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| Traumatic Incident Reduction (TIR) FAQs |
TIR is a brief, one-on-one, non-hypnotic, person-centered, simple and highly structured method for permanently eliminating the negative effects of past traumas. It involves repeated viewing of a traumatic memory under conditions designed to enhance safety and minimize distractions. The client does all the work; the therapist or counselor offers no interpretations or negative or positive evaluations, but only gives appropriate instructions to the client to have him view a traumatic incident thoroughly from beginning to end. Hence, we use the term "viewer" to describe the client and "facilitator" to describe the person who is helping the client through the procedure by keeping the structure of the session intact and giving the viewer something definite to do at all times. The facilitator confines herself simply to giving a series of set instructions to the viewer; she offers no advice, interpretations, evaluations, or reassurances - but rather offers sincere and appropriate acknowledgement as well as unconditional positive regard.
The viewer locates a specific trauma that he is interested in working on -- one with a specific, finite duration. Then he treats the incident like a "videotape". First, he "rewinds" it to the beginning, then "plays" it through to the end -- without (usually) talking about it while he is viewing it. After he has viewed it, the facilitator then asks him what happened, and he can then describe the event or his reactions to going through it.
After the viewer has completed one review (and one description), the facilitator has him "rewind the videotape" to the beginning and run through it again in the same fashion. The facilitator does not prescribe the degree of detail, sensory modalities, or content the viewer is to get on each run-through. The viewer will view as much as he is relatively comfortable viewing. After several run-throughs, most viewers will become more courageous, contacting the emotion and uncomfortable details more and more thoroughly. Typically, the viewer will reach an emotional peak after a few run-throughs and then, on successive run-throughs, the amount of negative emotion will diminish, until the viewer reaches a point of having no negative emotion about the incident. Instead, he becomes rather thoughtful and contemplative, and usually comes up with one or more insights -- often major -- concerning the trauma, life, or himself. He displays positive emotion, often smiling or laughing, but at least manifesting calm and serenity. At this point, the viewer has reached an "end point" and the facilitator stops the TIR procedure.
A TIR session is not ended until the viewer reaches an end point and feels good. This may take anywhere from a few minutes to 3-4 hours. Average session time for a new viewer is about 90 minutes. Average total session hours to eliminate PTSD symptoms is 15 (usually about 10 sessions).
It is highly effective in eliminating the negative effects of past traumatic incidents. It is especially useful when:
a. A person has a specific trauma or set of traumas that she feels has adversely affected her, whether or not she carries a formal definition of "PTSD".b. A person reacts inappropriately or overreacts in certain situations, and it is thought some past trauma might have something to do with it.
c. A person experiences unaccountable or inappropriate negative emotions, either chronically or in response to certain experiential triggers.
TIR has been in use since 1984 in something similar to its current form. It has undergone minor modifications over the years, mostly in the interests of greater simplicity and teachability.
In the great majority of cases, TIR correctly applied results in the complete and permanent elimination of PTSD symptomatology. It also provides valuable insights, which the viewer arrives at quite spontaneously, without any prompting from the facilitator and hence can "own" entirely as his own.
By providing a means for completely confronting a painful incident, TIR can and does deliver the positive gain a person would have had if he had been able to fully confront the trauma at the time it occurred.
a. Are psychotic or nearly so. TIR is most definitely an "uncovering" technique and hence is not appropriate for such clients.b. Are currently abusing drugs or alcohol. TIR is not useful for detoxifying clients. A client should be stably off drugs or alcohol for two months before starting TIR. However a special TIR program addressed to drugs can be very effective in preventing recidivism.
c. Are not making a self-determined choice to do TIR. For TIR to work, the client has to really want to do it. If the client is there under duress (e.g., on court order) or trying to please someone, TIR will not work. It may be possible, however, to explain to a reluctant client what TIR is and "educate" him on the idea of doing it. But the client must be well-motivated before starting.
d. Are in life situations that are too painful or threatening to permit them to concentrate on anything else, such as a TIR session. If the client is afraid of being murdered, or is preoccupied about the possibility of having cancer, or engaged in constant fighting with her spouse, such issues/situations would have to be addressed first, by in-vivo behavioral interventions or other means, before the client will be ready to do TIR.
e. Have no interest in or attention on past traumas. A general rule is to follow the interest of the client. If, when the client isn't interested in looking at past traumas, you address what the client is interested in looking at, the client may then become interested in looking at past incidents.
Since the TIR technique is completely client-titrated, client-timed, and non-forceful, clients will protect themselves if they are getting in too deeply by simply discontinuing the procedure. Hence there are no known cases of negative effects from properly facilitated TIR. If the facilitator tries to force the client to run an incident, TIR may cause a considerable (though temporary) upset. But one of the cardinal rules of facilitation is never to force the client and always to follow the client's interest. Since we follow the client's interest at all times, we don't encounter "resistance". If the client resists, we consider that we are not addressing the material the client should be looking at, at present.
