Counting method

1. Introduction

Version followed: Frank M. Ochberg's original description, "The Counting Method for Ameliorating Traumatic Memories" (Journal of Traumatic Stress, 1996), read in the full-text republication on the Gift From Within site. The later Counting Method Manual (Johnson, Lubin & Ochberg, revised 2007) and Johnson & Lubin's 2005 revisions paper are not drawn on. Where secondary sources report how those versions differ, this is marked [uncertain]. Greenwald's Progressive Counting is covered only as a named variant.

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 it and close on what the client achieved. Ochberg, a psychiatrist, developed it in the early 1990s in his private practice. It is not a standalone therapy but one component of his "PostTraumatic Therapy", which he describes as "collegial, normalizing, and individualized". That wider therapy uses education, holistic health, social support and the exploration of meaning, with the aim of moving the client from a victim identity to a survivor identity. [source: Ochberg 1996 via Gift From Within; Wikipedia, Counting method]

How change happens: Ochberg proposed three mechanisms and stated that they are unproven [source: Ochberg 1996].

Linking. The memory becomes tied to the therapist's voice and the safety of the therapy relationship, so later recall feels less frightening and degrading.
Bounded, controlled exposure. The recall is limited to about 100 counts (under two minutes). The client gains some control over starting, holding and stopping the memory, which can reduce fear of spontaneous intrusions.
Titrated affect. Distress rises and falls within the count, which gives practice in dosing and regulating feeling.

Johnson & Lubin (2006) later argued that imaginal exposure alone may be both necessary and sufficient, and presented CM as a parsimonious exposure treatment. [source: Francine Shapiro Library abstract of Johnson & Lubin 2006]

2. Framework

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 Further sessions. [source: Ochberg 1996]

Phase A. Groundwork in PostTraumatic Therapy (before any counting)

Goals: build a collegial, normalising relationship; educate the client about PTSD; strengthen supports; begin to shift the client toward a survivor identity.
Format: ordinary outpatient therapy sessions. Ochberg's case example began counting six months into therapy. [source: Ochberg 1996]
Move on when all of the following hold: specific memories are clearly part of the PTSD picture; therapy is underway; progress is evident; the client feels more like a survivor; and client and therapist agree to schedule counting as an elective choice. Ochberg likens it to "elective rather than emergency surgery". [source: Ochberg 1996]
He says there are no firm rules for when to hold the first session. [source: Ochberg 1996]
Added readiness checks [synthesis]: no acute suicide risk; no active substance intoxication; the client is not currently in danger (for example, still living with the abuser); dissociation has been assessed; the client has at least one grounding skill.

Phase B. Preliminary discussions (one or more sessions before the counting session)

Goals: explain the method, answer practical questions, choose a date, and preserve the client's sense of choice. [source: Ochberg 1996]

Phase C. The counting session (one session)

Sequence: review progress, then count early in the session (about 100 seconds), then the client's account and the therapist's verbatim notes, then reflection and closure.
Schedule the session at a convenient time, such as the end of the day, and leave extra minutes for closure. [source: Ochberg 1996]
Dose: one counting run per session in the 1996 description. Secondary sources say the 2007 manual likewise runs the "movie" once near the start and spends the rest of the session reviewing and discussing it [source: Greenwald, TICTI blog; uncertain].

Phase D. Further counting sessions

Number: often two or three are enough, because mastery tends to generalise to other memories. Short, specific memories need few sessions. Multidimensional ones, such as being held hostage for days, may need several (Ochberg suggests about six), often spaced months apart. [source: Ochberg 1996]
Pace: the next session can be decided later, because the first session usually gives plenty to process. [source: Ochberg 1996]
Partial relief: repeat on the same memory, taking a different aspect each time. [source: Ochberg 1996]
Move on or stop when spontaneous intrusions are reduced or gone; when the client senses the memory is mastered; or when counting no longer serves the survivor goal. Counting should not prolong therapy unnecessarily. [source: Ochberg 1996]

Phase E. Integration and ending

Return to the broader PostTraumatic Therapy aims of meaning, relationships and a survivor identity. [source: Ochberg 1996]
Ochberg gives no detailed termination protocol. Monitoring intrusion frequency and intensity with a standard PTSD measure before and after counting sessions is [synthesis].

