Once Upon A Time...

TI/CTI Blog

Feb
04
0 comments
The other day my five-year-old and her friend were excitedly planning their next get-together. Mine said, “And we’ll play hide and seek!” and her friend said, “And we’ll think all the same thoughts!”This longing for magical closeness does not fade with age. But finishing each others’ sentences (or sandwiches) is not always all it’s cracked up to be – as Anna (in Frozen) learned the hard way. Sometimes, the longing for closeness can lead to problematic compromises and unhealthy relationships. While the risk is higher when one or more party is desperate (e.g., Anna), anyone can find themselves accepting things they shouldn’t, for the sake of friendship or love.How to do love and friendship so it’s good for you? The general guideline is that a relationship should make…
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Jan
09
2 comments
Most of our intensive therapy clients achieve profound healing from their trauma and loss memories. This typically leads to a dramatic reduction of symptoms, which in turn enables them to pursue their goals more effectively. Once in a while, though, there’s a glitch. Days, or even weeks or months, after the trauma work is done, the client reports feeling destabilized.There are three common reasons this can happen:
1. The trauma work was not complete. Either we knew it wasn’t complete, or we thought it was, but learned otherwise. For example, several weeks after treatment appeared to be completed, one client recalled an additional perpetrator of his childhood abuse, leading to a spike in distress. This type of situation is best remedied by the client returning to…
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Nov
01
4 comments
We’re in the golden age of trauma therapy. We have research-supported treatments that are effective, efficient, and well-tolerated by clients. A lot of traumatized people are getting a lot more better than they ever dreamed was possible.Yet many people who contact me for help are leery, because they’ve already tried trauma therapy and had a bad experience.So you get into a room with a therapist and start opening up about the worst things that ever happened to you. What could possibly go wrong?Well... a lot of things. The problem is that many therapists who are trained in a particular trauma resolution method (such as EMDR, PE, TF-CBT, etc.) are not very well trained as trauma therapists. Here are the treatment mishaps I hear about the most.
Wrong Therapist
This…
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Sep
28
2 comments
I know a lot of people think that sliding scale is a cool thing to offer. I am opposed to sliding scale. I'll tell you why: Because in my first year of private practice, a college counselor convinced me to take on one of his students at half price. Then she came in every time with some new gold bracelet or cashmere sweater, and talked about the fancy restaurants and clubs she went to, that I couldn’t afford to go to. It didn't work for me.At the same time she was paying me $50/hr and I resented it, I was accepting other clients via Medicaid and getting $39/hr, and not resenting it. It wasn't the money, it was the dynamic.And on the other side, when I'm a client, I despise sliding scale – even in those years when it would have allowed me to pay on the low side. It…
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Sep
05
4 comments
As the director of our intensive trauma-focused therapy service, I receive a lot of phone calls from people who would like to be feeling better and/or doing better. Some are in extreme distress. I’m often asked, “Should I be checking myself into an inpatient program, or going for intensive outpatient therapy?”Here are the questions I ask, to determine how to respond:

Are you safe? If left to your own devices – e.g., in the evening after your day’s therapy is done – are you at risk of hurting yourself, drinking, or drugging?
If you are at risk, is there someone who can accompany you, whose presence would eliminate the risk?

When the immediate concern is safety, I recommend inpatient placement. An outpatient therapist cannot provide 24/7 monitoring and…
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Aug
04
2 comments
A slide in one of our training programs used to list prolonged exposure (PE) as “the gold standard” of trauma therapies, but then we took out the “g.” For two reasons. One is that eye movement desensitization and reprocessing (EMDR) has now surpassed PE, in acceptability to clients as well as efficiency (Greenwald et al, 2016). The other is that the gold standard trauma therapy should be useful with real clients, and it’s not clear that PE is.The so-called gold standard trauma therapies were established on the basis of randomized controlled trials, with EMDR, and other cognitive-behavioral therapy variants such as cognitive processing therapy (CPT) leading the pack. Both PE and CPT have now been implemented on a large scale in the field, mainly in settings that treat…
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Jun
15
4 comments
It’s an old lament: They don’t like us, and we don’t like them. Practitioners and researchers, that is; us and them being whichever one you are, and aren’t, respectively. So why don’t we get along? We all care about the same things, don’t we?Researchers complain that practitioners don’t read the research. “That’s not responsible!” they say. “They should be using what works, not just whatever they feel like doing. Why don’t they listen to us?” Good point. Practitioners should be paying attention to the research, to improve practice based on what has been shown to work. So why don’t they?Well... Practitioners complain that researchers are too focused on doing studies that are not relevant to practice. “So why bother to read that junk? It’s got nothing to do with my…
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May
03
21 comments
Does being a transgender child entail being doomed to a life of posttraumatic stress and misery? At first glance it doesn’t look so good. Let’s start with the 41% attempted suicide rate. Yes, 41% – nearly half of transgender individuals have tried to kill themselves. Other research indicates that compared to cisgender children, transgender children have substantially higher rates of anxiety and depression (a fair estimate of post-traumatic stress when the latter is not directly assessed).The obvious question is whether the transgender child’s terrible fate is somehow inherent to transgenderism, or rather the result of the shaming, bullying, and discrimination that has been visited upon the child. Fortunately, the answer, as per a recent landmark study, is the…
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Apr
04
11 comments
Here’s the problem:

An estimated one in six women has been the victim of either an attempted or completed rape.
Fewer than an estimated 1/3 of rapes are ever reported.
Of those, only an estimated 6% of accused rapists end up serving time, despite the fact that an estimated 90 - 98% are guilty.
We do have laws against rape, but the system is rigged in the rapist’s favor. We routinely dismiss victim’s claims and even blame or attack the victim. It’s no wonder that such a small percentage of rapes are reported to the authorities.
We also tend to reflexively disregard claims of rape when the victim was drunk or otherwise incapacitated, making it easier to believe that she may have given some kind of consent but just not remembered it that way later. Of course…
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Mar
06
2 comments
The standard of care in trauma therapy includes a stabilization phase prior to engaging in the trauma resolution work. This preliminary phase gives clients an opportunity to improve their affect regulation and coping skills, in order to be more successful in facing and overcoming their trauma memories during therapy. This standard has just been challenged in a critique co-authored by 21 prominent trauma therapy experts (de Jongh et al, 2016).
The Critique
The authors note that the various expert guidelines advocating for a stabilization phase in treatment of complex PTSD are based on limited research that does not specifically support the independent value of the stabilization phase. They further note that at least a few studies disconfirm the need for the…
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Feb
04
3 comments
I like gambling; used to play in a regular poker game. But I prefer fair odds, so I’m not a fan of playing against the house. I did it only once, when I was 17: dropped 85c worth of nickels into a slot machine in Reno. That was it, until recently. I was cashing in some bottles at the supermarket and when I took my receipt to the service counter, there was the lottery ticket machine. I’d been reading about the 1.4 billion dollar prize, and on a lark threw in enough change to add up to a $2 ticket.Like so many, I found myself envisioning my new life as a billionaire. Over the next couple of days I planned it all out.First there was the personal stuff. My 2000 Chevy Metro can be replaced with a more reliable car, maybe a Honda Fit. Pay off the mortgage. Pay off another…
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Jan
06
5 comments
Therapists often ask me which trauma treatment they should learn: eye movement desensitization & reprocessing (EMDR) or progressive counting (PC).First of all: Yes – you should learn EMDR or PC, if you haven’t already! Efficient, effective trauma treatment methods enable therapists to systematically guide clients in healing from their psychological wounds. This is much better than merely teaching coping skills. When you heal, you don’t have to cope with the symptoms anymore! Learning EMDR or PC is a real game-changer, and the therapists we train routinely report feeling reinvigorated in their work.EMDR is the best of the well-established trauma therapies (as per the latest meta-analysis, currently under review), in that it is at least as effective as the other…
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Dec
05
6 comments
I don’t really know. Self-help books have kind of a bad reputation, right? They’re like diets: you get the suckers to pay for each new one that comes along, and the sellers are the main beneficiaries.Okay, I’m sure some legitimate self-help books are published, that provide useful information, and teach useful skills and attitudes. In my particular areas of interest, I can think of a few that were quite successful: One Two Three Magic, The Instinct To Heal, The Seven Principles for Making Marriage Work. Yeah, these (and some others) have done a lot of good. Phew.It’s just that I’ve never wanted to join that club (of self-help authors), so I’m relieved to recall some honorable examples. Now that I’m coming out with a self-help book. Or at least the “beta” version –…
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Nov
02
8 comments
Maybe this story starts when, at age 11, I tell my uncle that when I grow up, I want to make the world better. He both smiles and scoffs, knowing that I’ll learn the ways of the world and get a regular job like everyone else. I scoff back, because I know I will do it.As a young adult, I was not sure exactly how to do this. I felt that I had missed the boat. All the boats: Freud was long gone, family therapy had been invented, the civil rights movement, feminism, organic farming... Would there be any big/important movement left for me to join?The story picks up in 1992, when I walk away from the already-started dissertation, to do one instead on a new trauma treatment I had learned, eye movement desensitization and reprocessing (EMDR). EMDR offered a method of healing…
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Aug
31
1 comment
We have a project looking for a home. We want to create a brief intensive trauma therapy diversion program for teens on their way into residential placement. The goal is to dramatically reduce time in residential placement, reduce costs accordingly, and improve outcomes. If it works – which it should – this can become a preferred alternative to typical longer-term residential care. Here are the details.For example, let’s say we have a catchment area in which an average of 12 youth per week are placed in residential care for an average of three months duration. We reserve five beds in a residential facility, for the diversion program. We hire five therapists and train them in our intensive trauma-focused therapy approach.On the way into placement, each young person in…
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Jul
28
3 comments
So you’ve found a good trauma therapist, now you can just relax and get treated, right? Well, not exactly... getting psychotherapy is not like getting a massage. Your therapist will be asking a lot of you, both in session and out. Here are some things you can do, on your own initiative, to get the most out of your therapy. Then you will have the best chance of solving your problems and achieving your goals.1. Show up early. If your target is to show up on time, and something goes wrong, then you’re late. So aim for early, and you’ll have the cushion. Might as well get what you’re paying for, right? This may seem simple and obvious, because it is. Minutes matter, especially if you’ve only got maybe 45 or 50 of them in your session.2. Get the practical questions…
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Jun
25
8 comments
So you want to go for it, but you’re not sure how to go about it? Here’s the step by step.
Get ReferralsOne good source of referrals can be people whose opinion you respect, whether that be a friend, clergy, doctor, or someone else. But take the referral with a grain of salt, because:

