Strategic Narrative

When beginning to treat traumatized adults, adolescents, or children, to help them reintegrate and reprocess the traumatic experience, a clinician needs to exercise great care to be sure that reexposing them to facts of the traumatic event will not retraumatize them. Therapists should be careful to bring forth only as much event information as the client is capable of confronting without creating or triggering traumatic symptoms. A secure baseline should be established from which to move forward with a strategic form of narrative in which new information is reintegrated into the traumatic experience by the therapist. We have found that the use of a narrative process (Neuner et al., 2004) has yielded good results. It is also wise to be sure to place the traumatic memory in a “clear container” that provides some emotional distance. The client can imagine that he or she is watching the event on a video, or looking at it in a book; either will close at the end of the specific segment. Often, counterphobic clients will push cli?nicians to delve into many traumatic memories prematurely, insisting that they want to “deal with it all right now.” Clinicians should not comply with such urgings, because the client’s insistence is more rooted in maladaptive defense mechanisms such as the counterphobic wish to prove his or her prowess, as opposed to good sense.

Before beginning this technique, a therapist should tell the client exactly what information will be used during the process, to help him or her feel secure about retrieving the memories and working with them appropriately. In this way, the process is less likely to startle or confuse, and the client will feel safe and in control. Ideally, the new, higher-level information that is needed for understanding and resolution will be smoothly folded into the experience of the traumatic event by the strategic introduction of new information via narration, with as little dissonance as possible. He or she can continue discussing information from the narration until it has been fully integrated. In the case of the severely traumatized client, the therapist may have to break traumatic memories down into very small segments, so that the person will be able to cope with each one in turn.

In some more complicated cases of trauma, clinicians may need to spend considerable time with the person to reveal and resolve traumatic memories through this narrative reintegration process. Only a few sessions may be sufficient to resolve the symptoms of an uncomplicated traumatic experience. Even so, these kinds of interventions may not always be applicable to survivors who are “flooded” with severe traumatic memories or who have experienced intense flashbacks early in the trauma experience. With people who are in the early stages of severe trauma, a therapist should focus on interventions that are aimed at stabilizing the client and reducing those symptoms that do not involve reexposure.

 
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