Here's how to use the Glossary.

1. From within the individual chapters making up the ETM Patient Education Program, click the Glossary buttons that follow italicized words.
• A JavaScript enabled window overlays your reading position to display the selected term's additional meaning.
• Return to your original place in the text by closing the Glossary window (click on either the icon in the upper left corner - then "Close" - or click on the "X" in the upper right corner).
2. From the Patient Education Program's main menu, enter the Glossary directly; select a term in the navigation frame on the left and the term's meaning will present in the frame to the right.

Trauma

In this glossary, trauma usually refers to "psychological" as opposed to "physical" trauma. Generally, where physical trauma refers to direct physical damage to the body, for example, an injury or trauma to one's legs or arms that occurs during an accident, combat or criminal assault, "psychological" trauma refers to event-induced changes to one's psychological management system. When referring in the ETM Patient Education Program to physical trauma, it will be specifically identified as such.

As you proceed through the ETM education chapters, "psychological trauma's" definition will be accorded much more detail.

ETM (Etiotropic Trauma Management)

Etiotropic in "Etiotropic Trauma Management" means that the helping approach addresses (clinically and managerially) psychological trauma at its etiology.  "Etiology" is a medical term that refers to the source or cause of a disease or problem.

Where psychological trauma is the concern, its etiology is made up of the contradictions to identity (values, beliefs, images, and other realities) caused by the event. The contradictions are then maintained or otherwise stored in memory. The memory retained contradictions then divide pre traumatic event from post traumatic event identity. Thus, psychological trauma etiology consists of both the contradictions to and divisions of identity.

To make the concept of "Etiotropic" clearer through comparison, "etiotropic" stands in contrast to Nosotropic or symptom-focused methods. "Nosotropic" is a medical term that refers to methods that focus upon a problem's or disease's symptoms, as opposed to the etiotropic approach that focuses on etiology/cause. Where psychological trauma is the problem or disease, its symptoms are behaviors that function apparently abnormally from what they would be absent the trauma.

The etiotropic and nosotropic models have different goals. When a nosotropic approach to psychological trauma is administered, it wants to help you to identify and correct thought and behavioral changes or symptoms brought about by the trauma's etiology. In contrast, the etiotropic method helps you to identify and reconcile the changes to identity forced by the event.

Identity

The "Identity" sundered by the traumatic event and focused upon by the etiotropic method refers to an individual's values, beliefs, images, and related reality. This aspect of identity serves an individual's psychological make-up akin to the way that threads of a fabric serve the weave of the cloth. That is, values, beliefs, images and other realities comprise the warp and woof of an individual's being. Because these threads, or values, beliefs, images, and other realities draw their importance to the person from their existences within that person's psychology as established (foundational) elements, they are referred to in ETM language as "existential" identity. This identity relates ontology or being, as opposed to the identity discussed next which relates to activity.

That action-oriented identity is also  influenced by trauma. This other identity, in ETM parlance called "operational identity," relates primarily to the psychological management operations that help an individual to proceed through day-to-day functionings, to survive during very difficult times, to analyze one's Self and environment, to plan life, and to choose, form, or otherwise alter the foundational or existential elements of identity. Referring to those functions, operational identity is also said within ETM language to provide an individual with the abilities to feel, to think analytically (discerning various values and beliefs), to act, to care, to use intuitive capacities, and to protect and promote one's self.

In the patient educational chapters regarding nearer-term trauma, trauma's influences on operational identity are not a focus of the nearer-term trauma resolution process because those influences are not demonstrable when the trauma is addressed early (within approximately 90 days). Consequently, "identity" refers (in the nearer-term chapters) to "existential identity," emphasizing one's values, beliefs, images and reality.

For more explanation about trauma's effects on existential and operational identity, see the description of the trauma's influence (below) under "Sequelae" and "Additional Explanation of the Traumatic Sequelae."

