Use this index to find a place to read, not to select a treatment automatically. The event chapter provides context and cautions. The theme helps locate the meaning that may be blocking processing. Neither tells you that an interweave is needed.
Begin with the client's words. “I should have stopped it” may concern responsibility, loss of control, or fear that it will happen again. Ask what the statement means before choosing an entry. When processing is moving, allow it to move. Emotional intensity, silence, or repeated wording alone does not establish a block.
Responsibility, safety, choice and control, and self-worth are this book's editorial organizing scheme. They are not a validated assessment, an exhaustive account of trauma, or four stages of recovery.
Start with the event chapter
- Chapter 7 — Pregnancy loss. Look for responsibility when the client attributes the loss to a thought or ordinary action; safety when another pregnancy feels dangerous; self-worth when loss becomes evidence of personal failure. Preserve medical uncertainty and the legitimacy of grief.
- Chapter 8 — Sudden death. Consider hindsight, missed opportunities, unfinished communication, or present fear of another loss. Regret and love can remain even when exaggerated responsibility shifts. An entry must not promise closure.
- Chapter 9 — Suicide or overdose loss. Look for impossible responsibility for another person's survival, stigma, unanswered questions, and competing feelings. Do not infer intent, explain the death with one cause, or promise certainty.
- Chapter 10 — Neglect. Consider unmet needs being interpreted as undeservingness, premature responsibility, or the belief that asking has no purpose. Assess actual present supports before using imagery about receiving care.
- Chapter 11 — Childhood abuse. Look for age, power, dependency, coerced secrecy, and responsibility assigned to the child. Safeguarding and dissociation assessment may take priority. Do not suggest facts or memories.
- Chapter 12 — Sexual assault. Consider consent, survival responses, shame, and ownership of present choices. Do not equate freezing, appeasing, prior intimacy, or bodily response with consent. Avoid imagery that makes the person an object to repair.
- Chapter 13 — Domestic violence. Start with current safety, coercion, privacy, and realistic options. Responsibility and worth may be central, but a safety metaphor cannot establish that danger has ended or make leaving easy.
- Chapter 14 — Betrayal and relationship trauma. Look for incomplete information, hindsight, damaged confidence in judgment, and relationship choices. Distinguish established events from suspicions. Do not steer toward forgiveness, separation, or reconciliation.
- Chapter 15 — Accidents and disasters. Consider limits of control, survival guilt, reminders of danger, and proportionate responsibility. Account for ongoing displacement, injury, and practical needs rather than treating everything as past.
- Chapter 16 — Medical and birth trauma. Look for loss of agency, frightening bodily experiences, disrupted trust, and blame. Medical needs and uncertainty remain real. Do not imply that a metaphor replaces evaluation or informed consent.
- Chapter 17 — Illness and disability. Consider worth being tied to productivity, changed capacities, dependence, and constrained choice. Avoid cure promises and images that describe disability as moral damage or personal defeat.
- Chapter 18 — Bullying and rejection. Look for internalized labels, belonging, visibility, and fear of renewed exclusion. Determine whether harassment continues. A different self-understanding does not remove another person's behavior.
- Chapter 19 — Discrimination. Consider imposed shame, cumulative threat, constrained choices, and rightful anger. Do not recast a structural problem as inaccurate thinking or assume that the treatment room represents every environment.
- Chapter 20 — Occupational trauma and moral injury. Look for responsibility in the context of role, authority, resources, and conflicting duties. Allow accurate accountability and grief. An interweave cannot issue an ethical or legal verdict.
- Chapter 21 — Witnessing trauma. Consider what the witness could perceive or do, the consequences of trying to help, and the meaning of surviving. Do not assume that witnessing was passive or that intervention was possible.
Use the theme to sharpen the question
Responsibility: What action, knowledge, role, or power is being attributed to the client? Useful cross-reading includes Chapters 7–9, 11–16, 20, and 21. Distinguish causing, contributing, failing to prevent, and wishing for a different outcome.
Safety: Is the danger remembered, current, anticipated, or a mixture? Useful cross-reading includes Chapters 11–17, 19, and 21. Assess the environment before using a then-versus-now image. Safety in one setting does not establish safety everywhere.
Choice and control: Which choices existed then, which exist now, and what do they cost? Useful cross-reading includes Chapters 10–17 and 19–20. An option may be technically possible but unsafe, unaffordable, or inconsistent with the client's values.
Self-worth: Is an event or another person's behavior being treated as a definition of the self? Useful cross-reading includes Chapters 7, 10–14, and 17–20. Worth should not be made dependent on productivity, forgiveness, composure, or a particular recovery story.
Check the adaptation chapters before speaking
Go to Chapter 22 for communication and developmental fit; Chapter 23 for culture, faith, and personal meaning; Chapter 24 when an image misses; Chapter 25 for complexity and limits; and Chapter 27 for turning a written entry into a brief clinical conversation. Chapter 29 offers a drafting worksheet. Chapter 30 provides a final check.
If two entries seem equally plausible, return to the client's meaning instead of combining them. If none fits, use direct language or no interweave. The index should shorten the search without shortening the assessment.
OCD and other complex presentations
Chapter 26 focuses on OCD, dissociation, psychosis, bipolar disorder, severe depression and risk, borderline personality disorder, substance use, and eating disorders. It distinguishes condition-specific care from optional metaphor language; use it alongside the general limits in Chapter 25. Read Chapter 26 →