Progressive counting

1. Introduction

Version followed: Ricky Greenwald's Progressive Counting (PC) as delivered inside his phase model of trauma-informed treatment (the "Fairy Tale Model"), per Greenwald (2013) Progressive Counting Within a Phase Model of Trauma-Informed Treatment (table of contents and publisher page), the Trauma Institute & Child Trauma Institute (TICTI) client FAQ and PC pages, Greenwald's own spoken account (inSocialWork podcast ep. 245), and Barron & Tracey (2017, open access), a case study of PC as trained and fidelity-rated by Greenwald. Confirmed from these sources: the 10-20-30 count and good beginning/ending images, the test run on a minor memory, one target memory per session and 4–5 PC sessions per youth in one case study, the purpose (not the steps) of Attachment Visualization and Parent Protector, and Frank Ochberg as originator of the counting method. The book's scripts (including the "PC Quick Guide"), the PC training manual and the full procedural texts of Greenwald's 2008, 2012 and 2013 papers are not reproduced here; the count ceiling of 100, the shortening of counts near resolution and the SUDS-0 end point rest on a secondary summary (Wikipedia) of Greenwald 2008 [uncertain: secondary, unverified]. The steps for the preparation tools (4.1–4.9), memory sequencing beyond the test run, counting pace, typical session count and resource PC remain [synthesis] or [uncertain]. Chapter numbers below follow the table of contents first consulted; the Routledge listing is unnumbered.

Progressive Counting is a trauma-memory resolution procedure developed by Ricky Greenwald (Trauma Institute & Child Trauma Institute, Northampton, Massachusetts, USA). It is a modification of the counting method (CM), designed by psychiatrist Frank Ochberg in the early 1990s, in which the clinician counts aloud to 100 while the client recalls the memory, followed by discussion of it [source: TICTI PC page; Wikipedia, Counting method (secondary)]. In PC the therapist counts aloud, first to 10, then 20, then 30 and so on, while the client silently imagines the troubling memory as a "movie" from a neutral beginning (before the event) to an ending after the bad part is over, where the client is through to the other side [source: TICTI PC FAQ; inSocialWork transcript; Barron & Tracey 2017, citing Greenwald]. The trauma memory sits between a good beginning image and a good ending image [source: Barron & Tracey 2017]. Rounds become progressively longer, so the client faces the memory in a graded, contained way, without needing to tell its content aloud [source: TICTI PC page; TICTI PC FAQ].

How change happens (developer's account, attributed): Greenwald holds that traumatic memories are stored in a "frozen", fragmented form that drives current symptoms, and that repeatedly activating the memory in a safe structure lets the client "digest" it and integrate it as part of the past; he links this to memory reconsolidation [source: inSocialWork transcript; Lasser & Greenwald 2015 abstract; TICTI PC FAQ]. The FAQ says repeated imagining may work through desensitisation, emotional processing, gaining perspective or other means; recipients themselves named emotional processing, desensitisation, a sense of mastery, making sense of the event, dual focus/distancing, relaxation and therapist presence as the active ingredients [source: TICTI PC FAQ; Greenwald 2012, Traumatology abstract]. Greenwald also uses PC to build resources such as confidence and self-esteem [source: TICTI PC FAQ].

2. Framework

PC is a single procedure, not a whole therapy. Greenwald teaches it as the trauma-resolution step inside a phase model; the same model accepts EMDR or another effective method in that slot [source: CEBC Fairy Tale Model profile; Greenwald 2013 TOC].

Phase model (Fairy Tale Model), in order [source: CEBC Fairy Tale Model profile; inSocialWork transcript; Greenwald 2013 TOC]. Each phase continues until its client outcome is reached or as far as possible; fidelity means achieving the outcomes in sequence, while the therapist chooses the methods (allowing cultural adaptation). Greenwald stresses there is "a lot of leeway" in the order.

