1overviewstructuredstrategic2

At ETM TRT SHOM’s Core is its meaning to and of “Structured and Strategic Psychodynamic”

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TRT ETM and SHOM combine to provide a Structured and Strategic Psychodynamic approach to the treatment

and management of psychological trauma and PTS for both single and multiple sources of trauma affecting

individuals and systems. The first page in this section introduces, chronicles and distinguishes the more than thirty year history of this approach. This second page overviews the “structural” component as applied to individuals.

The third summarizes the “strategic” element as it is applied to systems.

ETM TRT Structure’s Description ETM and TRT’s structure focuses clinical and human caring upon the crux of the traumatic condition, its etiology, the goal of the

detailed attention being to reverse the etiology. The structure

consists of an ordered approach which directs both the client and clinical procedures focuses upon and to the etiology(s). The ETM component of the model refers to the subsections 1, 2, 3 and 6

below. TRT consists of subsections 4 and 5. And, the six

subsections function inseparably. One needs them all and applied in the order referenced herein and in the ETM TRT Tutorial and Professional Training and Certification Schools for the goals to be achieved.

ETM TRT Structure’s Components 1. Assessment, Evaluation, and Strategy (treatment plan) for

addressing Single and Multiple Sources of Trauma 2. ETM TRT SHOM Etiotropically-Focused Patient, Family,

Organizational Management Education 3. Module required for Application of TRT 4. Core for and of Trauma’s Resolution-Cure is Applied Inside

the “TRT Module” 5. TRT’s Interactive Rules for facilitation and Giving Feedback by Group members 6. Conclusion and Measuring for Trauma’s Resolution

1.a Assessment, Evaluation, and Strategy (treatment plan) for addressing Single and Multiple Sources of Trauma ETM utilizes assessment and evaluation psych-socials supporting standardized government and JCAHO audited documentation to determine the condition to be addressed. When the information provided by the evaluation data connotes or asseverates the presence of traumatic etiology(s) and its prospective causes, which may present from exposure to Alcoholism, drug addiction, homicide survival, sexual assault, other violent crimes, combat, accident, natural disaster, life with a pathological drug user manifesting aberrant behavior, and etcetera, that trauma etiology ‘s address is then incorporated into the treatment plan. Quite often, an individual will have been affected by more than one cause of trauma. That occurrence in ETM TRT SHOM parlance is called Multiple Sources of trauma. Recently (the last two decades), the field of psychology has coined the phrase “complex trauma” in addressing similar and identical conditions. Where the explanations in this section 1.b provide more definition of this phenomenon and its relationship to ETM TRT SHOM’s structured approach, the ETM TRT Tutorial addresses the matter and application of the referenced structure in detail. For a quick overview, when more than one source of trauma exists, all five phases of TRT are applied to one source at a time and until the etiology comprising that source is reversed. Following the formula for addressing multiple sources, TRT's five phases are then applied to any additional sources, but almost always one source at a time. Clients usually exit therapy for a while, however, between the address of the sources. See 1.b for more clarification of Multiple Sources of Trauma. 1.b What are “Sources” and thus “Multiple Sources” of trauma? In the ETM TRT SHOM lexicon, a source of trauma refers to the trauma’s cause. The source can consists of one to numerous incidents of trauma causing behavior. For example, life with a pathologically drug (to include alcohol) using spouse, parent, sibling or child will produce a single source of trauma. Many events stemming from the drug induced aberrant activity will likely present within and from that source. A source of trauma can also be comprised of a single event, for example, as occurs from the homicide of a loved one. Under the ETM formula for addressing multiple sources, TRT applies to all the events comprising a single source before addressing another source. That formula assigns, as a rule, the TRT clinical address to the most recently occurring source, then in declining order until all sources are addressed. When a professional studies ETM Multiple Sources theory and methodology, one finds that it allows for variances in the order and symmetry of the TRT applications. For example, when a dramatic event from one source of trauma, as occurs with the death of a loved, or physical harm to the patient presented during a combat episode, the exigency is managed under the provision of the “Most Pressing Trauma”, anachronized as the “MPT,” methodology. Bringing order to the address of the occurrences of multiple sources of trauma is a fundamental requisite of ETM TRT SHOM’s structure. It is mandatory for facilitating a consistent, congruent, and complete conclusion to the trauma’s resolution (cure).

