Smart phones, they’re everywhere. In fact, currently there are approximately 91.4 million smartphones in the United States alone. Whether or not you have one and no matter your views on how good, bad or ugly smartphones are for society, statistically speaking the probability that your clients wear one like an extra appendage is very high. In fact, approximately 3 out of 5 clients aged 25 – 34 own a smartphone, which is more than any other age group.
The last blog entry on in vivo exposure discussed some strategies to help your client be better prepared to benefit from in vivo exposure. This week I want to talk about “post-in vivo processing”. We don’t usually emphasize processing when we discuss in vivo exposure but it is just as important for in vivo exercises as it is for imaginal exposure. Post-in vivo processing is not merely a check the box activity to make sure the homework was done but instead is an opportunity for a client to reflect on the homework assignment, and extract some understanding or insight from the experience of facing fear and living to tell about it. For some, this may simply mean concluding, “It was easier than I expected it to be!” But for others, it may mean evaluating and dismantling some strongly held beliefs that have kept them “safe” from harm for a long time. Give example?
A common concern we hear from new PE therapists is that they’re not sure how to record sessions or are uncomfortable setting this expectation about the treatment.
If recording sessions has not been explained to your patient before they arrive to Session #1 of the treatment, or even if it has been mentioned to them before, it’s important at the very beginning of the first session to explain this standard procedure (again) and why it is used in PE. Candor is critical.
So you have constructed an in vivo hierarchy in collaboration with your client. You have identified a variety of exercises across a wide range of SUDs ratings that appear to target the client’s core fears. You have proactively discussed the use of safety behaviors and asked your client to refrain from using them during the in vivo exercises. You’ve specifically instructed them not to use the breathing retraining exercise they’ve been learning when they do in vivo homework.
Developing the in vivo hierarchy with a client is an important step in implementing effective Prolonged Exposure (PE) treatment, but it is often given less attention by novice therapists because the more anxiety provoking and dramatic aspects of the upcoming imaginal exposure draw the focus of both the therapist and the client. However, the in vivo exposures address important avoidances in the client’s real life that may not be addressed in imaginal exposure, and are instrumental in making it possible for the client to participate fully in his or her own life.