Not every good therapist is good at trauma therapy. And the person who makes the referral might not know how to tell which therapists are which.
Not every good therapist is good for you.

Another source is listings. For example, you can find a listing of EMDR therapists at the EMDR International Association web site; it allows you to search by location, specialty areas, and level of credentialing (trained, certified, consultant). We also have a listing of therapists we’ve…
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May
04
6 comments
Is it possible to inoculate, or de-traumatize, someone who has just experienced a probably-traumatic event?This would entail somehow interfering with the traumatization process, if slightly after the initial fact of the event. When distress and shock overwhelm the mind’s normal ability to process and integrate an experience, it is consolidated, or stored, as a traumatic memory. Traumatization arises from the individual’s subjective experience of an event, as well as subsequent coping process, especially during the six hour post-event memory consolidation period.What if, after a potentially traumatic experience, we could disrupt or modify the memory consolidation to prevent the event from having traumatic impact? Two studies have attempted this, with some…
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Mar
27
2 comments
The concept of post-traumatic growth has been around since long before the term was coined. For example, people have long proclaimed, “What doesn’t kill you makes you stronger.” The thing is, sometimes it does, and sometimes it doesn’t. And when it doesn’t, the point of trauma-focused therapy is to help those who have been wounded by their experiences to heal and come out stronger. In other words, when post-traumatic growth doesn’t happen naturally, we try to induce it.The processing of trauma or loss has long been regarded as a primary method of personal growth (e.g., Cassem, 1975). My favorite take on this is Jungian, and my favorite exemplar is Joseph Campbell’s (1949) classic, The Hero With a Thousand Faces. Campbell surveyed numerous cultures’ coming-of-age…
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Feb
26
2 comments
Economic value is an important consideration in obtaining mental health care. Nobody wants to spend more than they have to, and that applies to individuals as well as grant funders, insurance companies, or government agencies. I’ve found that the idea of “getting it done” via intensive trauma therapy appeals to many people, but some wonder about the cost. Fortunately, economy and quality are not necessarily in conflict: spending more up front for quality treatment can be far more economical than the alternatives.Impact of TraumaTrauma is among the leading public health issues in economic as well as social impact.