TIR grew mainly out of the work of Carl Rogers and Sigmund Freud. In "Two Short Accounts of Psycho-Analysis", Freud describes a method to resolve sequences of similar traumas:
"What left the symptom behind was not always a single experience. On the contrary, the result was usually brought about by the convergence of several traumas, and often by the repetition of a great number of similar ones. Thus it was necessary to reproduce the whole chain of pathogenic memories in chronological order, or rather in reversed order, the latest ones first and the earliest ones last; and it was quite impossible to jump over the later traumas in order to get back more quickly to the first, which was often the most potent one."
Freud later abandoned this technique in favor of free-association. It seems likely that (in retrospect) the reason it didn't work well was the degree of "interference" the analyst introduced by interpretations and by forcing the analysand in various ways, and the lack of a systematic, repetitive approach to achieving the desired anamnesis.
The work of Carl Rogers was invaluable in providing rules -- such as a proscription against interpretations and evaluations -- and an overall viewpoint of respect for the authority of the client, both of which tend to help create a safe environment for running TIR.
Although Rogers first described his work as "non-directive" and later as "person-centered", it seems obvious that "non-directive" doesn't mean the same thing as "person-centered". "Person-centered" describes the attitude of respect for the superior authority of the client and the concomitant rules for not stepping on the client's reality. "Non-directive" means the client gives structure to the session. These two are actually orthogonal to each other. For instance, classical, free-associative psychoanalysis is non-directive, but not person-centered. Cognitive and behavioral therapies are non-person-centered (because the therapist disputes the reality of the the client) and directive (the therapist determines the agenda). Rogers is non-directive and person-centered. TIR falls into the fourth category: person-centered and directive.
Freud based his work on the theory that in order to recover from past traumas, it is necessary to achieve a full anamnesis (recovery of lost memory). He never adequately explained why anamnesis was necessary, however. here is proposed a person-centered explanation.
A trauma, by definition, is an incident that is so painful, emotionally or physically, that one tends to flinch away from it, not to let oneself be aware of it, or, in Freud's terms, to repress it. It is the flinch and not the "objective" description of the incident that makes it a trauma. Hence an event that is challenging and exciting for one individual may be traumatic for another. The one for whom it is a mere challenge is able to "stay with it" and master it; the one who experiences it as a trauma is not.
By definition, then, a trauma contains repressed material. Contained in a trauma, too, is one or more intentions. At the very least, there is the intention to push it away, to blot it out, to repress it. And there are usually other intentions as well, such as the intention to fight back, to get revenge, to run away, or (quite commonly) the intention to make sure that nothing like this incident ever happens again.
From a person-centered viewpoint, an intention is simply the most proximal, the most subjective part of an activity. If I intend to win a race, from that intention flows all the means I use to win it: the various movements of my muscles, leading to forward movement of my body and ultimately to pulling ahead of the other racers, etc. In other words, the intention is the beginning of the action, and the consequences flow outward to become manifest physically. An activity continues so long, and only so long, as the corresponding intention exists. That means that for each ongoing intention, there is an activity (at least a mental one) that continues as part of the here and now.
In fact, people subjectively define time in terms of the activity they are engaged in. Objectively, time is a featureless continuum. But subjectively, time is divided up into chunks, "periods" of time. For every given activity (and for every given intention) there is a corresponding period of time, and so long as you have an intention, you remain in the period of time defined by that intention (and activity). Holding onto an intention holds you in the period of time that commenced with the formulation of that intention. There are only two ways of ending an intention:
1. Fulfilling the intention, whereupon it ends spontaneously. You can't keep intending to win a race after you have won it.2. Unmaking it. Even if you don't fulfill an intention, you can decide not to have that intention anymore and cause it to end. This, however, requires a conscious decision. You have to be aware of the intention and why you formed it.
But what if the intention is buried in the middle of a repressed trauma? In this case, neither condition (1) nor (2) can be satisfied, and the intention persists indefinitely. The person remains in the period of time defined by that intention, i.e., the person remains in the traumatic incident! The incident floats on as part of present time and is easily triggered (i.e., the person is easily reminded of it, consciously or unconsciously).
The only way a person can exit from that period of time (and from the intentions, feelings and behaviors engendered by the trauma) is by confronting the incident, whereupon one can see:
a. What intentions were formulated at the time of the incident.b. Why they were formulated at that time.
Then, and only then, one can satisfy condition (2), above, for ending an intention, and one can let go of the intention. Without a thorough anamnesis, condition (2) cannot be satisfied.
Up until recently, there have been two main approaches to PTSD:
Some therapists give their clients specific in vivo methods for counteracting or coping with the symptoms of PTSD. These clients learn to adapt to, to live with, their PTSD condition. They learn, for instance, how to avoid situations that trigger them, how to distract themselves when they are triggered, how to rebreathe in a paper bag to avoid hyperventilation. Women who have been assaulted or raped may take self-defense classes.
