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.