized role, as compared to mental health providers, and proficiency in assessing these states and providing interventions that mediate change, often before a veteran is enrolled in a PTSD treatment program, this paper introduces a brief, chaplain-led, preparatory exercise called the “Warrior’s Journey Intervention” (WJI). This narrative based, meaning-making exercise is designed to improve motivation for treatment and mitigate post-trauma symptoms by impacting hope, meaning, and guilt through use of a universally shared, metaphoric story of trauma recovery. A case study will demonstrate use of the intervention, observe its effects, and analyze mechanisms of change. Research is recommended at the end of the article to test the hypothesis that the intervention promotes motivation for treatment and reduces symptoms of PTSD and Moral Injury (MI). A standardized manual for the exercise is available from author.
The Need for Motivational, Preparatory Treatment Components
Though highly effective post-traumatic stress disorder (PTSD) treatments exist for veterans with significant symptoms of combat stress, survey data reveal an alarming underutilization of these mental health programs and services (Seal et al., 2010). Only 50% of veterans in need of treatment sought help from these services (Kulesza et al., 2015) while cognitive processing therapy and prolonged exposure therapies demonstrate a symptom remission rate of 80% (Resick et al., 2002).
Stigma associated with seeking out mental health care within the military is well documented as a barrier to treatment engagement (Acosta et al., 2014). Self-perceptions of character deficiency, anticipated negative public perceptions about competency and leadership credibility, and adverse career repercussions are examples of stigma-laden beliefs that drive veterans away from the help they need (Sharp et al., 2015). Interestingly, research shows that veterans are more likely to seek help from a chaplain than conventional mental health providers because of the high degree of confidentiality afforded by chaplains and absence of required medical documentation (Carey et al., 2016; Nieuwsma et al., 2014). Thus, chaplains often play a key role in circumventing stigma and, thereby, enhance treatment engagement (Carey et al., 2016).
High dropout and non-response rates among efficacious PTSD programs may further indicate the need for chaplain-led interventions designed to increase engagement and, more principally, enhance motivation for treatment success (Bradley et al., 2005; Garcia et al., 2011; Hembree et al., 2003; Hoge et al., 2014; Imel et al., 2013; Murphy et al., 2009; Schottenbauer et al., 2008). A recent meta-study showed that approximately one third of OEF/OIF/OND veterans with combat-related PTSD drop out of treatment (Goetter et al., 2015).
Poor treatment outcomes as well as the development and maintenance of post-trauma symptoms are consistent with a loss of hope and meaning and increased feelings of guilt associated with combat-induced trauma (Fontana & Rosenheck, 2004; Held et al., 2011; Henning & Frueh, 1997; Hendin & Haas,1991). Targeting these psychological states has been shown to impact symptoms associated with trauma and affect treatment outcomes (Gilman et al., 2012; Irving et al., 1997; Long & Gallagher, 2018; Marco et al., 2016; Norman et al., 2014; Owens et al., 2009).
Role of Chaplain in Treatment Engagement
Tasked with protecting confidentiality, while assessing hope, meaning, and guilt, and administering interventions that impact these psychological states (often before patients enroll in PTSD treatment programs), chaplains may be especially helpful in enhancing engagement and ensuring treatment success. (Association of Professional Chaplains, 2019; VHA Directive 1111, 2016; Carey et al., 2016; Nieuwsma et al., 2014). Some of the assessment scales that chaplains utilize for this purpose include: “Screening for Spiritual Struggle” (Fitchett & Risk, 2009), the “Spiritual Injury Scale/Index” (Berg, 1992), “Moral Injury Questionnaire” (Currie et al., 2015) and “The Spiritual Distress Scale” (Kopacz et al., 2015). Chaplains may additionally offer interventions designed to renew hope, and enhance and attenuate guilt, which may increase motivation for treatment as well as relieve post-combat symptoms. A taxonomy of chaplain interventions was recently compiled in an effort to standardize terminology associated with spiritual care (Massey et al., 2015). Though the catalog does not assume a direct correlation between intervention and outcome, it lists strategies that target the aforementioned psychological states such as exploring hope, sharing words of hope and inspiration, encouraging story-telling, life review, asking guided questions about purpose, and facilitating understanding of limitations (Massey et al., 2015).
