Trauma-Informed Stabilisation Treatment (TIST) is a trauma treatment developed by Dr. Janina Fisher and designed for treating more severe trauma-related symptoms and disorders. Many trauma survivors struggle with profound self-hatred, self-harm, eating disorders, substance abuse, and suicidal thoughts and impulses. Traditional treatments for these symptoms may not result in improvement or the gains made often do not last, leaving the individual in a constant state of crisis, in and out of hospital or in and out of addiction and eating disorder recovery programmes.
TIST is based on the assumption that these severe reactions are not evidence of personality disorder or mental illness but are indications of trauma-related fragmentation and alienation from self.
Surviving trauma, especially as a young child, requires disconnection from the body and mind. Distance is needed to tolerate the overwhelming events and reactions, to allow the child to continue developing normally, and to facilitate attachment even to very abusive caretakers. Because the human brain consists of individual structures holding different kinds of information, fragmentation or dissociation under stress is common and adaptive at the time of the event. But most trauma occurs in a context of “enduring conditions,” such as child abuse, domestic violence, war, terrorism, gang warfare, etc. Rather than having survived a single event, most traumatized individuals have been faced with day-in/day-out threats over many years. The daily anticipation of threat evokes an individual’s instinctual survival responses: fight, flight, freeze in fear, cry for help, or submit. In some environments, anger or fight is punished and must be inhibited in favour of freezing to be seen and not heard; in some environments, it is more adaptive to flee into books or fantasy or to be passive and compliant. As these responses are stimulated over and over, it is not surprising that traumatized individuals frequently develop parts of the personality driven by one or more animal defences.
Very commonly, traumatized individuals enter adulthood split in such a way that one part of the personality can “keep on keeping on:” going to work, studying, caring for children, keeping up with household tasks, etc. But at the same time, a different part might feel fraudulent and fake; another part might resent having to carry so many responsibilities, and another part might feel guilty for not doing enough or feel ashamed and filled with self-doubt. Often, the parts appear to others as mood swings or attention-seeking or inappropriate behaviour. Suicidal thoughts and feelings or self-harming might be misunderstood as wishes to die rather than as a desperate attempt at seeking relief.
TIST was first developed to address the issues of chronic suicidality and self-harming behaviour in a hospital for the chronically mentally ill. Most of the patients who participated in the early trials of this approach had been in hospital continuously for 2-10 years. Even whilst in hospital, they had continued to harm themselves and even attempt suicide. Some had also assaulted hospital staff. No form of treatment had been successful until the introduction of TIST.
TIST is a mindfulness-based approach that asks the individual to observe distressing emotions and impulses as indications that some part of the self has been triggered. Rather than assuming that ‘what you feel is who you are,’ clients are asked to notice each part and inhibit acting on its feelings and impulses in favour of being curious about what each parts fears or needs. Its mindfulness component helps individuals to slow down and be interested in what they notice. Understanding their actions and reactions as the instinctive responses of their trauma-related parts diminishes shame and self-blame, freeing clients to work on their healing process.
The healing process in TIST is not focused on the traumatic events as other approaches are. Instead, its focus is the legacy of those events as carried now by young, traumatized parts. Healing is the outcome when the adult individuals they are today accept and welcome each part as a contributor to their survival and when they can make use of the gifts of each part to forge a life beyond trauma. Each part can be a problem or a solution: the fight part can harm the body or harm others, or it can contribute strength, courage and energy for the challenges ahead. The submit part can get stuck in chronic depression and shame—or it can provide willingness and the ability to compromise as a balance to the fight part’s ability to dig its heels in. As individuals begin to feel more warmly toward their traumatized parts, there is a feeling of calm and safety, a sense that the past is over and all are safe now.
Up to this point, no systematic controlled studies of the effectiveness of the TIST model have been completed, though several are underway. However, self-reports from clients working with this model are generally very positive in describing the benefits they have experienced.
Get in touch
If you have a client, or know of someone who is struggling to heal from psychological trauma and could benefit from Trauma Informed Stabilisation Treatment, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).