Evaluation: strengths, resources, trauma/loss history, life situation, presenting problems. Book: Trauma History (ch. 5, appendix form). Move on when you have a working trauma/loss history and problem list.
Goals and motivation: identify and strengthen a goal the client actually wants, which keeps them willing to do the hard work. Move on when the client can state a personally meaningful goal.
Trauma-informed case formulation and treatment contract: the client understands how past trauma/loss feeds current problems and agrees a plan (book ch. 6–7, appendix Case Formulation form). Move on when the client accepts the formulation and the plan.
Safety and stabilisation: case management, parent training, problem-solving, consequential thinking, avoiding high-risk situations (book ch. 8) [source: CEBC; Barron & Tracey 2017]. Move on when the client is safe enough and no longer deteriorating.
Coping and affect-tolerance skills (book ch. 9: Coping Skills; ch. 10: Enhancing Attachment). Move on when the client can tolerate the emotion that trauma work will raise without deteriorating.
Trauma/loss memory resolution with PC (book ch. 11–12). Greenwald calls this the "main event".
Consolidating gains (book ch. 13: After Trauma Resolution): new skills and coping once symptoms fade [source: TICTI PC FAQ].
Anticipating future challenges (relapse prevention).

Greenwald's personal-trainer metaphor: get the client motivated, safe and strong enough to do well in the trauma work. He also argues that "the best stabilization intervention is trauma healing", and that in intensive format most coping-skill work becomes unnecessary [source: inSocialWork transcript]. Do not read this as permission to skip readiness: the FAQ warns that PC must be tailored to the presenting problem and emotional stability, and that untrained use may be "incomplete, ineffective, or even harmful" [source: TICTI PC FAQ].

Readiness criteria before PC (gate into phase 6) [source: inSocialWork transcript; CEBC profile; TICTI PC FAQ; additions marked]:

Client understands the link between past events and current problems and has a goal they want.
Client is currently safe (no ongoing abuse, living situation stable enough) and not deteriorating.
Client has enough coping and affect tolerance that activating the memory will not cause deterioration.
Client consents knowing they control whether to continue or stop and how much detail to share.
[synthesis] Current suicide risk assessed and managed; substance use, psychosis, active self-harm and severe dissociation assessed, with dissociative disorders treated as needing extra stabilisation and specialist adaptation before memory work. Not specified in the PC sources.

Format and dosing.

Individual sessions are the norm; the Fairy Tale Model also uses some group/milieu work [source: CEBC profile]. Group PC was trialled (Greenwald & Schmitt 2010, Psychological Trauma) [source: TICTI publication list].
Within a session: several counting rounds (multiple exposures per session, unlike CM's one), counts rising in steps of 10 [source: inSocialWork transcript; Barron & Tracey 2017], to a ceiling of 100, then shortened once the memory is nearly resolved [uncertain: secondary, unverified (Wikipedia summary of Greenwald 2008)]. The client can stop at any time [source: TICTI PC FAQ].
Session count and session length: no standard figure is published; the Fairy Tale Model's duration "varies by client/situation" [source: CEBC profile]. One published case study of youths in secure care used one target memory per PC session and 4–5 PC sessions per youth, after the earlier phases; therapists wanted longer sessions for some youths, but session length is not stated [source: Barron & Tracey 2017]. Treat these as one study's figures, not a protocol norm [uncertain].
Intensive option: consecutive full working days until goals are met; Greenwald reports it roughly halves total hours and reduces dropout [source: inSocialWork transcript].
Children: Greenwald developed the stepped 10-20-30 count partly for children, instead of CM's single long count [source: inSocialWork transcript].

Criteria for moving on within PC: a memory is done when SUDS reaches 0 and further rounds bring no further change (CM allowed stopping at SUDS 2 or lower; PC aims for 0) [uncertain: secondary, unverified (Wikipedia summary of Greenwald 2008)]; counting continues until no memory-related distress remains [source: Barron & Tracey 2017]. Then take the next memory. Sequencing: a minor upsetting memory is used first as a test run [source: Barron & Tracey 2017]; beyond that, Greenwald's rule for ordering the memory list (chronological, by rating or by link to symptoms) is not published outside the book and manual [uncertain]. Move to phase 7 when target memories are resolved and symptoms are fading [source: TICTI PC FAQ].

