Counting method

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Frank M. Ochberg · 1990

What it is

The Counting Method (CM) is a brief imaginal-exposure technique for intrusive traumatic memories in PTSD. The client silently recalls one traumatic memory while the therapist counts aloud from 1 to 100 at about one number per second. Afterwards the client describes what came up, and the pair review…

Format

• CM is a single, repeatable session format that sits inside a longer trauma therapy. It is not a fixed-length protocol. The phases below follow Ochberg's 1996 headings: Scheduling, Preliminary discussions, The day of the session, During the counting, After the counting, Reflection and closure, and…
• Format: ordinary outpatient therapy sessions. Ochberg's case example began counting six months into therapy.

Who practises it, and how they are trained or regulated

• Titrated affect. Distress rises and falls within the count, which gives practice in dosing and regulating feeling.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Hesitation. Re-confirm consent before you start.
• Do not over-explain. Let the client's sense of mastery lead.
• Last-minute cancellations, which may signal avoidance or a crisis.
• Self-blame. Also overcontrol or avoidance, which may need more groundwork.
• The client's own statements of control or relief show the closure is working.

Problems the guide addresses

• Readiness and contraindications
• Overwhelm during the count
• Dissociation, or remaining foggy after 100
• No affect, or the client couldn't recall
• Avoidance, postponing, cancellations (non-adherence)
• Lingering terror, or new or forgotten images after the session
• Embarrassment or feeling exposed after the count (rupture)
• The therapist's voice or presence feels intrusive or mechanical (rupture)
• Partial relief, or flashbacks persist
• Multiple traumas

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.