While it is almost impossible to plan out every unique aspect of therapy, there is an essential framework that should guide the the therapy process. This framework provides a way to evaluate progress as well as setbacks and brings a sense of order to some of the chaos trauma has created.
Prior to your first session, you will complete intake documents, a client interview document, and several assessments (you can view all of these under new client forms). Completing these prior to meeting is essential to allow us to have as much time as possible in our first session.
Your first four sessions are usually a planned process of determining issues as well as strengths and resources for engaging in the process. Each session is outlined under Session Information. You are welcome to download and review any of the documents under each session to better understand what to expect.
With adolescents, the second session is for parents without their kiddos present. This allows for me to have a greater understanding of family dynamics as well as how your child's trauma is impacting your current quality of life. There will be a few additional assessments for parents to complete on their own. This is also a time to express concerns as well as ask questions.
You will also be encouraged to explore more ideas and research related to Adverse Childhood Experiences (ACEs) as well as the biological and neurobiological impact of trauma on kids as well as adults. Increasing your ability to view your child's behaviors through a trauma-informed lens is critical to creating an environment of felt safety in your home.
The fourth session wraps up Step One. It culminates in a treatment plan that describes all the information we have gathered and addresses issues that seem to be problematic. We will talk about the specific research and evidence-based approaches to working through steps to overcoming trauma's impact. Everyone participates in identifying goals for each step of therapy and the skills and strategies we will use to reach these goals. A treatment plan not only guides our work together, it creates a real sense of informed consent. This means you (and/or your kiddo) are informed and know ahead of time what we are going to do together. This takes the mystery and, hopefully, suspicions about therapy away and increases active participation for everyone.
All the research and my clinical experiences point to the idea that trauma work cannot begin until there is an established sense of safety, and survivors feel strong enough to begin working on trauma. This includes an internal sense of felt safety in my office as well as an increased sense of safety in other life domains.
There are multiple interventions to create awareness and increased regulation throughout this step. Progress is established through learning and practicing skills in sessions as well as at home. Many of these skills come from Dialectical Behavior Therapy and other evidence-based ideas in multiple therapy models.
Emphasis is placed on skills related to what is needed for survivors to go back and "rescue the parts left behind during traumatic experiences." There is more of an "in-training" feel to this step in order to become equipped to return to trauma and resolve its' impact.
Progress is measured by ongoing weekly outcomes measurements as well as clients noticing they are increasingly less reactive to stressful circumstances. Many of the skills can be learned and practiced at home with the brief video introductions (coming soon) to each skill session and then working through the materials.
This step involves the use of developmentally-modified trauma protocols that are an intentional combination of Brainspotting (BSP-David Grant), Somatic Experiencing (SE -Peter Levine), Eye Movement Desensitization and Reprocessing (EMDR - Francine Shapiro) and Accelerated Resolution Therapy (ART - in press and is recently the standard for processing combat trauma in the military).
There is typically a balance of one session of trauma work followed by a session of reviewing and processing. Initially, only one trauma episode per session is possible. As survivors become more comfortable and excited about the changes they are able to make in this process, it is common for multiple trauma episodes to be processed. During this step, all sessions are on an individual basis.
Trauma processing can lead to a return to some of the negative behaviors that subsided in step one due to the increased focus on the sensations associated with trauma history. Patience and continuing to engage in awareness and self-regulation exercises is critical to maintaining an ongoing sense of felt safety.
Step Three is usually completed when survivors no longer identify upsetting events from the past that are interrupting their present reality. Sometimes, during Step Four additional memories of trauma will surface and there is a brief return to the trauma protocols mentioned above.
Even though trauma is no longer complicating the scene, survivors often still follow some of their old patterns until new patterns can be identified. There is a balance of proactive problem solving in anticipation of recurring issues and chain analysis (a DBT skill) in the aftermath of upsetting events to gain more information and facilitate identifying better options for future events. As these skills become increasingly available to the entire family, I become less necessary!
The outcomes measurements in combination with a more peaceful home, school, work, and social environment usually lead to reduced frequency of sessions and eventual discharge from treatment.
Kenny Dennis, MA, LPC
1864 Woodmoor Drive, Suite 214 Monument, CO 80132 719.321.1976