3. Guiding principles

Phase first, then PC [source: CEBC; transcript]: do not start counting until motivation, safety and affect tolerance are in place.
Outcomes over techniques [source: CEBC]: each phase is defined by a client outcome; use any effective method that gets there.
Approach, not avoidance [source: TICTI PC FAQ]: the FAQ's rationale is that an avoided memory keeps its disturbing power; treatment provides a structured, safe way to face it.
Graded, contained exposure [source: TICTI PC page]: progressively longer movies; raise or lower the count to keep the dose tolerable.
Start safe, end safe [source: transcript; Greenwald 2012]: each movie starts before the event and ends after relief, and the end of each round should be as complete a resolution as possible. Never stop a movie at the worst moment.
Client control [source: TICTI PC FAQ]: the client decides whether to continue or stop and how much to share; the therapist guides and may encourage them through hard parts.
Privacy allowed [source: transcript; TICTI PC FAQ]: the client need not narrate the memory; useful for shame-laden material and for clients who cannot speak about it.
Minimal review between rounds [uncertain: secondary, unverified (Wikipedia summary of Greenwald 2008)]: brief comment and a number, not a retelling; keep momentum.
Don't stop in the middle of distress [source: TICTI PC FAQ]: distress generally passes within a few minutes if PC continues; staying with it is part of the method (within the client's consent).
Finish the job [source: Barron & Tracey 2017 (counting continues until no memory-related distress remains)]: aim for SUDS 0 and stability, not "good enough".
Expect processing between sessions [source: TICTI PC FAQ]: insights, vivid dreams, strong feelings or new recall may follow for days or weeks; plan for it.
Trained use only [source: TICTI PC FAQ; TICTI training pages]: PC requires training in PC and trauma-informed treatment; TICTI lists PC-trained and PC-certified therapists.
The memory is the client's experience [synthesis]: work with what the client brings; never suggest content, never use PC to "recover" memories, and do not treat what emerges as verified history.

4. Intervention inventory

Scope note: the components below are those named in Greenwald (2013) (table of contents and Appendix C list of scripts: Trauma History, Case Formulation, Self Control Skills, Attachment Visualization, Parent Protector, Progressive Counting, PC Quick Guide, Safe Place, Float Back, Container [source: Greenwald 2013 TOC; Routledge product page]), Greenwald's 2017 EMDRIA workshop abstract on attachment-related impasses, the CEBC Fairy Tale Model profile, the TICTI PC FAQ, Greenwald's interview, Barron & Tracey (2017) and, as a secondary source, Wikipedia's summary of the 2008 procedure. The book's scripts are not published outside the book [uncertain], so for the preparation tools in 4.1–4.9 the steps remain general trauma practice [synthesis], not Greenwald's scripts. Example wording is illustrative throughout. Where an item's content is not published at all, it is listed but not reconstructed.

4.1 Trauma/loss history and memory list

Purpose / when: phase 1. Map the events (trauma and loss) that may drive current problems, to formulate and to choose PC targets [source: CEBC; Greenwald 2013 ch. 5 and Trauma History form].
Steps [synthesis]: (1) explain you will list headlines, not stories; (2) go through life periods and event types (abuse, violence, accidents, medical events, losses, separations, humiliations), writing a one-line label per memory; (3) ask for a 0–10 disturbance rating for each when the client thinks of it now; (4) note which memories link to current triggers and symptoms; (5) stop and ground if the client becomes flooded. How Greenwald orders the list for PC (e.g. chronologically or by rating) is not published outside the book [uncertain].
Example language (illustrative): "Just give each one a short title, like a chapter heading. You don't need to tell me what happened. How upsetting is it now, from 0 to 10?"
Watch for: rising distress while listing (keep it brief, return to the present); gaps that may reflect avoidance [synthesis]. All memories and details are generated by the client [source: Barron & Tracey 2017]: never press for or suggest events.

4.2 Trauma-informed case formulation

Purpose / when: phase 3. Help the client see how past events and current problems connect, which builds motivation for the trauma work [source: CEBC; transcript; Greenwald 2013 ch. 6 and Case Formulation form].
Steps [synthesis]: (1) take one current problem (e.g. outbursts); (2) identify its triggers; (3) link the trigger to the reaction to a listed memory; (4) summarise jointly in a short written or drawn sequence: past event → learned alarm → trigger now → reaction; (5) check that the client agrees.
Example language (illustrative): "When someone raises their voice, your body reacts as if it's back then. That makes sense. If we help that old memory finish, the alarm may not need to go off so hard."
Watch for: the client experiencing the formulation as blame; adjust until it feels true to them.

