Survivorship consists of two closely related, but separate issues. First is the original trauma: in this context, the personality disintegrating impact of being imprisoned in a German concentration camp which completely destroyed one's social existence by depriving one of all previous support systems such as family, friends, position in life, while at the same time subjecting one to utter terrorization and degradation through the severest mistreatment and the omnipresent, inescapable, immediate threat to one's very life. Second, there are the life-long aftereffects of such a trauma, which seem to require very special forms of mastery if one is not to succumb to them. (Bettleheim, 1979, p. 24)In this description, the person must contend with both the reality of the original trauma and the trauma's effects. TRT patterns one and two correlate to Bettleheim's description of the original trauma. Patterns three and four relate to the "life-long effects."
The idea that the four patterns can be linearly connected and sustained as an entity is supported neuropsychologically by Dr. Donald Hebb's Cell Assemblies Theory (Organization of Behavior, 1949). Hebbs argues that the brain is not always a function of helping the organism to relate to its environment, but that it can become a function of relating to itself within itself. In an interview by Restak (1984), Hebb explains this view as the formation of cell assemblies that support psychological entities within the brain. Kolb (1987) describes cyclical (pattern) relationships between the effects of the event on neurophysiology, the role of emotion and subsequent correlation of the neurophysiology and emotion to the production of neurophysiological/ behavioral symptoms. These patterns, although not delineated in terms of the relationship of contradicted existential identity to loss, are generally related (parallel) to the patterns described by us in the TRT theory of psychological trauma.
Weizman had developed a method through which couples could describe in writing a multitude of different values and beliefs about the constitution of the marriage agreement. Because the spouses of alcoholics (and spouses of batterers) were attempting to describe similar realities as basic expectations that had been sundered by the alcoholism and the violence, I saw a parallel between the GBMT approach to marital therapy and our helping spouses to identify such sundrances.
Subsequently, I developed the Matrix (described in other sections of this information system) to be used as a means of helping these people to codify the large numbers of values and beliefs being intruded upon and large numbers of losses that are correlative to such intrusions. For physically damaged people, I added "images" and "realities" to the values and beliefs category.
This addition was originally made for people who sustained disfigurements to their faces as a result of blows by an intruder. For example, a nose that was broken, a tooth knocked out, a broken jaw, or a discoloration of the face (bruises), produced alterations in the individual's facial image and physical reality (and perception of reality) of themselves.
As this identification method was applied to people affected by automobile accident or combat where either a disfigurement had occurred, or had been observed as occurring for another person, say in the line of duty while carrying medical evacuees during combat in Vietnam, the image and reality delineations had the same effect as the similar identifications had had for physically assaulted and disfigured people.
Although, at the time, I looked in the literature, and have since reviewed it on numerous occasions, I have found no one else who has studied this aspect of the psychology and in terms of loss as a response to specific contradictions to values, beliefs, images and realities as we organized it. In Hofer's (1984) article on biology of bereavement (relationships as regulators) he also indicated that he knew of no studies on this general concept, his statement on the subject being:
"Do the chronic background symptoms of bereavement occur to the same degree in this case in which the loss is not one of actual interaction but of hopes, expectations, and memories?" (1984, pg. 191).In support of this concept, there have been numerous workers who view loss as a consequence of changes in the internal psychological dynamics. One such person is Dr. Henry Olders. He argues that
Losses occur in ways other than by death or separation, for example, losses occasioned by giving up childhood attachments.
Changes during development can be experienced as losses for which mourning is adaptive (1989, pgs. 272 -273).Olders then references Fleming and Altschul (1963) on their belief that separations provide effects on ego development; Brice's (1982) view that loss is an ordinary and expected result of life process, including change, is also referenced by Older.
Parkes's (1972, 1987) describes the effects of loss of a loved one on identity; but the description is provided in terms of the individual's having to establish a new identity now that the old one, established in the relationship with the deceased family member, is gone. Parkes' focus is on showing how people redevelop that new identity.
