Untangled Heart Support

Verbatim Counselor Script:
"When you say 'I don't care about anything anymore,' let's get curious. Is that ALL of you, or is that a protective armor part stepping up because the tender sadness feels too dangerous to touch? Let's thank that armor for trying to shield you, and ask if it's willing to step back just an inch."

Narrative Re-Authoring & Externalization

Workbook Page 4

Clinical Goal: Shift teen locus of control from helpless victimhood to agentic author of their emergent identity.

Verbatim Counselor Script:
"In ambiguous loss, teens often take on the burden of broken family systems or lost friendships as personal failures. But look at this creature we just drew: the Grief Fog is an outside event visiting you. It does not own your character, your creativity, or what you choose to write in your next chapter."

Untangled Heart • Facilitator Guide Page 2 • Clinical Scripts & Verbatim Coaching

Clinical Safety & Monitoring Risk Assessment, Caregiver Liaison & Progress Metrics

Tier 3 Scaffolding

Red Flags & Crisis Escalation Workflow

1. Severe Dissociation

Unable to name 5 sensory items, glassy stare. Action: Immediate ice grounder, low vocal tone, avoid trauma processing.

2. Active Suicidal Ideation

Expressions of desire to escape ambiguous pain. Action: Administer C-SSRS, initiate school crisis safety protocol immediately.

3. Caregiver Enmeshment

Extreme parental guilt or parentification. Action: Coordinate multi-disciplinary team & family therapy referral.

Caregiver Psychoeducation Talking Points

When consulting with guardians, caregivers, or foster parents regarding ambiguous grief:

• Normalize fluctuating moods: Explain that ambiguous grief lacks closure rituals, causing sudden regressions.
• Avoid "toxic closure": Remind caregivers never to say "Just get over it" or "At least they're still alive."
• Reinforce pocket coping deck: Encourage caregivers to prompt teen to check their custom coping cards during home dysregulation.

MTSS Outcome Tracking & Goal Benchmarks

Somatic Regulation SUDs reduction of ≥2 pts within 10 min using TIPP.

Cognitive Flexibility Identifies 2 dialectical "Both/And" truths independently.

Values-Action Step Executes 1 weekly committed action despite grief waves.

Untangled Heart • Facilitator Guide Page 3 • Tier 3 Risk Protocol & Progress Metrics

+ ____ %

Clinical Domain Competency Benchmarks

1. Somatic Co-Regulation

Demonstrates independent use of TIPP / Butterfly Tap during physiological activation.

[ ] Emerging   [ ] Mastered

2. IFS Unblending

Can identify protective managers/firefighters without fusing with destructive scripts.

[ ] Emerging   [ ] Mastered

3. Narrative Agency

Externalizes grief fog and articulates values-driven personal next chapter.

[ ] Emerging   [ ] Mastered

4. Safety & Crisis Action

Has active de-escalation plan and pocket coping deck accessible on campus.

[ ] Emerging   [ ] Mastered

Clinician Summary & Next Steps

Step-down to Tier 1 Maintenance Continue Tier 2 Group Step-up to Tier 3 1-on-1 / Referral

Clinician clinical notes & transition plan:

Untangled Heart • Tier 2/3 Evaluation Page 2 • Clinician Scoring & Outcome Rubric