Introducing the Warrior’s Journey Intervention
Rooted in Jung’s archetypal “Hero’s Journey” (1981) and popularized by Joseph Campbell (2008), the Warrior’s Journey is a universally shared story of recovery from hardship. Therapists, especially those aligned with narrative therapy, have long valued the sequential developmental tasks within each stage of the archetypal story as internal cognitive processes that lead to healing (Lawson, 2005; Wilson & Lindy, 2013, p. 33–35, 90, 204). Recognizing the potential of these embedded, narrative mechanisms for increasing hope and meaning and reducing guilt, the story was organized into a therapeutic script that proposes to increase readiness for treatment and mitigate post-trauma symptoms.
The following case study demonstrates the Warrior's Journey Intervention (WJI) and reports descriptive evidence of its effect. A subsequent analysis describes the narrative mechanisms at work to bring change. Among the numerous qualitative cases the author has collected, the following study best illustrates the impact of the intervention upon post-combat symptoms. This case graphicly depicts an injurious combat incident, resultant post-trauma symptoms, and highlights a dramatic shift in hope, meaning, and guilt. All names, background information, and clinical disclosures were altered to safeguard anonymity, while preserving the authenticity of the story. Informed consent was obtained from the participant prior to conducting intervention. Notes were taken by the author and verified by the participant to insure validity. This qualitative interview lasted approximately an hour.
Case Study: Jim’s Story
Dressed in brown hospital clothes, Jim, a twenty-eight-year-old army veteran diagnosed with combat-related PTSD, welcomed me into a patient lounge of the Acute Psychiatric Care Unit and sat at a table with his back to a wall. Six months after his return from Afghanistan, he began to experience symptoms of depression and the onset of suicide ideation. Holding his hands tightly together and looking furtively toward the door, he shared his spiritual history. He described a mostly positive picture of his Baptist upbringing in the South, recalling memories of summer Vacation Bible School and pot luck dinners. As he began to share more current information about his spirituality, he suddenly arched his back and blurted out, “I used to believe in God and a bright future but after you see a baby get eaten by a pack of dogs while your commanding officer orders you to stay in your vehicle, you kind of say what’s the f—ing point of anything.” Welcoming me into the darkness of his war experience, he whispered, “Chaplain, I’ve lost my hope.”
Jim recounted the brutal scene. Five menacing dogs gathered around an infant in a stroller left unattended by an Afghan mother who disappeared suspiciously inside an apartment building. Jim repeatedly asked permission from his commanding officer to dismount his vehicle and intervene. Fearing an ambush, his commanding officer ordered him to stay in his personnel carrier. In bitter tears, Jim described how helpless he felt as he watched the dogs attack the child.
I allowed a long joining silence to honor Jim’s description of events. Holding him with my eyes, I acknowledged his sorrow. Only after he assured me that he had been fully heard did I ask permission to share the Warrior’s Journey story.
Introducing a metanarrative, like the Warrior’s Journey, requires discretion to avoid “overriding” and unintentionally discounting a participant’s personal experience. Jim’s words, “I lost my hope,” served as a bridge to the intervention: “With your permission, Jim, I’d like to share with you a story that might capture the meaning of your lost hope. It’s called the WJI and it’s the story of many religious, historical and movie characters who went to war and struggled to return home, normal and whole.” Jim consented and, providing him with a diagram of the TWJ, I read the standardized script.
The first four stages of the story, “Ordinary Life,” “Initial Call,” “Entering the Call,” and “Training, Allies and Testing,” (see Figure 1) help participants identify with the adventures of eleven historical, mythic, and fictional figures. Jim’s mood seemed to brighten as he recalled memories from boot camp. Identifying with one of the heroes in the script, he joked, “Yeah, but I never qualified to use a light saber …”
The Warrior’s Journey diagram, adapted from Edward Tick’s A Soldier’s Heart Transformational Model, referenced in Tick, E. (2014). Warriors return: Restoring the soul after war. Boulder, CO: Sounds True.
A reflection question in this early section brings to mind a participant’s younger and perhaps more naïve self, opening the door to hidden and unresolved feelings of betrayal, disillusionment, and guilt, “In your own words, how would you describe your call to service?” Jim replied, “I wanted to get the bad guys—that’s why I signed up. I’m still proud to have served but it just wasn’t that simple—who really are the good guys?” Bringing moral pain to the surface early on in the story prepares participants for a thorough appraisal of guilt in later stages.