1.a and 1.b ETM TRT SHOM First Structural Element - ETM Assessment and Strategy Assessment, Evaluation, and Strategy (treatment plan) for addressing Single and Multiple Sources of Trauma

Introduction to and Description of ETM TRT SHOM’s Structural Elements

For more on TRT’s Structure, go to pg2

For more on ETM SHOM’s Strategic application to organizations, go to pg3

For the Introduction to this section, go to pg1

3. ETM TRT SHOM Third Structural Element - TRT Module The “TRT Module” supports TRT’s application to a single Source of Trauma for an Individual.

The TRT Module

The goal of TRT’s application to an individual is to completely resolve that trauma attending a single source. “Complete resolution” is

analogized as a “cure” for psychological trauma and its Behaviorally codified manifestation, “PTSD.” Achievement of that goal depends from the onset on the establishment of a clinical environment which precludes interference by certain exogenous or cultural variables with delivery and thus use of the methodology. In TRT, that environment is called a clinical module. It consist of a set of rules, standards of clinical delivery of the service, and agreements between TRT therapist and patient that when adhered to establish the referenced environment which supports achievement of the noticed goal. Those rules, standards of delivery and agreements preclude: 1. parallel application of psychotropic medications and previous applications of the same even though the patient has withdrawn from that use; in the latter instance, a substantial period of time since the use may support TRT’s application in the current period, but not with the expected complete resolution or “cure” level of results. 2. periodic social drug / alcohol use (not chemical dependency – see “3” next), for example, the patient engages in TRT group on Wednesdays and drinks even only two beers or glasses of wine on every Saturday, and no other alcohol or drug consumption occurs during the week. 3. co-morbidly occurring issues, such as Bipolar Disorder and Chemical Dependency are not addressed within the module simultaneously with the trauma. Should they present parallel or in concert with the source of trauma being addressed or considered at this stage, these additional issues are addressed in separate clinical forums and not in this application of TRT. 4. non pathological social use is treated herein as an exogenous variable that will preclude reaching the highest completion of resolution (cure) level {see above “2”}; pathological drug / alcohol use is addressed as a primary issue of its own and one of the sources of trauma that should be addressed after the patient attains substantial sobriety within the ETM multiple sources definition and instruction for treatment. 5. application of TRT for the purpose of controlling or ending symptoms (meaning DON’T do this) rather than for resolving the trauma, that is, reversing the trauma’s etiologies (there are two); do not apply TRT when or if the person is engaged in a rigorous Behavioral control or modification program parallel to TRT’s application. 6. addressing a traumatic event(s) that occurred before the age of three years (this is not exogenous variable, but a limitation of the therapy; it can, however, possibly and even likely be addressed by TRT if done so within the multiple sources of trauma TRT application

guidelines). 7. traditional application of TRT when a traumatized person is currently being exposed to an ongoing threat to the continuity of life, for

example, as is a person who is (currently) living in the role of a battered spouse; specialized - strategic application of TRT is required in order to first protect the person’s life. 8. psychotropically medicated, social drug / alcohol using, or Chemically Dependent using therapists from attempting to administer TRT.

