Trauma-Informed Stabilization Treatment (TIST Level 1): Healing the Fragmented Selves of Trauma Survivors
Janina Fisher · Ph.D.
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CE’s are included in the cost of the course.
Course Details
Janina Fisher, Ph.D. is a licensed Clinical Psychologist and Instructor at the Trauma Center, an outpatient clinic and research center founded by Bessel van der Kolk. Known for her expertise as both a therapist and consultant, she is also a past president of the New England Society for the Treatment of Trauma and Dissociation, an EMDR International Association Credit Provider, a faculty member of the Sensorimotor Psychotherapy Institute, and a former Instructor, Harvard Medical School. Dr. Fisher has been an invited speaker at the Cape Cod Institute, Harvard Medical School Conference Series, the EMDR International Association Annual Conference, University of Wisconsin, University of Westminster in London, the Psychotraumatology Institute of Europe, and the Esalen Institute. Dr. Fisher lectures and teaches nationally and internationally on topics related to the integration of research and treatment and how to introduce these newer trauma treatment paradigms in traditional therapeutic approaches.
Childhood trauma, neglect, and failed attachment leave individuals with a legacy of overwhelming memories and emotions but also with a fragmented sense of self and a compromised nervous system that impairs the capacity to tolerate emotion or stress. Unaware that their intense feelings and reactions represent non-verbal implicit memories held by fragmented parts of the personality, these clients resort to desperate measures: addictive behavior and self-harm to numb the body or increase hyper-vigilance, suicidal ideation to restore a sense of control over painful emotions, dissociative and borderline responses of fight or flight when hurt, threatened, or rejected. Rather than offering a context for healing the effects of childhood trauma, therapy often becomes a crisis center whose goal it is simply to ensure the client’s safety.
The therapist is left with a quandary: how do we treat the underlying trauma when the client is unstable or unsafe, living from crisis to crisis, or caught in a revolving door of hospitals or treatment approaches? How do we acknowledge what has happened without opening up too much? The Trauma-Informed Stabilization Treatment (TIST) model was developed to provide some hopeful answers to these puzzling and frustrating challenges. Based on theoretical principles drawn from the neuroscience research on trauma, TIST offers a treatment approach that combines mindfulness-based cognitive therapy, Sensorimotor Psychotherapy, ego state techniques, and Internal Family Systems to address the challenges of treating clients with a wide range of diagnoses, including complex PTSD, borderline personality, bipolar disorder, addictive and eating disorders, and dissociative disorders.
Using a combination of didactic and experiential learning (demonstration, videotapes), participants will learn a new and promising model for treating trauma survivors that does justice to the traumatic past while stabilizing the ability to live a normal life here and now. When trauma symptoms are understood and treated neurobiologically as communications from young traumatized selves, even the most self-destructive, therapy-destructive, and de-stabilized clients become understandable and manageable.
Trauma-Informed Stabilization Treatment (TIST) Level 1
Pre-recorded Content/Recorded Live Sessions
Agenda
The main points of the workshop are:
- Understand the relationship between trauma and structural dissociation
- Decoding crises and problems as internal struggles between parts
- Learning various methods for increasing a client’s mindfulness of parts
- Re-framing self-destructive behavior as a parts issue
- Using the social engagement system
- Developing the capacity for internal dialogue
- Teaching internal communication skills
Surviving trauma, especially when young, requires that we disown the abused, humiliated child and try to be a child who is too ‘good’ to be abused. The effects of disowning and rejecting ourselves to survive have lifelong consequences, resulting in personality or dissociative disorders, unsafe behavior, and tumultuous relationships, including the therapeutic one. In this module, we will look at a trauma model that addresses this important issue and how to help clients understand themselves with compassion rather than shame and self-judgment. Recorded Zoom Session 1 – Trauma and Self-Alienation – 2 Hours – 2 CEs Session Content:
• Structural Dissociation – the more trauma, the more splitting to avert future threats (15 mins)
• TIST = using the medial prefrontal cortex to ‘heal’ the parts (15 mins)
• Learning parts language as a second language (15 mins)
• “Speaking the language” of parts (15 mins)
• The challenge of vulnerable parts (15 mins)
• The challenge of protector parts (15 mins)
• Q & A (30 mins)
Module 2: Foundational Skills for Trauma-Informed Stabilization – 2 Hours – 2 CEs
Overcoming internal fragmentation and self-alienation require the ability to focus mindfully rather than ‘going with’ the flood of emotions and impulses survivors experience daily. Step-by-step instructions will help the therapist guide clients from impulsive actions and reactions to mindful awareness and increasing their ability to be “with” themselves. Learning to relate to their intense distress as a communication from young traumatized parts changes their relationship to the strong emotions and tendencies to act out.
