Techniques

Grounding activities

Grounding activities assist women to focus on their present experience and detach from their emotional pain. These activities are intended to help women regain control over their emotions, as well as to connect them to the present and to reality.

Women can learn to do grounding exercises on their own. These exercises can be done at anytime and in any place, including in any circumstance in which women experience a trigger, a flashback, a substance craving, emotional distress, or dissociation.

The following strategies are important when completing any grounding exercise:

• Suggest that she rate her mood before and after all grounding exercises in order to monitor how well the exercise worked for her (e.g. invite her to give a number from 1 to 10 to indicate her current mood, with 10 representing extreme pain).
• Leave the lights on, ask her to keep her eyes open and to scan the room throughout the exercise.
• Avoid talk of negative feelings or journal writing.
• Avoid making judgments.
• Focus on the present.

Forms of grounding may be organized into mental, physical and soothing exercises.

Mental grounding refers to focusing one’s mind and exercises can be used when working with a woman in person or on the telephone. Examples of such exercises include:

• Ask the woman to describe her current physical surroundings, including how it looks, sounds, feels and smells.
• Ask the woman to count backwards from 10.
• Invite a woman to recite a statement that represents safety (e.g. "My name is _________; I am safe right now; I am in the present and not the past").
• Ask the woman to read something positive (e.g. affirmations).

Physical grounding focuses on the woman's senses (e.g. touch, sound and smell). Examples of such exercises include:

• Invite the woman to remove her shoes and tap her feet together, or dig her heels into the ground, while asking her to focus on the feeling of becoming grounded.
• Provide the woman a glass of water to drink.
• Have objects in the counseling space for women to hold (e.g. rocks, soft stress balls, beads, pieces of cloth and so on) and invite her to hold any objects that help her to feel grounded;
• Ask the woman to focus on her breathing. Invite her to breathe together and count aloud, while encouraging her to breathe deeply.

Soothing grounding exercises involve talking to one’s self in a kind and gentle manner. For example:

• Ask the woman to repeat positive statements.
• Ask her to think of her favourite color, animal, food, book, song, TV show, etc.
• Ask her to repeat a statement that represents coping (e.g. “I can deal with this; I know that this feeling will pass”) (Najivits, 2002 as cited in Alberta Council of Women's Shelters, 2009).

Containment exercises

Containment exercises are intended to "contain" painful emotions, allowing the woman to manage overwhelming feelings. These exercises provide a way for women to take action and assist them to be in control over their own healing process. Containment is not about denying or repressing emotions, but consciously choosing to put intrusive, painful or disruptive emotions aside for a temporary period of time. For example:

• Invite the woman to imagine a container or holding vessel of some sort.
• Ask her to visualize putting into the container any painful thoughts and/or emotions that she chooses to deal with at a later time.
• Have a container in the counseling office and invite women to write down thoughts and emotions that they choose to deal with at a later time and place them in the container.
• Let her know she is in control of these emotions and thoughts, and that she can choose when to take them out of the container and have a look at them.
•  Writing in a journal can also be used as a temporary container for emotions.

Self-soothing strategies

Counsellors can help women to learn about self-soothing, which can provide alternatives to any unhealthy self-soothing activities women may be using such as consuming alcohol and drugs. Encouraging women to identify and use new self-soothing techniques can be promoted by equipping the counseling space with activities that may bring comfort, such as: 

• Play relaxing music prior to a counseling session.
• Make drawing materials available and invite the woman to use them when beneficial.
• Keep a basket of cards with statements of affirmation written on them (e.g. I am a strong person, I am a good person, I am a good mother, daughter, etc.).
• Ensure that pictures or posters on the walls provide comforting images.
• Have a variety of stuffed animals in the room.
• Keep a basket of self-care items in the room (i.e. blanket, pillow, shawl) and invite the woman to choose an item at the end of a session; and
• Keep fresh drinking water in the room at all times.

Journaling

Counsellors should give women a notebook or pen and paper to enable them to confidentially and safely express their thoughts and feelings through writing or drawing.  Journaling provides women with a way to consider and clarify evolving and emerging thoughts and emotions (Vermilyea, 2002).

Women can be invited to keep a journal with suggestions for using it, such as:

• Find a quiet place to write in the journal
• Get started by writing any words that come to mind
• Focus on feelings, considering what is felt in the moment, where it is felt it in the body, etc.
• Draw pictures (including visual expressions of feelings).
• Write a letter to someone that has supported her; a higher power or spiritual figure.
• Write about a dream vacation; her accomplishments; strengths.
• Drawing/writing about a safe place, and/or her safe place.
• Writing a letter to herself affirming who she is.
• Making a list of things that bring her joy or the things that she accomplished each day.

(Alberta Council of Women's Shelters, 2009. Sheltering Practices)

Audio-visual and other methods using creative expression

In addition to individual and group counselling support, many shelters across regions have integrated audio, visual and other forms of expression (e.g. theatre, performance, yoga, etc.) as part of their psychosocial support to survivors. Both the creative process and products resulting from it have been noted by survivors and advocates as beneficial in the process of overcoming abuse.

Tools:

International Society for Traumatic Stress Studies

Webinar: Developing Trauma-Informed Practices and Environments: First Steps for Programs (Terri Pease for the National Center on Domestic Violence, Trauma & Mental Health, 2012)

National Center on Domestic Violence, Trauma and Mental Health

Photovoice methodological resources and training materials