Metapsychology Monographs

Let's consider why Traumatic Incident Reduction (TIR) would be expected to be different with an autistic client. One of the hallmarks of autism is a lack of connection with the real world, so the world view of an autistic individual is limited and often very inaccurate. A second hallmark of autism is difficulty with intrapersonal and interpersonal relationships so that insight into how to make relationships better, or work at all, would be expected to be limited. So, within a TIR session where we expect our clients to come up with their own insights, that's really a tall order. Then the meltdowns I've talked about; as a Davis facilitator I understand these as prolonged and severe disorientations, analogous to a PTSD episode, in which the emotional reaction is really out of sync with true facts and conditions in the current situation. Added to all this are the phobias and the extreme aversions that many autistic individuals experience, which can limit full participation in life. One of the things that makes working with autistic clients challenging is that often we simply have to wait until they give us that little window of time when they are able and willing to proceed. If I were to use the guidelines in my TIR Workshop manual, I would have to conclude that there was not enough ego strength or resiliency in these individuals for them to be able to engage for a successful TIR session. You know what they say about fools who rush in where angels fear to tread... A less foolish person than I am, and especially someone new to TIR, would likely never have tried to use TIR with autistic clients. However, based on the wonderful results I have seen using TIR with many of my other clients who do not have autism, and some of the really significant problems that some of my autistic clients were presenting, I decided to try TIR with a few of them. In the remainder of this lecture, we'll consider two specific case studies. Veronica, a sixteen-year old who basically lived as a recluse in her mother's basement, and Joshua, a young boy obsessed with drum kits who was given to periods of extremely oppositional behavior. Cathy Dodge Smith uses Davis Methods in her practice (Davis Dyslexia Correction Program, Davis Autism Approach, and Davis Attention Mastery ). She is also a Certified TIR Facilitator. This article is from her presentation at the 2014 Symposium. Originally appeared in AMI/TIRA Newsletter, Volume XII, Number 1 (March 2015).

"Sexual addiction is strongly anchored in shame and trauma. Research conducted over the past fifteen years has consistently shown the prevalence of emotional, physical and sexual abuse in this population" (Cox & Howard, 2007, p. 1). As well, there is also high co-morbidity of sexual addiction with other addictive disorders. An additional layer of sexual addiction is the underlying shame associated with the actions and behaviors the client engages in for this addiction. This intense shame is likely to fuel and perpetuate the cycle of the addiction. With such a strong link, it is important for clinicians to address the underlying trauma while assisting clients with sexual addiction (Cox & Howard, 2007). To assist clients in overcoming a sexual addiction there are minimal options. Unlike gambling where absolute abstinence from the behavior is the desired effect, this type of a decision regarding sex will hinder a healthy relationship. One strategy is to use a Sexual Boundary Plan (Weiss, 2004). Fortunately, with Traumatic Incident Reduction (TIR) and related techniques, this is not the only strategy to assist clients with a sexual addiction. It is important to remember that a sexual addiction is similar to alcoholism in that the individual uses sex to cope with pain and numb difficult feelings. For the sex addict, sex is mood altering like a drug, and the individual needs more and more to achieve the same elevated feeling. Often this results in more frequent sexual behaviors and increased risks. Sex becomes the focus in a person's life and thus there is no room for healthy relationships. In addition to abuse experiences, other traumas for the sexual addict are betrayal, abandonment or rejection. "If the betrayal is severe enough, trauma results. Fear and terror become the catalyst that allows betrayal to move into the area of trauma" (Cox & Howard, 2007, p.6).

The following article is based on materials presented at the Proceedings of the Tenth National Symposium on Doctoral Research in Social Work (1998). Statement of the Research Problem Conducted in the Tallahassee Federal Correction Institute (FCI) in Florida, this experimental outcome study examined the effectiveness of Traumatic Incident Reduction (TIR) (Gerbode, 1989) in treating trauma-related symptoms of female inmates who were victims of interpersonal violence. TIR is a brief (in this case, one session), straightforward, memory-based, therapeutic intervention most similar to imaginal flooding. A memory-based intervention implies that the symptoms currently experienced by a client are related to a past event and that lasting resolution of those symptoms involves focusing on the memory rather than focusing on symptom management. TIR is straightforward in that the roles of both the client and therapist are very clearly defined and strictly followed. There are several reasons for studying the influence of TIR on previously traumatized female inmates. Since 1980, the rate of family homicide has increased fivefold (Joffe, Wilson, & Wolfe, 1986). Women are the target of much violence, as illustrated by the following: 75% of adult women have been victims of at least one sexual assault, robbery, or burglary (Resnick, et al., 1991); and 53.7% are victims of more than one crime. Abundant data suggest that PTSD can result from having been a victim of crime or having witnessed a violent crime (Astin, Lawrence, & Foy, 1993; Breslau, Davis, Andreski & Peterson, 1991; Resnick, et al., 1991). Therefore, the number of women affected by PTSD is growing as violence and sexual abuse increase in society as a whole (Ursano & Fullerton, 1990). There is a lack of empirical research on the traumatic effects of interpersonal violence (e.g. robbery, rape, incest, physical assault). Since inmates are typically victims of interpersonal violence (Gabel, Johnston, Baker, & Cannon, 1993), the inmate population studied was particularly suitable for TIR.

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 (literally "in life") 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 (recovery of repressed memories) 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.

I developed renewed faith in the power of psychotherapy after I attended a Traumatic Incident Reduction (TIR) course in 2011. It opened many doors for me as I began to understand the impact of previously overlooked, objectively minor traumatic incidents on psychological disorders and problems. This article is about the application of this powerful tool over the entire spectrum of psychological problems and disorders and how this brings about impressive and permanent change. The optimal use of this tool in psychotherapy requires a shift in epistemology in which we begin to view mental health through a trauma lens. The definition of psychological trauma can vary. From a TIR perspective, trauma can be defined as any incident that had a negative physical or emotional impact on an individual. This is a very subjective issue as the something could be perceived as traumatic by one individual, but as commonplace and harmless by another. The important thing is the emotional and physical impact the incident had on the individual, its subjective impact. The reason it is so important to view trauma in the broadest way possible is because it explains the chronic mood states of our clients as well as how subconscious intentions and automatic emotional responses affect their current lives. These will be explained below. Traumatic incidents, when understood in the broadest sense possible, have a massive effect on our neurobiology, emotional states and behavioral patterns. Therefore, they can be seen as the driving force behind almost all psychological problems and disorders. When I say traumatic incidents "in the broadest sense possible," I refer to the everyday incidents of trauma that are objectively perceived as minor, such as an embarrassing comment by a teacher, conflict with a friend, breaking your mother's expensive vase, etc. It involves an understanding of how the emotional knocks we take on a daily basis affect our neurobiology and continue to have an impact on us in later life. The understanding of subconscious intentions, automatic emotional reactions and responses and chronic mood states are so crucial when it comes to looking at mental health through a trauma lens. Minor and major psychological and physical trauma involves a complex description of the effects on the brain. This article includes detailed case studies including specific incidents such as birth trauma and jealousy and rage. We will look in detail at how trauma results in Goleman's "Amygdala Hijacking" and how we can help the client break destructive cycles. I also explain why sheer willpower is insufficient to change behavior in the face of traumatic re-stimulation. Additionally, the article explains how TIR avoids re-traumatization even as clients revisit past incidents.