As Janina Fisher shares in her course Helping Trauma Survivors Get Unstuck: A Fragmented Selves Approach in Therapy was born in a time of crisis. At the request of two state hospitals, where they were seeing trauma survivors in chronic states of suicidality, self-harm, eating disorder behavior, and addictive behavior, and things in both hospitals had reached a breaking point, Janina offered a new approach that brought together different modalities and techniques for working with trauma to support these challenging patients in a new way.
Join Trauma Informed Stabilization Treatment Webinar by Dr. Janina Fisher
Helping Trauma Survivors Get Unstuck: A Fragmented Selves Approach in Therapy
In This NEW Janina Fisher Webinar you will learn:
How to understand perplexing clients using the TIST perspective so you can see the fragmented selves at work.
How to organize a treatment plan using the TIST model so you have an effective approach to care.
How TIST helps shift even the most stuck clients so they can finally make progress.
How to relieve your frustration and prevent burnout with more effective trauma treatment.
on April 4, 9-10am PDT / noon-1pm EDT / 5-6pm BST
Treating Complex Trauma or Bad Patients?
Janina shares…
What this group of patients had in common is that they all had been traumatized, all were subject to very impulsive self-harming suicidal behavior, and had a history of assaulting the staff who were trying to help them. They were seen by the hospital as bad patients.
Called attention-seeking, called manipulative, called oppositional, called passive-aggressive. None of which seemed to improve the situation. It had reached a breaking point because the doctors at the local medical hospital had started to threaten to refuse treatment to the patients because they were so furious that they had to take time away from saving the lives of people who wanted to live to save the lives of people who were trying to die.
The theoretical premise upon which these clients were being treated was the same model of treatment that has been prevalent since the late 80’s – based on Otto Kernberg’s approach to treatment of borderline personality disorder premised on the idea that unsafe behavior is manipulative and attention seeking and should therefore not be indulged. That if you don’t respond to the attention seeking manipulative behavior, it will subside.
However, this approach to unsafe behavior had not worked nor has it worked in most places in the world. We know this as dialectical behavior therapy (DBT), a very very popular approach to treating unsafe behavior. And actually, I admire DBT, I’m a DBT fan. But DBT also had been tried and failed. It was not a treatment model that clients could connect to.
Janina Fisher´s New Approach To Clinical Trauma Therapy
So I arrive at these hospitals with a whole different premise (which informed Helping Trauma Survivors Get Unstuck: A Fragmented Selves Approach in Therapy ). My premise is that self-destructive behavior is inherently a survival strategy gone wrong. And that that behavior is not intentional and conscious, it is an instinctive response with internal sense of danger and that when stimuli of all kinds, usually interpersonal, trigger this sense of threat, automatically fight-flight instinctive responses are evoked and those result in unsafe self-destructive action.
Trauma Survivors and Their Brain Scans
Now, one of the most durable findings of the literature on post-traumatic stress has been the brain scan studies that have shown over and over and over again that when trauma responses are stimulated, what happens in the brain is that the prefrontal cortex, the language areas here in the left brain, the centers that hold our ability for good judgment, the ability to learn from experience, to put feelings into words, that shuts down. The whole prefrontal cortex, this center area, the medial prefrontal cortex shuts down thereby making self awareness difficult, if not impossible. Because DBT requires remembering and utilizing skills, it wasn’t working for this group because the part of the brain that holds memory of those skills wasn’t available in the crisis. Good judgment, the safety plan that the client might have signed or signed on for, is also dependent on the prefrontal cortex.
Another premise that I felt was missing but should be in a trauma-focused approach to these clients is that we were not understanding them as structurally dissociated and internally conflicted. We weren’t understanding these violent actions toward their own bodies, as well as those of others, as inherently an attempt to survive.
TIST Trauma Treatment Begins to Take Form
For this trauma therapy approach which I developed to meet the need, I brought a number of different models, very typical of the trauma treatment world. Back in the 90s, there was no trauma treatment. For the most part, we continued to use psychodynamic therapy for the treatment of trauma. It didn’t work terribly well because clients got overwhelmed by their own memories and their own emotions. So the trauma counseling world back in those early days cobbled together interventions, skills, approaches from many different models to be able to address the needs of trauma type clients.
The theoretical model I brought was a heavily neurobiological model as the result of the work of Bessel van der Kolk, Stephen Porges, Joseph LeDoux, and others. I brought in the structural dissociation model of Onno van der Hart, Ellert Nijenhuis, and Kathy Steele, a very very well-known approach in Europe. I brought in ideas from the attachment research on disorganized attachment status.
I also brought in some of the body centered ideas and techniques developed by Pat Ogden, recommended by Bessel van der Kolk. And so many clinical models have contributed and been integrated to create the Trauma-informed Stabilization Treatment (TIST) model. And those of you who are trained in some of these models will recognize them…
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To learn more about this model, how it developed, and how you can apply it in your work as a trauma therapist, we recommend you start here: Trauma-Informed Stabilization Treatment (TIST) Certification with Janine Fisher – TIST LEVEL 1 for Trauma Therapists.