4.3 Goal setting, motivation and treatment contract

Purpose / when: phases 2–3. A goal the client wants keeps them engaged; the contract makes the plan explicit [source: CEBC; transcript; Greenwald 2013 ch. 7].
Steps [synthesis]: (1) ask what the client wants life to be like (not just less of a symptom); (2) make the goal concrete and observable; (3) link it to the formulation; (4) present the plan in phases (stabilise → skills → resolve memories → consolidate); (5) agree on roles, frequency and how progress will be tracked.
Example language (illustrative): "If this work goes well, what will you be doing in six months that you can't do now?"
Watch for: goals owned by others (parents, courts) rather than the client; mandated teens may need a goal of their own first.

4.4 Safety and stabilisation

Purpose / when: phase 4. Stop deterioration and current danger so trauma work is possible [source: CEBC lists case management, parent training, problem-solving, avoiding high-risk situations; Greenwald 2013 ch. 8].
Steps [synthesis]: (1) assess current safety (violence, abuse, housing, suicide risk, substance use); (2) act on what is unsafe (case management, safeguarding, safety plan); (3) involve caregivers for children/teens (parent training, supervision); (4) problem-solve high-risk situations the client can avoid; (5) reassess before PC.
Watch for: ongoing abuse or contact with a perpetrator (resolve safety before memory work); risk escalation.

4.5 Self-control / coping skills

Purpose / when: phase 5. Give the client ways to manage arousal and urges while still traumatised, and enough affect tolerance for PC [source: transcript; CEBC; Greenwald 2013 ch. 9 and Self Control Skills script].
Steps [synthesis]: (1) identify the client's current coping, keep what works; (2) teach one or two skills (e.g. slow breathing, noticing early warning signs, a planned pause); (3) rehearse in session with a mild trigger; (4) practise between sessions and review.
Watch for: skills used only in session; the client still being unable to tolerate mild activation (more preparation needed).

4.6 Safe Place

Purpose / when: a calming imagery resource for regulation before, during or after trauma work [source: named in Greenwald 2013 Appendix C].
Steps [synthesis]: (1) client chooses a real or imagined place that feels calm and safe (avoid places linked to the trauma); (2) build it through the senses; (3) notice the body's calm; (4) give it a cue word; (5) practise calling it up after a mild upset; (6) use it to close sessions.
Example language (illustrative): "Picture a place where you feel calm. What do you see… hear… what's the temperature? Notice where in your body you feel that calm."
Watch for: the place turning negative (pick another or use a different resource); for some clients imagery is not calming, so use grounding in the room instead.

4.7 Container

Purpose / when: imagery for setting aside unfinished material between sessions [source: named in Greenwald 2013 Appendix C].
Steps [synthesis]: (1) client imagines a strong container; (2) puts the remaining disturbance in it; (3) closes it and leaves it with the therapist or somewhere safe until next session; (4) checks the SUDS after.
Example language (illustrative): "Imagine something strong enough to hold what's left over today. Put it in, close it, and know we'll open it together next time."
Watch for: use as avoidance of planned work; material leaking (strengthen with Safe Place and grounding).

4.8 Enhancing attachment: Attachment Visualization and Parent Protector

Purpose / when: phase 5, Greenwald 2013 "Enhancing Attachment" chapter; both are scripted exercises in Appendix C [source: Greenwald 2013 TOC; Routledge product page]. Greenwald presents them as structured, scripted interventions for clients whose parents fell short in important ways: Attachment Visualization is a guided visualisation to develop or enhance secure attachment status; Parent Protector is a container-type exercise for clients who fear becoming too angry at a parent, a fear that might otherwise block processing [source: Greenwald 2017 EMDRIA workshop abstract, Francine Shapiro Library].
Steps: the scripts' steps and wording are published only in the book and workshop materials and are not reproduced here [uncertain]; take them from the book's Appendix C or TICTI training, not from a reconstruction. The workshop abstract says the scripts can be used without further training [source: Greenwald 2017 abstract], so the book script is the practical route.
Watch for [synthesis]: in child work, caregiver involvement and caregiver stability shape whether trauma work holds.

