Trauma-Informed Stabilization Treatment (TIST)

Using Trauma-Informed Stabilization Treatment (TIST) to Treat Unsafe and Addictive Behavior in Clients with Histories of Trauma

Overview of TIST Approach:

Research has clearly shown associations between a history of trauma and suicidality, self-harm, and addictive behavior, but these behaviors are rarely treated using a trauma-informed approach. Skills-based methods (for example, DBT) usually result in some improvement but not the acquisition of safety. Psychodynamic or TF-CBT are contraindicated for clients with unsafe behavior because of the risk of stimulating increased overwhelm and impulsivity.

Access to brain scan technology in the 90s yielded important data about the effects of trauma on brain activity and physiological responses, resulting in compromised prefrontal functioning and difficulty remembering or verbalizing experience. In addition, we now know that childhood trauma leaves individuals not only with overwhelming memories and emotions but also with a fragmented sense of self, a compromised nervous system, and impairment of the capacity to tolerate emotion or stress. Unaware that their intense feelings and reactions represent non-verbal implicit memories, these clients resort to desperate measures: addictive behavior, self-harm, suicidal ideation and impulsive attempts, and intense fight or flight responses. Rather than offering a context for healing the effects of childhood trauma, the goal of inpatient and outpatient treatment often becomes simply to ensure the client’s safety.

The therapist is left with a quandary: how do we treat the underlying trauma when the client is unstable or unsafe, living from crisis to crisis, or caught in a revolving door of hospitals or treatment approaches? How do we acknowledge what has happened without opening up too much? How do we treat a client who attempts to live today and then tries to die the next day? The Trauma-Informed Stabilization Treatment (TIST) model was developed to provide some hopeful answers to these puzzling and frustrating challenges.

Based on theoretical principles drawn from the neuroscience research on trauma, TIST combines mindfulness-based interventions with techniques drawn from Sensorimotor Psychotherapy, ego state therapies, and Internal Family Systems to address challenges of treating clients with a wide range of diagnoses, including complex PTSD, borderline personality, bipolar disorder, addictive and eating disorders, and dissociative disorders.

Using a combination of didactic and experiential learning (demonstration, videotapes), participants will learn a new and promising model for understanding these individuals as fragmented and internally at war with themselves. This way of working allows trauma survivors to acknowledge the traumatic past while stabilizing the ability to live a normal life here and now. When trauma symptoms are understood and treated neurobiologically as emotional memories held by split-off, disowned ego states, even the most self-destructive, therapy-destructive, and de-stabilized clients become understandable and manageable.