Others encourage their clients to "release their feelings", to have a catharsis. The idea is that past traumas generate a certain amount of negative energy or "emotional charge'", and the therapist's task is to work with the client to release this charge so that it does not manifest itself as aberrant behavior, negative feelings and attitudes, or psychosomatic conditions. This notion, derived from Freud's libido theory, is an "hydraulic" theory of psychopathology. Charge generated in past traumas supposedly exerts a pressure towards its expression. If not expressed in affect appropriate to the experienced trauma, it must express itself in inappropriate ways. Therapists espousing this theory use methods such as implosion therapy, psychodrama, and focus groups to help the client release the charge.
Coping methods and cathartic techniques may help a person to feel better temporarily, but they don't actually improve the client's stability. Instead, what you get is a "Chinese Dinner Syndrome": clients feel better temporarily after coping or having a catharsis, but the basic charge remains in place, and shortly thereafter they are hungry for more therapy. In cathartic work, the presence of an affective discharge indicates that the client has contacted a past trauma and "worked it through", but not that she has eliminated it. Coping strategies don't provide a permanent solution either. A week, a day, or an hour later, some random environmental stimulus such as a loud noise or the sound of helicopters can trigger anew the same charge.
TIR could be regarded as a kind of "exposure technique", in that, as with exposure, the point of TIR is to help the viewer become more aware of the traumatic incident. Exposure theorists rely on a desensitization model, in contradistinction to TIR's person-centered model, but the two techniques converge on the need for repeated exposure to the trauma.
(Editors note: "Direct Therapeutic Exposure" is a tool long used by the VA and others to treat PTSD. Clinical research by Dr. Lori Beth Bisbey has shown DTE to be more effective than no intervention at all, but not as effective as TIR.)
There are certain features of TIR that do not form part of the DTE approach, however:
a. TIR embodies the concept of an end point, with certain particular characteristics. DTE's "end point" occurs when the client feels little or no distress as a result of confronting the incident. In TIR, we usually await the onset of positive emotion, not just the absence of negative emotion. Plus there are the other components of an end point, as described in TIR: insight, extroversion, and frequently the expression of what the intention was that the viewer made in the incident.b. TIR is stricter about not permitting any input from the facilitator concerning detail or content of the incident. In DTE, the therapist reads a script to the viewer, and the viewer goes through at the therapist's pace. In TIR the viewer confronts only what she feels comfortable confronting on any particular run-through. Exposure in TIR is client-titrated, rather than therapist-titrated.
c. In TIR, we endeavor to reach an end point in a single session; in DTE, working on a given incident typically takes a few sessions.
d. TIR includes specific ways of checking for earlier and similar incidents that might be triggered when running through a later one. Thus, a sequence of incidents can be traced back to its root in a single session and resolved.
e. When the client suffers from unaccountable uncomfortable feelings, emotions, sensations, psychosomatic pains, and unwanted attitudes, but there are no obvious major traumas in evidence that could be addressed, a type of TIR called "Thematic TIR" can be used to trace these "themes" back to the incidents they came from and eliminate them, also in a single session.
More recently, proponents of certain techniques have claimed that they can permanently eliminate the effects of PTSD. Charles Figley and Joyce Carbonell at Florida State University have recently studied these techniques -- TIR, Francine Shapiro's Eye Movement Desensitization and Reprocessing (EMDR), NLP's Visual / Kinesthetic Disassociation (VKD), and Roger Callahan's Thought Field Therapy (TFT) -- to determine what the active ingredient was. Although their study wasn't designed as an outcome study, it suggests that all four techniques can be effective.
Like TIR, EMDR and VKD contain elements of exposure, but they also contain other elements, such as inducing eye movements or producing other repetitive, bilateral stimuli (as in EMDR) or creating a deliberate state of dissociation (as in VKD). Otherwise they differ from TIR in the same ways that DTE does. TFT is utterly different from TIR, relying, as it does, on manipulating acupuncture meridians.
As mentioned above, Charles Figley and Joyce Carbonell have studied four different approaches to trauma resolution: TIR, EMDR, VKD, and TFT. In their view, all are very effective. However, also as noted above, their study was not designed as an outcome study.
The largest controlled study to date (57 subjects), completed in February, 1995, compares TIR to DTE and waiting list controls, using a variety of test instruments, on crime victims with PTSD. Waiting list controls showed no significant improvement over time; DTE showed significant improvement over controls (P < .01) on test instruments relating to PTSD; TIR performed significantly better than DTE (P < .01) on most test instruments. This study was part of a Ph.D. thesis by Lori Beth Bisbey and was done under the auspices of the California School of Professional Psychology, San Diego, CA.
Another doctoral study was done by Wendy Coughlin (St. Petersburg, FL) on the effects of TIR on Panic Disorder. That study showed TIR producing significant improvement on test scores.
(For written information, bibliographies, or to get questions answered.)
You can learn TIR by taking the four-day TIR Workshop from a certified TIR trainer---see list, or contact the Traumatic Incident Reduction Assocaition (TIRA) as above in order to be put in touch with the nearest certified trainer.
Essentially, a willingness and intention to help others and a reasonable degree of intelligence. Further information can be found under "Who can attend the TIR Workshop?"
See the List of Practitioners
or use our Enquiry Form.
If you need further assistance, contact the Traumatic
Incident Reduction Association (TIRA).
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