A-TIP Acute -Traumatic Incident Procedures Roy Kiessling, LISW, ACSW

Transcription

1 A-TIP Acute -Traumatic Incident Procedures Roy Kiessling, LISW, ACSW This brief model (3-6 sessions) contains/restricts the processing for clients who have experienced a recent trauma and for a variety of reasons (i.e., time restraints, limited affect management skills, complex history), need more restricted or contained EMDR processing. INITIAL SESSION 1) Informed Consent a) Nature of the Treatment b) Three six session limit suggested c) Explanation of use of Bilateral Stimulation (BLS) 2) Intake Questionnaire (Pre-treatment Information) a) Check-off of important background information b) Traumatic event (brief statement) i) SUD: 0-10 ii) Negative Belief & VoC (1-7) (1) In this case you want to know how TRUE the negative belief feels to the client. iii) Positive Belief & VoC (1-7) 3) A stroll down memory lane An Affect Management Skill (choose appropriate intervention) a) Container b) Concrete Skill c) Breathing d) Muscle Relaxation, Etc. e) Use of tapping (slow, rhythmic & relaxing relatively short sets) f) Or other (as appropriate) 4) Walking Through The Story (narrative of the trauma, with continuous slow BLS) a) Continuous slow rhythmic & relaxing heel tapping (or other form of tactile BLS) b) Client s narrative of the incident 5) Incident Specific Data (time permitting) a) Incident b) SUD (0-10) c) Negative Core Belief d) Positive Core Belief 6) Closure a) Debrief b) Discuss next session options c) Affect management skill if necessary for stabilization before ending session Roy Kiessling,

2 PROCESSING SESSIONS 1) Reevaluation a) Global experiences: dreams, behaviors, triggers, behaviors, etc.? b) Target specific: insights, thoughts, new perspectives, etc.? c) New traumatic aspects of the incident? 2) Target (within incident) Selected a) Worst part of the incident for the client at the time of the session 3) Explanation Of Desensitization Process a) Explanation of the BLS in the treatment process 4) Processing Skill (optional) 5) Stop Signal a) Stop signal to pause procession b) Stop signal to STOP treatment 6) Accessing And Activating Checklist a) Sensory Component b) Negative Belief c) Positive Belief d) VoC (1-7) e) Emotions f) SUD (0-10) g) Body Location 7) Processing The Disturbance a) BLS Running through the Experience (rapid heel tapping or other form of BLS) approximately 10 seconds per set b) Take a breath, then c) Think of the incident, from 0-10 How disturbing is it now? d) Go with that/ Start with that /Think about that (if the client is over-accessing) e) Repeat a-d 4-5 times f) Then ask: What is different about the target? i) Then, take a SUD (0-10) and go with that g) Repeat above (a-f) until SUD no long lowers 8) Installation Of Positive Belief a) Does the original positive belief still fit? b) VoC (1-7) c) BLS Dancing to Success (fun-type heel tapping or other form of BLS) d) Take VoC after each set of dancing until maximum enhancement of VoC 9) Repeat Processing (Steps 1-6) with additional targets (time permitting) a) Chronologically from the beginning? b) Remaining targets (from within the entire experience) organized by SUD from highest to lowest 10) Debrief And Closure a) Affect management skill if necessary for stabilization before ending session Roy Kiessling,

3 FINAL SESSION 1. Reevaluation (Global) Check for: a) Changes in the person s life? b) Dreams? c) Startle response? d) Triggers? e) Attitudes? f) Etc. 2) Reevaluated Target(s) a) Processed Targets b) Remaining targets i) Old? ii) New (that arose between sessions)? 3) Process Remaining Targets a) Processing and Installation Procedures (p 9-10) Or 4) Future Action Planning a) Imagine potential aspects similar to the traumatic incident b) Hold positive belief with that situation c) Check VoC (1-7) d) BLS (rapid heel tapping joyful celebration ) until VoC moves to an adaptive level e) Repeat above (4.a-d) with other aspects until all have been addressed 5) Exit Interview a) Exit questionnaire b) SUD c) Negative belief VoC (How true does the NEGATIVE feel to the client at termination?) d) Positive Belief VoC 6) Potential referral for more extensive EMDR therapy (R-TEP or full EMDR) Roy Kiessling,

