Trauma Treatment

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 so far.

Cognitive Processing Therapy (CPT) 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. 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, it appears to be more efficient than the more traditional exposure methods (for adults and kids), 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 worked as well and as quickly as EMDR (PE took about 50% longer for the same results).

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 well-researched, and the above link is to a free TF-CBT training program.

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.

Progressive Counting (PC) is an in-developement exposure variant, based on the Counting Method but with substantial modifications. Over the coming months, more information and outcomes on PC will be posted here.