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.

Future TIR: A Gift to Anxious Children who Have Experienced Traumatic Stress

By: Patricia A. Furze, MSE, RSW
This article is contained in the book, Beyond Trauma: Conversations on Traumatic Incident Reduction (Volkman, V. 2005).
Abstract

I worked with children for over nine years in a mental health area of a local hospital, one of the challenges I faced was in assisting children who had experienced traumatic stress to face the traumatic stressor. Once the need for this was acknowledged, it could be addressed and released. Future TIR, a variant of Traumatic Incident Reduction,, offers anxious children a focused, efficient way to process their fears of anticipate negative events[1] . These feared events are often projected into the future by these children. This paper will explore this variant, how it has been used with children, the tremendous impact it has had on the resolution of traumas and in preparation for other TIR sessions.

Introduction

Children who have experienced traumatic stressors often show symptoms of: varying levels of mood instability, sleep difficulties and disorder, interpersonal difficulties, eating and elimination difficulties, focus and concentration struggles and behavioral difficulties. Often the mood instability occurs as depression or high levels of anxiety and panic. An overall increased sensitivity to others and the environment leaves them feeling vulnerable, exposed and out of personal control in their behaviors. Anxiety is a healthy, physiological response in our nervous system that alerts us to perceived danger. When we are anxious, a set of chemical and neurological responses occur leaving us prepared for fight/flight, or freeze.

For children affected by traumatic stress, the nervous system goes into overdrive and there is perceived danger what seems to others to be innocuous events or circumstances. For many children, this stimulation of the nervous system leads them to become stuck in their responses, and less flexible. Procrastination and avoidance behaviors surface in the individual's attempts to self manage and decrease the fear of the unexpected.

One aspect of Western cultures that contribute to children's avoidance of unpleasant feelings and sensations is our instruction to children to use distraction to move their attention away from what upsets them. This works well in the short term. Repression pushes the sensations and feelings out of conscious awareness. They lie dormant, yet in a position to continue to affect the choices the child makes.

As a result of these factors, some children resist revisiting the traumatic events or experiences but are willing to discuss in detail their fears of the future. These fears of the future often involve numerous cognitive distortions. Depending on the age and developmental stage of the child, they can also include some fantasy material. They also have imbedded within them aspects from the original traumatic events or experiences. According to Frank A. Gerbode, M.D., "TIR handles the negative feelings that cause people to have unwanted aversions to things." (Volkman, V. 2005)

For such children, Future TIR is an amazing resource. I have found these formerly reluctant and fearful children to more readily agree to and engage in Future TIR. Future TIR works well on events that are likely to occur as well as those unlikely to occur. A person's ideas about a dreaded future event can contain fixed beliefs and irrational fears, which lose their intensity and become desensitized and benign through the application of Future TIR.

When working with Future TIR, we start with the worst possible scenario that the child could imagine as the first version to address. With some exploration, a time period is determined to establish some parameters and to identify a start point. Each version is viewed until the child is no longer interested in it. At this point the child imagines a version that is slightly better and continues viewing again and proceeds with progressively better versions. The child establishes when to move to another version through their interest.

Existing or new avenues of possible support and resources can be revealed by this work. The session completes when the child is no longer troubled by the originally feared event and circumstance. Often the child is more relaxed and feels more capable of handling the dreaded event. Change becomes less scary and more possible. Resilience often increases and the child develops enhanced emotional and cognitive flexibility.

Here are some examples of the myriad ways Future TIR has been used with children from toddlers to young adults. (Names have been altered to protect confidentiality.)

Michael - Fear of Tomorrow

"Michael", age 10, presented as a very emotionally unstable, somewhat immature, sensitive child, large for his age but highly fearful. Since grade one, he had experienced ongoing incidents of name-calling and ridicule. Over time the verbal taunting had escalated and become physical. He was being pushed, poked and tripped. Michael had received speech therapy intervention as a young child and never felt confident that he could express himself verbally. He retreated into himself, trying to make himself invisible to avoid being noticed. However, his size and his tendency to cry and withdraw made that difficult to achieve.

At the point he came for assistance, he was shunning all social contact and was being bullied by a number of children on a daily basis. His increased reactivity and suspicion of others made it difficult for children to support him. He was very isolated and lonely. Michael alluded to an event that had occurred in grade one that had been the start of his difficulties, but he was unwilling to discuss it. He was willing, however, to discuss his numerous fears about what lay in store for him at school the next day. Over the next couple sessions, Michael was introduced to TIR and to the variant Future TIR and readily agreed to try it. He was having ongoing stomach aches, calling parents to request they take him home, and he dreaded going to school.