Typical format: individual adult outpatients in ongoing therapy with an experienced clinician. Ochberg reports use with several dozen clients over about seven years. [source: Ochberg 1996]

3. Guiding principles

[source for 1–12: Ochberg 1996; 13–15: synthesis]

Collegial, normalising, individualised stance. Work alongside the client as a colleague, frame the symptoms as understandable, and fit the method to the person.
The survivor identity is the goal; counting is a means. Use counting only when it moves the client toward a stronger, realistic sense of self.
Elective, not emergency. Offer counting as a future option that the client chooses and schedules. Never spring it on a client in crisis.
Client control. The client picks the memory and the date, and learns that a memory can be switched on and off.
Bounded exposure. The recall has a clear beginning, middle and end of about 100 seconds. Do not extend it.
Privacy. The recall is silent, so the client decides what to disclose afterwards.
Your voice is the link to the present. Count in a clear, friendly, natural voice. Your steady presence is part of the active ingredient.
Titrate, don't flood. Expect feelings to peak in the middle and plan for the client to come back to the present before 100.
Take the account seriously. Wait for the client to speak, then record their words verbatim and attend to the details.
End on a positive note. The client should leave composed and willing to continue therapy.
Failure belongs to the method, not the client. If the count does not work, say so in those terms and decide together whether to repeat it.
Not every trauma needs counting. Coverage of all events is unnecessary, because mastery tends to generalise.
Memory is the client's experience, not a fact to verify. [synthesis, following the house trauma rule] Do not suggest content, do not use counting to uncover "hidden" events, and treat newly recalled fragments as experience to process, not evidence.
Counting is not hypnosis. Ochberg notes that it sometimes has a trance-like effect, so watch for dissociation and use a clear reorienting cue. Do not add hypnotic suggestions. [source: Ochberg 1996; synthesis for the last clause]
Safety first. [synthesis] Stabilise before processing, and keep a grounding plan ready in every counting session.

4. Intervention inventory

The 1996 source describes one core procedure, the count, surrounded by preparation and processing steps. Each step is listed below as its own intervention, in the order used. Unless tagged otherwise, everything comes from Ochberg 1996 (Gift From Within full text). All therapist wording is my own and labelled (illustrative), except the two short quotes from Ochberg, which are marked and cited.

4.1 Assessing whether specific memories drive the PTSD

Purpose / when: First step. CM targets recurring, vivid, distressing memories that make clients doubt their sanity, their progress and their safety. Establish that such specific memories are part of the clinical picture before offering CM.
Steps:
1. Map the client's intrusive memories and flashbacks: which events, how often, how vivid, and what the client does when one arrives.
2. Note whether there is one discrete event or several, and whether any memory is long and multidimensional, such as days of captivity.
3. [synthesis] Rate frequency and intensity with a standard PTSD measure, so the effect of later counting sessions can be tracked.
4. [synthesis] Screen for current danger, suicide risk, substance misuse, psychosis and severe dissociation. Defer counting until these are addressed.
Example language (illustrative): "When the memory of the attack pushes in, what exactly do you see? How often has that happened this week?"
Watch for: Clients whose distress is mainly about current stressors, grief or shame rather than intrusive images may gain less from CM [synthesis].