Lindeman delineates symptoms of grief resulting from loss in his classic article on bereavement (1944). Bowlby has written extensively on attachment and loss (1969, 1980) and is recognized as one of the primary investigators and theoreticians on the subject; Bowlby's analysis of the literature on loss is recognized as a hallmark in scientific endeavors to understand loss. Parkes' (1972, 1987) Bereavement is also a classic book about loss that describes grief and its process and facilitation as it affects adults who have lost a spouse to death. Bowlby and Parkes are, or have been, cohorts and their work overlaps. Parkes' second edition (1987) also considers the value of grief therapies in facilitating loss; and the second edition has a section on psychological trauma. Osterweis, Solomon and Green produced Bereavement: Reactions, Consequences, and Care (1984), a scientific approach to the study of loss and bereavement that includes the scientists' emphasizing a conceptual framework for future study of the subject. Hofer, who is a contributor to the aforementioned scientific group (the chapter on the biology of bereavement), has produced additional articles on loss and grief, most notably the one article on relationships as biological regulators (1984).
These works by Osterweis, et. al. and Hofer provided us with the underpinnings of our understandings about the endocrine, immunological, and other biological responses to trauma and loss, and subsequently initiated this aspect of the TRT theory related to the endocrine response to trauma and loss. All 7 of these writers' views are discussed again in additional subsections and their works include well developed bibliographies substantiating their ideas and methods.
As indicated in the previous subsection on contradicted existential identity, loss resulting from trauma not necessarily related to loss of a loved one, but to loss of abstractions about the ongoing aspects of life, are harder to find. Other than the references in that section, van der Kolk describes the "essence of psychological trauma" as a "loss of faith in the continuity of life." (van der kolk, 1987, p.31). Walker (1990) recommends helping PTS victims by assisting their identification and reconciliation of intangible losses related to the inner construction of the self.
The literature is replete with animal studies where the consequences of separation (loss) on psychology, neurobiology, endocrinology and immunology are considered. Some of these studies are considered later, but may primarily be found in van der Kolk's extensive review of the subject (1987).
Loss is the central linkage to depression. Although there are examples of endogenous depression (the occurrence of depression unrelated to external events), the literature is full of data demonstrating that many depressions have their roots in the ending of relationships (bereavement) and loss resulting from psychological trauma.
Of course, Bowlby (1980) and Parkes (1987) delineate both cognitive and emotional patterns of grief for people who are experiencing the loss of a loved one. Some of these patterns are closely related to those observed and reported by us (Part One). In an early work depicting the effects of tangible loss on family members of chemically dependent people, Kellerman relates the emotional and behavioral processes observed as affecting those people to grief (1976).
Repressed emotion resulting from loss and disruptions in life activities is well known. However, we find no hypothesis that the emotion resulting from psychological trauma is repressed in 3 unresolved grief cycles as we have suggested that it is being retained.
There is some general support for the idea that the paradoxical system of control presents the patient and therapist with difficulties. One example has already been quoted at the beginning of this comparison section.
He calls one of these responses the "orthodox" response; it provides for necessary survival activities during and following the traumatic event. Examples provided of such necessary activities include dilation of the pupil, increased blood pressure and heart rate, redistribution of blood flow to tissues requiring the additional nutrients, increased coagulability, stimulation of energy producing cell functionings, depression of some instinctual adrives like hunger and sex, increased alertness, stronger muscle capacities, and analgesia (Silvestrini, 1990, pg 6).
The other biological stress response is called the paradoxical stress response; it produces the opposite functions and outcomes provided by the orthodox one. Silvestrini's examples of the behavioral manifestations of this response include increased sexual and hunger activity, passivity, mental pain, etc. (pg 7).
Silvestrini suggests that this opposite or paradoxical stress response is responsible for such conditions as obesity, bulimia, panic attacks, some sexual deviations, depression, and alcoholism. The biological underpinning of the paradoxical stress response is not known, but is hypothesized to be, like its orthodox counterpart, initiated through adrenergic activity: stimulation of epinephrine.
Silvestini's theory supports the TRT theory of the paradoxical system of control by bringing attention to the idea that some behavioral opposites are occurring during and following survival for some people. Moreover, the ideas that these opposites are biological in their basis and that they produce conditions that in themselves become psychopathological (like depression and compulsivity) are also supportive. The obvious (you may want to return to this part after reading section 2) differences are that:
There are, however, other models that use structure. Some of them include letter writing (Kopp), grave visitation and use of pictures of the deceased (Williamson) to facilitate grief resolution, psychodrama to include reexperiencing the events through art forms like family sculpturing (Satir) and art therapy.
