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Section 16
Identifying Focal Points from Problems

Question 16 | Test | Table of Contents

In the previous section, we discussed a strategy for your client to come up with resources that focus on helping clients with their life difficulties, blocking beliefs, and maladaptive schemas.

In this section, we will discuss how you can aid your client in identifying a focus point from a current issue or problem he or she is facing.

When a client presents you with a current issue or problem he or she is facing, you may begin by exploring with him or her and gather information about the problem.

Tips for Finding Focus Points:
I have found that the following four tips have been helpful for me when I begin working with a client facing PTSD to identify focus points to work on. I went through this process with Andrew, who was mentioned in the previous section.

1. I ask myself to focus on the following physical and psychological symptom questions as my client discusses his or her current issue or problem: What are my client’s symptoms? What issues brought my client into therapy? What are the negative cognitions, emotions, and body sensations that I have observed or my client has shared with me surrounding his or her issue or problem?

Andrew came in to me with an issue he was having at work surrounding being upset when facing his boss. The following is the dialogue Andrew and I had regarding his current issue.

Clinician: What do you feel when your boss interacts with you harshly?
Andrew: I get choked up, feel small and stupid, and get distracted from my thoughts.
Clinician: And what happens as an effect of these emotions?
Andrew: I become upset.

2. What incidents, if any, are precipitating this issue? Are there memories that are linked to my client’s symptoms?

Andrew and I then began a discussion about past memories that may have an effect on his current issue at work. When talking with Andrew about his history, he discussed the commander that he served under during his 6 years in the army. That commander used intimidation to get his soldiers to follow his orders. When his current boss used a very direct, harsh tone of voice, Andrew is reminded of his old commander.

3. Organize your client’s memories by listing them chronologically. I have found it helpful to identify the level of distress for your client for each of these memories. Determine which memory to focus on first based on the activation or emotional significance it holds. It is often helpful to identify the earliest or the most charged memory for your client. Reprocessing either the earliest or most emotionally charged memory can often affect related memories by alleviating his or her presenting problem and symptoms.
Since Andrew identified memories of his commander as part of his anxiety surrounding interacting with his boss, we began working on identifying key memories to focus on.

Clinician: What picture represents the worst part of the memory of your commander?
Andrew: There was one time when he made me fall out of line and he got inches from my face. He was yelling so loud at me that I began to fall in and out of hearing what he was saying.
Clinician: What do you feel in your body as you remember that experience?
Andrew: My chest is tight. I feel very tense in all my muscles.
Clinician: What do you believe about yourself?
Andrew: I’m worthless.
Clinician: On a scale of 0 to 10, how disturbing does it feel? 0 being not disturbing or neutral and 10 being the highest you can imagine.
Andrew: 10

I then began tapping Andrew’s knees to begin BLS to further help him reprocess this first memory making sure to focus on this past memory and not directing toward the present or future. As Andrew worked through this memory he began to realize that his commander and his current boss were two very different people.

Once Andrew had worked through the memory, we regrouped by checking in on how he was feeling.
Clinician: On a scale of 1 to 10, how disturbing is the memory now?
Andrew: A 1.
Clinician: Why is it not a 0?
Andrew: I still feel vulnerable.
Clinician: Go with that. How can you feel less vulnerable? Think of how you can gather strength.
Andrew: I feel much better. I feel stronger. I now feel it is a 0.

Once you and your client focus on resolving past memories, you may find it helpful to move from a past frame to a future frame of mind. You can do this by helping your client imagine his or her situation in the future when the issue comes up but he or she is now better prepared to deal with the situation. You may find bilateral stimulation (BLS) helpful to further instill his or her positive beliefs and feelings.

Clinician: Let’s now begin repeating the positive phrase "I can adapt and I have things to offer others." Now think about your current situation with your boss. How do you feel?
Andrew: It feels okay. It’s a good thing.
Clinician: Now imagine the next time you interact with your boss. How do you feel?
Andrew: It feels fine. I feel more confident.

4. Work with you client to develop a target map.
This process takes time and may have to occur over several sessions and only when your client is in a state to share with you his or her memories.
As we worked through Andrew’s most charged memory, we developed a map of the next memories we should tackle. These memories should be as chronological as possible, working from the oldest memories, working toward the present issue, and finally focusing on the images of future situations dealing with the issue or problem.

In this section we discussed how you can aid your client in identifying a focus point from a current issue or problem he or she is facing. The four tips to help your client find a focus point are focus on physical and psychological symptom questions regarding your client’s current issue or problem; find any precipitating issues; determine which memory to focus on first; and develop a target map. To determine a first memory to focus on with your client, it is often helpful to identify the earliest or the most charged memory for your client.

In the next section we will discuss developing targets for clients with multiple traumas.

Parnell 123-129
Reviewed 2023

Update
PTSD, subsequent violence, and increased focus on trauma-informed care

Wallinius, M., & Nilsson, T. (2023). PTSD, subsequent violence, and increased focus on trauma-informed care. The Lancet. Public health, 8(6), e398–e399. https://doi.org/10.1016/S2468-2667(23)00099-3


Peer-Reviewed Journal Article References:
Halevy, N., & Chou, E. Y. (2014). How decisions happen: Focal points and blind spots in interdependent decision making. Journal of Personality and Social Psychology, 106(3), 398–417.

Held, P., Coleman, J. A., Petrey, K., Klassen, B. J., Pridgen, S., Bravo, K., Smith, D. L., & Van Horn, R. (2021). A case series examining PTSD and depression symptom reductions over the course of a 2-week virtual intensive PTSD treatment program for veterans. Psychological Trauma: Theory, Research, Practice, and Policy.

Polizzi, C. P., Aksen, D. E., & Lynn, S. J. (2021). Quality of life, emotion regulation, and dissociation: Evaluating unique relations in an undergraduate sample and probable PTSD subsample. Psychological Trauma: Theory, Research, Practice, and Policy.

Samuelson, K. W., Bartel, A., Valadez, R., & Jordan, J. T. (2017). PTSD symptoms and perception of cognitive problems: The roles of posttraumatic cognitions and trauma coping self-efficacy. Psychological Trauma: Theory, Research, Practice, and Policy, 9(5), 537–544.

Zorzella, K. P. M., Muller, R. T., Cribbie, R. A., Bambrah, V., & Classen, C. C. (2020). The role of alexithymia in trauma therapy outcomes: Examining improvements in PTSD, dissociation, and interpersonal problems. Psychological Trauma: Theory, Research, Practice, and Policy, 12(1), 20–28. 

QUESTION 16
What are the four tips to help your client find a focus point? To select and enter your answer go to Test.

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