4.2 PostTraumatic Therapy groundwork

Purpose / when: The context counting depends on. Ochberg names its components (education, holistic health, social support, exploring meaning, a collegial and normalising stance) but does not give step-by-step procedures in the 1996 paper. [uncertain: detailed procedures]
Steps (as named, with practical form [synthesis]):
1. Educate the client about PTSD so that symptoms make sense.
2. Normalise reactions as understandable responses to abnormal events.
3. Attend to sleep, exercise and health habits.
4. Mobilise social support.
5. Explore what the trauma means to the client.
6. Track the shift from victim to survivor language.
Example language (illustrative): "Flashbacks are what a nervous system does after an overwhelming event. They don't mean you're losing your mind."
Watch for: Evident progress and a growing survivor self-view. These are Ochberg's signals that counting can be scheduled.

4.3 Preliminary discussion: introducing the method

Purpose / when: After the groundwork. The aims are informed consent, lower anxiety and a preserved sense of choice.
Steps: Explain each of these points:
1. The session has a clear beginning, middle and end, lasting about 100 seconds.
2. The recall is silent, so it stays private.
3. Hearing the therapist's voice connects the painful past with the safer present.
4. Terror, horror or helplessness may return, but should be brief and moderated by the therapist's presence.
5. The memory itself may change, and later spontaneous recall may become less distressing.
6. Memories during counting are usually no worse than spontaneous ones, but forgotten images occasionally return.
7. Two or three sessions are often enough.
8. The client does not need to recall every trauma or every moment.
9. If flashbacks have been recent or very vivid, it is advisable to arrange a companion for the trip home.
10. Present counting as an option for a future date that the client chooses.
Example language (illustrative): "There's a technique I'd like you to consider for when you feel ready. You'd go through the memory silently while I count out loud to a hundred, which takes under two minutes. Then we'd talk about it. You decide if and when we do it."
Watch for: Relief, curiosity, or relief at being given a choice. Persistent dread or repeated postponing is useful information; see section 5. [synthesis]

4.4 Scheduling the counting session

Purpose / when: Once the client agrees.
Steps:
1. Choose a convenient time, for example the end of the day.
2. Book extra minutes for closure.
3. Confirm transport and a companion if needed.
4. [synthesis] Agree a stop signal, such as a raised hand, and confirm the client's grounding skill. Ochberg does not describe a stop signal.
Example language (illustrative): "Let's put it at the end of your day, with a little extra time afterwards. Who could drive you home that evening?"
Watch for: Last-minute cancellations, which may signal avoidance or a crisis.

4.5 Progress review at the start of the session

Purpose / when: The opening minutes of the counting session. Reviewing gains reduces anticipatory anxiety and pessimism before the recall.
Steps:
1. Briefly summarise improvements since therapy began.
2. Check the client still wants to proceed today.
3. Move to counting early in the session, without a long warm-up.
Example language (illustrative): "Before we start, look at what's changed since spring: you're sleeping more and you went back to the store on your own. Do you still want to do the counting today?"
Watch for: New crises or danger that have arisen since the last session. If present, postpone [synthesis].

4.6 Choosing the target memory

Purpose / when: On the day. When there are several traumas, the client chooses which one to recall.
Steps:
1. Ask which memory to bring up.
2. Agree on the one event to use this time.
3. For long, multidimensional events, agree which part to use; later sessions can take other aspects.
Example language (illustrative): "Of the memories we've talked about, which one do you want to work on today?"
Watch for: A client choosing the "easiest" memory first is acceptable. Ochberg notes that mastery tends to generalise.

4.7 Pre-count instructions

Purpose / when: Immediately before counting. They set out the time course of the recall.
Steps:
1. Tell the client to fill the 100 seconds with the chosen memory.
2. Say that feelings will probably be most intense somewhere in the 40s to 60s.
3. Ask the client to bring themselves back to the present during the 90s.
4. Check the client is comfortable.
5. Allow the client to look away rather than at you, or [synthesis] to close their eyes.
6. Begin counting.
Example language (illustrative): "Let the memory fill the whole count. It'll probably be strongest around the middle. When you hear me reach the nineties, start coming back to this room. Look wherever is comfortable. Ready? One..."
Watch for: Hesitation. Re-confirm consent before you start [synthesis].