The most pronounced structure comes in the form of Grief Confrontation Therapy (GCT) and Guided Mourning Therapy developed by Ramsey (1981). Ramsey's work, as already described, is directed primarily toward grief resolution: loss of a loved one.
A review of Soloman, S.D., (1992) describing the various treatment approaches to psychological trauma and their effectiveness shows that psychological trauma treatment models that use some element of flooding, which is used by Ramsey, provides an edge in obtaining some form of success. That article considers some of the efficacy of some of these approaches when applied to the treatment of post-traumatic stress disorder, the viability of the use of flooding is shown to have the across-the-board strongest positive outcomes. "Flooding of memories" is of course an important, but only small, element of the TRT process.
Scrignar (1988, pgs 147 and 148) offers what we consider to be the best rationale for the use of structure in the treatment of PTSD when he describes the "information overload" that can occur when using the psychodynamic model to help the trauma-affected individual to reconcile the myriad effects resulting from the trauma. Scrignar quotes leaders who have made attempts to assist people in making these reconciliations (quote Horowitz, 1974, 1980; Brende, 1981, 1984; and Crump, 1984).
In addition to providing literature reviews of the subject, each of these presentations also offer concepts or framings of psychological trauma that both support and conflict with the ETM theory and methods presented in this book. Those three works as presented from the perspective of that support and conflict, are overviewed here with four other methodological conceptualizations -- hypnosis, conversion, psychotherapy and grief resolution -- that overlap in practice to the previous 3 mentioned (non ETM) theories and methods. Cognitive/Behavioral Concepts and Methods; Scrignar's 3 E's
The cognitive/behavioral approach to the treatment of post-traumatic stress is addressed in this section from two perspectives. They include a general consideration of cognitive/behavioral theory and methodology as applied to psychological trauma; the cognitive/behavioral concepts and some of the methods are compared to TRT. Scrignar's perspectives, his delineation of the 3 E's and his treatment modality for them, are then considered.
The theory underpinning this approach is that the symptoms are maladaptively learned responses to the traumatic event; the effects of this event can also have a neurobiological basis. The cognitive/behavioral idea is that these responses can be unlearned, in behavioral terms, and in the process hopefully right the neurophysiological changes that have resulted from the event.
Some of the methods utilized to help the individual accomplish the goal of symptom reduction include, desensitization, relaxation therapy, the use of biofeedback machines and cognitive/behaviorally oriented group therapies. The underlying concept is that if it were not for the manifestation of the trauma through symptoms, treatment would not be necessary. Thus, therapy is thought to be most helpful if the symptoms are addressed directly and the person is taught new coping skills that are not controlled by the trauma.
Although controlled studies validating the efficacy of any model used in the treatment of PTSD are scarce, some believe the behavioral approach will eventually be proven to be the most effective. (Scrignar, 1988, pgs. 149,150). Obviously, cognitive-behavioral concepts and methods have their origins in the nosotropic approach to psychological trauma.
TRT uses cognitive therapy to identify the event and its rational and experiential effects. Writing, which includes the achievement of tasks, could be considered a behavioral feature of TRT.
First, TRT learning (or re- or un- learning) concepts are applied equally to all 4 psychological trauma patterns. In contrast, cognitive/behavioral models apply learning or relearning to, as a rule, the third pattern only -- the survival responses, which are referred to as symptoms of PTSD.
Second, in ETM/TRT theory, cognitive/behavioral models are interacting directly with the paradoxical system of control; they are trying to reform that (paradoxical) system in order to change the symptoms emanating out of those controls. TRT's structure specifically precludes such attempts to change the paradoxical system of control or the symptoms, the idea being that to engage in such an effort strengthens the controls that prevent the identification and reconstitution of existential aspects of identity (see Clinical/ Long-Term Trauma/ TRT Phase Three and Facility Operations).
Moreover, TRT relies on the application of structured grief resolution methods concomitant with cognitive learning and relearning to provide the identification and reconstitution (of existential identity) processes. The cognitive/behavioral model does not, as a rule, give consideration to such existential-based, grief/loss resolution needs: the need to identify, experience, express, understand, and accept loss and accompanying emotion retained in the subconscious as both a result of contradictions to existential identity and as damage to the same. We assume that such loss resolution focused methods are relegated by behavioralists to psychodynamic methods and thus are not used by behavioralists because of philosophical differences that exist between those methods and the behavioralism approach.
