Grasping ice has been found to be helpful for clients who have tendencies toward self-harm. The ice allows for a physiological stimuli or shock to the body that engages sensation centers in the brain similar to those engaged in cutting, burning, etc.
Although my five-phase model is based in foundational counseling theories and skills, I offer it here as one guide for counseling clients who have experienced sexual assault.
The amount of time spent in this phase typically ranges from one to three sessions depending on the client’s trauma history, presentation and comfort with therapy, and assessment of the client’s basic needs.
To facilitate an environment that feels supportive and safe, I use the client’s own language, focus on appropriate and accurate reflections, and allow the client to emote without much intervention on my part.
I complete the assessment to focus more on trauma-related history, both specific to sexual trauma and complex trauma (any previous trauma-related incidences a client identifies as having experienced).
This focus is helpful in gauging client resilience, gaining insight into a client’s threshold for stress and obtaining increased awareness of potential maladaptive cognitive patterns the client might possess related to any current situations or traumas.
Phase 1 also consists of a psychoeducational focus that is helpful in increasing the client’s confidence in pursuing and maintaining therapy services.
After completing the psychosocial assessment, I file the assessment in the client’s chart to review later in the therapeutic process and provide the client with trauma-related materials on normative responses that may be experienced in all facets of the client’s functioning (cognitive, emotional, physical, mental, social, etc.) At this time, I walk the client through a trauma symptoms checklist that includes emotion-, behavior- and cognitive-related questions.
In phase 2, I encourage clients to take a break from our immediate focus on the sexual trauma and to instead explore their perceived strengths.
This phase deviates slightly from other trauma-focused therapies by offering clients allotted time to engage in intrapersonal exploration that is separate from their trauma.
I often explain the difference between empathy and sympathy during this phase to help clients identify which felt most supportive and when.
In this phase, I encourage clients toward increased positive views of self and self-confidence and the ability to seek support from individuals who can provide it.
In phase 3, I explore clients’ cognitive processing.
During this phase, I recall the initial assessment (initial narrative of recent trauma) and work with clients to identify how they retell their history and describe their current functioning.
The hope is that clients will then recognize the potential in their support systems and, incorporating increased self-confidence from the previous phase, will feel comfortable conveying and eliciting more effective and efficient support from friends and family members.
I purposefully separate this from and have it follow the cognitive phase because I have found there are residual and intense emotional responses that often outweigh clients’ abilities to rationalize or self-soothe.
Clients with complex trauma or a lack of effective coping skills often report numbness, a sense of disconnect from their bodies, intense and seemingly uncontrollable anxiety responses, and self-harming or self-medicating behaviors in various forms.
In this phase, I primarily use Gestalt-based interventions to help clients better understand mind-body communication as it relates to emotional response.
I ask clients to walk me through a recent trauma-related episode, having them focus on what they felt bodily versus emotionally or cognitively.
It is at this point in the therapeutic process that clients are displaying and self-reporting more stable emotional and cognitive-related responses to stress and more effective use of healthy coping skills.
These same clients have engaged in trauma work sooner in the therapeutic process than have our clients treated without the five-phase model.
Tenets of this model include effective assessment skills, a focus on client history and complex trauma, empowerment and encouragement of clients, an empathic strength-based approach and the incorporation of CBT/REBT and Gestalt-based interventions.