6. Measuring for Trauma’s Resolution or Cure Pattern One (Trauma Sequela’s First Element) The experience of the event contradicts pre-trauma values, beliefs, images and realities. TRT Phase One Applied to the trauma sequela’s first element Begins the identification of the contradictions by assisting the patient to first describe the experience created by the event. Pattern Two (Trauma Sequela’s Second Element) Following the event contradictions, the related loss and associated emotional responses/outcomes are maintained in memory. Sometimes (often), the most painful aspects of these retentions are suppressed into memory so that during survival a person can still function. TRT Phase Two Applied to the trauma sequela’s second element Helps the patient to identify and reconcile the contradictions to (intrusions upon) identity. He or she may also restore that identity by completing Phase Two. Pattern Three (Trauma Sequela’s Third Element) The maintenance of the emotional elements resulting from the contradictions creates the need for survival protective measures: thoughts and behaviors that serve to dissociate the person from the reality of both the contradictions and the emotional memory retention; in the process of that dissociation, some protective behaviors function contrary to identity, creating additional contradictions for it. TRT Phase Three Applied to the trauma sequela’s third element) Makes it easier for the patient to identify and to understand how the trauma influenced thought and behavior while trying to survive. TRT Phase Four Applied to the trauma sequela’s fourth element) Helps the patient to identify and reconcile contradictions to identity created during survival. Phase Four also assists restoration of identity caused by the trauma. Excepting the summary of the resolution process provided in TRT Phase Five, this fourth TRT phase completes the resolution process. Pattern Four (Trauma Sequela’s Fourth Element) The contradictions to identity (caused by dissociative - aberrant behavior and other activity) produce additional experiences of loss and emotion; they are maintained in memory. TRT Phase Five: A summary of Resolution for this Source of Trauma Phase Five summarizes the four phase resolution process and concludes TRT. The summary reviews the patient's understandings of: 1. Who she or he was before the traumatic event occurred. 2. What happened to him or her because of the event. 3. The differences between who the patient was and what he or she had to do to survive. 4. Who the patient is now that the trauma is resolved. Phase Five's conclusion facilitates the patient's exit from TRT. Theory of Trauma Patterns (a sequela) Correlated to TRT’s Practical Application (to a single source of trauma) Four Psychological Trauma Patterns (Four Trauma Sequela Elements) and TRT's Structured Approach to Resolution (for a single source) Trauma Sequela Theory Correlated to TRT’s Application inside the TRT Module

4. ETM TRT SHOM’s Fourth Structural Element - TRT’s Application From with inside the TRT Module, Apply TRT Theory and Methodology to a Single Source of Trauma

6. ETM TRT SHOM’s Sixth Structural Element - Conclusion and Measurement Conclusion and Measuring for Trauma’s Resolution (Cure)

TRT’s Interactive Rules for facilitation of and Giving Feedback by Group Members (inside the TRT Module)

5. ETM TRT SHOM’s Fifth Structural Element - Interactive Rules

Two perspectives hallmark the structure comprising TRT’s interactive rules: 1. A patient’s/clients rules for giving feedback when TRT is applied in group address of trauma, and 2. The facilitator’s rules for applying TRT in either individual or group clinical environments. In both applications, the guidelines are engineered to focus all human caring and its quality upon the

trauma’s etiology pertaining to the source of trauma being addressed. Moreover, the application is

provided, as shown here graphically, within the TRT module. It enhances the capacity of the focused-

caring to its highest standard of influence, enabling individuals to exceed what otherwise they would

expect from themselves or others. The outcome of this directed method, which is called Etiotropic

Incremental Fusion Induction, is therapy that functions akin to the use of a laser’s address of etiology, as opposed to the more generalized or broad brush approach that attends free association (from analysis), Person Centered Therapy, or say for example, exposure therapy. The specific rules and their rationales are studied and agreed to by all clients before entering TRT’s

treatment application. When the patient leaves the TRT setting, the method is left there and the patient returns to standard interactive processing that attends traditional so called Person Centered Therapy discussions and so forth . Importantly, however, Rational Emotive Therapy (RET) and the like emotional and intellectual control constructs do not function congruously with simultaneous application of TRT,

even when applied in different settings (within the overall treatment regiment). These interactive rules for facilitation and group member interaction and how to use them are described in detail in the ETM TRT SHOM Professional Training and Certification Manual, the ETM TRT Tutorial (online), and for patients in the booklet Giving Feedback in TRT. Both facilitator and patient educational materials strengthen the ETM TRT structured approach to psychological trauma’s complete resolution (cure) and its remedy for Post Traumatic Stress (PTS).