The third and most profound difference between TRT and cognitive/behavioral models is shown in the following. In the TRT approach, symptoms of psychological trauma are not required to initiate treatment. The occurrence, as opposed to the symptoms, of the trauma-causing event(s) activates the need for treatment regardless of symptomatology.
There are two reasons for this approach. One is that PTS symptoms come and go (Laufer, 1985, van der Kolk, 1985, and Bower, 1988) and thus are not reliable for ascertaining whether a problem exist (see appendix A). The other is that neurobiological changes initiated by a traumatic event can spawn secondary changes at any time following that event, and frequently not within a timely fashion -- it may be years before secondary neurobiological changes occur, which then may catapult, unsuspectingly, the individual into a dangerous neurological state, which then may produce symptoms like depression, etc. These changes occur as a consequence of the individual functionings and capacities of synaptic pathways and the interactions of certain neurotransmitters like serotonin, dopamine, and norepinephrine and other important neurochemicals like the neuroenzyme monoamine oxidase (see About/ Comparison - Contrast/ Biology).
No one knows when the postsynaptic receptors can become overworked or overloaded and no longer support the neurotransmitter/modulator processing. Nor does anyone know when fluctuations in MAO can bring about the depression.
Once these changes do occur, the remedy is placed on the defensive. It is trying to reverse the neurotransmitter deficits, which deficits may have accelerated the problem by producing thought/behavioral manifestations of depression and so forth; a degenerating cascade of destructive sequelae can ensue. Thus, cognitive/behavioral models, which are by definition and philosophy nosotropically (symptom) -focused, symptoms have to be manifested in order to apply the remedies -- symptom reduction methods, can only be reactive responses to the neurophysiological time-sensitive problems.
In contrasts, ETM only needs the initial trauma-causing event to have occurred for the therapy to be initiated (see "Fast Help" sections describing the application of TRT to long- and short-term trauma, emphasizing the latter as the most proactive of the two methods). ETM/TRT do not have to wait for symptoms to manifest. Thus, TRT is not subject methodologically and philosophically to the happenstance of secondary neurotransmitter and other neurochemical over-or under-interactions.
In other words, the cognitive/behavioral model is, by definition and methodology when considering the time capsule effect, that is, the potentially explosive realities of a PTS-affected neurobiology, reactive. TRT, on the other hand, is, by definition and methodology, proactive, when considering the same factors.
The first E stands for environment. In this context, the term environment represents the relationship of the externally generated traumatic event to the physiology and psychology of the person. Scrignar explains in some detail how the various senses respond to the traumatic events.
From this description, he progresses logically to the second E, which stands for encephalitic aspects of the trauma. "Encephalitic" refers to the brain's adaptive mental responses to the environmentally initiated trauma.
The third E references the person's endogenous response to the trauma. "Endogenous" refers to the way the trauma affects the person's physical status. Examples include psychosomatic manifestations of the trauma.
Scrignar's opinion is that people suffering post-traumatic stress disorder need cognitive behavioral forms of therapy as opposed to a "personality overhaul." The "overhaul" remark is an apparent reference to some psychodynamic models that explore pre-trauma childhood issues as if they are related to the current problem (Scrignar, 1988, pg. 148).
Scrignar's own application of this cognitive-behavioral approach includes the use of a method through which a rubberband is placed on a patient's wrist, and then snapped when a thought believed to be a symptom of the trauma crosses that person's mind. Apparently, the pain of the rubberband's snap against the skin of the wrist dissuades further such thoughts, likely PTSD symptoms, from manifesting themselves.
Another of Scrignar's methods involves the therapist's yelling "Stop" at the patient when thoughts that are apparently PTSD symptoms are presented. Scrignar says his patients seem to like both the rubberband snapping and yelling methods (1987, pg. 161).
I recommend reading Dr. Scrignar's book, not only because it provides a fuller description of this approach, but because his work in total provides a great resource document that aids in understanding post-traumatic stress disorder.