4.8 The count

Purpose / when: The core exposure, about 100 seconds.
Steps:
1. Count aloud from 1 to 100 at a steady pace of about one number per second. Exact precision is not essential, but a consistent pace helps comparison across sessions.
2. Use a clear, friendly, natural voice. Do not use a hypnotic or monotone voice [synthesis on the second point].
3. Watch the client throughout for tearing, grimacing, shuddering, clenched hands or a defensive posture.
4. Do not interrupt the count with questions.
Example language: The numbers only.
Watch for:
- Visible distress means the memory has been engaged. Its absence may mean the memory was not reached and affect was not engaged.
- Signs of overwhelm, such as hyperventilation, a panic surge, or switching or loss of contact. For these, see 4.9 and section 5 [synthesis].

4.9 Reorienting cue: "Back here"

Purpose / when: Near the end of the count. Ochberg says counting is not hypnosis but sometimes has that effect. At 93 or 94 he says "Back here" to help a partly dissociated client return to the present. [source: Ochberg 1996, quoted]
Steps:
1. At 93 or 94, insert the short phrase in the same calm voice.
2. Finish the count to 100.
3. Then pause and let the client be silent.
Example language: "Back here" [quoted, Ochberg 1996]. A fuller version, if the client stays foggy after 100 (illustrative, [synthesis]): "You're in my office, it's Tuesday afternoon. Feel your feet on the floor."
Watch for: Eyes refocusing, posture loosening and normal breathing show reorientation. A blank stare, no response or time loss call for active grounding before any processing [synthesis].

4.10 Waiting for and eliciting the client's account

Purpose / when: Straight after the count. Clients often look dazed, moved or changed, and may be silent for a while.
Steps:
1. Wait for the client to speak first.
2. If they stay silent for long, or change the subject, ask them to describe what they just remembered.
3. Expect reactions such as accomplishment, relief, lingering terror, recovered details, excitement about a revelation (more common) or embarrassment (rare).
Example language (illustrative): after a silence, "Take your time. When you're ready, tell me what came up while I was counting."
Watch for:
- Lingering terror or fogginess. Ground the client before going on [synthesis].
- Accomplishment or relief, which point toward a successful exposure.

4.11 Probing by number ranges

Purpose / when: When the account is fragmented or skips parts of the recall.
Steps:
1. Ask about specific stretches of the count, such as what came up in the 20s and 30s, then the 40s to 60s.
2. Let the client fill in each segment in their own words.
Example language (illustrative): "What was happening in the memory around the twenties and thirties? And when I was in the forties and fifties?"
Watch for:
- The count gives the client a timeline to hang the fragments on, so stay with the client's material and do not supply content [synthesis].
- Peak distress usually falls mid-count, which can show where the "hot spot" is [synthesis inference from Ochberg's peak timing].

4.12 Verbatim note-taking

Purpose / when: While the client gives the account. Ochberg gives three reasons: it allows uninterrupted reporting, it preserves the images for later discussion, and it shows the client that their experience is being taken seriously. He considers visible attention to the details more important than eye contact here.
Steps:
1. Write the client's words as closely as possible.
2. Do not interrupt or interpret during the telling.
3. Keep the notes for review and for comparison across sessions.
Example language (illustrative): "I'm going to write down what you tell me, so we have it exactly as you said it."
Watch for: A client who is put off by the note-taking. Explain why you are doing it, or briefly pause and summarise aloud [synthesis].

4.13 Reflection and closure: redirecting to accomplishment

Purpose / when: The remaining time. The main goal is a positive ending, with the client composed enough to leave and willing to continue therapy.
Steps:
1. Shift attention to what the client did: they called up the memory, held it, and let it go.
2. Name this mastery explicitly.
Example language: "You turned the tape on and you turned the tape off" [quoted, Ochberg 1996]. Illustrative continuation: "You chose when it started, and you brought yourself back. That's control you didn't have when it ambushed you."
Watch for: The client's own statements of control or relief show the closure is working.