The next two sections, “The Battle” and “The Great Ordeal,” helped Jim view his trauma memories through the soft lens of metaphor, preventing direct exposure and the risk of emotional flooding and reactivity (White, 1989). A box provided in the handout offers a selection of feelings and spiritual/emotional conditions gleaned from interviews of other combat-exposed veterans. I asked Jim to check which feelings best describe his personal “Great Ordeal.” [] I feel stuck without hope. [] I feel alone. [] I feel angry. [] I feel used. [] I feel betrayed. [] I could not prevent a terrible thing from happening. [] I participated in an event that brought suffering and loss. [] I feel guilty. [] Why didn’t I do more to stop the loss and destruction? [] Why did I survive, and others did not? [] I lost a part of me and do not know how to get it back. [] I don’t know who I am anymore. [] I will never be the same. [] I don’t know how to move ahead. [] I feel dead inside. [] No one understands me. [] Others might think I’m a monster.
Jim’s words, at face value, signal a glimpse of hope and motivation for recovery. His insight, “others made it through,” infers the existence of agency; that is: the capacity to achieve goals and pursue a desirable future. His statement, “Maybe there is a way through,” suggests a tentative perception of “pathway,” a possible way out of his sorrow. Together, these two beliefs affirm the presence of hope as a cognitive motivational system (Snyder et al., 1991).
The next module, “Miracle of Rebirth,” invites participants to consider the possibility of life-giving resources beyond one’s own when lost within the death-like grip of the Great Ordeal. While not promoting a religious/spiritual preference or theistic view, the script presumes the operation of transcendent, external agencies, or “higher powers,” capable of intervention and assistance in time of need. The text reads, “Some call it luck, some good fortune or fate, others karma or providence, still others destiny. In every scenario, something unforeseen and inexplicable happened to restore hope just as personal strength gave way.” In response to the reflection question, “How have you experienced a power greater than yourself along your journey, if at all?” Jim replied, “I guess God kept me around for a reason, but I sure don’t know why.” Implicit in his statement is a search for meaning (a form of motivation) promoted throughout the text (Mascaro & Rosen, 2005).
The eighth stage, “Forgiveness, Reconciliation, and Atonement,” targets two forms of combat-related guilt: moral injury and survivor’s guilt. Whereas “survivor’s guilt” refers to guilt felt when surviving combat while others have not, moral injury (MI) is a recently conceived post-trauma condition experienced when one engages directly or indirectly in actions that violate deeply held moral beliefs and expectations (Litz et al., 2009). In the context of war, such violations of conscience may be caused by acts of betrayal by those in authority, engaging in a disproportionate violent response, an inability to prevent death or suffering, death or harm to civilians, violence within military ranks, and exposure to blood and body parts (Drescher et al., 2011; Shay, 2003). Symptoms associated with MI are: guilt and shame, loss of trust, difficulty forgiving, loss of meaning/purpose, feelings of failure, and a weakening of religious faith (Koenig et al., 2017; Litz et al., 2009). MI’s characteristic shame has been found to be a predictor of demoralization (lack of motivation), substance use, risk taking, and suicidality (Litz et al., 2009) as well as a barrier to treatment (Held et al., 2011).
Addressing survivor’s guilt, the script offers a guilt-relieving interpretation of the “chance” events that spared a warrior: “they were alive, and they remember.” Preservation of a warrior’s life intimates a survivor’s duty to remember the lost and “make right that which was wronged.” More will be said about the productive power of grief and guilt shortly.
Regarding MI, a prepared question reads, “In what ways do you feel angry or betrayed?”
Jim explained how following orders might have been the right decision for him to make as a soldier, but that doing so left him in perpetual moral anguish as a human being and in his own words, “scarred for life.” The standardized script offers two strategies for resolving MI. First, it guides participants to a more accurate appraisal of their presumed wrong doing. Correcting distorted perceptions about one’s role, responsibility, and participation in a traumatic event has been found to decrease levels of guilt (Kubany & Manke, 1995; Norman et al., 2014). Second, when an accurate appraisal is insufficient, the script offers a conceptual framework for addressing a need for atonement. Atonement has been conceived as a palpable expression of remorse and a “making right” of that which is perceived to have been wronged (Litz et al., 2016).