4.8a Resolution conversation with a parent

Purpose / when: the third of Greenwald's scripted interventions for attachment-related treatment impasses: a resolution conversation with a parent, whether or not that parent is still living [source: Greenwald 2017 EMDRIA workshop abstract, Francine Shapiro Library]. Whether it appears in the 2013 book and where it sits in the phase model is [uncertain].
Steps: not published; not reconstructed [uncertain].
Watch for [synthesis]: never arrange a real conversation with a parent who is unsafe or abusive; treat what the client says or imagines as their own process, not as a way to establish what happened.

4.9 Float Back (identifying target memories)

Purpose / when: to find an earlier memory linked to a current trigger or reaction, to target with PC [source: named in Greenwald 2013 Appendix C].
Steps [synthesis]: (1) bring up a recent upsetting situation and notice the feeling, thought and body sensation; (2) invite the mind to drift back to an earlier time it felt like this, without searching or guessing; (3) note whatever comes as a possible target; (4) if nothing comes, accept that and use known memories.
Example language (illustrative): "Stay with that feeling and just let your mind go back to the earliest time you remember feeling like this. Whatever comes is fine, and if nothing comes, that's fine too."
Watch for: this must not become memory recovery. Do not suggest content, do not interpret vague images as events, do not use with hypnosis; work only with what the client already recalls [synthesis].

4.10 Orientation and consent to PC

Purpose / when: start of phase 6, before the first counting round [source: TICTI PC FAQ].
Steps: (1) explain the procedure: you count aloud, they run the memory as a movie; (2) explain why: avoiding a memory keeps its power, and facing it in a structured way lets it lose its charge; (3) say upsetting feelings may rise but usually pass within a few minutes if you keep going; (4) state their control: they can stop at any time and need share only as much as they want; (5) agree a stop signal [synthesis]; (6) explain that processing may continue for days or weeks after sessions and should be reported next time, with a call to you if they become worried or low. [source for 1–4, 6: TICTI PC FAQ]
Example language (illustrative): "I'll count out loud, starting with a short count. While I count, you run the memory like a movie in your head, start to finish. You don't have to tell me what you see. If you need to stop, raise your hand and we stop."
Watch for: consent given under pressure (e.g. from a parent or court); revisit until it is the client's own choice.

4.11 Selecting the target memory

Purpose / when: each PC session. Greenwald: you have to decide which memory you are working on [source: transcript].
Steps: choose with the client from the memory list and formulation. Begin with a minor upsetting memory as a test run [source: Barron & Tracey 2017]; [synthesis] this lets the client experience the procedure working on low-stakes material. In that case study one target memory was processed per session [source: Barron & Tracey 2017]. Greenwald's rule for ordering the remaining memories is not published outside the book [uncertain]. [synthesis] Reasonable default after the test run: a memory central to the current problem and within the client's tolerance.
Watch for: picking the worst memory before the client has tolerance; picking only easy memories to avoid the central one.

4.12 Setting up the movie: beginning and ending

Purpose / when: just before counting starts. Defines a contained exposure with a safe start and a relief ending [source: transcript; Barron & Tracey 2017].
Steps: (1) identify a beginning moment in ordinary life before anything bad happened (Greenwald's example: coming home from work and putting things away); (2) identify an ending moment after the bad part is over, when the client was through it and had some relief or safety, even if that is well past the worst part; (3) take a starting SUDS (0–10) for the memory [source: Crane 2018 record (SUDS as the session measure)]; (4) [synthesis] if no relief point exists in the event itself, choose the first later moment of relative safety, or the present day.
Example language (illustrative): "Where does the movie start, a moment just before anything went wrong? And where can it end, a moment when it was over and you were OK, or at least safer?"
Watch for: endings that land in the middle of the bad part; Greenwald (2012) stresses that each exposure should end in as complete a resolution as possible.