Nearer- and Longer-Term (Traumatic) Experience

"Nearer-term experience" refers to experiences resulting from traumatic events that have occurred within the fairly immediate period, for example, within the past (approximate) 90 days. "Longer-term experience" refers to experience of traumatic events or series of events that have happened at least after 90 days; "long-term trauma" usually refers to events or series of events that occurred in past years, or even decades ago.

Sequelae

"Sequelae" refers to the causal, consequent and sequitur elements comprising an ordered series of related happenings. In this use, they are the traumatic event's attack upon and disruption to identity (forming the initial element of the sequelae), causing consciously and unconsciously experienced emotional pain (second element), which then interferes with decisionmaking (third element), producing trauma-altered and often additionally identity-contradicting behavior (fourth element), and culminating in incapacitation of the Self's ability to correct or otherwise intervene successfully upon the sequelae.

Sequelae: additional information about the traumatic sequelae

Contradicted Identity

Trauma attacks an individual's identity. It is made up of the most important things one values and believes, and the images one has of Self, relationships, family and environment.

The attack creates for that identity the opposite of that which comprised it before the attack (event) occurred. For example, when an event-caused injury results in the incapacitation of related body functionings, the incapacitation or disuse of the otherwise ordinary functions is the opposite of that enjoyed before the event occurred. To take another example, the death of a loved one, friend or close associate sustains myriad opposites for identity; the relationship and all of its meaning to the surviving individual no longer exist.

In ETM parlance, these trauma-induced "opposites" to the old (or pre-trauma) identity serve as unreconciled contradictions and loss. Both the contradictions and loss then depreciate the identity until they are reconciled.

The effects of the attack upon and contradictions to identity can carry over to the way that a person functions. There are 4 elements to this trauma-altered functioning. The affected elements include emotional response, analytical (decisionmaking) impairment, apparently destructive behavior, and Self-corrective/management incapacitation.

Emotional Response

In the first functional change to trauma-contradicted identity, it can bring about (both obviously and sometimes unknowingly) radical emotional experience. That is, the depreciations to identity causes conscious and unconscious experiences of grief. And those experiences can be very painful; they include (but are not limited to) shock, fear, terror, hurt, anger, shame, guilt and great sadness -- mourning.

Analytical (Decisionmaking) Impairment

When this pain and emotional suffering occur, they can also and often do impair analytical (decisionmaking) efforts. Where they require unfettered use of the brain's ability to reason in the abstract, the simultaneous emotional processing of grief by other parts of the brain encumbers the reasoning efforts. And this encumbrance can occur even if the pain is affecting the individual unconsciously: the person is unaware of the trauma's emotional effects and subsequently unaware of the trauma's influence on reasoning.

Destructive Behavior

Adverse influences upon decisionmaking can then impede one's ability to behave as ordinarily expected. These trauma-induced changes in behavior are described in detail in the professional side of this information system addressing long-term trauma, but not here because they usually do not manifest themselves over the short term. Thus they are not the focus of this clinical approach to near-term trauma. Nevertheless, if the trauma's disruptions to identity are not addressed and the subsequent affects on decisionmaking ended, the trauma-induced untoward behavior can and may likely continue until the emotional experience has run its course and the contradictions and loss to identity are reconciled.

Self-Corrective/-Management Incapacitation

Absent the immediate address of the trauma, its adverse effects on identity, emotion, decisionmaking and behavior can become more complicated -- the effects compound themselves. That is, the trauma-induced influences upon identity, emotion, decisionmaking and behavior can unknowingly prevent Self-correction of the same traumatic sequelae. Thereafter, the trauma-induced behavior (fourth) element of the sequelae) can also function counter to identity, repeating the sequelae by creating new contradictions to (opposites for) identity, additional emotional pain, greater interference with decisionmaking, and then reinitiating the sequelae over and over by continuing to produce more identity-contradicting behavior. To summarize this complication brought about by the trauma's compounding effect, because of the sequelae's impediments to Self-corrective management, the sequelae can be turned into a self-perpetuating, degenerative, and chronically destructive traumatic cycle.