The loss resulting from the initial trauma is an internal psychic contradiction resulting from the environmental (first E) effect (the trauma-causing event). Neurological etiology underlying contradicted existential identity and neurological symptomatology underlying survival responses can be correlated to the encephalic aspects that produce second E thought processes and third E endogenous conditions.
The principal difference between the three E's and the loss model's theory is that TRT is concerned with providing an internal psychic model (theory) as a guide to etiology-reversal (reconstitution of values, beliefs, images, and realities via structured loss resolution), where the 3 E's provide for a tracking of environmental influence-to thought response-to physiological effect that does not rely as much on identification, understanding, or resolution of loss. In this way the 3 E's become the basis for delineating symptoms, which in turn are then apparently intended to be directly responsive to a behavioral/learning treatment approach.
Because TRT does not focus on changing behavior, that is, trying to change behavioral responses to the trauma, but rather TRT addresses all 4 patterns of the trauma's influences on existential and operational identity evenly, and despite the parallels between the concepts, the 3 E's theory provided by Scrignar is not incorporated into the TRT trauma definitional process, other than as support for the concept that PTS is a function of an externally initiated event, in contrast to its being considered a function of a particular personality.
In addition, Hendin and Hass (1984) concluded in the treatment of PTS as it affected combat veterans, that the retelling of the story and the sharing of feelings must be accompanied by an eventual understanding of the meaning of combat to the particular individual. The "meaning of combat" to Hendin and Hass, was found to be the "veteran's subjective, often unconscious, perception of the traumatic events of combat" (p. 36). Thus the "meaning" of the traumatic experience was dependent on the individual reality system of the person who existed prior to the combat experience, the combat experience itself, and the way in which the person responded at the time.
This attempt by Hendin and Hass to codify the "meaning of combat," which underpins most psychodynamic applications, for example they determine the meaning of the trauma to the person, is similar to the process used in the second, third, fourth, and fifth TRT phases. In those phases the feelings, contradicted values, subsequent loss, survival responses, and additional loss are identified. Like Hendin and Hass, we agree that this "meaning" for each trauma victim, regardless of the trauma's cause, will depend on the original values and beliefs (reality system) being contradicted and the nature and intensity of the traumatic event as it relates to those pre-trauma variables.
Although there are several differences existing between TRT and unstructured psychodynamic models, and which differences are addressed in other selections (About/ Comparison - Contrast/ Distinguishing ETM) including the later one in this section entitled "Psychotherapy," there are two primary differences that stand out over all others. Those differences result from the effects of the paradoxical system of control on unstructured efforts to address the specific damage done to specific values, beliefs, images and realities contradicted by the traumatic event versus the lack of effect that the paradox has on the structured approach.
In the first difference, during application of the non structured effort, the therapy's attempt to establish conscious control mechanisms, to include that component of those mechanisms responsible for modulating between emotional experience and abstract understanding, will always be occurring within an ongoing battle with the paradox: the goals of the paradox in this battle are to maintain the Survivor's existence and maintain the psychological trauma etiologies. To achieve victory over the paradox's controls, which victory is no small feat as great scientific and artistic skill is required on the part of the individual administering the therapy (see "Psychotherapy"). Even then, the probabilities that the damage reflected in all four patterns will be allowed by the paradox to be addressed in their entirety are highly unlikely --- complete resolution, full etiology reversal, will not occur except in the most profound therapeutic circumstances.
In contrast, the neutralization of the paradoxical system of control by the structure relieves the conscious control mechanisms of the responsibility to produce an effective modulator because the modulation is occurring through the unconscious first: the trauma resolution process facilitated through the application of the structure automatically results in the restoration of control (operational identity) which includes the eventual return of the capacity to modulate both consciously and unconsciously between emotional experience and abstraction, and without interference from the paradoxical system of control. Moreover, the resolution process via the structured approach is mechanical in nature to the extent that complete resolution is practically unavoidable: incomplete resolution will only occur when external variables like drug use or other helping methods (outside of the TRT application) influence the administration of the structure.
With regards to the second difference, during the application of the unstructured psychodynamic approach, especially where there is little to no knowledge by the therapist of the initial trauma, the TRT theory posits that the paradoxical system of control will automatically divert the individual's efforts from the address of the initial trauma -- the first two psychological trauma patterns, by refocusing attention upon the third and fourth patterns. In so doing, the Survivor strikes a deal with the helping modality: the survival thoughts and behaviors and subsequent damage to existential identity are assumed to be the principal problems. The Survivor accepts responsibility for the presenting problems and commits to a lifetime of self-discovery, self-analysis, and responsibility-taking.
