Back of the head scale (BHS)



It appears that sets of bilateral stimulation (BLS; alternating eye movements, tones or hand taps) have the potential to invite unfinished traumatic experience into awareness. This can be a problem for many clients who are dissociative, or who are on the verge of being overwhelmed by a traumatic memory. If disturbing memory material is extremely intense or has been deeply dissociated, the emergence of that material during therapy can potentially overwhelm the client's sense of being safe in the present. The memory can feel more real than the real situation the patient is in, and the experience can be one of nontherapeutic retraumatization. Given these considerations, it is important, for both the therapist and the client to know when the client is drifting into derealization, that is, the client is losing a felt sense of the reality and safety of the present situation. For clients who are potentially dissociative, the degree of orientation to the present situation can be assessed through the use of the BHS. This procedure allows both therapist and client to be able to closely monitor and maintain the dual attention aspect of successful trauma processing; the simultaneous co-consciousness of the safe present and the traumatic past. This procedure is introduced to the client during the Preparation Phase, before any desensitization of trauma is begun.


Book Section




Jim Knipe

Original Work Citation



“Back of the head scale (BHS),” Francine Shapiro Library, accessed September 21, 2021,

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