4.14 Discussing the method itself

Purpose / when: During closure. Talking about the technique lowers residual intense feeling and refines the next session.
Steps: Ask whether 100 counts felt right, whether the counting helped or distracted, and whether the "back here" cue was useful.
Example language (illustrative): "How was the length, too short or too long? Did my voice help you stay anchored, or get in the way?"
Watch for: The answers guide changes for next time. Adjusting the count length is a Greenwald-style modification, not Ochberg's protocol [uncertain/synthesis].

4.15 Allowing abreaction and further disclosure, or deferring

Purpose / when: If time allows after the count. Relaxation may bring up material that was previously inaccessible.
Steps:
1. If it is tolerable and time permits, allow ventilation and fuller disclosure.
2. If not, name the material and agree to return to it later.
3. Make sure the session still ends on a positive, composed note.
Example language (illustrative): "This is important, and I don't want to rush it in the ten minutes we have. Let's write it down and make it the first thing we look at next week."
Watch for:
- Rising distress near the end of the session is a reason to contain the material rather than open it [synthesis].
- Treat newly recalled details as the client's experience. Do not probe them as possible historical facts [synthesis per trauma rule].

4.16 Linking the memory to the therapy experience (optional)

Purpose / when: Consolidates the linking mechanism. Ochberg says making the link explicit can help but may be unnecessary, because clients usually sense when a memory has been mastered.
Steps: Point out briefly that the memory has now been recalled in a safe room with you, at the client's choosing.
Example language (illustrative): "Next time it comes up, part of it may carry this room and my voice counting along with it."
Watch for: Do not over-explain. Let the client's sense of mastery lead.

4.17 Handling a count that did not work

Purpose / when: When the client could not recall the memory, or only retold the story without feeling.
Steps:
1. Say plainly that the method, not the client, did not work this time.
2. Decide together whether to repeat it, adjust it or stop.
Example language (illustrative): "It sounds like the memory didn't really come alive this time. That happens, and it's about the technique, not about you. Shall we try again another day, or set it aside?"
Watch for: Self-blame. Also overcontrol or avoidance, which may need more groundwork [synthesis].

4.18 Further sessions and repeat counting

Purpose / when: Partial relief, multidimensional memories, or several traumas.
Steps:
1. Defer the decision about further sessions; the first session gives plenty to process.
2. Repeat counting on the same memory, taking different aspects each time, to build control and courage.
3. Space sessions for complex memories, often months apart.
4. Stop once counting no longer serves the survivor goal.
Example language (illustrative): "Last time we worked on the moment they came through the door. Is there a part of those days that still grabs you most?"
Watch for: Ochberg reports that most clients have fewer and less intense intrusions afterwards; this is anecdotal and not controlled evidence. Track change with the measures from 4.1 [synthesis].

4.19 Client-generated alterations of the memory

Purpose / when: Ochberg reports that some clients spontaneously change the memory during or after counting, adding fantasies of resolution or reversal. In one case a client turned her abuser into a cartoon figure who ran away.
Steps:
1. If the client brings such a change, accept it as their own creative mastery and explore what it means to them.
2. [synthesis] Do not suggest the alterations yourself. Ochberg describes them as client-initiated, and rescripting is a separate technique.
Example language (illustrative): "You changed the ending this time. What was it like to see him run?"
Watch for: Clear framing that a rescripted image is a mastery fantasy, not a revised account of what happened [synthesis].

