Critical Issues in Trauma Resolution

by: Frank A. Gerbode, M.D.

Traumatic Incident Reduction: A Simple Trauma Resolution Technique

Most common approaches to Post-Traumatic Stress Reduction fall into two categories: coping techniques and cathartic techniques. Some therapists give their clients specific in vivo methods for counteracting or coping with the symptoms of PTSD, tools to permit their clients to learn to adapt to, to learn to live with, their PTSD condition. Others encourage their clients to "release their feelings", to have a catharsis. The idea is that past traumas generate a certain amount of negative energy or "emotional charge", and the therapist's task is to work with the client to release this charge so that it does not manifest itself as aberrant behavior, negative feelings and attitudes, or psychosomatic conditions.

Coping methods and cathartic techniques may help a person to feel better temporarily, but they don't resolve trauma so that it can no longer exert a negative effect on the client. Clients feel better temporarily after coping or having a catharsis, but the basic charge remains in place, and shortly thereafter they need more therapy.

The Need for Anamnesis

Traumatic Incident Reduction (TIR) operates on the principle that a permanent resolution of a case requires anamnesis [recovery of repressed memories], rather than mere catharsis or coping. To understand why clients have to achieve an anamnesis in order to resolve past trauma, we must take a person-centered viewpoint, i.e., the client's viewpoint and, from that viewpoint, explain what makes trauma traumatic. 

Time and Intention

Let us start by taking a person-centered look at the subject of time (See Fig. 1). Objectively, we view time as a "never-ending stream", an undifferentiated continuum in which events are embedded. But subjectively, we actually experience time differently. Subjectively, time is broken up into "chunks" which we call "periods" of time. "A time", for me, is a period during which something was happening or, more specifically, during which I was doing something, engaging in some activity. Some periods of time are in the past; some are in the present. Those periods defined by completed activities are in the past; those defined by ongoing (and therefore incomplete) activities are in the present.

For that reason, we don't experience the present as a dimensionless point. It has breadthcorresponding to the width of the activities in which we are currently engaged. For example, I am still in the period of time when I was a father, when I was attending this conference, when I was delivering this workshop, when I was uttering this sentence, when I was saying this word. These are all activities in which I am engaged, and each defines a period of time with a definite width. In fact, I am inhabiting a host of periods of time simultaneously.

Moreover, each of the activities in which I engage is "ruled" by a governing intention. In the example I just gave, the intention was to get from Paris to Rome but, in the case of a combat veteran, it could be an intention "to get revenge". In effect, therefore, an activity cycle starts when I formulate an intention, continues so long as that intention continues to exist, and only ends when the intention is ended. Therefore, there is an intimate relation between time and intention.

Each of the activities in Fig. 1 is coextensive with the existence of a corresponding intention. Each continues until the intention is fulfilled or unmade. Present time consists of periods of time that are determined by my current intentions.

In fact, there are only two ways to end an intention and thus to send a period of time into the past: 

In other words, you can't stop doing something you don't know you are doing!

The Effects of repression

Repressing an incomplete activity cycle makes it destructive and, at the same time, much more difficult to complete. As mentioned above, to complete a cycle, I must be aware of the intention that rules it. But if, because of the trauma it contains, I have repressed the incident in which I created the intention, I am not aware that I have intention or why I have it, so I cannot unmake it! That period of time continues up into the present, and some energy remains tied up in it. In fact, it makes sense to define emotional "charge" as "repressed, unfulfilled intention". Getting rid of charge, then, consists of un-repressing intentions and then unmaking them.

Now it becomes obvious why we need anamnesis in order to resolve the effects of past traumas. To reduce the charge contained in past traumas, the client must come fully into contact with them, so that he can find the unfulfilled intentions that he has repressed and why he formulates them, and unmake them.

Whenever something painful and difficult to confront shows up in life, one has a choice.

1. Allowing oneself to experience it fully.
   1. Thus being fully aware of one's intentions in the incident, and why one formed those intentions.
   2. Thus having a choice whether or not to unmake the intentions.
   3. At which point, the incident is discharged, by the above definitions of "charge", and becomes a past incident. 
      
      or
2. Repressing it, wholly or partially.
   1. Thus not being aware of the intentions one made in the incident, or why one made them.
   2. Thus not being able to unmake those intentions.
   3. So that the incident remains charged and subjectively continues on as part of the present.