ETM, through TRT’s application, ascertains trauma’s complete resolution or not of each element of the

traumatic sequela (the previously referenced four patterns) as the patient progresses through it. If the

resolution is not completed fully for a particular sequela element, the patient will not progress to the next one. Because much of the application of TRT engages the patient in written description of the trauma’s etiology and its reversal, the process of resolution is naturally demonstrable. Nevertheless, ETM’s measurement of the

completeness or no of trauma’s resolution is codified in its documentation, which formats can be found in both the ETM TRT SHOM Professional Training and Certification Manual and within the ETM TRT Tutorial. ETM’s measurement of trauma’s complete resolution focuses not upon the ending of post-trauma behaviors, but upon the differences between pre trauma existential aspects of identity and post trauma elements of the same. Generally speaking and in the end, that is, simplifying, ETM’s measurement of the efficacy of TRT’s application shows to the patient, therapists and any third party observer at least and primarily three perspectives, albeit they are detailed (within the clinical setting) for thoroughness: 1. Who the person was before the traumatic event occurred. 2. Who he or she became during the event’s occurrence and aftermath. 3. Who he or she is now that the trauma has been resolved. The resolution process and measurement of each stage’s completion (for the source of trauma being addressed) is documented in writing as a part of clinical charting of patient progress and correlated to the goals established at the initial treatment planning activity. When both patient and facilitator (Certified ETM TRT Therapist)

agree that the trauma for this source has been completely resolved, the patient exits the TRT clinical process. If there are additional sources of trauma discovered during the application of ETM TRT SHOM’s structure, the patient is apprised of them (it) and encouraged to address them (it) at a later date. The patient then exits this application of ETM TRT until such time that he or she wishes to address the other source(s) of trauma.

2. ETM TRT SHOM Second Structural Element - Etiotropically-Focused Education ETM TRT SHOM Patient, Family, Organizational Management Etiotropically-Focused Education

Etiotropically-Focused Education

“Etiotropically-Focused Education” means that all educational materials didactically define psychological trauma, post-traumatic stress disorder (PTSD), and ETM TRT SHOM’s theories and applications (remedies) in terms of their individual and systemic etiologies and reversals. Thus, education in ETM TRT SHOM, whether on the individual or system (families and organizations), focuses on the influence of a traumatic event or series of events (multiple incidents and sources of trauma) on individual and systemic identities. Significantly, considerable attention is accorded distinctions between the trauma’s influences and its resolution by didactic-styled education on identity as opposed to behavior. That is, the

education reinforces the goals of resolving (curing) trauma, as opposed to teaching affected people to cope with it (the Behavioral or Cognitive Behavioral approach which is the identification and attempted, but almost always whack-o-molic-styled and -outcomed psuedo-control of PTSD symptoms). Three coordinated (for therapists, organizational treatment and crisis managers, and patient) educational levels comprise the Etiotropically- Focused curriculum. They are: 1. ETM TRT SHOM Professional Training and Certification which support ETM TRT SHOM Therapists and Managers; included are o The ETM TRT SHOM Professional Training and Certification Program School o The ETM TRT SHOM Professional Training and Certification Program Manual o The ETM TRT (online) Tutorial 2. The TRT Patient Educational Program; it is comprised of nineteen pamphlets and booklets which provide patients/clients both theory and

instruction for completing all applications of TRT with the coordinated facilitation by a Certified ETM TRT SHOM clinician. 3. The ETM TRT SHOM Management Program for implementation within and to crisis management organizations, also referring to application to communities.