Toward the goal of right-sizing moral responsibility, the story suggests that, apart from intentional perpetration, much of the loss and destruction of war is unforeseeable, unintended, and beyond one’s personal control. In addition, the story proposes the universality of war-induced guilt which generalizes responsibility and reduces self-blame. All who participate in the horror of war are contaminated by its foulness: “They recalled the destruction and loss of life they witnessed: a generation lost in the wilderness, the execution of innocent men, women and children, depravation, starvation, thousands of dead and injured on distant shores, entire planets destroyed, and good friends, like Rue, who died so they could live.” Such efforts to rationalize trauma-related guilt in no way excuse true perpetration; rather, these strategies help clarify the origins of self-blame so that a more accurate appraisal of combat-related guilt may ensue.
Despite such efforts, many veterans continue to endure a pervasive sense of guilt and shame. Given the reality that not all guilt is based on faulty logic—that culpability often does exist on some moral level—attempts to correct maladaptive beliefs may not be enough to heal MI (Litz et al., 2016; Pearce et al., 2018). Furthermore, attempts to rationalize guilt-related beliefs may undermine the therapeutic alliance by failing to honor the conscience of a veteran who truly believes he or she has crossed a moral line.
When guilt is tied to a religious concept, like sin, chaplains may be called upon to receive confession, pronounce forgiveness, and offer prayer and religious ritual in keeping with the veteran’s faith preference. Confiding in a moral authority figure, like a clergy-person or chaplain, has been promoted as a moral injury specific treatment in the literature (Carey et al., 2016; Litz et al., 2016).
Addressing a need to more tangibly express remorse, the story illustrates the value of active remembering: “Remembering is their reason for living.” The unique relationship between trauma-induced guilt and grief has been investigated and relates to an appraisal that the survivor should have done more to prevent the loss (Duffy & Wild, 2017). Utilizing grief’s “remembering” and guilt’s need “to do more,” the standardized script suggests a participant transition from passive mourning and guilt to active remembering and purpose. The reflection question reads, “How can your remembering be used to make right that which was wronged?”
In response to the question, a veteran will often express a need to take reparative action. chaplains may explore with the participant various ways of honoring a deceased unit member or a wronged community through gift and/or service while clarifying realistic outcomes and minimizing the risk of further distressing victims. When contact with the injured party is not possible, treatment studies recommend sharing stories among peers and letter writing (Litz et al., 2016; Pearce et al., 2018).
Jim’s response to the question acknowledged deep grief and a yearning to make amends, “How can I possibly make up for the loss we caused that mother? What can I really do?” I suggested he express his grief and sorrow in a letter to the woman, asking for her forgiveness, and then imagine her response. I also offered to review the letter with him and provide a list of organizations that help victims of war at a later date.
Asking Jim directly about his suicidal intentions flowed easily out of conversation exploring guilt and grief. Reading from the script, I asked: “It’s not uncommon to experience thoughts of ending your life by suicide at some point in the Warrior’s Journey. This in mind, where in your journey might you have thought about dying by suicide? What kept you from following through?” Jim candidly shared his feeling about ending his life by suicide, “There are days when I wonder, what is the point? I’m just so tired … It seems like the only way out.” Jim explained that he had never attempted suicide but frequently experienced intrusive and preoccupying thoughts. Referencing the story, he noted how he was beginning to see “a way through.”
In the ninth stage of the journey, warriors receive a reward for completing their journey, “Those who complete their journey are rewarded with the power to repair a broken world. Just as they have been healed through the Warrior’s Journey, they now share its healing power with others.” Here, the script suggests that despair gives way to renewed hope and purpose as participants realize how their transformative experience has imbued them with the gifts (wisdom, compassion, and strength) their world needs to survive and prosper.
In the final stage of the adventure, each character returns home “the master of two worlds,” the world of war and peace, and assumes a role of service through which they guide others and, often, entire communities through the trauma-recovery process: “Just as they were called to protect their community through the power of war, they are now called to bring healing and reconciliation through the power of their story.” Jim’s reply to the question, “How might the world need what you have learned on your Warrior’s Journey?” reflects the developmental task of the final stage of the journey. While not denying trauma’s terrible cost, Jim observed how his war experience initiated a transformative process that changed and equipped him to lead others out of their Great Ordeal, “I’ll never be the same. War will make you sick, but you don’t have to stay that way, and no matter what you go through, you are not alone–there’s a way out.”