Paradoxically, by trying to get rid of the incident by repression, one causes it to remain present indefinitely.

Effects of Emotional Charge

Emotional charge represents a drain on a person's energy or vitality, because energy remains tied up in the incomplete activity cycle connected with the intention in the trauma, and more is tied up in the effort to repress the incident. Hence a person with unresolved past traumas tends to be rather listless or goal-less in life. A second effect of past traumas compounds the difficulty: similar conditions in the environment can trigger, "restimulate," or "reactivate" past, repressed traumas, just as the sound of a bell could cause Pavlov's dog to salivate. When one is reminded of a past trauma one has, again, the choice given above: one can either allow oneself to become fully aware of what happened in the original incident or one can repress the incident of being reminded. Repression causes the "reminder" incident to become a secondary trauma in itself. Later, similar occurrences can then reactivate it.

For example (See Fig. 3), consider a combat veteran who has a past traumatic incident of being in a combat situation in which a close friend was killed. Contained in this incident are, say, the sound of a helicopter, a loud noise, the taste of chewing gum (assuming he was chewing gum at the time), and, perhaps, children (if he was in a village), also, a tree line. Since this incident is extremely traumatic, the soldier represses it, at least partially. He "doesn't want to think about it". Later, some years after returning home, he goes to a barbeque in the park. There, he is, say, chewing gum and sees some children. He also sees a tree line. He starts to be reminded of the original incident and feels the rage contained in it. This becomes uncomfortable, so he represses the incident in the park, wholly or partly. Contained in the incident are also a barbeque smell and a dog barking.

In a later incident, he is talking with his wife and chewing gum, and they are barbequing on the back porch with the kids, the dog barks, and the veteran suddenly experiences a feeling of rage, because the earlier incident, the one in the park, is reactivated by the common elements: the dog barking, the barbeque smell, and the chewing gum. This is uncomfortable, so he represses this one also, and it becomes another secondary trauma. This incident also contains some additional elements: the sound of traffic, and the man's wife.

Later, he is drinking beer on the back porch with his baby and his wife and smoking a cigarette, and he is trying to talk to his wife but there is also traffic noise. Again, he flies into a rage because of the reminders, although, because the past trauma is repressed, he will attribute the rage to something else, e.g., to the fact that his wife forgot the salt shaker for the third time. This incident contains a sensation of being intoxicated, the taste of beer, the smell of cigarette smoke, and his baby. It, too, is repressed.

Later still, he is smoking, drinking beer, and watching TV. The sensation of intoxication and of smoking reminds him of the earlier incident and he feels rage. Now whenever he gets drunk or watches television, he is prone to fly into a rage. Random dream elements restimulate the same sequence of traumas, resulting in recurrent nightmares. Finally, he goes to a therapist and is found to have full-blown PTSD.

This is a sequence of traumatic incidents, starting with a "root" incident and encompassing, probably, a large number of subsequent incidents in which the root incident or one of its sequents (separate incidents that are part of a sequence) got reactivated. The only thing in common to all these incidents is the feeling of rage that he experiences each time. He attributes this rage to something in present time, but it actually stems from the original rage he felt in the root incident.

The Traumatic Incident Network

Although we have only shown a few incidents, in real life a sequence may contain hundreds or even thousands of incidents. Furthermore, the average person usually has a fairly large number of these sequences, with different themes in common. These sequences overlap each other to form a network of traumatic incidents which we call the traumatic incident network or "Net" (See Fig. 4). The object of TIR is to reduce the amount of emotional charge the Net contains so that the person is not subject to the reactivating effects described above and also so that he can reclaim the stuck intention that was tied up in past incidents in the Net.

What we have shown, here, is not just the situation of a combat vet or a rape survivor. It is the human condition. Every one of us has had at least some past traumas that cause us to be dysfunctional in certain areas of life, those incidents that contain reactivators.