Source of Trauma 
(also see next "Traumatic Experience, Incident, Event"
or "Series of . . . ")

A "source of trauma" refers to a particular cause of a traumatic event. For example, combat or series of combat events can be a source of trauma. A physical assault or series of them occurring as a result of a marital or parental relationship can be a source of trauma. Disease, a criminal event, or chemical dependency can also be causes of trauma; they are then sources of trauma.

A person can have been affected by multiple sources of trauma if exposed to more than one source. For example, an individual who has been affected by both combat resulting from employment as a police officer, and also by chemical dependency, would have been affected by 2 sources of trauma. TRT uses a special formula (described in ETM Patient/ Longer-Term/ Theory/ How to Apply TRT to Multiple Traumas) for addressing multiple sources of trauma.

Traumatic Experience, Incident, Event or Series 
of Traumatic Experiences, Incidents or Events
(See also above "Sources of Trauma")

"Multiple experiences or incidents" of trauma, although they could be viewed as sources of trauma, are looked at in ETM as a traumatic event or series of events making up a source of trauma. For example, a person affected by combat from war might have been exposed to myriad traumatic episodes or combat events all occurring within the one source. All of the combat episodes occurring during that war make up the one source. Sometimes, however, a single traumatic experience, incident or event, like a violent crime episode, also constitute a source of trauma.

TRT uses a special method (described in ETM Patient/ Longer-Term/ How To Do TRT/ How to do TRT Phase One) for addressing multiple experiences or incidents occurring within the same source of trauma.

Trauma Resolution Therapy (TRT)
Applied to Nearer-Term Trauma

TRT  provides a structure through which the client and counselor may discuss the event and its effects on client identity. When applied to nearer-term trauma, this "structure" is comprised of  six steps. Through their directions and order, the help both client and counselor to maintain their combined focuses on the primary goal of resolving the trauma, reconciling the trauma's effects upon one's identity.

The idea of a "non structured" as opposed to "structured" approach to trauma's resolution stems out of the difference between helping models that call for an individual to, respectively, discover (primarily) on his or her own the myriad effects of a traumatic experience on one's self, versus the client's being more actively assisted in that discovery by the counselor. Although non structured methods have considerable value, for example, proceeding without direction through grief resolution or without direction within a protracted psychotherapeutic process may be methods that help many people (in professional parlance these two examples are called "psychodynamic" models), there is considerable documentation within the scientific literature that shows that the non structured (psychodynamic) helping methods allow both patients and therapists to become overwhelmed during the helping process by an "information overload." It often accompanies an individual's attempts to discern the trauma's substantial effects on identity (see Professional/ About/ Bibliography: Scrignar, 1988).

When those attempts involve painful emotional experience of the information, as they almost always do when recounting prospective and real tragedy, the overwhelming informational overload effect can have insurmountable consequences for addressing the trauma successfully by both counselor and patient. In fact, and as the bibliography shows, many professionals abandon the so called "psychodynamic" model all together because of this "informational overload" or "overwhelming" effect.

In contrast to the non structured methods, the structured approach is intended to help both the patient and therapist to maintain their joint focuses upon the resolution goal by applying order and direction to the discovery effort, but at the same time provide enough flexibility within the structure to encourage the user of TRT to experience substantial self-discovery of the event's influences. Furthermore, if the order and direction are offered in conjunction with empathy for the patient's need and capacity to identify, experience, express and understand the accompanying emotional consequences of the trauma, then the structured approach would presumably make it easier to assimilate and process the considerable information stemming from the trauma's effects on an individual's identity. Through the order and definition, the structure precludes both the "information overload" and subsequently "overwhelming" effects. Such are the intended benefits of TRT's 6 step (structured) approach.

Restating for emphasis, the primary objective of the TRT structure (TRT's six step application to near-term trauma) is to provide an ordered and thus hopefully simpler means of processing the information required to reconcile near-term trauma's influences on identity.