A summary question at the end of the standardized script assesses the overall impact of the exercise, “Describe in a sentence how this story has helped you, if at all?” Jim immediately replied, “I don’t feel so alone anymore. I got lots more work to do but it seems worth it.” Once again, Jim acknowledged the support of an ancient fellowship of warriors and indicated through language of change increased motivation for treatment.
A final question asks, “To assist you on your journey back home, how might psychological services benefit you?” Jim’s answer was telling, “Sure. I think I just started, didn’t I?” Afterward, I encouraged him to speak to his medical provider about enrolling in an evidence-based PTSD program.
Analysis
This case study provides preliminary support for use of the WJI as an exercise for enhancing motivation for treatment and relieving symptoms of post-combat stress. It’s proposed that the qualitative change reflected in Jim’s statements are the result of five narrative meaning-making mechanisms embedded in the story. These narrative-based, causal-intermediate processes to be identified and linked to outcomes are: (a) goal envisioning; (b) re-authoring or narrative reconstruction, (c) neuro-coupling, (d) self-transcendence, and (e) externalization.
Goal envisioning has been found to increase hope as a motivational belief system (Snyder et al., 1991) as well as improve treatment engagement and response (Irving et al., 2004). As participants identify with the Warrior’s Journey, they assume the story’s overarching goals and outcomes as their own, thereby, operationalizing hope and motivation to pursue recovery. The story’s “big picture” of the trauma-healing process also provides a motivating rationale for treatment. Jim demonstrates the story’s capacity to generate motivation through goal envisioning when he observed, “I got lots more work to do but it seems worth it.”
Reauthoring a trauma narrative (a process of narrative reconstruction), whereby one makes meaning out of what was previously viewed as chaotic and destructive, has been found in the literature to increase agency, hope, meaning, and motivation (Adler, 2012; Graci & Fivush, 2016; McAdams, 2018; Meichenbaum, 2017). At first, Jim did not seem capable of making sense of, or finding value in his combat experience. Identifying with the story’s redemptive theme and hidden benefits of wisdom, resilience, and meaning, he reauthored his story to include a more positive future and sense of purpose, “War will make you sick, but you don’t have to stay that way.”
It appears that the meta-story may have “telepathically” imparted a conceptual framework with overarching goals (following the warrior’s path will lead you to wholeness and wellbeing) and structures of meaning (the world needs to hear your story) from which Jim was able to reconstruct his trauma narrative and find hope and meaning. This transmission of new schemata, in Jim’s case what appears to be a cognitive map charting a course to recovery, may be the result of a phenomenon called neuro-coupling. Neuroscientists have observed cortical activity “syncing” or aligning between a story-teller and story-listener while stories are being told (Hasson et al., 2010). Researchers conclude that simply telling a story has the potential to “plant” or transfer information from one brain to another (Hasson et al., 2012).
The impact of these transported structures of meaning are observed in statements that reflect freshly conceived, transcendent insight. Jim’s initial self-limiting beliefs, “I feel lost, like I don’t know how to move ahead,” evolved into perceptions of agency in “others made it through,” support in “you are not alone,” hope in “there’s a way out,” and meaning in “God kept me around for a reason.”
The genesis of this productive, transcendent insight may be found in the power of a metanarrative’s ability to carry one beyond cognitive barriers (self-focused needs, biases, and distortions) toward an awareness of a greater and unlimited source of strength, culminating in an expanded, more hopeful and meaningful worldview (Bauer & McAdams, 2006, August; Wong, 2016). Self-transcendence has been shown to have a positive correlation with hope, agency, and meaning (Bauer & McAdams, 2006, August; Cloninger, 2015; Pargament et al., 2000; Wong, 2016). Jim’s recurring reference to agency and support beyond his own (“others made it through”) may reflect insight generated by a self-transcendent experience.
According to prominent PTSD theories, fresh insight is essential for the construction of a narrative-context conducive to the integration of trauma’s fragmented and highly charged memories known to continually resurface as nightmares and flashbacks (Brewin, 2014; van der Kolk & Fisler, 1995). Jim’s new agentic insights (support of a fellowship of warriors, God as an available, and achievable goals of meaningful service) may serve to reorganize his trauma narrative into an expanded, forward-moving story capable of integrating intrusive and highly reactive memories into a coherent and meaningful narrative (Brewin, 2014; van der Kolk & Fisler, 1995).
