Last week I had the pleasure to attend Janina Fisher PhD's workshop on her Trauma Informed Stabilisation Treatment or TIST organised by Psychotherapy Excellence. This is a model that incorporates what we now know from the trauma field to working with people that experience suicidality, self-harm, addictions, eating disorders and other self-destructive behaviours.
This way of working borrows from other approaches to therapy like mindfulness, Internal Family Systems, Sensorimotor Psychotherapy and the Structural Dissociation Model. A bit of a mouthful, I know! The essence of this model, however, is that repeated trauma in childhood creates parts.
In this instance trauma would refer to the stuff that happened, or didn't happen in the past including abuse or neglect, any witnessing of violence like fighting in the family, bullying, early loss or a caregiver being themselves mentally unwell or having an addiction themselves and more. The parts created by experiences of chronic traumatisation could also be seen, as was explained by the lovely Janina, as fragments of body memory, an echo of what things felt like back then.
Taking the shame out of it, this model reframes addictive behaviours, eating disorders, suicidality and self-harm as parts. We would talk rather about the addict part or the suicidal part of the person and get curious together about how this part helped them to survive in the past and about what this part is trying to accomplish.
But will we reinforce the behaviour if we befriend these parts and got curious about them, re-framing their intentions as positive, as an attempt to cope with extremely difficult feelings? Quite the opposite. By going alongside all parts of the person, offering some understanding and giving some alternatives, if they interested in learning about them, we might well stimulate the person innate sense of agency and desire to get better, rather than playing cat and mouse.
I loved the focus on mindfulness in this model, noticing without judgement, to help re-activate the pre-frontal cortex that goes offline for people who have experienced trauma. I also loved the gentle but persistent focus on welcoming and allowing all parts whilst helping the person to dis-identify from them. A subtle balance between being in relationship with all parts but also knowing that we are more than our emotional parts, strengthening the wise adult self and building on their resources.
This is what Internal Family Systems therapists call Self-energy, a centred and competent state where the person has access to more transpersonal qualities like curiosity, compassion, calmness, clarity, confidence, courage and creativity. According to this way of working the more we can help the person be in touch and attend to the needs of emotional parts linked to their past, the more we can free them up to experience more and more of these bigger qualities, more richness, more aliveness, more love and more connection. What's not to like?
The trade-off perhaps is that the process of therapy, in this model like in any other approach to therapy, takes time. Addicted or eating disordered parts, suicidal parts that cope by having an 'exit plan' or by self-harming would have to agree to learning something that, admittedly would not provide the same quick fix or work as effectively as some of these behaviours. The new coping strategies however might offer the benefit of getting similar results without getting them in trouble and without harming the body, providing a more long term solution, if they are willing to work on it.
Having observed the amount of shame that people in addiction and eating disorder treatment carry around these behaviours, what a breath of fresh air, what a kind and almost revolutionary thing to do, to validate the survival value of these sometimes desperate gestures. to help the person understand that they are not crazy but that they just have trauma parts having a bit of an argument inside and that they can get better, with a little bit of patience, curiosity, a bit of inner communication to negotiate new ways of being.
Janina has a book out called 'Healing the Fragmented Selves of Trauma Survivors' where she talks about this model in more detail, together with being involved in the Sensorimotor Psychotherapy training in London and being about to launch a new webinar with PESI on working with the neurobiological legacy of trauma in the next three months.
To learn more about this
Anderson, M. et. al (2017) Internal family systems skills training manual. USA: PESI.
Fisher, J. (2017) Healing the fragmented selves of trauma survivors. USA: Routledge.
Ogden, P. & Fisher, J. (2015). Sensorimotor Psychotherapy: interventions for trauma and attachment. USA: W.W. Norton & Company.
Siegel, D. (2011). Mindsight. USA: Oneworld publications.
Van der Kolk. B. (2015). The body keeps the score. USA: Penguin.