The person then uses this self-evaluative/ responsibility-taking model to cope with life and in so doing become a productive citizen. Regrettably, neither the therapist nor patient know of the continuing existence of the first two psychological trauma patterns. The outcome can only be that the person must struggle throughout life never actually knowing what happened to him or her self and thus remain pitted in an ongoing and internal tug-of-war that is always controlled by the paradoxical system of control and the unaddressed two psychological trauma patterns (patterns 1 and 2) that underpin it; the initial and subsequent total etiology has not been reversed and remains unreversed indefinitely.
In van der Kolk's presentation, CNS change results from the externally generated trauma-causing event. Included in this change are reductions in the capacity to produce various neurochemicals --- norepinephrine, serotonin, and dopamine. Reductions or depletions of these and other neurochemical stores and processes underpin the formation of defenses, symptoms of the trauma. Such symptoms include hyperarousal, hysteria, startle response, repeated reliving of the event, increased drug (psychoactive) use, depression, and aggression. Endorphin activity stimulated by attempts to address the trauma result in increases in the various neurochemical activities making the address difficult for both patient and practitioner (see About/ Comparison - Contrast/ Biology). "Difficult" means that wide emotional swings, hyperarousal and hysterical reactions to the attempted remedy, block the direct address.
From this biological/neurological perspective, van der Kolk considers the recommendations and trials of other professional's and his and their application of various medications to offset the symptoms' blocking (to treatment) effects. Once interrupting symptoms are stabilized through medicating techniques, van der Kolk describes a host of talking therapies including individual and group psychotherapies that may be administered in the treatment of the PTSD. My impression from reading the cases in his book (van der Kolk, 1987) is that van der Kolk does not always apply psychoactive substances in the treatment of psychological trauma.
In the pharmacological approach, medications appear to be used both as tranquilizers of the emotional response to the trauma and as blocking agents against CNS responses to the victim's reliving the experience to the extent that hyperarousal and hysteria preclude attempts to resolve the trauma. Van der Kolk reports that although there have been various experiments with different drug based applications to PTS sufferers, no studies confirm or detract from the use of such applications.
The primary difference between TRT and the pharmacological approach to therapy is that TRT uses its structure to provide a perspective of, and approach to, the trauma's resolution that relies on the controlled release of neurochemicals through a similarly controlled identification, experience and expression of specific grief responses to specific trauma-initiated damage to both the existential and operational elements of identity. Through the structured, that is, the ordered and concomitantly occurring experiential/cognitive learning processes, it is assumed that natural neurochemistries initiated by the controlled grief/learning experience, restore depleted neurochemistries (neurotransmitters, modulators and neurophones) to pretrauma levels and, at the same time, restore synaptic capacities to bind with the necessary neurotransmitters, to pretrauma functionings (see ETM neurobiology theory and related bibliographical chapters).
Evidence of the restoration is demonstrated through the dissipation of symptom activity, the previous evidence that the depletions had occurred. Medication is not administered (as a rule) simultaneous with the use of TRT because the medication, depending on the type and class, blocks the neurochemical interactions that underpin the experience and expression of the very symptoms that when manifested under the application of the TRT structure, become remedially responsive to the controls provided by the structure and the following of the learning path to understanding also provided through the structure's use.
As indicated, that "understanding" is experiential-and cognitive-based. That is, the passage through and to understanding involves the experience of specific grief resolutions through specific cycles of grief resulting from the delineation of specific contradicted values, beliefs, images and realities, and specific loss resulting from those contradictions.
In our view and experience (see About/ Theory/ Drug Use for a discussion of our observations of the effects of pharmacological approaches mixed with TRT), blocking of the neurochemical interactions underpinning any symptoms, especially those demonstrating the intensity of the repressed trauma, blocks the trauma victim's entry into and subsequently progressions through the concomitant learning process, that is, the negotiation of grief cycles and simultaneous with cognitive identification and reconciliation of the trauma's effects upon the existential identity. As indicated, the neurobiological bibliography chapter explains the biological path for resolution referenced here.
