Counterinsurgency (COIN) has become the cornerstone of the military's strategy to combat terrorist threats. COIN operations are complex and often expose soldiers to unfamiliar stressors as they fight the enemy while developing and maintaining rapport with the local populace. Utilizing a retrospective record review protocol, we examined 282 mental health files of soldiers assigned to a brigade combat team that operated from a large forward operating base in Iraq during the counterinsurgency campaign. Most reported sleep disturbance, depression, anxiety, irritability, and conflict with supervisors related to either operational stress, exposure to direct combat, or home front concerns. Most received brief individual supportive therapy or attended solution-focused group counseling emphasizing life skills training, post-traumatic stress treatment, women's support, or relationship skills. Psychopharmacologic treatment was an essential adjunct to the counseling program. Results indicate that supporting a COIN deployment requires a comprehensive mental health program that can respond to a wide range of mental health problems.