Client: A.S., 34-year-old male Setting Outpatient Veterans Affairs Mental Health Clinic Presenting Complaint: "I can't sleep and I keep reliving what happened." History: A.S. is a recently discharged military veteran who survived an improvised explosive device (IED) attack during deployment. He reports persistent nightmares, emotional numbing, and avoiding crowded environments. His spouse notes increased irritability and detachment from family members. A.S. denies substance use and suicidal ideation but expresses "hopelessness about things ever changing." Exhibits For each intervention below, identify whether it is indicated, nonessential, or contraindicated based on the client's current presentation.

• Reinforce consistent medication adherence: The client has recently started sertraline, which typically requires 2–4 weeks to achieve therapeutic effects. Reinforcing adherence supports symptom improvement and prevents relapse. Education on side effects and realistic expectations of symptom improvement is essential in managing PTSD and anxiety symptoms effectively. • Discuss long-term goals for reintegration and recovery: Focusing on long-term goals helps the client regain a sense of purpose and direction, which is crucial for PTSD recovery. Structured planning supports coping, social reintegration, and employment aspirations. Addressing goals collaboratively can increase engagement and reduce hopelessness. • Explore feelings of survivor guilt in individual therapy: The client expresses guilt over surviving the IED attack, which is a common PTSD symptom. Individual therapy provides a safe space to process these emotions. Addressing survivor guilt can improve coping, reduce avoidance behaviors, and enhance participation in group therapy. • Performing suicide risk assessment every other day: Given the client currently denies suicidal ideation, performing suicide risk assessments less frequently than daily is nonessential. While monitoring is important, there is no immediate risk requiring every-other-day assessment. More frequent assessment may be unnecessary at this stage but should be increased if risk factors change. • Perform Abnormal Involuntary Movement Scale (AIMS) assessment: AIMS assessment is used for clients taking antipsychotics to monitor for tardive dyskinesia. The client is taking an SSRI, not an antipsychotic, making this assessment nonessential at this time. There is no indication of movement disorders related to current medications. • Recommend discontinuing SSRI after one week if no signs of improvement: Discontinuing sertraline after only one week is contraindicated because therapeutic effects typically take 2–4 weeks. Early discontinuation can prevent symptom improvement, increase anxiety, and risk relapse. Patience and adherence are crucial to allow the medication to work effectively. • Encourage sleep avoidance to reduce nightmares: Sleep avoidance is contraindicated because it worsens fatigue, mood, and PTSD symptoms. Encouraging avoidance can exacerbate anxiety and impair recovery. Sleep hygiene strategies and grounding techniques are safer and more effective methods for managing nightmares.