4.13 Progressive counting rounds (core procedure)

Purpose / when: phase 6, the trauma-resolution step [source: TICTI PC FAQ and PC page; transcript].
Steps:
1. Ask the client to imagine the whole story of the memory as a movie, from the chosen beginning to the chosen ending, while you count aloud [source: Barron & Tracey 2017, citing Greenwald 2014]. First count: to 10.
2. Count at a steady, even pace. The public sources (TICTI pages, Barron & Tracey 2017) give no counting pace [uncertain]; [synthesis] about one number per second.
3. The client fits the whole movie, start to end, into the count, so longer counts let the movie run slower and in more detail.
4. After each round, a minimal review (4.14), then the next round with a longer count: 20, 30, 40, and so on [source: TICTI PC FAQ; transcript], up to 100 [uncertain: secondary, unverified (Wikipedia summary of Greenwald 2008)].
5. Adjust the dose by raising or lowering the count to keep the work tolerable and productive [uncertain: secondary, unverified (Wikipedia summary of Greenwald 2008)].
6. Keep going through distress if the client agrees: distress generally passes within a few minutes if PC is not stopped; encourage the client through difficult parts [source: TICTI PC FAQ].
7. When the memory is nearly resolved, shorten the counts progressively [uncertain: secondary, unverified (Wikipedia summary of Greenwald 2008)].
8. Continue until SUDS is 0 and further rounds produce no change [uncertain: secondary, unverified (Wikipedia summary of Greenwald 2008)].
Example language (illustrative): "Start the movie at the beginning, and finish it by the time I get to ten. Ready? One… two… three… [to] ten. OK. Now we'll do it again, a bit longer, to twenty."
Watch for: signs it is working: SUDS falling across rounds, the client reporting the movie as more distant, more past, less vivid, or new perspective ("it wasn't my fault") [source: Greenwald 2012 mechanisms list; TICTI PC FAQ]. Signs to adjust: no change over several rounds, the client skipping or freezing the movie, dissociation (see section 5).

4.14 Minimal between-round review and SUDS

Purpose / when: after every round [uncertain: secondary, unverified (Wikipedia summary of Greenwald 2008)].
Steps: (1) ask for a SUDS (0–10); (2) invite a brief comment if the client wishes; do not ask for the movie's details; (3) decide the next count (up, same, or down); (4) continue.
Example language (illustrative): "What's the number now? Anything you want to say about it, or shall we go on?"
Watch for: long discussions that dilute the exposure (CM's original single round followed by talk is what PC moved away from) [source: transcript].

4.15 Closing a PC session

Purpose / when: end of every session, whether or not the memory is resolved.
Steps [synthesis except where cited]: (1) end on a completed round that reached the relief ending [source: Greenwald 2012 on complete resolution at each round's end]; (2) take a final SUDS; (3) if material is unfinished, use Container and/or Safe Place (4.6–4.7); (4) ground in the room; (5) remind the client that processing may continue, to note dreams, feelings or memories and report them next session, and to call if they become worried or depressed [source: TICTI PC FAQ]; (6) check safety before they leave.
Example language (illustrative): "We'll stop here for today. Things may keep shifting this week, in dreams or feelings. Jot down anything that comes up and bring it next time. If you feel worried or very low, call me."
Watch for: leaving at high SUDS without a containment step; next-session reports of increased distress (see section 5).

4.16 Resource PC (building confidence or self-esteem)

Purpose / when: the FAQ states PC can also build resources such as confidence and self-esteem [source: TICTI PC FAQ].
Steps: the procedure for resource work is not described in the public sources (TICTI FAQ, Barron & Tracey 2017, TICTI publication list) [uncertain]. [synthesis] A conservative adaptation: choose a memory of success or being valued, run it as a movie with the same counting, and ask for a strength rating instead of SUDS. Mark this as your adaptation, not Greenwald's protocol.
Watch for: positive memories that link into negative ones; switch to closing steps.