He fit the profile of a child who can slide into school avoidance, and to curtail this we decided to move to Future TIR as quickly as possible. Michael cautiously began his session, and once into the first of several scenarios, he fully immersed himself in the process. He ran through the first scenario three times, then was asked to make it slightly better. What came next was a qualitative shift, as if Michael was now recounting the experience of the grade one event. He continued with this next scenario seven times, becoming progressively less tense, expressing lots of tears, shame for the action of others and becoming calmer. He was asked to create another better scenario and did so for two repetitions followed by a big sigh of relief and a smile.

The next session, Michael's mother was jubilant in recounting Michael's shift. He was now able to leave for school more easily, he had not had any bad dreams over the week, and he had not called home asking to be picked up from school. Michael's teacher had noticed a difference in the classroom. Michael was projecting a more confident manner.

Michael met me with a big smile and a more relaxed demeanor. He spoke about how the other children did not seem to be bothering him. He reported his good news with more direct eye contact. He identified a couple of incidents that were still on his mind that he was now ready to address with TIR. He also began to talk about a future that could include friends and possibly having others to his home to play. Completing another thematic TIR session related to the bullying behaviors left Michael more aware of his contribution to the situations and a willingness to assume his own personal power.

Within four months, Michael was reporting no difficulties with peers. He could get perspective on the teasing he did encounter. Michael recognized that he was not alone, that others were teased as well. His problem solving abilities increased. He was no longer triggered into feelings of shame and powerlessness. He started to reach out to others and saw himself capable of making positive things happen for himself and others.

Michael's school attendance became regular and his focus and concentration improved. His grades increased and he made one close friend and began to have play dates in his home. Michael continues to develop his social skills and to appropriately increase his level of independence. The Future TIR session seemed to have incorporated the incident from grade one and subsequently brought him tremendous relief.

Troy - Separation Anxiety

"Troy", age 11 years, was able to use Future TIR to successfully address his intense anxiety when participating in sleepovers with his friends. He also eliminated his anxiety about being away from home on a school trip.

Separation anxiety often involves a shared avoidance of the fear of abandonment by the child and parent. The child struggling with separation anxiety is best supported if the parent sharing the anxiety is identified, and helped to process the fear. When parents realize that they can assist their child through completing their own work, they are willing and receptive to engage in TIR sessions. The following account involving Troy illustrates this process.

Troy is a very sensitive boy and is close to his mother. His mother had felt abandoned by her own mother, an addict who struggled with alcohol and prescription drug abuse. When his mother became preoccupied with her own fears of abandonment, Troy experienced her lack of emotional presence as abandonment. Troy and his mother agreed to use TIR to address their shared fear of losing one another. The incident they chose to address was Troy's first day of kindergarten. Troy's processing demonstrated his acute awareness of his mother's pain and the fear in dropping him off for school. He found it confusing and alarming, contributing to his own insecurity and fears. The session unfolded quickly and easily to a good end point, leaving Troy calm and settled.

His mother's session began with saying goodbye to him in kindergarten and went back to a number of earlier similar incidents that involved the theme of the terror of abandonment. This was a much longer session and the gains were enormous. His mother was able to achieve closure on her separation from Troy's father, the death of her grandmother, and the repetitive events in childhood wherein her mother emotionally and physically neglected her while acting out her addictions. The impact on Troy was immediate. He became less burdened emotionally and was happier more often. He became less cautious and more spontaneous and seemed to be gaining confidence in developing a social life. At last point of contact, his mother continued to work on her significant trauma history with another therapist, and continued to make progress.

Future TIR has also been used successfully with social anxiety. Situations such as answering a question in class, approaching a server at a restaurant to order, answering the phone, planning for going on a holiday, and preparing to give a speech, have all been handled with Future TIR with successful outcomes for the children involved.

Future TIR has been a welcome approach for children whose attention is fixated upon fears of future and are frightened and reluctant initially to face the past. For older children, the Unblocking procedure can be effective as well. In my experience, however, Unblocking tends to be too cognitively challenging and slow-moving for younger children. Future TIR allows one to meet the child at the point their attention is drawn to. Resolution of future fears often brings a sense of safety and a higher level of trust of self which translates into more confidence in the exploration of past events.

References

AMI/TIRA (2006). Traumatic Incident Reduction Expanded Applications Workshop. Ann Arbor, MI: AMI Press.

Gerbode, F.A. "Metapsychology: The Un-Belief System: also in Volkman, Victor (2005) Beyond Trauma: Conversations on Traumatic Incident Reduction, 2nd Ed., Ann Arbor, MI, Loving Healing Press, p 296.

Volkman, M. "Future TIR" in Volkman, Victor (2005) Beyond Trauma: Conversations on Traumatic Incident Reduction, 2nd Ed., Ann Arbor, MI, Loving Healing Press, pp. 66-68.

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