Types of Trauma Therapy

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. EMDR is the most efficient of the well-researched trauma therapies, and we use it as well as teach it.

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 as EMDR, well tolerated by clients, more efficient, and relatively easy for therapists to learn. We use PC and also feature it in some of our training programs.

Flash Technique involves having the client concentrate on a positive engaging image along with a distractor such as watching the therapist’s moving fingers, or the therapist counting aloud. Every so often the therapist says “Flash” and the client blinks while avoiding thinking about the trauma memory. This enables the client to process the memory without experiencing distress. Preliminary studies have found Flash to be rapid, safe, and effective. We are also using, and teaching, Flash.

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.

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 tolerated by children and well researched.

Narrative Exposure Therapy (NET) begins by creating a graphic time line of the client’s life, marking all of the best and worst events along the way. Then the worst events are addressed sequentially using narrative exposure (basically PE). NET has been found to be rather efficient with children as well as adults, perhaps because the broader life perspective from the time line has been structured in.

Traumatic Incident Reduction (TIR) involves having the client imaginally view a “movie” of the trauma memory, and then discuss it with the therapist. This is repeated until no further distress is reported. TIR could use more research but appears to be efficient and well tolerated by children as well as adults.

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.

Note that there are other promising methods around, such as Emotional Freedom Therapy, Brainspotting, Somatic Experiencing, etc., which may be added to the list if/when sufficient supportive research is published.