Chapter 6. The Structure Copy

Tasha crosses her arms. “Ok. So how do I handle these cues?”

“Well, Cue-Centered Therapy is all about the cues,” you reply with a smile. “There are four different phases to the treatment. The first is what we’ve already been doing, learning about trauma. And we’ll also develop coping tools and strategies that you’ll get to practice to help you feel less stressed.”

Tasha raises her eyebrows impatiently.

“And the second is when we start talking about your traumatic experiences, and we do that by creating a story together.”

“A story? You mean, like making up a trauma?”

“No, no,” you say quickly. “We’ll be talking about your real-life experiences—you’ll be telling your own story.”

“I don’t know,” Tasha stammers. “That might make me feel upset. I don’t like to talk about them.”

“I know it’s not easy, but that’s exactly why we’ll be practicing coping tools first, so you’ll feel prepared when you do tell your story. Trauma can sometimes change how we think about ourselves, or the world in general. Kind of like when you said earlier, ‘Bad things always happen.’”

“But it’s true!” Tasha exclaims with wide eyes. “Bad things always happen to me!”

“I hope that with my help, by the time you do tell your story, we can think about what you’re feeling along the way. We’ll identify your thoughts and feelings, and later down the line, we’ll use some coping tools to examine them specifically, and see how helpful they are to you.”

Tasha’s eyes have softened a little, but her brow remains furrowed. “Okay,” she shrugs.

“We’ll also create a life timeline for you,” you continue, “to place your traumas in the context of who you are, of everything that has happened to you, both negative and positive.”

“Huh,” Tasha says, as her brow furrow dissolves. “I like that we’ll be talking about positive experiences, too.”

“Positive experiences are just as important to your life timeline as negative ones,” you reply with a smile. “Now, in the third phase of CCT, we’ll identify the cues you might be reacting to, like the football jersey, for example. We’ll also have your mom start a list of her own for you, and by the time we get to our eighth session, we’ll compare the two lists and you’ll decide which cues you want to work on.”

“Why the eighth session?”

“It’s how CCT is structured. We’ll meet once a week for 15 sessions, so CCT is a fairly short program. Part of why I really believe in CCT is because it has this defined format and guideline to treatment…In any case, when we do compare our list of cues, we don’t have to tackle every single one, because just working on even a few will help you deal with any others you may face down the line. And the ones you do tackle, we’ll use them for something called ‘exposure.’”

“Uh-oh, that doesn’t sound good.”

You chuckle, “Oh no, it doesn’t mean we’re jumping into the traumatic experience itself. Think of exposure as the opposite of avoidance, which, we discussed, is how trauma is sustained. Exposure just means we’ll start to confront the stress, in a gradual way—by imagining the cues, then simulating them, then practicing at home with your mom.”

“Is the goal to make a cue go away?” Tasha asks, slightly confused.

“Not necessarily. We’re not going to make a cue go away, or completely erase your anxiety. But we’ll work together to help you develop adaptive responses to your cues.”

“What do you mean by that?”

“Well, we want you to basically learn the skills and go out there and use them on your own,” you answer. “That’s partly why CCT is so short, too.”

Tasha takes a moment before gesturing at her mother, sitting next to her. “Do I have to bring my mom all the time?”

You grin and shake your head. “Most of the time we’re going to meet alone. Your mom will join us for specific sessions when we’re ready to share with her what you’ve been learning and what we need her to do. We can get updates from her on how things have been going on her end, as well.”