Northwest Brief Therapy Training Center
Olympia, Washington
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Doing Something Different: SOLUTION-FOCUSED IMAGINAL EXPOSURE


Clients who are traumatized by some experience are often struggling very hard to avoid thinking of whatever traumatized them, usually with only partial success. Sometimes the thoughts/feelings/visions/ experiences are so compelling that they think of little else.

Coping with overwhelming thought and feelings by avoiding them is adaptive at first, it allows the person to do whatever needs to be done during and immediately after the emergency. But after the emergency has passed, this way of coping tends to lose its adaptive function as the person gets further away from the traumatic event and it takes more and more mental energy to avoid thinking of the emotionally powerful stimulus. At the same time it is often harder and harder to let go of since the person does not want to be overwhelmed with such a negative emotional experience.

As a therapist, it is your job to help your clients gain control over traumatic experiences and help them reduce the power of the experiences over their lives. There are a number of different options to reduce the power of the trauma. A solution-focused approach involves working briefly and not being “in charge” of the client’s improvement.

First, have clients tell you about their goal picture, so that any changes they make will be in to context of what they want, instead of just the absence of the problem of the trauma.

Unfortunately, as a general principle, the harder a person tries to avoid thinking of something, the more that person is condemned to do so, especially if the thing to be avoided has a great deal of emotional power.

When the client has tried to overcome the traumatic experience by avoiding the thoughts/feelings/visions/experiences and it hasn’t worked, it is time, in Steve de Shazer’s words, “to do something different.”

Paradoxically, deliberately thinking/mentally experiencing something a person is trying to avoid helps him/her ultimately be able to have less trouble with the thought/feeling/vision/experience. But the client is rightfully afraid that the traumatic experience is going to take over if he/she just allows the image to be there without any controls.

A homework assignment borrowed from Weeks’ and L‘Abate‘s Paradoxical Psychotherapy and modified for trauma treatment can help get the affected person back on track. Instructions are as follows:

“Pick a time of day each day when you can be undisturbed for a little while. Set a timer for ten minutes and during the ten minutes, go over the traumatic event detail by detail, letting yourself experience whatever feelings come up. If the feelings get too strong, back off a little, but try to stay with the feelings as much as possible. When the timer goes off and the time is up, make a note of whatever you have been feeling and thinking about that still has emotional power. You can just write a word or two, just as long as you know what it means. Keep your list with you.

Then, once you have finished making notes, go about your day and when any of the traumatic event comes to mind, immediately stop thinking of it right away if it is on your list. If it is not, add it to your list. Then remind yourself that you have set aside time to think of it. And make sure you go over any intrusive thoughts during the next time you have set aside, about 24 hours after the last ten minute time period. Make sure that you keep stopping thoughts and do the ten minute exercise daily, no exception. You will notice immediate effects, have a good idea of the power of this tool in two weeks of doing it daily and should notice the full effects in a month.”

This exercise helps the client turn tables on the intrusive experiencing by controlling not whether to have the experiences (since this is not an option) but when to have them. The client can do this at home on his/her own terms and does not require the presence of the therapist.

About 80% of clients report an immediate cessation of nightmares, if they had them before starting this exercise. Most notice a decrease in the emotional power of the traumatic event within a week and, as they continue the exercise, are able to observe other symptoms fade.

Most clients bring up the effect of this exercise when you ask them in subsequent sessions “What is better?”, although it can be useful to ask about it if they don’t bring it up on their own.

Rarely, clients are overwhelmed by the exercise and in that case it is often helpful to have them think of the traumatic event more abstractly, such as from another person’s point of view or if they were reading about it in the newspaper. Once they are able to do the task this way for a while, getting closer and closer to the actual event can be tried.

Some clients focus on the aftermath of the traumatic event, such as the physical pain they now have, or the economic effects of being unable to work. It is useful to encourage these individuals to at first focus on the details of the event itself and later get to the subsequent effects of the event on their lives.

ref: G. Weeks and L. L‘Abate, Paradoxical Psychotherapy. New York:
Brunner/Mazel, 1982.

(copyright: Northwest Brief Therapy Training Center 2007)

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