4 INITIAL SESSION Informed Consent While your concerns and disturbances are being addressed, you are being asked to participate in a project that in which seasoned therapists are utilizing a cutting edge mental health treatment. This approach is based on a growing knowledge of how the brain works to receive and process information, especially information that is emotionally charged. Your brain receives information through your five senses. When the information is too intense or overwhelming, it is as if the brain is prevented from working normally to digest the experience and learn from it. A similar thing happens when a bone breaks or there is an extreme medical condition and the medical provider performs a beneficial healing treatment or intervention. The technique involves bilateral stimulation to decrease the impact of the traumatic event. The goal is to reduce the symptoms of Post-Traumatic Stress Disorder. To measure the success of this endeavor there is a pre-test and post-test instrument that you are asked to complete. Gathering this data will allow us to measure the effectiveness of this method when used in a time-limited treatment model. The information collected will include no names or identifying data, but be presented in numbers and percentages of decreased negative symptoms experienced by the client following the treatment. The brief model is limited to a specific traumatic event. A supportive group treatment is available to you both during and following the sessions. If there are additional or long-term issues that you wish to address, a referral is provided for you. We will ask you to complete a questionnaire that allows you to evaluate the success of the treatment in approximately three months. We appreciate the opportunity to work with you on this project. Your signature reflects that you have read, understood and agreed to participate in the project. Signature Date Roy Kiessling,

5 INTAKE QUESTIONNAIRE (abbreviated Bio-psychosocial Assessment) General Information: Male Female Age Ethnicity Married Partnered Single Divorced Widowed Living arrangements Career Health: Excellent Good Fair Poor Medical concerns: Medications: Behaviors: Smoke Alcohol Drugs Other Family of Origin Parents: Married Divorced Stepparent(s) Father s parenting style, major characteristics: Mother s parenting style, major characteristics: Number of siblings: Client s birth order: Religious/Faith/Spiritual Background: Positive Resources: Family Friends Role models Activities Other Significant childhood traumatic experiences: Medical Abuse: Sexual Physical Emotional Neglect Other issues of concern (past or present): Major Depression Major Anxiety Suicidal Ideations If yes, details: Roy Kiessling,

6 PRESENTING INCIDENT WORKSHEET (Baseline Information & Measurements) Incident Description (including length of time since incident occurred SUD (Level of Disturbance): No Disturbance Negative Belief/Thought Associated with the Incident (check the most dominant) I am powerless I am helpless I am trapped I am vulnerable I am bad I am going to die I am overwhelmed I am in danger I am responsible I am damaged Maximum Disturbance other VoC (Level of Agreement): ( How true does it feel when you think about the incident now? ) Totally False Totally True Positive/ Adaptive Desired Perspective you would LIKE to have associated with the incident It s over. I survived I did the best I could I m okay, regardless I can get through this I can protect myself I can recognize appropriate responsibility VoC (Level of Agreement): ( How true does it feel when you think about the incident now? ) Totally False Totally True Roy Kiessling,

7 Constructing a Container Worksheet (Adapted from Landry Wildwind) 1. Container Specifications: "I'd like you to develop a container that would help you manage some of the troublesome feelings and memories you have. The container should be strong enough to hold whatever you put into it. It also should have a two-way valve system that would allow you to put things into it and take things out without any of the other material that is already inside jumping out at you. The two-way valve system should also allow you to take out only as much of any given problem as you want. Additionally, the inside of the container should be comfortable enough that the material you put into it will be willing to stay until you are ready to work with it" 2. Description: "Take a moment to think about what your container will look like. [pause] There is no right answer. What do you get? 3. Emotions and Sensations: "If you knew your container could hold some of your troublesome feelings and memories, how would you feel?" 4. Enhancing: "Focus on your container and those good feelings. [BLS] "What do you notice now?" [repeat and enhance if positive] 5. Cue Word: "What word or words best describe your container?" 6. Cueing with Disturbance: "Now imagine some mildly disturbing recent memory, and notice how your body feels." "Imagine putting that memory into your container. Notice how differently it feels." [BLS] Repeat as necessary until client reports positive experiences. Strengthen with BLS 7. Putting presenting problems away: "Now imagine another mildly disturbing incident and imagine putting it into the container without my assistance." [pause] "How did that work? [get report] "Think about how you did that and follow my fingers." [If it worked well, strengthen with BLS] 8. Using the Container: "I would like you to practice using your container whenever you feel stressed. We ll check next time we meet to see how things have worked." 9. Re-evaluation: When your client returns, review their use of the container, strengthening successful times with BLS, re-scripting unsuccessful times until they become experienced at using their container. Strengthen and re-script with BLS when possible. 10. Go to extending a resource Roy Kiessling,

8 Extending a Resource Objectives: 1) Attune your client to positive, future focused, successful events. 2) Reinforce previous positive experiences to help client achieve their current goals. Goal: 1) Help client recognize prior successes and how to utilize pre-existing strengths and skills to address current stress. 2) Mindfulness: Keep positive skills in client s weekly thoughts. STAGE ONE: Focusing on Positive Resources "Imagine how you would like to be when you have achieved your goal. Tell me about it. (develop image, affect, body sensations, adaptive behaviors, etc.) _ What positive belief would go best with the picture of you accomplishing your goal? (ex: I am capable, lovable, in control, etc) "When you focus of that positive belief, what feelings are you experiencing now?" "Where do you notice it in your body?" "Tell me about a time in your life when have you thought, behaved and felt the same way." "Focus on that earlier event and follow my fingers" [slow, short BLS] "As you focus on those positive experience, what posture or body movement would most represent those feelings? "Hold that body posture (or movement) for a moment. Notice the positive feelings, and follow my fingers." [Slow, short BLS] Roy Kiessling,

