Monday, June 22, 2009

Model for trauma debriefing **

This model is primarily for use with non current ongoing trauma or very recent trauma (less than 4 months old). With very recent trauma one needs to use a different therapeutic approach

1. Use the facts and feelings technique as a method to open up the work and get the debriefing or grieving process moving. Usually no more than 5 to 6 sessions would be needed for this

2. Behavioural contracts that are relevant to the trauma. Assess trauma and changes in behaviour and thus make the relevant contracts.

3. Life script decisions. Identify new decisions and script decision reinforcement. Client to become aware of these and the use of 2 chair.

4. Identify the body script correlates using the tensiongram technique. This can assist the the facts and feelings process and the life script decision process.

5. Identify secondary gain of the client. This will exist to some extent and on occasions will play a significant role.

Recent examples:

Agoraphobic woman controlling her husband whom she feels insecure in her relationship with. As she became more and more house bound she discovered that she by and large could keep tabs on him. He had a job where he was out and about on the road most of the day. When ever she needed something done that involved going out of the house he would have to do it for her. It allowed her to gain more control and power in her marriage. So the agoraphobia is unlikely to be cured unless one also deals with the relationship problems.

The most common type of secondary gain is with the stroke deprived person. When one is bereaved, depressed, suffers panic attacks and so on most often others will respond with some kind of Nurturing Parent response. They will be kind and caring and giving and understanding to the person and their ‘illness’. If the person is from a stroke deprived background where they got very few positive strokes then this will be most appealing. They discover that their neurosis brings them this love and kindness they have craved their whole life. Thus one needs to deal with the stroke deprivation as much as the depression or panic attacks.

A recent example of a client I was working with. Her son had died a few years ago and she stated:

”In a way I don’t want the pain to go away. I don’t ever not want to miss him! I don’t get why I have to be without him??”

The secondary gain is that the emotional pain gives a connection with the deceased. The Child ego state can kind of trick itself that the person is kind of not dead if they can still feel the pain for him.

In such circumstances one needs to change the usual process in the ‘Goodbye work’. This work is where the person emotionally and cognitively says goodbye to the ‘lost’ object. That maybe a loved one, a pet, an item such as a house or a car, or a job, a limb and so forth. Any animate or inanimate object that the person has formed a psychological attachment to.

The usual process is for the person to express the feelings about the loss and the object. There is usually an array of emotions and these get expressed in a number of sessions in a variety of ways. The final point is when the feelings are dealt with and then the person is in a position to make the cognitive shift and accept the fact that the person is gone forever. This is the Child ego state cognitively accepting the facts, not the Adult ego state acceptance.

We all are capable of magical thinking and this can at times confuse our grieving

The problem with the secondary gain expressed above is that it is the pain that keeps the connection in the first place. So doing the usual goodbye work would increase the problem. The release of emotion usually will reduce the psychological connection to the deceased but in this instance it could be increasing it or at least supporting the connection. One would need to reverse the usual process and do the cognitive acceptance (a least to some degree) before the emotional release.



  1. Oh hey, that girl looks familiar:P

  2. No, I'm flattered that you enjoyed it enough to include it:)

  3. I think I have just realised, reading this, that I maybe do my goodbye work before the goodbye. In anticipation.

    I think I am doing that with work right now and the house we live in. I just reckon I will change job this year and maybe geographocal location.

    I guess I hate change so I try to do the changing first.

  4. Another attempt to comment here...

  5. I do that too Kahless - make the break before it actually happens. I've been over this house for about 2 years now. Totally ready to move into the other one.

    I do that with people too. I don't tend to miss them if i haven't seen them for a while. Perhaps its something i've trained my self to do because i could say it 'just seems to happen like that' but i don't think it does.

    The closer the relationship the longer the goodbye process (usually). Then when it happens, its sad and all that but i don't get broken as much.

    Oh... Kahless! I must hate change too. I always thought that i loved it. Hmm...

  6. Yes it is a good picture Lee


  7. I think you make a good point Kahless and Roses,

    When people know a change is going to come with some form of attachment they have such as to a house or location then the Free Child will automatically prepare itself.

    It knows that it may suffer some angst when the change comes so it gets in first to reduce the potential pain.

    In counselling I not uncommonly do this with the client. I am working with such a person at the moment. A woman who's life script is to be a mother and her youngest child is just at the point of leaving school and 'home' geographically and socially and psychologically. In the past months I have in essence been getting her to do goodbye work in this way before the event actually arrives.

    Welcome to my new home! I better do some goodbye work about leaving my old home. I actually feel Blogspirit is a rodents rear end though.

    That can be my next post. Goodbye work with some thing that you don't like and want to get away from. This complicates the goodbye or detachment process and in fact makes it harder to do.


  8. Well, i guess a rodents rear end doesn't do quite as much damage as a rodents front end. Does stink abit. My exam isn't tomorrow but Thursday so i've got a whole extra day to study. Phew! So nice!

  9. Well that is good news Roses to have another day to study.

    make sure you work hard


  10. *Fizz Fizz Pop*

    Yup, zapping out the bugs.

