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Progressive Counting (PC)

Topic Areas
Scientific Rating
Child Welfare Relevance
Trauma Treatment (Adult)
3  — Promising Research Evidence
Low

About This Program

Target Population: Adults who have experienced trauma; has been used with teens and children ages 6 and up

Program Overview

PC is a psychotherapy procedure for resolving trauma or loss memories via memory reconsolidation. Briefly, it entails guiding the client to imagine a movie of the distressing memory, from beginning to end, while the therapist counts aloud first from 1-10, then 1-20, then 1-30, etc., to a maximum of 100. As the distress level goes down, the movies get shorter. This continues until no memory-related distress remains. PC can be done as a stand-alone treatment or within the context of a comprehensive phase model of trauma-informed treatment.

Program Goals

The goals for Progressive Counting (PC) are:

Primary goal:

  • Help the client to fully process the targeted distressing memory, so that the memory is no longer distressing

Secondary goal:

  • Reduce or eliminate the client's presenting problems, to the extent that such problems may have been caused or exacerbated by the distressing memory

Logic Model

The program representative did not provide information about a Logic Model for Progressive Counting (PC).

Essential Components

The essential components of Progressive Counting (PC) include:

  • PC is preferably done within a phase model of trauma-informed treatment, so that the client understands the rationale of trauma work, and is sufficiently motivated, stable, and strong as to be likely to be successful with PC.
  • PC is done individually, with one person at a time.
  • The memories to be targeted with PC are systematically identified as relevant to the client's presenting problem.
  • If more than one memory is to be treated with PC, the memories are treated in chronological order, once the client is judged to be capable of doing this.
  • The therapist guides the client to identify a beginning and ending of the movie, each of which (beginning and ending) are not part of the distressing event, but rather outside the event, and part of the broader life story.
  • The therapist counts aloud from 1-10 (then 1-20, etc., as per the PC system) while the client watches the movie of the distressing memory, in imagination, from beginning to end each time.
  • The therapist briefly obtains feedback from the client including a current distress rating. The feedback guides the therapist's next step.
  • The therapist recognizes when the client is stuck (as per the PC system) and utilizes a range of possible interventions (as per the PC system) to assist the client in getting unstuck and continuing to make progress.
  • The therapist persists with PC until the client reports no remaining distress associated with the memory, and no further changes in memory-related thoughts, emotions, or physical sensations.
  • The therapist follows up with the client to determine whether any memory-related distress remains, and if so, treats it with PC.
  • When PC is used with parents in conjunction with parenting-focused intervention, it is typically used to treat those memories which are presumed to interfere with the parent's capacity to parent up to the level of their natural competence. For example, a parent who is short-tempered with the child might be treated for his or her own history of abuse, which tends to lead to calmer parenting

Program Delivery

Adult Services

Progressive Counting (PC) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Posttraumatic stress disorder (PTSD), posttraumatic stress symptoms, grief, and a wide range of presenting emotional or behavioral problems for which unresolved trauma/loss may be a contributing factor

Recommended Intensity:

Typical 45-50 minute outpatient therapy session or longer, more intensive sessions

Recommended Duration:

Varies depending on how many memories are to be treated, and how it goes with a given client, can be as short as 10-15 minutes or take multiple sessions

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster / Kinship Care
  • Hospital
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

This program does not include a homework component.

Languages

Progressive Counting (PC) has materials available in languages other than English:

Dutch, Hebrew, Spanish, Turkish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Any room or other space suitable for conducting individual therapy

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Master's level or higher mental health professional

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Training is provided on site and is also available to individual therapists who can register for advertised trainings in various locations.

Number of days/hours:

Five full days of 6.5 training hours/day

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Progressive Counting (PC).

Formal Support for Implementation

There is formal support available for implementation of Progressive Counting (PC) as listed below:

Ongoing group consultation via web-based videoconference is available.

Fidelity Measures

There are no fidelity measures for Progressive Counting (PC).

Implementation Guides or Manuals

There are implementation guides or manuals for Progressive Counting (PC) as listed below:

Greenwald, R. (2013). Progressive Counting within a phase model of trauma-informed treatment. New York: Routledge.

