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Joyce Boaz & Dr. Frank Ochberg, M.D.

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Professionals: Using The Counting Method with Clients

Q: Dear Frank, I recently received an email from a graduate student counseling intern. She wrote " I am interested in the Counting Method that you created and read about on Gift From Within. I have one client who experienced repeated violent trauma as a child and teenager and so tolerating a relationship is very difficult for her. She's in a great deal of distress and I'm trying to find ways that will help to lessen the power of the triggers that destabilize her. When a trigger is encountered she immediately dissociates and could be out of body for an extended period of time. Once it happens relaxation exercises are not really applicable anymore. I thought you might have some suggestions about using the counting method or not. Thank you.

A: Dear Joyce, I congratulate the correspondent for joining the ranks of helpers, and for asking a perceptive and difficult question.

The Counting Method (http://countingmethod.com/) is best used for "Paragraph B" PTSD symptoms, especially flashbacks and unwanted re-experiencing. I think of it as a way to bring the trauma memory into the room with the therapist. These memories, conscious, clear and disturbing, are occurring at home and elsewhere. Why not have them deliberately, voluntarily, in the presence of a trusted professional? Then the client gains the experience of turning the memory on and off. It has a beginning, a middle and an end. After allowing a bad memory to run its course, silently but vividly, the client then tells the therapist what has just been recollected. This telling of the trauma story is limited in time (and in intensity) to what has just been silently experienced. By the time the therapist reads that account back to the client, there have been three successive rounds of the same piece of terror. Fearful feelings are, usually, reduced.

None of this makes sense if a person cannot face conscious recollection of a real trauma and, instead, dissociates.

There must be conscious memory and realistic awareness to make use of the method.

I'm not saying to give up on applying the Counting Method to this client, because she may have some recent traumas that are in her awareness and that she can relive with you.

If she experiences relief in your presence, she may be able to confront more difficult situations. She probably dissociated at the time of early trauma, and is therefore easily moved to dissociate when reminded of those traumas.

I'd try to help her improve her overall sense of confidence, trust, fitness and resilience, before seeking a partnership in facing those wolves from the past. And remember this: the counting method is not meant to be a hypnotic procedure for uncovering repressed experience. There are therapies that are based on "making what is unconscious conscious." But PTSD treatment is really the opposite of that. We make what is all too conscious part of normal memory rather than part of a trauma-memory system. The trauma-memory, unlike autobiographical memory, bursts into awareness, disrupts concentration, has sharp, painful qualities, and needs to be "tamed" and "modulated."

Maija, my first patient with trauma memories who used the counting method, dissociated during repetitive rape by a psychopath. But she did not dissociate during the counting. She recalled during counting what she recalled during intrusive episodes of traumatic memory. She said, "that's when I would leave..." - referring to the phase of victimization when she dissociated. Counting helped her transform a trauma memory into a tolerable autobiographical memory. It did not serve to make the dissociated part of her experience conscious and clear.

Other patients have recalled forgotten or repressed parts of their trauma during counting. For example, Paul, the soldier who was ordered to kill Iraqi soldiers in a pitch dark bunker wearing night-vision goggles, recalled stepping on a body. He had not remembered that before we did the counting method. It is common for PTSD to include missing pieces of the trauma experience. This is PTSD diagnostic criterion C 3. The counting method may aid in recovering these missing pieces.

In sum, use the Counting Method to help reduce the frequency and intensity of conscious traumatic memory. Do not use it to search for totally repressed traumatic experience, although pieces of a trauma experience may come to light for the first time during counting. If your client dissociates (enters a trance or altered state of consciousness) when triggered by a reminder of a childhood trauma, consider ways to improve overall esteem, resilience, fitness, social support, and symptom reduction. Mastering the memory of recent trauma, becoming unafraid to think about it and to share it, may be an important part of this over-all therapeutic work. And the Counting Method may help with that.

A client who has built her resilience and resistance is much better able to heal the hurt child within.

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Page created on 29 December 2011
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