TIRA

Traumatic Incident Reduction Association

Case Studies using TIR and Related Technique

The views and opinions expressed in these articles and interviews are those of the individuals speaking, and do not necessarily represent those of Applied Metapsychology International" or the TIR Association.

A Day in the Life of a Trauma Counsellor

By Irene Schoenfeild, CTS, CGF Reprinted with permission of author Note: Names and some details of the incidents have been changed to protect the clients' identities.

Irene Schoenfeild, CTS (Certified Trauma Specialist), during her work as a Trauma Counselor specialized in working with survivors of motor vehicle accidents.


Session notes: July 6, 1995

It's Thursday morning and I have arrived at the rehabilitation clinic early to review my clients' files.

"Cindy" is my first client for the day. In our last session, we had worked on a car accident she had 4 years ago. She had been driving at a slow speed and when she couldn't stop her car on the ice, she hit a light standard (pole). She received some soft tissue injuries, for which she had been treated, but had become anxious about driving. I had her repetitively visualize this car accident till her anxiety had been relieved (using Basic TIR, used when a client has awareness of a specific trauma). After the session, she no longer felt anxious about the incident. When she returned for the next session, she reported that her anxiety as a driver had lessened dramatically but she was still anxious as a passenger. I asked Cindy how she felt when she was in a car and she gave me a list of the three symptoms. I systematically ran Thematic TIR (traces back the negative feeling through a number of earlier incidents to the root, or first incident with that particular feeling) on all three negative feelings and then we went back to address the first car accident again.

It's interesting to note this was the first car accident in a series of four accidents that Cindy had in the last five years. She was sent to me because she was suffering from Post-Traumatic Stress Disorder. In the previous session, our fourth, we had spent a full two hours repetitively visualizing the first car accident. She became very agitated while going through this incident but was willing to continue even when she became "freaked out" by the intensity of the emotion that this incident was bringing up. This was the turning point and from then on the affect continually lessened till it was no longer there.

Cindy arrives for today's session. I ask her if she has eaten breakfast and is well rested. She replies yes on both points (for TIR to be effective clients need to be well rested and well nourished). We start the session and I ask her how she has been since last session. She reports that she has had no nervousness, body clenching or anxiety while she is a passenger or driver. She is very excited about this because she hasn't felt this calm around cars in five years. After a ten-minute session she leaves and I close her file. I notice that I have seen her for a total of 13 hours including a history-taking session. (Note: Cindy still goes to the clinic for physical therapy and reports that her nervousness has not returned. It has been three months since I last saw her)

My next file is "Joe". Joe had a minor car accident five months before he came to see me. He was suffering from Post-Traumatic Stress Disorder but his flashbacks went back to an incident earlier than the car accident. Three years previously, Joe had been overseas working on a farm and had been trampled by a horse. His injuries were quite serious and he had lost most of his pre-accident memory. He had also become much quieter and enjoyed life less after the accident. He felt he had been getting over the horse accident quite well and hadn't had any flashbacks in a long time. The car accident had triggered his current flashbacks to the horse accident. We had completed the intake/history taking last session and today we were ready to tackle the horse accident. We chose to work on this before the car accident because it was what interested Joe the most. Traumatic Incident Reduction is a client-centered method; whatever the client is interested in, we work on in the session.

At this point, Joe comes in and we settle down to do the session. I inquire whether Joe is hungry or tired and he replies no. All traumatic incident reduction sessions are structured the same way so that there is stability and the client always knows what to expect. We start the session. The first few runs through the incident, using Basic TIR, go quickly because Joe is still dissociated from the incident. For the next few times through, I ask him to pay attention to specific details such as what he heard during the incident. This connects him with the incident and now it takes him longer to go through the visualization. He is beginning to remember things about the incident that he had never remembered before (This is a vital part of TIR to facilitate cognitive restructuring). As he is going through the incident, he is sitting with his head in his hands, becoming extremely agitated by the memory. He reviews the event a total of eight times and at the end he is able to reconstruct the entire incident; something he had never been able to do before.

At the end of the session, he is relaxed in his chair with his arm casually draped over the back of the chair talking about the incident in a very animated way (An indicator that the session has reached its conclusion). It has been three and one-half hours and I end the session. I write up my notes and put the file away ready for our next session. (After six hours of Traumatic Incident Reduction, Joe reports that he no longer suffers from flashbacks or any other symptoms from the car and the horse accidents. He is socializing again and is celebrating life with his friends. He also says that slowly and spontaneously he is regaining his pre-horse accident memory.)

As I come out of the session with Joe, the Clinic Director stops me and asks if I have time to see "Susan" who had an accident on Monday and was already developing symptoms of Post-Traumatic Stress. She shows Susan into my office and we start as I always do. Susan is well-fed and moderately well-rested. She was not sleeping well because the car accident gave her nightmares. I choose to go ahead with the session because if the trauma is not resolved she will not sleep any better in the future.

Susan had been driving home at night during a snow storm and lost control of the car when she entered an exit ramp. She remembered most of the accident but was missing what happened between when the car started to spin out of control and when it stopped. We went through the accident a few of times and she still couldn't recover that part. I asked her to go through it again, this time moving her body, in her mind, the way she imagined it would have moved during the spinning part. The first time she did this, it didn't match the way the car was moving in the incident. She realized that the car had actually only spun around once. She had originally thought it had spun several times. As we continued to run it she got her body position to match the way the car had spun and the all the missing details of the accident started to fill in. She recalled that she had thought during the accident, "I'm going to die." Then she realized that although this was a normal reaction during the incident, it was not a true representation of what really happened. When we finished running the accident she was bright and very impressed with the process she had just experienced.

I checked my watch; our session had taken 42 minutes.

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