Research on How to Implement the Program

Research has not been conducted on how to implement Progressive Counting (PC).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Greenwald, R., McClintock, S. D., & Bailey, T. D. (2013). A controlled comparison of Eye Movement Desensitization & Reprocessing and Progressive Counting. Journal of Aggression, Maltreatment, & Trauma, 22(9), 981–996. https://doi.org/10.1080/10926771.2013.834020

Type of Study: Randomized controlled trial
Number of Participants: 15

Population:

  • Age — Mean=41.6 years
  • Race/Ethnicity — Not specified
  • Gender — 67% Female and 33% Male
  • Status — Participants were individuals with traumatic experiences recruited via a website and fliers.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Eye Movement Desensitization and Reprocessing (EMDR) and Progressive Counting (PC). Participants were randomly assigned to the EMDR or PC. Measures utilized include the Posttraumatic Stress Diagnostic Scale (PDS), Dissociative Experiences Scale (DES), Subjective Units of Distress Scale (SUDS), and the Problem Rating Scale (PRS). Results indicate that PC and EMDR treatment did not significantly differ in effect size, efficiency, or client acceptability, for participants with and without posttraumatic stress disorder (PTSD). The low power, limited therapist experience with PC, and lack of evaluation of treatment fidelity make these findings inconclusive. Limitations include the small sample size, lack of evaluation of treatment fidelity, and inconclusive results.

Length of controlled postintervention follow-up: 1 week and 12 weeks.

Greenwald, R., McClintock, S. D., Jarecki, K., & Monaco, A. (2015). A comparison of Eye Movement Desensitization & Reprocessing and Progressive Counting among therapists in training. Traumatology, 21(1), 1–6. https://doi.org/10.1037/trm0000011

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 109

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were therapists participating in Progressive Counting and Eye Movement Desensitization and Reprocessing (EMDR) or Progressive Counting (PC) training.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Eye Movement Desensitization and Reprocessing (EMDR) and Progressive Counting (PC). Participants were therapists in either EMDR or PC training programs who worked on several of their own upsetting memories in practicums during the course of the training. Measures utilized include the Subjective Units of Distress Scale (SUDS) and the Treatment Difficulty Rating Scale. Results indicate that participants in both conditions reported large and significant reductions in memory-related distress, which persisted at 2 weeks and 10 weeks posttreatment. Results also indicate that there were no differences in effect size or maintenance of gains. PC was 37.5% more efficient than EMDR and was rated as being less difficult. Limitations include the nonrandomization of participants and lack of evaluation of treatment fidelity.

Length of controlled postintervention follow-up: 2 and 10 weeks.

Greenwald, R., Camden, A. A., Gamache, N., Lasser, K. A., Chapman, R., & Rattner, B. (2021). Intensive trauma-focused therapy with victims of crime. European Journal of Trauma & Dissociation, 5(3), Article 100146. https://doi.org/10.1016/j.ejtd.2020.100146

Type of Study: Randomized controlled trial
Number of Participants: 61

Population:

  • Age — 18–67 years, Mean=40.62
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were multiply-traumatized treatment-seeking victims of crime.

Location/Institution: Western Massachusetts, USA

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to conduct an open trial of trauma-focused intensive therapy featuring Progressive Counting (PC) and Eye Movement Desensitization and Reprocessing (EMDR). Participants were randomly assigned to either PC or EMDR. Measures utilized include the Trauma Symptom Inventory-2 (TSIP-2), the Problem Rating Scale (PRS), the Stability and Ability Rating Scale (SAS), the Quality of Life Assessment (QOL), and the Client Satisfaction Questionnaire (CSQ-8). Results indicate that there was strong participant retention as well as significant improvement at two weeks and 12 weeks posttreatment, with large to very large effect sizes on all outcomes, including posttraumatic stress and related symptoms, severity of primary presenting problems, quality of life, and overall stability and level of functioning. Outcomes were similar for PC and EMDR. Limitations include the lack of evaluation of treatment fidelity, inconsistency in getting the assessments done, no waitlist or weekly therapy comparison condition, and did not track whether a given participant may have engaged in further weekly therapy following their intensive work in the study.

Length of controlled postintervention follow-up: 2 and 12 weeks.

Additional References

Greenwald, R. (2009). Treating problem behaviors: A trauma-informed approach. New York: Routledge.

Greenwald, R. (2013). Progressive Counting within a phase model of trauma-informed treatment. New York: Routledge.

Contact Information

Ricky Greenwald, PsyD
Agency/Affiliation: Trauma Institute & Child Trauma Institute
Website: www.childtrauma.com
Email:
Phone: (413) 774-2340

Date Research Evidence Last Reviewed by CEBC: December 2023

Date Program Content Last Reviewed by Program Staff: March 2019

Date Program Originally Loaded onto CEBC: November 2015