Recorded Zoom Session 2 – Foundational Skills for Trauma-Informed Stabilization – 2 Hours – 2 CEs
Session Content:• Signs and Symptoms of Internal Struggles (15 mins)
• Heighten mindful awareness by using the “Language of Parts” (15 mins)
• What to say: the language of the parts (15 mins)
• How the Parts Dominate: “Blending” (15 mins)
• Mindful “Unblending”: Unblending is a two-step process (10 mins)
• A Protocol for Unblending (10 mins)
• The Importance of Unblending (10 mins)
• Q & A (30 mins)
Module 3: Suicidality, Self-Harm, Addictions, and Eating Disorders – 1.5 Hours – 1.5 CEs
Research demonstrates the strong relationship between a history of trauma and the development of unsafe behavior, addictions, and eating disorders. This module focuses on how to help clients learn to relate to unsafe impulses as trauma responses driven by protector parts. Trauma-related cues in daily life stimulate fear and shame, driving fight and flight parts to desperate measures that bring short-term relief but recreate the unsafe environment of childhood. Understanding their intentions as protective often calms the system and allows clients to build the resources and skills they need to manage emotional overwhelm.
Recorded Zoom Session 3 – Suicidality, Self-Harm, Addictions, and Eating Disorders – 2 Hours – 2 CEs
Session Content:• Re-framing self-destructive behavior as a parts issue (15 mins)
• When clients get “highjacked” by an unsafe part (15 mins)
• Communicating with Protectors (15 mins)
• Allying with Protectors (15 mins)
• Key Negotiating Strategies (15 mins)
• Strengthening the Normal Life Part (15 mins)
• Q & A (30 mins) Module 4: The Challenge of Traumatic Attachment 1.5 Hours – 1.5 CEs
Physical, emotional, and/or sexual trauma in childhood has a profound effect on attachment development, causing what researchers call ‘disorganized attachment.’ The child (and later adult) respond to the threatening environment with a heightened yearning for closeness and fear of abandonment alternating with fears of closeness and heightened mistrust. Separation anxiety alternates with pushing others away or fleeing from them. The intensity of these opposing drives is confusing and frightening for the client and often strains the therapeutic relationship. In this module, we will address how to deal with traumatic attachment as it complicates the treatment.
Recorded Zoom Session 4 – The Challenge of Traumatic Attachment – 2 Hours – 2 CEs
Session Content:• If the reactive impulsive nonverbal right brain is dominant (15 mins)
• If the client has a working PFC. (15 mins)
• If there is no working PFC (15 mins)
• How do we co-regulate fragmented, traumatized clients? (15 mins)
• Elements of co-regulation (15 mins)
• “Dyadic dancing” with clients (15 mins)
• Q & A (30 mins) Module 5: Developing Internal Communication and Collaboration – 1.5 Hours – 1.5 CEs
The next challenge in the treatment is the development of internal collaboration between parts driven by conflicting survival responses. Self-destructive behavior is usually addressed behaviorally, but high relapse rates confirm the need to also treat the trauma and traumatized parts. Learning how to help clients change their relationship to unsafe thoughts and impulsive actions is a first step. Next, treatment requires an ability for internal dialogue and negotiation that results in increasing empathy for the parts and a willingness to deal with them creatively and compassionately. Safety becomes common ground where all parts can be welcomed.