4.17 Monitoring progress: client feedback tools and the GPS rubric

Purpose / when: throughout. The table of contents consulted first showed an Appendix B of Client Feedback Tools, but the Routledge product page lists Appendix B as a reprint of Greenwald et al.'s controlled comparison of PC and EMDR, so whether the book contains client feedback tools is [uncertain] [source: Greenwald 2013 TOC; Routledge product page]. Greenwald describes a rubric that shows where a case stands, what is covered or missing, and why treatment may be stalling, used for brief consultation [source: transcript]. In one training cohort Greenwald rated therapist fidelity retrospectively on a 0–10 scale from recorded sessions [source: Barron & Tracey 2017].
Steps [synthesis]: at each review, check each phase outcome (understanding, goal, safety, coping, memories resolved, gains consolidated, future challenges) and work on the earliest one not yet achieved.
Watch for: repeated stalls in trauma work that trace back to an unmet earlier outcome (usually motivation or safety).

4.18 Consolidating gains and anticipating future challenges

Purpose / when: phases 7–8 [source: CEBC; Greenwald 2013 ch. 13; TICTI PC FAQ].
Steps [synthesis]: (1) review change against the goal; (2) build new skills and habits now that symptoms are fading; (3) list likely future triggers and stressors; (4) rehearse responses (in imagery or role play); (5) agree when to return for booster work.
Watch for: new symptoms pointing to remaining untreated memories; return to the memory list.

4.19 Intensive PC format

Purpose / when: when weekly therapy is too slow or keeps being disrupted [source: transcript].
Steps [source: transcript; details synthesis]: consecutive full days (Greenwald: roughly 9 to 5) from the start of the week until goals are met; phases are compressed, and Greenwald finds that most coping-skill work becomes unnecessary because the trauma work itself stabilises; finish when goals are met. [synthesis] Screen carefully, plan breaks and evening self-care, and arrange follow-up.
Watch for: fatigue and cumulative distress across days; clients without support at home.

4.20 Use with children and adolescents

Purpose / when: PC was developed partly in child work; Greenwald (2008) presented child cases in the Journal of Child & Adolescent Trauma, and the teen Fairy Tale Model manual is scripted for individual work [source: transcript; CEBC; TICTI publication list].
Steps [synthesis beyond the stepped count]: use the short starting counts; involve caregivers in stabilisation and attachment work (book ch. 10); keep explanations concrete; let the child stay silent about content; consider drawing beginning and ending scenes. A PsyD dissertation (Crane 2018) studied PC with a child using SUDS and caregiver reports [source: Pacific University record].
Watch for: ongoing unsafe home situations; caregiver distress affecting the child.

5. Handling problems

Greenwald (2013) has a whole chapter on "PC Problem-Solving" (ch. 12) and one on "Challenging Cases" (ch. 15); their content is not reproduced here [uncertain]. Guidance below is cited where a source supports it, otherwise marked [synthesis].

