Phase Model of Trauma-Informed Treatment

We use Dr. Greenwald's Fairy Tale phase model of treatment, so named because it is introduced with the telling of a fairy tale, in which each element of the story corresponds to one of the phases in treatment. For example, the hero's love for the princess (which moves him to try to slay the dragon) represents the treatment phase in which the client's motivation is identified and developed. The Fairy Tale model's phases of treatment are as follows:

1. evaluation including learning about the client's strengths, resources, trauma/loss history, life situation, and presenting problems
2. identification and enhancement of the client's goals and motivation
3. trauma-informed case formulation and treatment contracting
4. stabilization, potentially including case management, parent training, problem-solving, and strategic avoidance of high risk situations
5. identification and enhancement of coping and affect tolerance skills
6. resolution of trauma and loss memories
7. consolidation of gains
8. anticipation of future challenges

Trauma Resolution Methods

Here is a selective annotated list of leading proven-effective trauma resolution methods for adults and kids. Each involves some way of having the client systematically face the memory, without becoming overwhelmed, so that the healing can occur.

Prolonged Exposure (PE) involves having the client tell the story of the trauma memory in detail, along with thoughts and emotions, from beginning to end. And then tell it again, and again... The theory is that as avoidance of the memory is prevented, the client has a chance to learn that it can no longer hurt, and desensitization occurs. This is an effective, well-researched treatment, mainly for adults.

Cognitive Processing Therapy (CPT) is an exposure variant that involves having the client write down the trauma memory rather than speak it; the writing may provide some distance, making the procedure more tolerable. Most of the research on CPT has been with adult victims of rape, but one study of incarcerated teens with PTSD also showed CPT's effectiveness.

Eye Movement Desensitization & Reprocessing (EMDR) involves having the client concentrate on the worst part of the memory for perhaps half a minute at a time, while moving his or her eyes back and forth by following the therapist's moving fingers. This is done again and again until all distressing aspects of the memory have been worked through. The brief burst of exposure, combined with the distraction of the eye movements, may help to make the procedure more tolerable. This web site features a lot of information on EMDR, because it is well-researched, has been found to be more efficient than the more traditional exposure methods (such as PE, TF-CBT), and because Dr. Greenwald has been one of the pioneers in EMDR's development.

Counting Method (CM) involves having the client visualize a "movie" of the trauma memory, from beginning to end, while the therapist counts out loud from one to one hundred. The visualization, time limit, and distraction of the counting may help to make the procedure more tolerable. In the one controlled study completed so far, CM appeared to work as well and as quickly as EMDR (PE took about 50% longer for the same results). It has so far been used only with adults.

Progressive Counting (PC) is a variant of the counting method, developed by Dr. Greenwald, designed to make the treatment more efficient and better tolerated by clients. PC involves having the client visualize a series of progressively longer "movies" of the trauma memory while the therapist counts out loud first from one to 10, then to 20, then 30, etc. PC appears to be at least as effective and efficient as EMDR, well tolerated by clients, and relatively easy for therapists to learn. TI/CTI is teaching PC (replacing PE) in some of its training programs.

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a treatment for children that involves having the child create a book of the trauma memory, in which each page of the book represents one significant part of the event. The drawing helps to hold the child's interest, while going only a page at a time breaks down the memory into small parts, so that facing it is more tolerable. This method is not as efficient as EMDR but it is well tolerated by children and well-researched.

Structured Play Therapy is a structured, directive style of play therapy that guides the child to repeatedly go through the trauma memory, in symbolic form. This is not a manualized treatment approach like the others on this page, and the research supporting this approach is not as strong as for most of the others listed. Even so, it is a legitimate and potentially effective way of conducting "exposure" with a child.

Private Intensive Therapy Retreats

Find a Therapist