9 STAGE TWO: Re-scripting Recent Events Is there a recent situation when things would have been different had that resource been available? "Imagine using your resource in that situation and notice how you will behave and feel. What are you noticing? [If the client reports positive outcomes, enhance with BLS] [Repeat the previous two steps with other recent situations where that resource may have been helpful] STAGE THREE: Rehearsing Future Events T: "Can you imagine a situation, between now and when we meet again, when using your resource would be helpful. [pause] T: "Focus on that and notice what positive feelings, emotions and body sensations you are experiencing and how you would be behaving." [pause] [Enhance with BLS if positive] [Repeat the above two steps with each additional future situation the client imagines.] CLOSURE "I'd like you to try to remember the work we have done today, write down your positive belief, (PC) and read it every day, especially before situations you know might create a little anxiety. Next session, we'll review how things have gone." Debrief: Discuss next session options: Container Concrete Skill Breathing Muscle Relaxation Roy Kiessling,

10 REPROCESSING SESSION 1 2 3* 4 A) Incident for Reprocessing: B) Accessing and Activating the Target: 1. What is the worst or most disturbing part of the incident to you now? 2. What is the negative belief you have about yourself now, related to the experience? 3. What is the positive belief you would like to have about yourself now, related to the experience? 4. When you think about the incident, how true does the positive belief, [repeat the PC], feel to you now? Totally unbelievable Totally believable 5. When you think about the incident and that negative belief [repeat the NC], what emotions and sensations are you feeling now? 6. How disturbing does it feel to you now? No disturbance Maximum disturbance 7. Where do you feel the disturbance in your body? C) Processing Phase: 1. BLS (approximately 10 seconds of short, rapid bilateral stimulation) then ask for the SUD Take a breath. Now when you think of the incident, how disturbing is it now, 0-10? Go with that. Repeat BLS/SUD combination (above) 3-4 more times then ask 2. When you think of the incident, what are you noticing (what is different about it) now? 3. When you think of the incident, how disturbing is it now, 0-10? [pause] Go with that. 4. Repeat steps 1-2 (above) until the SUD stops moving lower. 5. Consider the ecological soundness of the SUD. Ask, Is there anything that would allow this to go lower? Roy Kiessling,

11 D) Installation Phase: 1. Does the original positive belief still fit, or is there a better one now? 2. How true does that positive belief feel now? Totally unbelievable Totally believable 3. Enhance the PC with rapid BLS until as strong as possible. E) Repeat B-D (above) to process remaining disturbing aspects of the experience as long as time permits 1. Collaborate with client to determine whether targets will be processed in chronological order or processed in order of disturbance. E) Closure: 1. Debrief: You ve done some amazing work today. How are you doing? [pause for response] Is there a positive that has come out of it that you d like to hold onto? [if appropriate, enhance with slow, short BLS] 2. Discuss next session options 3. Use affect management skills such as container and other state change mechanisms that work for your client. Developing Future Action Plans (Future Template) 1. Identification of Situation: "Think of a similar future situation you may find yourself in. [pause] 2. Linking with PC: Now hold that with your positive adaptive belief of [restate the PC]. 3. VoC: How true does that positive belief feel now, 1-7? Totally believable Totally unbelievable 4. Process/Install/Enhance the PC with long/fast BLS until as strong as possible (may not reach 7). 3. Repeat as indicated: Set your client up for success by developing action plans with whatever additional situations the client may imagine occurring and process them (steps 1-4 above). Roy Kiessling,

12 DEBRIEF & EXIT QUESTIONNAIRES a. Clinician Observations & Overall Evaluation: Poor Fair Average Good Excellent b. Additional Comments: Roy Kiessling,

13 CLIENT S POST-TREATMENT QUESTIONNAIRE 1. Time since traumatic incident: 2. Time since treatment was completed: 3. Brief description of traumatic incident: 4. Level of disturbance about the incident now: (please circle) No disturbance Maximum disturbance 5. Please list any negative belief you have about yourself that is still associated with the incident. 6. VoC: How true does that negative belief feel when you think about the incident now? (please circle) Totally False Totally True 7. What positive and/or adaptive belief about yourself have you come to associate with the incident? 8. VoC: How true does that positive belief feel when you think about the incident now? (please circle) Totally False Totally True 9. Overall evaluation of the treatment: (please circle one) poor fair average good excellent 10. Additional comments: Thank you for your participation. Roy Kiessling,