Adverse childhood experiences (such as abuse, neglect, loss, exposure to violence, etc.) incur risk for lifelong emotional, behavioral, and medical…
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Jan
28
5 comments
Perhaps Freud said it best over a century ago: a healthy person is able to work and love. This is pretty much what parents want for their children (along with simply surviving childhood): to grow up to be able to work and achieve, and to be caring, decent people. Fortunately, by now there is quite a bit of research on how to help our kids get there. Here are some of the key strategies that work.1. To promote achievement, praise the effort/behavior, not the talent/result.The problem with praising a child for being smart or for achieving a good outcome is that doing so can actually decrease the child’s motivation (Mueller & Dweck, 1998). A child who is praised for achieving good outcomes due to intelligence or talent may come to rely on “the easy A” and fail to…
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Jan
02
6 comments
In our clinical practice and training programs, we use a highly structured and directive treatment approach. The reason for this is that you (the therapist) are the professional, and your client is contracting you for services so that s/he can achieve his/her treatment-related goals. You are supposed to be the one with the expertise to deliver the service effectively and efficiently.This is not to say that the client has no choice or input. To the contrary, the whole point of treatment is to accomplish the client’s goals, so it’s essential to learn what the client’s goals are. However, that does not mean that the therapist should rely on the client for technical guidance on how the treatment should be conducted.If you went to a doctor who asked, “What diagnosis would…
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Nov
30
2 comments
Want to know why some relationships thrive and others deteriorate? This excellent and readable summary of the research tells us that it comes down to two things: emotional stability, and kindness.Let’s start with what kindness looks like in a relationship: a positive, interested, supportive response to your partner’s reaching out. We’re not only talking about flowers or hugs here – just the normal every day comments people make, in large part, to engage with one another. Things like, “I had a rough day,” or “I’m going for a walk,” or “It looks like rain is coming.” If the typical response is ignoring, dismissive, minimizing, or attacking, that couple will not last (or if it does last, they’ll be miserable). If the typical response is engaging, supportive, interested,…
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Oct
29
4 comments
The medical model has historically been promoted as the foundation of the psychotherapy approach, despite being a poor fit for psychotherapy (Wampold, 2010). In medicine one can actually provide a specific treatment for a properly diagnosed disorder and thereby effect a cure. However, mental health diagnoses are largely behaviorally defined rather than based on underlying dynamics or etiology, and the evidence for the superiority of a particular treatment for a given diagnosis is dubious (Wampold, 2010). Therefore common factors researchers have long been advocating a focus on good therapy applied to a wide range of clients and presenting problems.More recently the call for transdiagnostic treatment approaches is also coming from the CBT community, which has…
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Oct
01
7 comments
The landmark Adverse Childhood Experiences (ACE) study found that childhood experiences such as abuse, neglect, exposure to domestic violence, death of a parent, etc., incurred lasting and deleterious effects not only on mental health but also on medical status. Furthermore, there was a cumulative effect: each additional type of adverse childhood experience led to a dramatically greater lifetime risk of those problems. Such adverse childhood experiences are rampant and lead to enormous societal costs in terms of quality of life for the affected children (who become adults), and those they affect in turn – not to mention the economic costs associated with mental illness, addiction, behavior problems (including aggression and crime), medical problems, and impaired…
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Aug
27
9 comments
I have a lot of beefs (beeves? plenty beef?) with extant trauma training practices, so I might be offending a lot of prominent people here. Hopefully to good purpose. However, I will not be calling out trauma treatment training approaches by name, other than EMDR, which I can critique more freely as that is my own professional “family”.My training institute recently conducted a needs assessment by surveying clinical directors of mental health agencies in Western Massachusetts. We found that about one out of four agency therapists have been trained in a research-supported trauma treatment method. That’s good, right? But most of those trauma-trained therapists were not routinely providing trauma treatment to their clients. This despite the respondents’ belief that…
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Jul
31
12 comments
What makes trauma treatment work? And what can make it work better? This is another in an irregular series of posts focusing on key elements of trauma treatment.One of the early debates about eye movement desensitization and reprocessing (EMDR; Shapiro, 2001) was whether or not the eye movement component actually contributed to the treatment effect, or was just a gimmick. Despite the EMDR originator’s insistence on the importance of eye movements (Shapiro, 2001), a meta-analysis published in a top-tier journal concluded that eye movements make no contribution to EMDR’s treatment effect (Davidson & Parker, 2001). EMDR’s detractors characterized the eye movements as being like a “purple hat” that made the method appear distinctive but had no impact (Lilienfeld,…
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Jul
01
12 comments
How different things will be when we better understand how trauma can affect people!
