Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation by Janina Fisher

Author:Janina Fisher [Fisher, Janina]
Language: eng
Format: epub, pdf
ISBN: 9781134613083
Google: NJ40DgAAQBAJ
Publisher: Routledge
Published: 2017-02-24T05:00:00+00:00

Trauma-Informed Stabilization Treatment (TIST)

Trauma-informed stabilization treatment (TIST) (Fisher, 2015) is a treatment model developed to stabilize severe self-destructive behavior unresponsive to conventional treatments. TIST was initially developed in the context of a paradigm shift in the State of Connecticut’s Young Adult Services, a division under the Department of Mental Health and Substance Abuse. In an attempt to help some of its most severe cases in the age range from 18 to 25, a daring decision was made to explore the impact of trauma-informed approaches, given that a high percentage of these chronically suicidal, self-destructive clients had histories of severe trauma. The patients for whom the program was first designed had been given many different diagnoses over years of mental health treatment in inpatient and residential settings. What they had in common was an early childhood history of trauma followed by symptoms of severe self-injury, suicidality, substance abuse, eating disorders, and aggression toward others, primarily staff. All of them had been hospitalized for more than six months and as long as 10 years. Their difficulties in benefiting from existing treatment models resulted from the lack of a method that could simultaneously address the separate components of their self-destructive behavior: its origins in their traumatic past, trauma-related triggering, loss of perspective and judgment due to cortical inhibition, and the degree of relief experienced as a result of the behavior. By using the structural dissociation model as the theoretical foundation for TIST, each separate variable contributing to unsafe actions in a client could be identified and each of the self-destructive impulses could be externalized and assigned to the appropriate part. That single intervention in and of itself immediately supported the clients’ identification with the going on with normal life self, loosening the identification with the suicidal and self-harming impulses. To ensure that the model was not perceived as shaming by clients, all aspects of self (including the suicidal part) are consistently described in terms of their positive contribution to survival.

When treatment models conceptualize self-destructive behavior as pathological, “borderline,” or manipulative, and judge inhibition of unsafe impulses as “healthy,” attention is diverted away from the underlying issue: the internal struggle between conflicting drives. Should the client seek relief in impulsive action or find a way to bear the pain and go forward? Successful treatment of any conflict requires acknowledgment of all sides or parties involved, not just those toward whom we are biased. Although on the surface it seems that the answer should be easy, it is not. With no hope or belief in the future, with emotional vulnerability intensified by autonomic activation and adrenaline-driven fight-flight impulses wanting discharge, it is hard for traumatized clients to believe that “keeping on keeping on” has much chance of success. To resolve the struggle, clients have to learn to trust that all their parts are committed to survival in different ways; that even their most intensely suicidal parts “want to die in order to live.”

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.