Basically, we believe that the logic and evidence is with the TRT view, and that the application of pharmacological approaches is, generally, an exercise in guesswork: ongoing experimentation. Our position is that if controlled grief/cognitive learning is shown to mitigate and end all symptomatology, and medications are shown to interfere with those processes, then the burden of proof for the validity of the pharmacological approach lies with those advocating those administrations.
Anyone who assiduously studies this claim will likely find that it is not only true, but that the experiments with pharmacological methods should be terminated for ethical reasons: the pharmacological approach is likely to be shown to interfere with the remedy for psychological trauma, except where comorbity with biologically-based mental illness like borderline personality disorder and manic depression exists.
Consequently, medication is not administered (as a rule) simultaneous with the use of TRT. This recommendation strengthened through agreement of the delivery of TRT by professionals. Clearly, I cannot control the applications of medications by physicians, but do assert control of, through the certification process, the proper delivery of ETM/TRT.
In that regard, physicians are notified that the application of TRT is prohibited (as a rule) simultaneous with the application of pharmacological approaches. There are numerous compatible therapies, for example, psychotherapy, that provide physicians who believe in the pharmacological approach with appropriate alternatives to TRT.
At the time of this writing there is a great deal of controversy occurring over the validity of memories retrieved through the use of the unconscious regression method provided by hypnosis. We cannot comment on this controversy, as we are not experts on hypnosis. Moreover, we have never allowed its use in conjunction with the application of TRT.
As a rule, the literature does not address the application of conversion methods to the PTS condition. However, in practice all secular therapies like TRT must be provided in the context of reality systems based in some form of non secular belief (at least 80% of the time).
From our experience of facilitating the trauma's resolution with TRT, which itself is reported by clients as going to the heart and soul of the Self and ending the deepest and darkest voids in human life, and being required to facilitate this experience within the context of the individual's spiritual/religious beliefs, we have come to recognize the conversion approach as having dual psychological effects (as indicated in the next paragraph, I do not speculate about spiritual effects), positive and negative.
For some, the conversion approach does, by itself and without the need of TRT or any other assistance, expunge the psychological damage done by the trauma-causing event and does completely restore the individual to a new psychological life experience, if not restore them to pre-trauma existence. For others, some psychological aspects of the conversion method appear to serve as a means through which the internally retained trauma is denied. The psychological aspects of the method keep the individual in emotional and intellectual turmoil.
Consequently, the principal similarity between conversion and TRT is that both have the psychological capacity to resolve trauma completely, and do resolve trauma completely. A principal difference is that TRT will resolve the trauma completely in every case, and never serve to assist the individual in denying that the internal damage still exists in any case.
I cannot speak to the theology of the conversion method. I am not an expert on spirituallity or theology. In part because of this lack, ETM is presented as a secular program and offers no theological interpretation to its users.
I can say, however, that numerous pastoral counselors representing myriad religious and spiritual beliefs have trained in ETM and have reported using the model in the treatment of psychological trauma by their constituents, and without apparent infringement on the patient's religious/spiritual beliefs.
First, psychotherapy, as viewed by many practitioners, requires a balanced, but nonetheless dual, therapeutic approach; psychotherapy attempts to resolve the trauma and restore control, that is, to ameliorate, alter, or in other ways change the effects and influences that the trauma's symptomatology have had on the psyche. The TRT structured approach resolves the trauma and reconciles its effects, but without attempting to strengthen controls; there is no attempt to alter or change symptomatology.
Second, some psychological trauma experts think of psychotherapy as an art form, a mixture of scientific understanding, interactional skill, intuition, caring and trial and error efforts, all of which work toward the achievement of the dual goals --- resolving the trauma and restoring control. In contrast, the facilitation of TRT is a mechanical process that only requires caring as the principal attribute accompanying the client's use of the structure. The structure replaces the need for the highly specialized guesswork attending the artistic elements of psychotherapy.
Third, many forms of psychotherapy (certainly not all) require the maintenance of an objective orientation between therapist and patient; the purpose of this objectivity is to facilitate the therapist's ability to apply his or her art to meet the client's needs. In the five phase structured process, because the structure replaces the requirement of the artistic skill, objectivity, other than that required to follow directions, is not the basic orientation --- overt and expressed caring underpins the relationship.