“Michael” was a mid-40's married professional who had been subjected to extensive childhood abuse. In the course of his work with a particular client, the abuse memories became activated and his first-ever manic episode ensued. After a couple of months, at the urging of his wife, he came for therapy. However, at that time he did not believe that he had any problem. Furthermore, the abuse memories did not bother him and he did not see any point in working on them. This very brief course of therapy ended with an agreement: if certain problematic behaviors recurred, that would indicate that he did indeed have a problem, and in that case he agreed to hospitalization.He was hospitalized…
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May
30
2 comments
Last Saturday my 5-year-old daughter saw her friends go by on their way to shul, and she decided to try to catch up to them, before the rest of our family was ready to go. She’s walked this residential-area half-block daily for some time, often by herself or with her same-age sister. This time, though, a minute later she returned to the house in tears, and rushed into her mother’s arms. Through the open door, we heard a strange woman’s voice shouting at us, “She was walking by herself.” My wife answered, “We know where she was, we gave her permission.” And the strange woman shouted back, “No! Not allowed!” Then she disappeared.Moments later, a police officer came by. He apologetically explained that he was obliged to come because someone called in expressing concern…
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May
06
8 comments
Chicken and egg. Someone is unstable due to traumatization. So do you focus on stabilization interventions, which means the client continues to struggle with the trauma? Or do you take the leap, risking further destabilization, to treat the trauma and solve the problem?For example, many substance abusers have been told by therapists, “You can’t work on your trauma until you’ve been sober/clean for a year.” And they often respond, “But how can I get sober/clean while the trauma is still bothering me?”I believe in the phase model approach, in which stabilization and coping skills come before trauma resolution – in fact, I developed such a model. So I understand the therapist’s rationale in deferring the trauma work until the client is stable. But that doesn’t work for…
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Apr
06
5 comments
Perhaps the most frequent theme across posts in this blog is the promotion of psychotherapy for healing – via memory reconsolidation – as opposed to only symptom management, coping skills, emotional support, etc.This seems to strike a chord, and the blog post Got Memory Reconsolidation? has received the most “hits” (visits) of any so far. Therapists say (in various ways), “Yes! This is what I’ve been saying for years,” which makes me wonder if I’m only preaching to the choir. Therapy clients say (things like), “I got some and it was good,” or alternately, “Why haven’t I been able to get some of this?Some therapy clients are still being told that, for them, healing is not an option, so they might as well learn to cope/live with their symptoms. This means that some…
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Mar
05
2 comments
What makes trauma treatment work? And what can make it work better? This is the first in an irregular series of posts focusing on key elements of trauma treatment.A person’s trauma history can take up so much of the visual field that her primary sense of identity may be as a trauma victim or survivor. After healing has occurred, she’ll typically say something like, “Okay, it’s too bad [the trauma] happened, but it no longer defines me. I am much more than that; my life is much more than that.”I once viewed this broader life perspective as an outcome of trauma healing. I have long taught to include the really-over-ending as part of the trauma narrative, so that the bad part of the story could be connected to when it was over, allowing the client to “get” that it was…
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Feb
05
0 comments
Have you wanted EMDR training but it was too expensive? If so, you’re not the only one. When I ask this question at trauma workshops, nearly every therapist who has not been trained in EMDR says they wish they were, but for the cost.At present, eye movement desensitization and reprocessing (EMDR) is the most effective and efficient of the well-established trauma treatments (Ho & Lee, 2012; Greenwald et al, 2014), and it is well tolerated by clients. I’ve published numerous papers and books on EMDR, and (after EMDR’s originator) TI & CTI is the leading source of EMDR training in USA/Canada. Did I mention that I think EMDR is great? The problem is that EMDR is a complex treatment that’s hard to get good at (Greenwald, 2006), and therefore resource-intensive to…
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Jan
05
24 comments
Maybe there’s no nice way to say this, but I’ll give it a try.First of all, I’m not trying to put anyone down. Someone wants to tell their story, more power to them. But (you knew there was a but coming, right?) I just wish some of the stories went farther.A famous person – from sports, politics, pop culture – discloses having been abused. This is good, it models disclosure, puts the shame on the abuser and not the victim. It can help other people to speak, maybe for the first time, about what happened to them.A survivor of horrible abuse or other life tragedy writes his or her life story, and how he or she struggled for so many years and finally (maybe even with therapy) learned how to cope with the symptoms... Again, it’s great we have stories like this out there,…
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Dec
02
10 comments
The last blog post focused on the value of the intensive treatment format. The main point was that if the client comes to solve a problem, why not just get it done, instead of dragging therapy out for months? The post led to much back-channel discussion, continued here. (And this time please just post your comments below, OK? Makes for a better discussion. Thanks.)There are some situations in which intensive therapy is particularly helpful. The following case examples are composites representing typical but not actual clients.The client is at risk of hospitalization or residential placement.
“Sidney” was a 50-year-old emergency room nurse with a history of alcoholism (sober for many years), who was suffering from intrusive memories of various on-the-job horrific…
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Nov
04
1 comment
Why is therapy for an hour per week? Probably because:

You can fit it into a weekly routine.
Each session’s work can interact with the client’s life for incremental benefit.
This is what the insurance companies will pay for.

The fact that a convention exists for good reasons does not mean that it’s still the best way to do it today. The custom of the weekly therapy hour should be reconsidered in light of recent developments in the field, namely (a) the growing recognition that trauma, broadly defined, is a primary contributor to most presenting problems (Fairbank, Putnam, & Harris, 2007; van der Kolk, 2007); and (b) the development of ever more efficient, effective, and well tolerated trauma resolution methods such as EMDR and PC.For the first time in…
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Oct
05
3 comments
Since developing Progressive Counting (PC) in 2007, I’ve been teaching it quite a bit, often to therapists who are already trained in other trauma resolution methods. I enjoy the reactions: typically surprise and excitement for how well PC seems to work, how quickly, and how smoothly, relative to other trauma treatments. I’ve also heard two typical objections that I find curious:

Some EMDR-trained therapists say, “This can’t work – it wasn’t emotionally intense enough for real healing to occur.”


Some TIR-trained therapists say, “This can’t work – the client has to be able to tell the therapist what happened for real healing to occur.”

Oddly enough, the CBT people have no trouble with PC – it makes sense to them, perhaps because PC looks a lot like other…
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Sep
04
13 comments
Much has been made of the importance of non-specific factors (such as empathy, therapeutic alliance, etc.) to therapy outcome, and rightly so: therapists who use the common factors get better outcomes (Duncan, Miller, Wampold, & Hubble, 2010). However, that does not mean that only the common factors matter. For example, it’s well established that the trauma-specific treatments actually do treat trauma better than generic treatments do (Ehlers et al, 2010). So however important the common factors may be, there’s more to it.
The primary criticism of the common factors research is that it has relied on statistical analysis of randomized clinical trials. This means that outliers – for example, individual cases in which dramatic and lasting improvement occurred –…
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Aug
06
8 comments
When I call therapists in other locations to check them out for a referral, I briefly describe the case and ask what their approach would be. Quite a number of these therapists have said something like, “I mainly focus on the relationship, since that’s where the healing comes from.” In a recent survey I saw a number of similar comments. One question focused on choice of technique in a particular context, and a number of respondents wrote some version of, “The technique is irrelevant – it’s the relationship that heals.” Based on my nonscientific sample, I suspect that this position is not uncommon among therapists.The way it is expressed indicates that this view of the relationship’s primacy is not about psychodynamic theory – in which the therapy relationship is…
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Jul
09
13 comments
Hi. Ricky Greenwald here, founder and director of Trauma Institute & Child Trauma Institute, and this blog’s author. Welcome to our new/revised web sites, not to mention this new blog, first post. A chance to share thoughts and information about some of our own activities, as well as what’s going on in “our” world: trauma, loss, and healing. My intention is to post something new every month or two. Your comments are always welcome.And in case you’re wondering: The blog’s title, “Once upon a time...” refers to our Fairy Tale phase model of trauma-informed treatment.I’m opening this blog with a topic that I’m afraid might make you so uncomfortable that you don’t come back. But it has to be faced, and it’s my job to face uncomfortable things if they are important…
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