The Solution to the Net

Stating the solution is easy, but accomplishing it is somewhat trickier. Traumas contain very intense, repressed, unfulfilled intentions, such as the intention to get revenge, to escape, and of course, the intention to repress the incident. The client needs to find the root incident for each sequence and bring it to full awareness. Traumatic Incident Reduction accomplishes this result. When that occurs, the person becomes aware of the intentions in them and, since these intentions are generally no longer relevant to the here and now, s/he unmakes them. At that point, the activity cycles contained in the incidents are completed; they become part of the past, and they can no longer be reactivated.

What is required, then, to obtain the necessary anamnesis? An incident has four dimensions, not just three. In order to be aware of an incident, it is necessary to start at the beginning and go through to the end, like viewing a motion picture, not like looking at a snapshot. Hence, we call the procedure "viewing", the client a "viewer", and we call the one who helps the client to do the viewing the "facilitator".

You can't just glance at a part of an incident and expect thereby to have fully completed the process of anamnesis, because you will miss other parts of it, probably the most important ones, the ones that are most difficult to look at. In order to achieve a full anamnesis, you must be allowed to go through the entire incident without interruptions, without reassurances, in short without anydistractions. Furthermore, it does not suffice to go through the incident only once. If you want to become fully familiar with a movie, you must see it a number of times, and each time you will notice new things about it. The same thing happens during Traumatic Incident Reduction, except that the client is viewing a past traumatic incident instead of a movie, and that's somewhat harder to do.

Basic vs. Thematic TIR

If, as is often the case with survivors of single or discreet incidents such as an accident, a rape, or loss of a loved one, the viewer already knows which trauma needs to be looked at, you can use a relatively simple form of TIR called Basic TIR. You simply have the viewer go through the single, known incident enough times to resolve it. But in most cases, the viewer starts out being entirely unaware of what the root trauma underlying his or her difficulties is. So how can s/he find it? For that purpose we use a technique called Thematic TIR, in which we can trace back an unwanted feeling, emotion, sensation, attitude, or pain to the root trauma from which it originates.

End Points

When the viewer finds and discharges the root incident, a very specific and often quite dramatic series of phenomena appear, showing that the viewer has achieved a thorough discharge. Then we say the viewer has reached an "end point". These phenomena usually appear in the following order:

1. Positive "indicators": Viewer appears happy, relieved, or serene. They are not sitting in the middle of something heavy. Sometimes they will laugh or say something cheerful. in the absence of positive indicators, no end point has occurred.
2. Realization: Then viewers will usually voice some kind of realization or insight, a reflection of the fact that they are becoming more aware.
3. Extroversion: Finally, viewers will open their eyes or otherwise indicate that their attention is now back in the present. They will usually look at the facilitator or at the room, or make some comment about something in the here and now.
4. Intention expressed: Often viewers will explicitly tell the facilitator what intention was present in the incident. If they don't, the facilitator has the option of asking them to tell of any decisions made at the time of the incident.

When you see an end point, the most important thing to do is to stop. If you continue past the point when the root incident has been discharged and continue to ask the viewer to look for incidents, s/he will start to wander around more or less randomly in the Net, and will often end up triggering a lot of things that you will not be able to resolve with TIR.

We have found that TIR works well with most clients who fit the criteria for PTSD, as well as for people who have traumas affect their quality of life but who do not have PTSD. An exception is that TIR does not work well with people who are currently abusing drugs or alcohol. Virtually every time we have had a failure, it has turned out that the viewer was drinking heavily or abusing other substances between sessions.

Although the TIR procedure is not complicated or difficult to learn, it can only work in a session environment that is structured in such a way that it is safe. Much of the TIR training involves teaching certain Rules of Facilitation and communication skills specific to the TIR style of working with a client.

Research Findings

Among a number of research projects are those by Pam Valentine, Wendy Coughlin, who completed her Ph.D. dissertation Traumatic Incident Reduction: Efficacy in Reducing Anxiety Symptomatology and Lori Beth Bisbye's study: No Longer a Victim, A Treatment Outcome Study for Crime Victims with Post-Traumatic Stress Disorder (Ph.D. Dissertation, California School of Professional Psychology, San Diego, CA 1995).

For further information see Research