What TRT is Not

You might benefit from knowing what TRT is not, or what it does not try to do. In that regard, when attempting to achieve the goal of resolving the trauma, TRT would not and does not try to teach you or anyone else how to live life, cope with it, or how to be a better employee or citizen. Nor does TRT try to make you more successful in relationships, etc.

This does not mean that TRT counselors do not care about these things or about helping you to achieve them, should that be your interest. Rather, ETM's theory holds that if trauma-affected clients can be assisted to resolve their traumas, then those individuals are more than likely capable of achieving, by themselves, those additional goals. And if some individuals are not so capable, then additional clinical assistance (and possibly from the same the clinician who administers TRT), self help books/groups, religious-/ spiritual-based programs, and the media through talk-shows and so forth are abundantly available (in some cultures) to help in the additional pursuits.

Restoration of Identity

"Restored identity" suggests that the identity identification (of trauma's effects) and reconciliation (resolution) efforts described in this and the other sections return or otherwise reconstitute identity to the way that it was before the event occurred. But because some loss is irreplaceable, for example, the loss of a loved one, the identity that includes the relationship with that loved one may only be restored in part.

But regardless of the perpetual loss that accompanies loss of loved one, the restoration effort with TRT can still take into account these obviously immutable changes to the person's life undergone as a consequence of the event; the changes can be adapted to.

In addition to this glossary, you may also find under the chapters of the professional education menu additional explanation of the psychological and neurological aspects of both existential and operational elements of identity, their influences by trauma, and the restoration process.

Applying TRT in Individual and Group Therapy

Some counselors conduct TRT in "individual" sessions: only one client and the counselor meet. Other counselors employ TRT within "group" sessions; they refer to a clinical process where more than 1 client and the counselor meet to discuss the traumatic experience.

Myriad factors determine a counselor's choice of individual or group resolution models ("model" = clinical helping method). For example, the degree of trauma, the number and relationships of people affected by it, the practicality of the counselor's and clients' logistical capacities to, respectively, facilitate and participate in the resolution effort, all go into the decisionmaking process regarding the use of either the individual or group model. Sometimes, both models are used in concert.

With the intent to simplify TRT's application, when this education program refers to meeting with a counselor during "TRT sessions," the reference can be to either "individual" or "group" sessions, depending on a particular (your) counselor's choice of models used to administer TRT.

TRT Imagery

To facilitate identification, experience and expression of feelings, TRT incorporates a special imagery technique. Imagine if you can a vase, closed at its top and filled with a clear liquid. Add to the creation pockets of air or large bubbles. They move slowly from the bottom of the vase to its top where, when it is reached, the spheres return to the bottom. The vertical cycle is also perpetual. Most importantly to this imagery, the size of each bubble and the construction of the vase are such that only one air pocket at a time may make its way to the top before returning to the bottom.

Now, imagine that the vase is like you and that your feelings are like the air bubbles moving within the liquid. You might wish to assign different colors to each of the feelings/bubbles. For example, a bubble intended to represent "fear" to you might be imagined to be painted green; anger might be assigned the color "red." Also in this analogy, it is agreed that your feelings can only be identified when they rise to the top of the cylinder. Thus, you identify one feeling at time and then only for a while until the feeling passes into its rrotation back toward the bottom of the vase; another feeling or pocket of air then rises to the top, displacing the former consciously experienced emotion.

You probably have the idea. If not, your counselor can and will clarify the technique for you.

Now let's use the vase and floating air bubble analogy to enhance the emotion-identification, -experience, and -expression exercise. That is, let's use the analogy to strengthen your ability to know and experience feelings stemming from and related to the event.

Supportive Reading: Giving Feedback in TRT

"Giving Feedback in TRT" is written primarily to people who are participating in longer-term trauma resolution clinical activities where interaction frequently occurs with other trauma victims in group therapy styled process.  Although you may not be participating in group (and longer-term) clinical activity,  "Feedback" should nonetheless help by strengthening your understandings of the philosophy and methodology that underpin TRT's structure wherever it is used.