4.20 Named variant: the Johnson, Lubin & Ochberg manual version (2005–2007)

Purpose / when: The version used in Johnson & Lubin's comparison study of CM, prolonged exposure (PE) and EMDR in women with multiple traumas.
What is known:
- Secondary sources say that in this version the client runs the memory once as a "movie" from 1 to 100 near the start of the session. The rest of the session is spent reviewing and discussing its contents. [source: Greenwald, TICTI blog]
- The 2006 study framed CM as imaginal exposure only. [source: Johnson & Lubin 2006 abstract]
Caution: [uncertain] The revisions paper (2005) and the manual (revised 1/1/07) are not drawn on. Session numbers, any preparation sessions and any review structure in the manual cannot be stated. Reported sample sizes also differ: Wikipedia gives 38 women and the 2006 abstract gives 51. Obtain the manual before using this version.

4.21 Named variant: Progressive Counting (Greenwald)

Purpose / when: A spin-off of CM by Ricky Greenwald, designed for better efficiency and tolerability, including with children and adolescents.
What is known:
- Greenwald's early child version used shorter counts that increased over sessions (10, then 20, then 30, and so on).
- Progressive Counting uses more "movies" and less talk than CM.
- He credits its effect to the privacy option, working "at the speed of thought", and dual focus on the memory and the counting.
- It sits within his phase model of trauma-informed treatment. Training, consultation and certification are offered by the Trauma Institute & Child Trauma Institute (TICTI). [source: Greenwald 2017 TICTI blog; Greenwald 2008 abstracts]
Caution: [uncertain] The full Progressive Counting protocol (memory list, count lengths per session, between-count ratings, closing) is not drawn on. Use Greenwald's book and training rather than improvising it from this summary.

5. Handling problems

Ochberg 1996 addresses only a few of these: failed counts, lingering terror, dissociation near the end of the count, recovered images, embarrassment, partial relief and getting home safely. Everything else here is my own synthesis and is marked [synthesis].

Readiness and contraindications

Source position: The 1996 paper gives no formal contraindication list. It describes use with outpatients in ongoing therapy with an experienced clinician, and says more experience is needed to predict who will benefit. [source: Ochberg 1996]
[synthesis] Defer counting when any of these apply:
- acute suicidality or recent self-harm (assess risk with standard practice and agree a safety plan first);
- ongoing danger or contact with the perpetrator;
- active psychosis;
- a dissociative disorder or frequent losses of time;
- intoxication or untreated substance dependence;
- medical instability, such as cardiac conditions where acute arousal is a concern (get medical advice);
- pending legal testimony, where memory changes could matter (discuss with the client and their lawyer).

Overwhelm during the count

Source: Ochberg expects brief terror moderated by the therapist's presence. He uses "Back here" at 93–94 for partial dissociation, and does not describe stopping the count. [source: Ochberg 1996]
[synthesis] If the client signals stop or is clearly flooded:
1. Stop counting.
2. Speak the client's name.
3. Orient them to the room and the date, and slow their breathing.
4. Use their grounding skill, for example naming objects in the room or pressing their feet to the floor.
5. Afterwards, frame stopping as control, not failure.
6. Process the experience briefly, then decide together about a later attempt with more preparation, or a shorter count as in Progressive Counting.

Dissociation, or remaining foggy after 100

Source: Counting can be trance-like, and "Back here" is the in-count cue. [source: Ochberg 1996]
[synthesis] If the client stays unresponsive after 100:
- Ground actively with orienting questions and sensory anchors.
- Do not start the post-count account until the client is clearly present.
- Extend the closure time.
- Arrange the companion home.
- Review dissociation screening before the next session.

No affect, or the client couldn't recall

Source: Treat this as a failed attempt. Attribute it to the method, and decide together whether to repeat or stop. [source: Ochberg 1996]
[synthesis] Explore whether the client was protecting themselves through overcontrol, fear of losing control, or shame. If so:
- more groundwork or a different, less threatening memory may help;
- a different exposure-based therapy may suit the client better.

Avoidance, postponing, cancellations (non-adherence)

Source: Counting is elective, and the timing is the client's choice. [source: Ochberg 1996]
[synthesis]
- Explore the client's fears about counting without pressing.
- Revisit the explanation, especially that the recall is brief, private and bounded.
- Continue the other PostTraumatic Therapy work meanwhile.
- Repeated last-minute cancellations are a reason to reassess readiness, not to persuade.

