By Karen Carnabucci, LCSW, TEP

I remember the first time that I introduced the principles of sand tray into a psychotherapy session with a couple, who I’ll call Harry and Sally.

The couple, who were experiencing great conflict in their marriage, had arrived in my therapy room several weeks before, saying that they had difficulty communicating with each other and that most discussions of any substance resulted in angry feelings.

Each of the couple demonstrated stereotypical gender behaviors: Sally was highly talkative and verbally adept as she chatted easily for many minutes about what she was thinking, feeling, wanting and needing. By contrast, Harry showed up as the proverbial strong and silent type. He appeared to have difficulty bringing a full sentence forward when facing his talkative wife, even though he was well educated and highly successful in a demanding professional job.

By Karen Carnabucci,  LCSW, TEP

When working with survivors of trauma, the main objective of every clinician is the creation of a structure that supports safety and containment.

With the practice of action psychotherapy such as psychodrama, this objective becomes more crucial. Action therapy, including what appear to be rather benign techniques, is a powerful tool that can trigger unprocessed material in survivors of trauma, resulting in flashbacks and dissociation.

The Therapeutic Spiral Model -- developed by clinical psychologist Kate Hudgins, Ph.D., TEP, and colleagues -- is an integration of classical psychodrama, object relations and recent advances in trauma theory to provide additional safety and structure when working with trauma. It follows the goal of providing safety and containment at every step for the client as well as the helping professional. Aspects of the model can be employed in individual and group sessions and may be easily adapted by talk therapists.

The model identifies safety and containment in five areas: