Pre-session The ATF-A should be reviewed, and principle targets for the session ascertained. These targets may change as the session unfolds, but they should not be abandoned unless necessary (e.g., when the client discloses or experiences a new trauma, or is in crisis).
Opening (5-15 minutes) 1. Spend a few minutes making contact with the client. This may include discussion of relatively neutral topics, including recent activities or events in the client’s life.
Authentic caring and interest should be expressed early in the session, and repeated thereafter as appropriate.
2. Inquire about any changes in the youth’s life since the last session. •
Have there been any new traumas or victimization?
•
Has the client engaged in any dysfunctional or self-destructive behaviors?
•
If any of the foregoing is of concern, work to assure or increase the client’s ongoing physical safety. Do this before (or instead of) formal trauma processing.
3. Check with the adolescent regarding his or her internal experience since the last session. Ask if intrusive or avoidance symptoms have increased significantly. If yes, determine the nature of the trigger(s) and the thoughts, feelings, and/or
memories they produced. Normalize the experience and validate symptoms as internal trauma processing. If the intrusions or avoidance responses are
substantial, consider decreasing the intensity of exposure and activation in the current session.
4. Based on information from the opening part of the session, revise—if necessary— the goals of treatment for the session.
Mid-session (20-30 minutes) 1. Provide emotional and cognitive memory processing, staying within the therapeutic window whenever possible. Facilitate the youth’s discussion of his or her trauma history, support identification and expression of emotions when 158
Chapter 17: Sequence and Session-Level Structure of ITCT-A Individual Sessions