The Counting Method: Applying the Rule of Parsimony to the Treatment of Posttraumatic Stress Disorder

The authors contend that the primary therapeutic element in psychological treatments for posttraumatic stress disorder is imaginal exposure, and that differences among major approaches are determined more by secondary techniques designed to circumvent the client’s avoidant defenses against exposure. A study is described comparing Prolonged Exposure, Eye Movement Desensitization and Reprocessing, and the Counting Method with 51 multiplytraumatized women. Measures of PTSD were significantly reduced by all three methods, but differences among the methods were negligible. Because the Counting Method utilizes only imaginal exposure as a therapeutic element, support is given to the more parsimonious conclusion that imaginal exposure may be both the necessary and sufficient factor in therapeutic effect, countering a trend in the field toward more complex, multi-faceted treatment packages.