Recorded Zoom Session 5 – Developing Internal Communication and Collaboration – 2 Hours – 2 CEs
Session Content:• Internal communication (30 mins)
• Prioritizing relationships between the client and wounded parts (15 mins)
• “Direct access” work with parts (15 mins)
• Rupture and repair of internal attachment (10 mins)
• Attachment repair versus memory processing (10 mins)
• Resolving inner conflicts (10 mins)
• Q & A (30 mins) Module 6: Healing the Fragmented Selves of Our Clients – 1.5 hours – 1.5 CEs
In this last module, we will focus on helping clients ‘repair’ rather than remember the past in order to resolve the legacy of trauma borne by each part. As bonds of kindness and compassion are built internally, the parts’ intense reactivity diminishes, allowing clients to welcome home disowned parts and offer them a safe, loving internal environment. Rather than emphasizing ‘integration,’ this model focuses on internal collaboration and closeness and on the establishment of internal acceptance, forgiveness, and safety. The client’s ability to attach to each rejected, disowned part with warmth and loving-kindness becomes the healing antidote to the trauma.
Live Zoom Session 6 – Healing the Fragmented Selves of Our Clients – 2 Hours – 2 CEs
Session Content:• Our ability to help is contingent (15 mins)
• Diagnosing the causes of difficulty with clients who are stuck (30 mins)
• If the client’s non-verbal right brain and parts are dominant. . . (15 mins)
• Challenges of working with a system, not an individual (15 mins)
• De-coding treatment blocks (15 mins)
• Q & A (30 mins)
TIST Level 1 – Healing the Fragmented Selves of Trauma Survivors
Learning Objectives
Identify (three) psychoeducational techniques for supporting clients to recognize and cultivate understanding of their own neurobiological responses to potentially traumatic events, including natural tendencies to attach for survival, to flee, to fight, to freeze and to submit.
Describe a range of thinking, feeling and relating patterns in the lives of clients as a “living legacy” of trauma survival, thereby reducing shame, increasing self-compassion and communicating respect for the dignity and worth of each client, regardless of their circumstances.
Explain how to teach clients about fragmentation of neurological networks, each experienced as “I”, as a natural response to overwhelming experiences.
Explain how to list at least three techniques for empowering clients to regulate their autonomic arousal in order to cultivate a nervous system state that is calm enough to support curiosity about their distressing experiences.
Explain how to demonstrate how the use of parts language may help trauma survivors to view distressing experiences in the present as communications from parts that have naturally evolved to sequester or to protect the client from becoming flooded by memories of those overwhelming experiences.
Explain how regulation of a client’s nervous system state can support initiation of an internal dialogue with parts for purposes of making safe, stable functioning possible.
List traditionally underserved client populations, diagnoses or behavior patterns for which TIST may be an effective mode of treatment, (Inpatient, Borderline Personality Disorder, OCD, Anxiety, Depression, Suicidality, Substance Abuse, PTSD) as well as situations in which TIST might be contraindicated (lacking adequate support or self-regulation skills for keeping oneself safe between treatment sessions).
Identify two manifestations of fragmented parts of the self.Describe 3 somatic interventions for regulating autonomic arousal and affect dysregulation.
Explain the use of interpersonal neurobiology in the treatment.
Explain the use of social engagement techniques in the treatment.
Describe two or more ways of invoking client empathy for wounded child parts.
Describe three or more somatic techniques for resolving traumatic memory.
Describe three or more visualization techniques for resolving traumatic memory.
Describe three or more ego state techniques for resolving traumatic memory.
Identify two or more interventions for increasing internal secure attachment.
Identify two or more interventions for increasing internal self-compassion.
Describe the meaning of ‘integration’ in the treatment of splitting and fragmentation.
Describe three or more techniques for shifting from internal conflict to internal harmony in clinical session.
Identify three or more signs of disorganized attachment and traumatic transference.
Explain how to reframe self-destructive behavior in treatment.
Describe three or more techniques for utilizing ‘parts language’ within treatment.
Intermediate mental health care practitioners.
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