If you are addressing trauma within a group process, your reading of "Giving Feedback" would not just be important for you, but it would be imperative if the TRT group process were to achieve its goals of helping all group members. To review the referenced chapter, look to Patient Education/ Nearer-Term/ Theory/ Giving Feedback in TRT.

Transition Between Work/Living and Clinical Environments

Clinical settings are different from work/living ones. Transition is needed to accommodate the change from the former to the latter, and then back again. This section considers the transitional needs and  processes.

Generally speaking, work/living environments use interactive concepts and methods that respond well to socioeconomic competitive demands. They require high behavioral performance for success in achieving economic and many social service goals.

The trauma resolution environment's concepts and methods on the other hand are experientially-based. Their focuses on the experience of emotion, coupled with their reconciliation of trauma-damaged identity and resolution of loss, require neither competitive interactions nor high performance behavior.

To facilitate the transition between the trauma resolution and work/living worlds, grief resolution and Client Centered methods support beginning discussions of one's subjective experience of, and especially to include one's emotional response to, the trauma-causing event. These models emphasize that your feelings are the most important focus of the discussions.

A third supportive model, cognitive behavioral therapy, serves a more objective transitional function. Comprised of the educational materials that you are reading now and also consisting of the rules for participation in the clinical process, cognitive-behavioral methods assist people to analyze, evaluate and decide how to use the clinical world to best interface with the work/living one. The referenced cognitive-behavioal elements allow and encourage the prospective TRT user to inspect the clinical process for compatibility before, during and after TRT's application. This objective analytical activity is intended to facilitate the needed transition between the work/living and clinical domains and the predominant methods used to manage each.

Feelings (expanded discussion)

Feelings are described in the referencing (to this glossary) chapter (Nearer-Term/ Theory/ "TRT" as occurring in groups that contain like emotions or other manifestations. This discussion considers some of these additional experiences.

In the first group, "shock" is often manifested as the feeling of "numbness," "disorientation," or state of "disbelief." You may not be able to identify any feelings, including shock or numbness; but you may easily recognize thoughts where you say to yourself or others "I can't believe that this event happened" or "is happening." The feeling underlying this thought is inevitably interpreted as the emotional state of "shock."

In the second group, fear expands as horror and terror. Psychological paralysis, functional incapacitation, or even thoughts of aggression may overlay these feelings.

Embarrassment can expand to shame: social opprobrium.

Anger expands to rage. Thoughts overlaying the feelings of anger and rage also tend toward agression, especially revenge. Where you may not be able identify the feeling of anger or rage, you may likely know thoughts where you want to cause someone or something considerable damage.

Hurt may masquerade as painful vulnerability: there seems to be no available defense against the emotional destruction. Hurt may also be accompanied by thoughts that say that there will not be an end to the vulnerability.

Sadness can expand to great sorrow, mourning, and grief. At lesser intense occurrences of trauma, "sadness" by itself is most often felt. In response to more intense trauma, sorrow," mourning, and grief can be felt as prospectively overwhelming and also neverending, were it not for the assistance of other people, and for spiritual or religious people, were it not for their beliefs in God.

Neurobiology of Emotional Pain's Influence on Trauma's Resolution

The brain serves as an integrator of all things affecting the organism, including psychological change resulting from trauma. "Brain integration" infers learning.

     Learning is enhanced neurobiologically by emotional pain. The enhancement is a function of the interaction between several brain neurotransmitter systems. The following paragraphs summarize these interactions.

During grief, changes to neuronal synaptic formations (where learning and memory are molecularly enhanced, depreciated, and stored within the brain) brought about by the loss to identity stimulate a host of additional biological brain responses and counter responses. First of these is the opioid response to loss. It is manifested by reductions in opioid neurotransmitter (like the neurotransmitter enkephalin) bindings on synaptic receptors. That failure of enkephalin to bind on opioid synaptic receptors is reported in the literature to be where the deep pain of grief and loss come from. The emotions that you have identified during Phase One are manifestations, including expansions, of the pain resulting from trauma-induced loss.

