Section 23about 4 min · no rush
23

Alternative tools & techniques

Words are not the only door. For children, for low-literacy clients, and for bodies stuck in alarm, the curriculum's toolbox, play, paper, breath, story, often works before talk does.

The toolbox, tool by tool

CTEVT PSC curriculum
ToolHow it worksPrecautions
Play, games, drawingA child's natural language; themes surface in the sand, the doll, the pictureObserve, don't interrogate the drawing; keep materials local and familiar
Checklists: GAD-7 (Nepali version in the CTEVT course pack), Hopkins Symptom Checklist (HSCL-25), PTSD checklist, sentence-completion, SUDS (0–10 distress scale)Screen and track change over sessions; SUDS can track distress during exposure when that helpsNepali-validated versions exist for HSCL/PTSD scales: use them; a screen is not a diagnosis
Relaxation: deep breathing, box breathing, progressive muscle relaxation (PMR), safe place imagery, counting, 5-4-3-2-1 groundingTurns the fight-or-flight body map of Fear: the foundation down by hand: long slow exhale = parasympathetic brakeTrauma clients can find closed eyes or body focus triggering; offer eyes-open grounding first. A five-step sequence for a strong feeling (notice, find, name, exhale, ask) is on Techniques step by step
Diary / journal writingExternalises the worry loop; evidence for CBT thought-workPrivacy at home is real risk: a shared room means a found diary
Narrative exposure / retellingThe whole life story built in order, and the traumatic events within it narrated slowly and in detail until they can be told with less distressOnly with training, consent, stable clients, and time to finish what you open
Tree of life / river of lifeDraw a life as tree (roots=origins, trunk=skills, branches=hopes) or river (bends=events); strengths-based story of selfBeautiful for groups and children; let meaning come from the client
Me-map (social support map) · family map (genogram)Client at centre; circles for people, distance = closeness. The genogram draws the family tree with its bonds and conflictsThe curriculum's own tools for assessing social support (task 15) and the family environment (task 9)
Practice drill

Teach a partner box breathing (4-4-4-4) and 5-4-3-2-1 grounding, take their SUDS before and after, and record it the way you would in a session note.

A worked example: A counselor named Bimal meets a 10-year-old earthquake survivor who is too distressed to talk. Bimal chooses drawing over questioning because the child's natural language is play. He also selects the SUDS scale because the child can point to a number instead of naming feelings. The child's SUDS drops from 8 to 4 after ten minutes of drawing.

Key points
  1. Play, drawing, breath, story and checklists reach people that words alone cannot: children, low-literacy clients, bodies stuck in alarm.
  2. Grounding (5-4-3-2-1, slow breathing, muscle relaxation) calms the body first so the mind can work.
  3. Screening tools (GAD-7, PHQ-9, HSCL-25) track change; they suggest, they never diagnose.
Quick check

Three friendly questions to settle what you just read. This is reassurance, not a test: a wrong tap is part of learning, and you can try again.

SUDS is:

The long slow exhale works because it:

Narrative exposure should only be used with:

Learn more

Pick one, not all.

Video · 19 minSleep is your superpower: pairs with relaxation work: why the calmed body must also sleep.
PaperSchauer, Neuner & Elbert: Narrative Exposure Therapy manual: the method behind curriculum "retelling", developed for low-resource settings.
PracticeDenborough, Tree of Life (Dulwich Centre): the group protocol, free summaries online.

This page will still be here tomorrow, and it reads differently once you have met its ideas in real life.