A new champion in the world of trauma treatment
Nearly 20 years ago, Ricky Greenwald, Psy.D., founder and executive director of the Northampton, Mass.-based Trauma Institute & Child Trauma Institute, stumbled upon some surprising research. A leading trauma therapist who primarily worked with Eye Movement Desensitization and Reprocessing (EMDR), Greenwald saw a randomized comparison study by David Read Johnson, Ph.D., that showed that a treatment called the Counting Method was as effective as more complex and articulated approaches, including EMDR.
He was shocked – a simpler, easier to learn and administer method that matched the outcomes of EMDR? After trying it while teaching a course for trauma therapy, Greenwald accessed a training manual from Read Johnson to learn more. He soon realized he had been doing it wrong.
In the original Counting Method, first published by Frank Ochberg, MD, in 1996, the therapist counts to 100 while the client focuses on an interior memory, or a “movie,” of the event, from start to finish.
Greenwald had shortened the count to 10 since the training was for working with children, and then slowly increased it over the course of the session.
“I realized how much I had misunderstood,” said Greenwald. “In the Counting Method, you only do that ‘movie’ with counting once at the beginning of the session and the rest of the session, you guide the client in a structured way to talk about each thing that happened in the movie and about their thoughts and feelings, which is pretty much replicating prolonged exposure.”
Since Read Johnson’s results were better than those of prolonged exposure alone, Greenwald thought maybe it was not the exposure part of the therapy that was key.
“I was so excited,” he said. “What if you cut out all the prolonged exposure stuff and just did the movies? So that’s how Progressive Counting (PC) was developed.”
Since then, Greenwald has focused primarily on Progressive Counting, published several case studies, systemized the treatment, and developed a training program for therapists to learn how to fit the technique into a larger trauma treatment approach.
While more research needs to be done, preliminary studies have shown similar results to the original study, with PC working as well as EMDR. The technique, said Greenwald, is less resource-intensive to learn, and perceived as easier for the patient.
“We’ve got three direct comparisons with EMDR at this point and it’s looking like it is matching EMDR in effectiveness, efficiency, and dropout rates,” said Greenwald.
“EMDR has hundreds of studies by now, so Progressive Counting is not nearly as well established, but it is very well tolerated by clients since it’s less emotionally intense. We are using it with acting out teenagers, court-involved adults, people who may have low affect tolerance and might find it more difficult to do something like EMDR. It’s a bit of a lighter touch.”
While it is not yet clear why the technique works, on exit interviews, some clients said that it acted like desensitization and others said that the therapist counting was soothing and reassured them that they were not alone. Some said it helped to be the one organizing the “movie,” which gave them a sense of control.
Greenwald added that piecing the entire event together can help clients see a “beginning and an end” rather than just dealing continually with the most difficult fragments of a memory.
“Connecting a memory to its ending can provide a sense of relief, knowing that it is over,” he said. “I think it also create a mindfulness / observer effect. When you are in the memory yet concentrating on something else at same time, like the therapist counting, that facilitates being able to be an observer of it all.”
In addition to offering training for professionals and a distance learning guidebook, Greenwald’s team is currently working on further research with a prison recidivism project in New York and a child/adolescent study in North Carolina.