Fourth and finally, the artful use of transference, the process through which the patient reexperiences the traumatic event or history by transferring elements of that history to the therapist and then working through the experience positively with the therapist (as opposed to again experiencing the previously negative outcome), is, in some forms of psychotherapy, the engine or driving component of the therapeutic process. It helps the patient and psychotherapist to discover together the source of the current dysfunction, the initial trauma-causing event. Through the bonding and trust they both use the transference process to explore and eventually relive the event(s).
When the structured approach is applied, the trauma victim uses the phase one guided writing process to go directly to the event. The nebulously defined and often protracted period of exploration and discovery that accompanies the use of transference is replaced with a highly focused and controlled approach to the trauma.
In addition, the reexperiencing of the traumatic event is not the thrust of the therapeutic process as it is in psychotherapy, but only a small, albeit initial, component of the entire 5 part TRT process. Thus, the need to relive the experience through transference onto another is lessened.
Moreover, where one of the goals of the therapist's use of transference is to help the patient to learn positive and healthy adaptations to the traumatic episode after it has been relived, the structured approach makes no such attempt, as changing of adaptations to the trauma is unnecessary if the trauma itself is purported to be completely resolved: the etiology is reversed. In other words, the TRT structure practically makes the application of transference an unnecessary psychodrama technique, that is, when used in the treatment of psychological trauma.
Dr. Spiegle, in a PBS television documentary, attributed these results to the reduction or dissipation of the emotional pain comprising the person's grief response to the illness and imminent death. Through this dissipation, a phenomenon occurred --- the mind and body were thought to be strengthened in their abilities to resist the degenerating disease, which strengthenings apparently then added to the lengths of time they were expected to, and actually did, live. Dr. Spiegle hypothesized that the identification, experience and expression of the emotional pain and loss removed blocks to these people's abilities to apply themselves completely in combating the degenerative physical process associated with the illness.
When the interviewer, who had observed and then shown clips of the grief resolution group therapy techniques administered by the facilitator, confronted Dr. Spiegle --- the interviewer stated that Spiegle was "rubbing these people's noses in the reality of the illness" and not letting them escape it, Dr. Spiegle responded to the confrontation by addressing the alternative positive thinking modalities. In these contrasting methods, people did not dwell on the real and prospective loss, but rather emphasized the use of the intellectual/cognitive capacities of the mind to overcome the illness by conceptualizing a positive outcome and holding to that view despite degenerative physiological experiences.
As I recall the interview, Dr. Spiegle referred to this concept and method as, instead of the "power of positive thinking," the "prison of positive thinking" because people who were suffering an ever-degenerating physical illness could not address the emotional pain resulting from that degeneration without belying the modality --- the person continued to degenerate despite positive thoughts to the contrary.
This approach then, was considered a mental "trap" which apparently worked to "trap" unresolved grief in the subconscious, which then presumably reduced the mind and body's capacity to resist the assaulting illness. The idea, then, of Dr. Spiegle's approach was to remove that trap for people by allowing them to address their grief and in the process reduce the amount of psychological and biological energy required to sustain the unresolved grief; the energy presumably being diverted for the physical battle being waged against the illness. Such energy could then be directed toward fighting the illness with the prospects, according to the outcome of the study, for substantially greater results.
Although there is no claim by us that Trauma Resolution Therapy can be used to extend life for those people who are fighting physical illness, we do say that TRT is based on a concept that is similar to Dr. Spiegle's ideas --- if a trauma victim is helped to address the previously unresolved emotional pain and loss resulting from the trauma-causing event, regardless of the nature of the event, then these trauma victims will see their full capacities returned as an aid in the particular struggle in which the person is involved; for example, a physical illness, a combat veteran's attempts to come to grips with the experience of a war, a battered spouse's fight against an alcoholic husband's domination, an adult child's battle to overcome the effects of repressed sexual assault episodes, a mother's real or prospective loss of a child to a gang, homicide, suicide, or drugs.
Where Spiegle uses grief resolution and client centered psychodynamic therapies to achieve these task, TRT uses its structure to identify and resolve the trauma. The ETM theory of the biology of this process is described in About/ Comparison - Contrast/ Biology and About/ Theory/ Biology/ Etiology and Etiology Reversal.
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