At the same time that the opioid non receptor bindings are creating emotional pain, the same  system is used to defend the organism against the grief. In this second and countervailing usage, the binding of the endegenous opioid peptide enkephalin on synaptic receptors can create the feelings of shock, numbness, and so forth during the most rapid moments of the  change and following it.

These opioid dual and apparently offsetting interactions create a wave effect for grief. Non receptor bindings manifest as the pain wave. Bindings are experienced as denial, a return to normal.

Here is the most important point of this section. Neurohormonal modulators (like norepinephrine and serotonin) of the alternating opioid bindings and non bindings (experienced as waves of grief and denial), and stimulated by and stimulating the emotion felt by the person in grief, simultaneously assist the brain integrative effort by also facilitating synaptic (adaptive) change underlying trauma-induced psychological changes to identity, the initial locus of the trauma's biological influence on the brain. In this regard, both norapinephrine and serotonin neurotransmitter systems facilitate actions on synaptic structure and functioning underpinning identity and the trauma-induced changes it is undergoing.

Simplifying this important point, the more grief -- emotional pain experienced, the more adaptation to be expected by the synapse underpinning identity. Emotional pain leads to learning. Interference with the experience of emotional pain can prevent learning.

Summarizing, grief has a profound influence on the brain's ability to integrate the trauma. The emotional pain associated with grief facilitates that biological integration. And TRT attempts to ensure that that learning is allowed to go forward without interference. TRT's structure is intended to make that assurance of learning not only tolerable, but meaningful.

As indicated in the body of this chapter, if you are not a neuroscientist, you should not be expected to understand the molecular relationship of emotional pain to learning, and  subsequently to trauma's resolution. However, it is nonetheless the truest explanation of why we (you, your counselor, and me) concentrate on emotion; it is identified, experienced and expressed as each individual requires. And that exercise then strenthens you as you individually want, need and require for the next TRT Phase Two where the analytical work required to fully/completely resolve the trauma occurs.

ETM neurological theory of psychological trauma and its resolution is provided in considerable detail with attendent bibliographical references on the professional side of this Tutorial. Should you decide to read it, good luck.

Confronting Defenses in TRT: Never Do It

You may recall from having read "Giving Feedback in TRT" that TRT group process agreements preclude confrontation of prospective defenses. The TRT principle is that you will need them until they no longer serve a viable purpose, which diminishes as you here the reflections and become more integrated with the other group members. And when the trauma resulting from this event is resolved in TRT Phase, no need will exist for the defenses at all.

In addition, you should know that if someone were to say something to the effect that you were minimizing your experience, such confrontationsare stopped immediately by the TRT counselor. He or she would ask the person providing the interpretation to just share the feelings felt when listening to your story. The person's subsequent identification and expression of those feelings would then end the need to confront any defenses that you might still require.

Interpretation and confrontation of trauma's defenses rarely occurs in TRT. When it does, it's a mistake. One that is intended to be prevented through preliminary education regarding TRT's interactive methods.

Positive Reframing of Loss -- Why TRT Does not use this method

Positive reframing of loss refers to helping methods that assist an individual to look at the bright side of life following the tragedy. The effort is intended to alleviate loss's pain; it may and usually does, at least for a while. For example, if a person were to lose a child through a tragic accident, the helping method might reframe the loss by pointing out that the person still had other children, and they need the parent. If adapted, that view might lift the individual from the pain of the experience of the child's loss.

Regrettably, the adopted philosophy ordinarily must be remembered and then re-employed every time the pain from the loss not identified, experienced and expressed emerges. The pain and actual loss experience then must be continuously suppressed and repressed in order to maintain the positive perspective. A tug-of-war between the conscious positive thoughts and the unconscious painful experience of loss can and does for some people ensue. Great stress can cause the conscious controls (adapted positive view about the loss) to fail, exacerbating the original attack upon the person who lost the loved one.

