Trauma Healing Form


Trauma Healing Form

Below is the Trauma Healing form. Use when facilitating an emotional healing session. Print out and make copies. Leave the open spaces to have room to write out the answers. Print on one side of the paper only so that the back sides can be used for additional writing if needed. Feel free to share all of this with others.

[Note: When working with military personnel, it may be necessary to integrate the caring self [pre military programming self] with the combat self. This may be necessary before feelings are accessable for healing. If the traumatized person has a difficult time accessing emotions, please refer to handouts in workbook addressing this.]


TRIGGERED PERSON:____________________________________________


Questions to ask in a Trauma Healing

1. What are your suds? What is your distress level?

Subjective Units of Distress Scale = SUDS

On a scale of 0 to 10, where 0 is no distress and 10 is maximum emotional


Write down suds here_______:

1. If you were to really get into this upset, how high would your suds


Write this number down here:_______

1. What are you feeling now? Write down list of feeling words here [20

approximately. Give TP [triggered person] plenty of time to be silent and

go within to check in with feelings. If they say one or two feelings words,

such as: angry, betrayed, and then look at you, read back the words and

then say, "Go within and see what other feelings you have." Don’t

interrupt their silences. These silent times are when the most

important inner work is being done. Keep them doing this until you have at

least 20 feeling words.

1. Read back feeling word list. Ask, "When have you felt this

combination of feelings before?"

Make list of memories that trauma clearing person remembers. [Need approximately

5 memories of times he or she has felt this way before]. Write them here:

1. Start with the first memory, and repeat with each one in the list.


"If you had a magic wand and could magically heal all the feelings

associated with this memory, what would it do to your overall suds? Write

this number down next to each memory.

The one with the greatest lowering effect of overall suds is the memory you want to clear.

1. Ask the TP [triggered person] to give this memory a name or title.

Write it down.

Now ask, "How long will it take you to tell me this memory from start to

finish?" Write down the number of minutes. _______

1. The next step is to then ask, "When you went through this

emotional experience, what negative ideas and beliefs about life , about

the nature of reality, came from this? What negative ideas did you start believing?"

Write down list of negative ideas here:

(Typical examples: The people I trust the most betray me the most. I cannot

trust anyone. I am not loved. I am not safe.)

8. Read back the list of negative ideas. Now ask, "What positive ideas about

reality did you get from going through this trauma?"

[Note: Usually TP will say that there are not any positive ideas. Ask them to go

within and find at least three. (Typical examples: "Well, I survived." "I was

strong and got through it." "Somehow I learned to depend on myself." "A higher

power protected me.")

9. Stillphoto: Now ask the TP to pretend that he or she has a scrapbook of their

life. Ask them to describe the photograph of this trauma. Describe where, what

time of day, lighting, furniture or room or place, who was there, ect . Be sure

that they describe the scene, but do not let them start telling the trauma yet.

Write down the description of scene here:

10. Now tell TP to tell you out loud the entire memory from beginning to

end. (DO NOT INTERRUPT ANDDO NOT OFFER ADVICE. The healing process is within

the TP, and their attention must stay within. Any interruptions, no matter how

well intentioned, will break their process and concentration.) As they tell you,

write it down here:

Note: if at any time in the tell-retell sequence they make a comment expressing

something that they wish could have happened, guide them to go ahead and do this

in their imagination. For example: TP says, "I wish I could have [I should

have] told my father [buddy, friend, wife] _____________________[that I loved

them, that they should stop, that I am not going to take this any more]. Tell

them to take plenty of time to do this and to pay close attention to what the

reaction is from the other person. Remember that brainwave patterns in reliving

feelings are similar to having a dream, and that interaction with the memory,

just as interaction in a dream, causes deep changes in the psyche. In this case

it is a spontaneous healing image bursting from the deepest levels of the inner


This applies also to a spontaneous need to pray, or ask from help from a higher

source. Have them go ahead and do this in their imagination. [See book:

Remembering Our Home by Sheila F. Linn, William Emerson, Dennis Linn and Mathew

Linn. Available through for documentation and explanation of this


These processes, of course, create healing images in the mind. These healing

images are very important. A memory is composed of 3 things. This is known as

PET = a still photo of the memory or visual image, emotions, and thoughts. All

three must change for the trauma to be permanently healed.

The final image is called the resolution image. This is the image that the TP

will remember of this memory in the future.