Lingering terror, or new or forgotten images after the session

Source: Lingering terror and recovered details are both among the reactions Ochberg lists. Clients should be told beforehand that forgotten images occasionally return. [source: Ochberg 1996]
[synthesis]
- Treat new images as the client's experience, without confirming or disputing them.
- Do not use counting or any suggestion to search for more memories.
- Schedule a check-in call within a day or two.
- Remind the client of their coping plan.

Embarrassment or feeling exposed after the count (rupture)

Source: Ochberg says embarrassment is rare. [source: Ochberg 1996]
[synthesis]
- Acknowledge it directly and stress that the recall was private.
- Ask what would make the next session feel safer.
- Use the method discussion (4.14) to repair.

The therapist's voice or presence feels intrusive or mechanical (rupture)

[synthesis]
- Ask about it in the method discussion.
- Adjust your tone, volume or seating position.
- Because the linking mechanism depends on the relationship, repair the alliance before attempting another count.

Partial relief, or flashbacks persist

Source: Repeat counting on the same memory, taking different aspects. Space sessions for multidimensional events. [source: Ochberg 1996]
[synthesis]
- Check whether a different memory or a "hot spot" is driving the intrusions.
- Consider an established PTSD therapy if there is no change after several sessions.

Multiple traumas

Source: Let the client choose which memory each time. Covering every trauma is unnecessary, because mastery tends to generalise. [source: Ochberg 1996]
[synthesis] Track whether the untreated memories also ease before adding more counting sessions.

Getting home safely

Source: If flashbacks have been recent or very vivid, a companion for the trip home is advisable. [source: Ochberg 1996]
[synthesis] Ask the client not to drive if they are still foggy after the session.

Counting starts to prolong therapy

Source: Counting should serve the survivor goal and not prolong therapy unnecessarily. [source: Ochberg 1996]
[synthesis] Set a review point after two or three sessions.

Telehealth

[synthesis] Not addressed in the sources. If you do count by video:
- confirm the client's location and an emergency contact;
- make sure the client is in a private room;
- agree a plan for a dropped connection, for example to call back immediately by phone;
- extend the closure time.

Children and adolescents

[synthesis] The 1996 method was described for adults. For younger clients, Greenwald's Progressive Counting, with its shorter, graded counts, was developed partly for this group. Seek PC training rather than adapting CM ad hoc. [source: Greenwald 2008; TICTI blog]

Sources

Sources:

Printed sources cited (not drawn on unless noted):

Ochberg, F. M. (1996). The counting method for ameliorating traumatic memories. Journal of Traumatic Stress. Opened via the Gift From Within full-text republication.
Johnson, D. R., & Lubin, H. (2005). The counting method as exposure therapy: Revisions and case examples. Traumatology, 11(3). [uncertain]
Johnson, D. R., & Lubin, H. (2006). The counting method: Applying the rule of parsimony to the treatment of posttraumatic stress disorder. Traumatology, 12(1), 83–99. https://doi.org/10.1177/153476560601200106 [abstract only]
Johnson, D. R., Lubin, H., & Ochberg, F. (2007). The Counting Method Manual (revised 1/1/07). [uncertain]
Greenwald, R. (2008). Progressive counting: A new trauma resolution method. Journal of Child & Adolescent Trauma, 1, 249–262. [abstract only]
Greenwald, R. (2008). Progressive counting for trauma resolution: Three case studies. Traumatology, 14(4), 83–92. [abstract only]
Greenwald, R. (2013). Progressive Counting within a Phase Model of Trauma-Informed Treatment. Routledge. [uncertain]

Not reachable in this session: the countingmethod.com PDF of Johnson & Lubin 2005, the ResearchGate copies of the 2005 and 2006 papers, and the TICTI Progressive Counting FAQ.

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