    Happy Tuesday to you too... roses

  11. Tony..blogspot has a feature where one can import there entire older blog to the new blog you have could try doing that.

    Also just so you know....blogspot has lot of issues with IE6 but is awsome with fireforx etc.
    So many bloggers recently have shifted to wordpress...which also has importing blogs option.

    When you leave your old blog...the disadvantage is that you loose you page ranking.

    When i used to visit your blog instead of just reading on the reader...i remember my google tool bar used to show it as 3....which can really take a while to reach.

    Hence if you import your entire blog...atleast there will be tons of when google engine crawls your might give this new blog a higher rank.

    Every rank that you get won't change for 3 it is also very slow process.


  12. Thank-you for saying that I made a good point.

    Would you link me on this blog please? I am not normally as bold to ask. Its kind of crass dont you think? It is just that it would make me feel good about myself for a milli-second. That you considered me enough to link. And I will pretend I didnt have to ask; cos that would negate the whole act.
    And I will pretend that asking is irrelevant cos you would do what you wanted to do anyway without any impact of asking.
    Oh I hate that I asked.


  13. I am so uncool. Not a freak, but so damn, well, uncool.

  14. I remember as a very young girl (six maybe) being in the school play as one of the seven dwarfs. I remember singing

    "we dig, dig dig dig dig dig dig dig dig the whole day through.
    to dig dig dig dig dig dig dig is what we like to do.
    To dig dig dig dig dig dig dig is..."
    cant remember the other lyrics but kind of apt. Let me go youtube to investigate.

    Fuck I am an ass.

  15. Kahless,

    *Hug* You ain't seen an ass till you've seen mine. Huge!

    ... roses


  17. Tony?

    I don't understand a lot of those points you've quoted at the beginning of this post. It sounds all official and inflexable. Like boxes that are rigid and ungiving.

    What if stroke deprived people learn to function on less strokes instead of, as you suggest, creating situations that induce more stroke opportunities?

    This place 'blogspot' does weird things to my computer.

    AND... why did you say that stuff about blogspirit (being the rear end of a rat).

    AND... Blogspirit and blogspot must be organised or run from totally different places in the world. Its like a maze or something. Or are there multiple places where it is run? So strange to move about on this one. Like it's a total different language and stuff. I guess its just a matter of getting familiar with it.

    So different. Happy Wednesday...


  18. Hello Shruti,

    Good to hear from you again.

    I am not too sure about some of the stuff you said. I don't even know what a page ranking is!

    But I will slowly learn blogspot speak and sort things out.

    Hope all is well for you and your kin


  19. Thank you for saying thank you to me Kahless,

    I am not sure but there seems to be some angst going on between us. Is that right?

    If there is I am not too sure why. I did state that I thought your fringe was a bit questionable. Maybe you took exception to that?

    I think you have a pretty face and it seems a shame to cover half of it up like the fringe did.


  20. Hello Roses,

    You state

    "I don't understand a lot of those points you've quoted at the beginning of this post. It sounds all official and inflexable. Like boxes that are rigid and ungiving." (end quote)

    I keep having to write this. I write blog posts for a whole variety of reasons. There are a lot of my clients and supervises and workshop participants who read this blog and never comment.

    This post was a request. Yes I do requests on occasion! Even the odd encore as well!! One of my psychology supervisee's requested it and so I did it and it forms part of her homework for the next week supervision.

    I agree with you that it is just the hard cold facts of the matter as that was the purpose of the exercise in this instance of supervision.


  21. welcome to your new home Tony


  22. Yes Tony.

    I understand now. Thank you for clarifying that. Sorry you have to keep repeating yourself.


  23. You are welcome Roses,
    I always like your comments


  24. Thanks for dropping by kenoath

    Supposed to see Franco this weekend


  25. Thank you Tony. You're welcome too - and, you always say that. Did you know you have a habit of repeating yourself? Hmm...

    Happy Wednesday.

  26. No Tony, I have no angst with you. I did before I went to Rome but you asked about that and I honestly replied and let my angst go. I am not sure you remembered asking me though and therefore didn't pick up my comment (on my blog) in reply.

    As for my fringe. Yes it serves its purpose as camoflage. I wasn't upset you asked about it, as you have no way of knowing the story on that one, but it did make me very self conscious for a time. And I guess added to my self loathing. But you wernt to know and so I just asked you politely to move on. End of story.

    As for my comments here last night, I think they must read not what I intended and I apologise. I guess I was very badly reaching out for some positive strokes and hating myself at the same time for doing it. I had some bevies and they don't interact with my medication. I just couldn't get that darn critical voice out of my head. I have decided this am that I am going to abstain from the booze for a bit. I need to keep a tighter control on myself as I have got so much in my brain that if I am not careful I will explode. In fact I wish I could plant a plutoneum bomb in my head and just be done with it. I sit back and see some of my comments that I have littered in blogland this last week and it worries me. I have to sort myself out. Oh well, been sitting at my desk typing this on my blackberry. I should get to work.

  27. Tony,
    My name is Kristen, and I am currently a paramedic student writing a thesis on the effects of trauma, from a psychological perspective. Whould I be able to use some of your photos by chance? it would really pull my report together. thank you