In contrast, if the loss and its pain are allowed to be identified, experienced fully and expressed as is appropriate (emotionally needed) for the individual suffering the loss/tragedy, then that person need not adapt cognitive controls prematurely (before the pain of the loss and the loss, itself, are reconciled as needed by that individual). Following resolution of the loss/tragedy at individual identity levels, the person can and then may certainly adopt the positive view as he or she realizes it.

The greatest risk attending the use of positive adaptation methods is that those doing the helping may offer the positive suggestion because the loss and accompanying pain is intolerable to the helper. That is, if the person surviving the tragedy would adopt the positive perspective of the loss, then temporary aleviation of the survivor's pain and suffering simultaneously aleviates the helper's painful experience of the same. Consequently and unfortunately, the helping method so applied would and often does serve as an externally imposed barrier to individual experience, reconciliation and resolution of the tragedy.

From the ETM perspective, the tragedy requires resolution at individual ontolgical levels, not at imposed sociocultural ones. "Ontology" means "being." And being refers in large part to existential identity, the locus or etiology of the trauma as it is maintained within the psyche. And for many people, that psychological being is interactive with a spiritual One.

Where the referenced philosophical arguments for or against the address of pain and loss appear debateable, the biological view is not. Loss and its accompanying emotional pain are neurological and endocrinological, that is, naturally occurring, phenomena that contribute to learning. Their substrates (biological neuronal-hormonal structure and functioning) are readily available for review (see the professional side of this web site; "About ETM"). It will show that loss is locused in neuronal synaptic change (learning and unlearning) and it is modulated by neurological and endocrinological systems that are the substrate of painful feelings.

Guilt and Trauma's Resolution

When using TRT's nearer-term application, "guilt" may likely present in either  step 2 or 5. No matter, guilt is treated within the imagery procedure the same as all other presenting emotions. You should find, however, that as the TRT model is followed, the concentration upon (without judgment of) emotional experience and loss mitigates the need for the defensive abstract element of guilt: the client's assumption of responsibility for the tragedy not caused by him or her.

You should also notice that counselors will not attempt to persuade you not to feel guilt about the tragedy. That is, ETM counselors do not as a rule present logical (analytical and cognitive) arguments against assuming responsibility for tragedies not caused. Instead, the counselor's use of the experiential-based TRT imagery should replace the need for such efforts.

In some instances where the experience of guilt does not dissipate, your counselor will ask you directly to identify what you have lost. Upon identification, expression and experience of that loss, the guilt will most likely dissipate.

Levels of Loss

For purposes of summarizing losses in TRT's 5th phase, it emphasizes 3 levels of loss: intrapsychic (personal), interpsychic (relationship), systemic (family or team).

"Intrapsychic" refers to loss to the individual self. For example, losses of self-esteem and self-worth are losses pertaining to the individual. This level is concerned principally with a person's understandings of him or her self. These losses are strictly personal.

"Interpsychic" loss refers to losses shared between two people. The term also describes loss pertaining to that aspect of a person which is used to participate in a relationship. Thus interpsychic losses are also called "relationship" losses. Examples of relationship losses include losses of trust and respect.

"Systemic" loss refers to losses shared by a family, team or other unit. These losses pertain to that aspect of a person that functions as a part of a group. Examples of systemic losses include losses of family esteem and of a role model for members of a group.

Multiple Sources of Trauma (Reviewed through Example)

Lets take an example of the multiple sources of trauma concept. If you had been affected by childhood trauma 30 years earlier, and then war combat 20 years ago, each experience would represent a prospective and likely "source of trauma" for you. In conjunction with your counselor, you would have decided to address one of those "sources of trauma."

Then, you would apply TRT to all of the incidents stemming out of that source until it is completely resolved. Later, you could apply TRT to the other or remaining unresolved trauma, and at any time.

You might like to know that upon completing the resolution of one source of trauma, most people excuse themselves from TRT or other therapies for several months to a year. The patient then returns and applies TRT to the remaining trauma and until it is resolved.