The Wedging or Strengthening Technique has been modified in Germany and is called the Absorption Technique to create resources to deal with what the client is concerned about in the future, or having stress about working with eye movement desensitization and reprocessing (EMDR) in the future, a present trigger or even an intrusive memory. Having clients imagine a strength or skill that would help them during the problem often helps them to reduce their anxiety. Focusing on a specific strength or coping skill may create a wedge of safety or control that will assist clients with the difficult situation in the future. During the Future Phase of the Inverted Protocol for Unstable complex post-traumatic stress disorder (C-PTSD) use the Absorption or Wedging Technique to develop as many different resources for the different issues about which the client might be concerned.

The Absorption Technique for Children is a protocol that was derived from the work of Arne Hofmann who based his work on an adaptation of “The Wedging Technique”. The absorption technique for children is a resource technique that supports children in creating resources for present issues and future challenges such as dealing with a difficult teacher or handling a disagreement with a classmate and so forth. This chapter uses resource installation for stressful situations. It includes summary sheets to facilitate gathering information, client documentation, and quick retrieval of salient information while formulating a treatment plan. The absorption technique, and the constant installation of present orientation and safety (CIPOS) technique, are excellent ways to encourage children to work with eye movement desensitization and reprocessing (EMDR) step-by-step even if they are not prepared to work with the worst issue in the beginning.

This chapter describes maneuvers to access the internal system of the patient as well as means to accelerate or decelerate the work in that process of accessing the self-system. Eye movement desensitization and reprocessing (EMDR), ego state therapy, and somatic therapy fit together like hand and glove. An extended preparation phase is often necessary before trauma processing in complex traumatic stress presentations and attachment-related syndromes, particularly when dealing with the sequelae of chronic early trauma. Clinical practice suggests that the adjunctive use of body therapy and ego state interventions can be useful, during stabilization and later on in increasing the treatment response to EMDR. Traditional treatment of complex posttraumatic stress disorder (PTSD) and dissociative disorders has usually included hypnoanalytic interventions, during which abreaction is considered an important part of treatment.

Acceptance and commitment therapy (ACT) is a behavioral intervention designed to increase and improve psychological flexibility. Psychological flexibility, from the ACT perspective, is defined as contacting the present moment fully, as a conscious human being, experiencing what is there to be experienced and working to change behavior such that it is in the service of chosen values. The therapeutic work explored in ACT counters the problem solving approach. Clients are taught to be aware of their thoughts and emotional experiences. An important feature of the therapy is that the therapist approaches these issues with humility and compassion for the client’s experience. Many clients who have experienced military sexual trauma (MST) have limited their lives in a number of ways in an effort to control or prevent fear or fear-related experiences such as anxiety or difficult memories.

Traumatic brain injury (TBI) causes two injury types: primary and secondary. In infants and young children, nonaccidental TBI is an important etiology of brain injury and is commonly a repetitive insult. TBI is by far the most common cause of acquired brain injury (ABI) in children and is the most common cause of death in cases of childhood injury. In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) issued validated prediction rules to identify children at very low risk of clinically important TBI, which is defined as TBI requiring neurosurgical intervention or leading to death. The range of outcomes in pediatric TBI is very broad, from full recovery to severe physical and/or intellectual disabilities. Children and adolescents who have suffered a TBI are at increased risk of social dysfunction. Studies show that these patients can have poor self-esteem, loneliness, maladjustment, reduced emotional control, and aggressive or antisocial behavior.

Acquired brain injury (ABI), at any age, is a significant public health concern. It is particularly problematic in the elderly considering the increased rates of mortality and morbidity following ABI in this population. The aging brain demonstrates changes in the synthesis of key neurotransmitter, including dopamine and serotonin, and other chemicals important to brain health, such as brain-derived neurotrophic factors (BDNF). Formal diagnosis of various ABI causes may be relatively simple when given proper history and diagnostic tools. Prognosis following ABI is largely dependent on the etiology and the severity of injury and lesion location in the brain. Microvascular changes in the aging brain lead to attenuated cerebral blood flow, reduced vascularization of brain parenchyma, and increased cerebrovascular risk. Prevention of TBI for older adults should include behavioral and environmental adjustments to reduce fall risk.

This chapter explains paradigms of neurorehabilitation and explores the interdisciplinary and transdisciplinary nature of brain injury rehabilitation. Optimal rehabilitation of acquired brain injury (ABI) requires a multidisciplinary approach of trained rehabilitation specialists at appropriate timing and with appropriate intensity. Brain injury rehabilitation requires a comprehensive treatment program to reduce impairments and to restore function, participation and quality of life. Vocational rehabilitation specialist assesses an individual’s functional level and vocational potentials. Guiding principles for rehabilitation include all areas of therapy, namely, physical, occupational, cognitive, and speech-language therapy. Early functional rehabilitation in poststroke and traumatic brain injury (TBI) patients has been shown to improve functional outcomes and may decrease “learned nonuse.” Neurorehabilitation in the context of ABI continues to be a demanding challenge, which requires clinical translational approaches involving a multidisciplinary team.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies 10 separate classes of substances related to significant substance abuse concerns. Of the 10 separate substance classes, four have more clearly documented patterns of pathophysiological sequelae and demonstrated impact on cognitive functioning. These substance categories include alcohol, inhalants, sedatives/hypnotics/anxiolytics, and stimulants. The remaining six substance clusters include caffeine, cannabis, opioids, hallucinogens, tobacco, and other or unknown substances. This chapter discusses the specific impact of each of these separate classes of drugs and related acquired brain injury on cognitive and emotional functioning. The clinical presentation associated with acquired brain injury related to substance use/misuse is variable. Most importantly, the patient will need to gradually reduce his benzodiazepine use so as not to facilitate “rebound anxiety.” Consideration should be given to anxiolytic medications that are not benzodiazepines, as well as to cognitive behavioral therapy, potentially including interceptive exposure.

This chapter describes key steps, with scripts, for the phases of therapy with a dissociative identity disorder (DID) client, and for an eye movement desensitization and reprocessing (EMDR) session with a DID client. In brief, the method employs the artful use of EMDR and ego state therapy for association and acceleration, and of hypnosis, imagery, and ego state therapy for distancing and deceleration within the context of a trusting therapeutic relationship. It is also endeavoring to stay close to the treatment guidelines as promulgated by the International Society for the Study of Trauma and Dissociation. The acronym ACT-AS-IF describes the phases of therapy; the acronym ARCHITECTS describes the steps in an EMDR intervention. Dual attention awareness is key in part because it keeps the ventral vagal nervous system engaged sufficiently to empower the client to sustain the painful processing of dorsal vagal states and sympathetic arousal states.

This chapter explains the process of solution focused narrative therapy (SFNT) and offers suggestions for the therapist’s use of conversational questioning. SFNT therapy comprises six steps: best hopes, mapping the effects of the problem, constructing the preferred story, exception gathering, preparing the presentation of the preferred future and moving up the scale, and summarizing and inviting clients to watch for success. The most important step is beginning therapy. The therapist begins the session by introducing himself, learning the names of those attending, and asking the same question of all present. The chapter also presents an exercise, which may help to identify traits, values, and actions that help readers present their best self to their clients, particularly clients that are challenging.