Client won't engage or wants to quit trauma work. Phase-model answer: return to the earliest unmet outcome, usually goal/motivation or formulation; reconnect the trauma work to the client's own goal [source: transcript; CEBC]. [synthesis] Offer the privacy feature (no need to tell the story) and a short first count to lower the threshold.
Distress spikes during a round. Keep counting if the client agrees; the FAQ says it generally passes within a few minutes if PC is not stopped, and the therapist may encourage the client through [source: TICTI PC FAQ]. Lower the next count to reduce the dose [uncertain: secondary, unverified (Wikipedia summary of Greenwald 2008)]. [synthesis] Brief encouragement over the count ("you're doing it, keep the movie going, it's already over"); after the round, take SUDS and decide with the client.
Client signals stop. Stop; the client decides whether to continue [source: TICTI PC FAQ]. [synthesis] Ground, check what happened, offer a shorter count or a different memory; if stopping for the session, close with Container/Safe Place.
Overwhelm or dissociation (glazed, unresponsive, losing time, "not here"). [synthesis] Stop the count; orient to the present (name date and place, feet on the floor, describe objects in the room, sensory grounding); wait for the client to be able to rate and talk; then either resume with a much shorter count or close. Repeated dissociation means readiness was overestimated: return to stabilisation and affect-tolerance work and assess for a dissociative disorder before further memory work. Not addressed in the PC sources.
SUDS stuck (no change across several rounds). [synthesis] Check the movie: is the client running it to the relief ending or stopping at the worst moment? Is a specific "hot spot" or a different memory being triggered (use the next round on that, or Float Back to find a feeder memory)? Is a belief (guilt, self-blame) keeping it charged? Is there a current-life reason it still feels dangerous (ongoing threat, so a SUDS above 0 may be realistic)? The book's problem-solving chapter likely covers this [uncertain].
Client skips parts of the movie. [synthesis] Name it neutrally, lengthen the count so there is time for the skipped part, and agree to include it when ready.
Increased distress between sessions. The FAQ treats insights, vivid dreams, strong feelings or new recall as continued healing, to be reported at the next session, and asks the client to call immediately if worried or depressed [source: TICTI PC FAQ]. [synthesis] At the next session, check risk, review the log, and decide whether to continue the same memory (often the best response) or add stabilisation.
New memories surface. [synthesis] Note them on the list as the client's experience; do not probe, interpret or treat them as confirmed history; never use suggestion, hypnosis or imagery to fill gaps. Work with them only as they are recalled.
Non-attendance or dropout. Greenwald reports that intensive format reduces dropout because "life doesn't intervene" [source: transcript]. [synthesis] In weekly work, avoid long gaps between sessions in the middle of a memory; schedule PC sessions close together.
Rupture (client feels pushed or unheard). [synthesis] Stop the procedure, acknowledge, and restate client control; re-contract on pace. Recipients rated therapist presence as part of what helped [source: Greenwald 2012 abstract], so repair the relationship before resuming.
Ongoing danger (abuse, violence, contact with perpetrator). Safety comes before trauma resolution in the phase model [source: CEBC; transcript]. [synthesis] Safeguarding and reporting duties apply; defer PC on current-threat memories.
Suicide or self-harm risk. [synthesis] Assess with standard risk assessment before and during trauma work; maintain a safety plan, including lethal-means counselling (safe storage or removal); pause PC if risk is acute.
Children: caregiver undermining or unsafe home. [synthesis] Work on caregiver stabilisation and attachment (book ch. 10, CEBC parent training) before or alongside PC.
Therapist competence. The developer states PC should only be used by therapists trained in PC and trauma-informed treatment [source: TICTI PC FAQ]. TICTI offers PC training (also included in its Child & Adolescent Trauma Treatment Intensive, Treating Problem Behaviors and certificate programmes), a 9-CE book-based home-study programme, consultation, and an advanced PC Certification that requires prior PC training [source: TICTI PC page; TICTI book page]. Certification requires live in-person PC training, follow-up group consultation, a written test based on the book, substantial client practice and endorsement by a PC Consultant who has observed your work; it is not required to practise PC [source: TICTI PC certification blog]. In one published cohort, therapists had three days of Fairy Tale Model training and one day of PC training from Greenwald, then monthly group consultation with review of recorded sessions [source: Barron & Tracey 2017].

Sources

Web pages:

Further web pages:

Books and papers cited:

Greenwald, R. (2013). Progressive Counting Within a Phase Model of Trauma-Informed Treatment. Routledge.
Greenwald, R. (2015). Treating Problem Behaviors: A Trauma-Informed Approach. Routledge.
Greenwald, R. (2008). Progressive counting: A new trauma resolution method. Journal of Child & Adolescent Trauma, 1(3), 249–262.
Greenwald, R. (2008). Progressive counting for trauma resolution: Three case studies. Traumatology, 14(4), 83–92.
Greenwald, R. (2012). Progressive counting: Asking recipients what makes it work. Traumatology, 18(3), 59–63.
Greenwald, R., & Schmitt, T. A. (2010). Progressive counting: Multi-site group and individual treatment open trials. Psychological Trauma, 2, 239–242.
Lasser, K. A., & Greenwald, R. (2015). Progressive counting facilitates memory reconsolidation. The Neuropsychotherapist, 10, 30–37.
Greenwald, R. (2008). Progressive Counting Training Manual. Child Trauma Institute (cited by the 2008 paper).

← Previous · VI-051Counting method Next · VI-053 →Developmental needs meeting strategy