The narrative practice of externalization may have provided Jim with the emotional space he needed to accurately appraise the traumatic event for rational guilt. Representing traumatic experience indirectly, through metaphor, crippling emotions, like guilt and shame, are perceptually removed (externalized) from one’s immediate experience, creating a safe distance from which to review highly charged memories (White, 1989).
Researchers may ask, with good reason, the following questions: (a) how long will Jim’s new levels of hope, meaning, and guilt last, (b) do his statements truly account for changes in these psychological states, and (c) do these changes translate into motivation for treatment, program completion, and symptom reduction? Moreover, the question is raised as to the generalizability of the case study’s findings: what is the impact of the WJI upon the larger population of veterans with combat-induced symptoms in need of treatment? In response to these research questions, an empirical investigation is recommended.
Future Research
To date, no quantifiable evidence could be found to support the use of the Hero’s Journey or Warrior’s Journey in the treatment of trauma. Efforts are underway to manualize the Warrior’s Journey and standardize its script so that a randomized controlled trial of the intervention might be conducted to measure statistically significant changes in hope, meaning, and guilt, as well as, readiness for treatment and retention, and symptoms linked to post-combat stress. A program evaluation is currently in place and data is being collected through a scale that measures changes in hope, meaning, and symptoms of post-combat distress.
Perhaps the best way to determine the narrative’s impact on PTSD and program retention would be to incorporate it into a participating evidence-based PTSD treatment protocol and measure targeted outcomes against a program without the intervention (control group). Such a study would parallel Murphy et al.’s (2009) experimental design which tested the impact of a brief motivational intervention on treatment engagement, measuring readiness to change, perceived treatment relevance, and attendance, in a yearlong PTSD treatment program.
An investigation into the effect of the WJI on motivation for treatment and combat-induced symptoms could use the following reliable and valid scales to measure changes in hope, meaning, and guilt: Snyder’s Hope Scale (1991), Steger et al.’s Meaning in Life Questionnaire (2006), and Kubany et al.’s Trauma-Related Guilt Inventory (1996). To demonstrate “readiness for change,” the University of Rhode Island Change Assessment (URICA, 1999) could be additionally administered. Attendance and attrition could be measured by acquiring a control group, and changes in PTSD and MI through use of the Clinician Administered PTSD Scale (Blake et al., 1995) and Koenig’s MI Symptom Scale-Military Version (2017). Repeated measures could also be employed at six months and a year later to follow longitudinal change.
Conclusion
A review of the outcome literature among veterans with post-traumatic symptoms returning from war indicates the need for strategies that circumvent stigma among mental health providers, increase a readiness for treatment, and mitigate post-trauma symptoms. As members of an interdisciplinary mental health team, clinically trained chaplains are deeply invested in trauma recovery and uniquely qualified to safeguard a veteran’s personal information, while enhancing treatment engagement and ameliorating symptoms through spiritual interventions that inspire hope, meaning, and relieve guilt.
A case study offered preliminary support of the efficacy of a narrative-based, meaning-making exercise, called the WJI, proposed in this paper to enhance motivation for treatment success and reduce symptoms of combat-induced trauma by increasing hope and meaning and reducing guilt through the use of a universal story of trauma recovery. Narrative meaning-making processes were observed during the delivery of the intervention to access trauma memory through metaphor, and introduce, via story-telling, a conceptual framework through which transcendent insights (alternative global assumptions, structures of meaning, sources of agency, and life-goals) were acquired. It is proposed that these constructive insights were, in keeping with predominant PTSD theory, used to sculpt a more adaptive narrative-context through which Jim was able to integrate fragmented memories and form a coherent and redemptive narrative.
Evidence from the case study shows initial support for an investigation to quantify the impact of the intervention upon treatment engagement, completion, and mitigation of PTSD symptoms. Future findings would hopefully support or disconfirm TWJ as a preparatory, motivational exercise delivered at the initial stages of evidence-based PTSD treatments.
A shaft of sunlight revealed a path through the black smoke and charred debris of battle’s end. In the distance, warriors from ancient days call out, “This is the way! Come home!”