11. Now ask the TP to remember the entire memory again silently. Wait patiently

while they do so. Remember that any upset, crying, anger. is good. Have Kleenex

on hand to give them for tears. Have a pillow on hand to muffle their screams of

anger and rage, if necessary. When they are finished, ask them what their

suds are now. Write this number down here:_______

12. Now ask the TP to go through the entire memory out loud again from beginning

to end. It is not necessary for them to repeat anything that they have already

said, they can if they want to, or they can just say out loud new stuff that

they are now remembering as they go through the memory. Either way is OK.

Ask TP what their SUDs are. Write it down here._____

The SUDS, subjective units of distress scale, may go up or down, either way is OK.

Sometimes in reliving a painful memory, the SUDS can spike up as long suppressed information is accessed.

Write it down here as they talk:

13. Now ask the TP to remember the entire memory again silently. Ask what their

suds are now. Write this number down here:_______

14. Now ask the TP to go through the entire memory out loud again from beginning

to end. Write it down here as they talk:

15. Now ask the TP to remember the entire memory again silently. Ask what their

suds are now. Write this number down here:__________

16. Now ask the TP to go through the entire memory out loud again from beginning

to end. Write this down here:

Ask TP what their SUDS are now. It should be going down fairly consistantly at this point.

Write it down here._____

[During tell-retell, the TP gets new insights into why the trauma happened in

the first place. There will be insights into what was going on with the other

people in the trauma. Compassion and understanding for self and others will

begin to appear. Images of healing will spontaneously arise often at these

times. For example, the patient could say, "My father was worried about

supporting us, and he was acting out his rage and frustration about this and

really didn't mean to act so bad toward us. He really loved us deep down. I see

him turning to me and wanting forgiveness and understanding. I see it in his

eyes." At this point suggest that the TP tell the father whatever he feels in

response to this.

These insights are called ‘healing images’. Be sure to write these healing

images down.

17. Ask them to remember it silently again. Then ask, "What is your suds?"

Write this number down here:__________

Keep doing this process: silently and out loud, until suds get down to 0. Be

careful to write down insights and healing images.

If at any point the TP gets stuck at 1 or 2, ask them what is keeping their

suds at 1 or 2?

Ask them to scan their body for any tension. Ask them to go within the body

wherever they find tension and ask what the tension wants to say to them. Ask

them to put their hands over this area and say to it, "Soften and flow, soften

and flow, soften and flow. If the energy moves to another part of the body,

repeat this process.

This should take care of it and bring the suds down to 0. If it doesn’t ask them

to find whatever other tension there is in the body and to pretend that this

area has a mouth and can talk. Ask TP to respond to the tension and dialogue

back and forth until tension is resolved. [Example: "I am tense in my gut." Ask

them to ask the gut what message it has for them. Example: "My gut says that I

must learn to depend on myself".]

18. Ask the TP to take the final healing image and push it into the original

still photo [Number 9 above.] In other words, the TP will take the two images,

the original still photo and the final healing image and merge them together.

Give TP plenty of time to do this. Don’t interrupt. Wait until TP looks up to

you for a prompting. Then ask the TP to describe what happened to the two images

when he or she merged them together. Write it down here:

This final image is called THE RESOLUTION IMAGE. This is the image that the TP

will remember of this memory in the future.

19. Now ask the TP, "What words go with this memory now?" Write down the words


20. Ask = "What positive ideas go with this memory now?"

Write down here:

21. Ask = "How does clearing this change the way you feel about yourself now?"

22. Ask ="How does clearing this change the way you will behave in your life


23. HEALING BUBBLE: Right after the clearing, the person who just completed the

process goes into "The Healing Bubble." The TP is in a zone of silence.

They are still in a mild trance state, moving between past time and present time.

They are doing very important and deep inner integration of the 'new' self. Every

effort should be made to avoid confronting them, not bringing up loaded issues,

or introducing stressful choices at this time. The TP needs space, silence and

alone time for 2 hours to 6 hours or for days or for as long as 2 weeks. The TP

will let you know when they are ready for ordinary conversation.

Instruct the TP to be very careful and private for a few days while the psyche

integrates the change. Explain that the change in the subconscious and body is

like scar tissue, it is very delicate and tender now and will take a while to

firm up. Instruct them to NOT get involved in other people’s problems or issues,

and to protect themselves emotionally. It is very easy to get retriggered during

this time, they are very vulnerable. They must promise to protect themselves for

as long as it takes to integrate.



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