stage II trauma therapy/exposure therapies

 

The following are the goals for each stage of therapy. Many people coming into therapy have a history of trauma or are suffering from post-traumatic stress disorder. Below is a list of targets for each stage of therapy...new research now indicates that if trauma based issues are so overwhelming that they do not allow for other work to move forward, that stage II targets can, indeed, be worked on in Stage I of therapy. However, there is a particular protocol to move a person through this work, without doing more harm in the process. Here at Atlanta DBT, we use the DBT recommended methods, and protocol for resolving past traumatic issues.

 

Pretreatment

Work to orient the client to the philosophy and structure of therapy. Together the client and therapist agree to a treatment target hierarchy, which are the most important goals or targets for each stage. This means, the client and therapist will come up with a list, in order of importance, of issues that need to be addressed in therapy.Also try to maximize the client's commitment to the treatment.

    Agreements Made During the Pretreatment Stage           

Client

Agrees not to kill themselves while in DBT                   

Commits to 1 year of treatment including      

Weekly psychoeducational skills training group                       

Weekly individual therapy sessions                       

Telephone contact with therapist for crises (as needed)           

Therapist

Commits to providing a years worth of treatment                   

Attends weekly consultation group

 

Stage 1

• Work to develop greater behavioral control with a primary empahsis on the here and now.

• The treatment focuses on the severe behavioral dysregulation exhibited by the client.

• The goal is to decrease life threatening and other self injurious behaviors.

• The treatment comes through several mode (individual, group, telephone contact, therapist consultation)

 

Stage 2

• Work to decrease PTSD symptoms with the main focus on past trauma.

• The client is only able to move on to 2nd stage if target behaviors are clearly under control. This is because the client should not be forced to deal with the past trauma until they have more adaptive coping strategies.

• Posttraumatic stress reduction is acomplished through exposure and emotional processing of the past.

• The client is encouraged to eliminate distortions related to the trauma or denial of the facts.

• The client's tendency toward self invalidation, self stigmatization, and a dichotomous response style is challenged.

• Ultimately the goal is to increase the client's appropriate experiencing of emotions -- in non-traumatizing manner.

 

Stage 3

• Work to resolve problems of living and increase the client's respect for self.

• The client explores issues of ordinary happiness and unhappiness, improved relationships, and higher self esteem.

• During this stage, the client is encouraged to develop moderate levels of self reliance. Thus, the therapist will pull back some from the therapeutic relationship and will reinforce client's attempts at self-validation, self-care, and problem solving.

 

Stage 4

• Work to attain sense of connectedness, joy, and freedom.

• The client seeks to resolve their sense of incompleteness and to expand their personal awareness by finding spiritual fulfillment.

• These goals are achieved through long term insight oriented psychotherapy that is designed to integrate the past, present, and future.