2023 TIST Level 1 Certification with Janina Fisher

With the assistance of Giovanni Tagliavini and Maria Paola Boldrini, this module will be followed by the discussion of the case of Roberta*, a 45-year-old woman, professional and mother of 2 daughters. She finds herself asking for clinical help, for the third time in her life, for intense states of irritability and anxiety. She has previously obtained positive results after following targeted pharmacological therapy and implementation of behavioral strategies. This time she accepts the challenge of “trying to look beyond” and continue the therapeutic relationship to investigate this complex history of traumatic attachment.

* To protect the privacy of individuals involved in this vignette, names and identifiable traits may have been altered. However, these changes do not affect the integrity of the vignette, and the content remains an accurate representation of the situation

This will be released for viewing on Tuesday, November 7, 2023

To overcome internal fragmentation and self-alienation, it’s important to learn to focus on the present moment instead of getting overwhelmed by emotions and impulses. This can be especially challenging for trauma survivors who experience intense feelings on a daily basis.

But there is a way forward. In this module, we’ll provide step-by-step instructions to help therapists guide their patients towards greater awareness and a growing capacity to “be with themselves”. By learning to relate to states of intense distress as communication from traumatized young parts, patients can begin to change the way they relate to their emotions and reduce impulsive behaviors.

Our trauma-informed approach will help patients cultivate a new relationship with their inner selves, promoting healing and self-discovery. And with the guidance and support of their therapist, patients can learn to navigate the challenges of trauma and build a brighter future for themselves.

Clinical discussion of the case of Irene*, a 34-year-old woman with three young daughters.She is always dynamic and “never tame”, but has stuck in bed for 2 months due to a serious blood infection, followed by a collapse of the whole management system of daily life manifested by a severe depressive episode. The therapeutic relationship has worked on childhood trauma will allow her to begin to understand not only the infection-depression period, but her whole life seems to be a constant oscillation between moments of disconnection, impulsivity, destructiveness, despair, anguish and dissociative amnesia, alternating with others in which she manages to effectively construct things for herself, for her family and for her life today.

* To protect the privacy of individuals involved in this vignette, names and identifiable traits may have been altered. However, these changes do not affect the integrity of the vignette, and the content remains an accurate representation of the situation

This will be release for viewing on Tuesday November 21, 2023

Research shows that trauma can be closely linked to the development of addiction, eating disorders, and other dangerous behaviors. This module is designed to help patients understand their impulses to act out in harmful ways as responses to trauma, guided by protective parts of themselves.

Daily triggers can activate fear and shame, prompting fight-or-flight responses that recreate the insecure environment of childhood. By recognizing that these parts are trying to protect us, patients can learn to calm their system and develop the resources and skills needed to manage overwhelming emotions.

In this module, we’ll help patients build a new relationship with their impulses and develop a deeper understanding of themselves. With a compassionate and trauma-informed approach, patients can overcome the harmful patterns that have been holding them back and start on a path toward healing and growth.

This module is a clinical discussion of the case of Fabio*, a 20 years old who was manipulated and sexually used in childhood by a very shrewd and dangerous predator. Freed from this constant threat, he now finds himself stuck in a repetition of dangerous behaviors, which almost always includes self-harm that leads him to the emergency room.

* To protect the privacy of individuals involved in this vignette, names and identifiable traits may have been altered. However, these changes do not affect the integrity of the vignette, and the content remains an accurate representation of the situation

This will be release for viewing on Tuesday, December 5, 2023

Childhood traumas can have a lasting impact on attachment development, leading to what researchers call “disorganized attachment.” This can manifest in a child (and later, an adult) as a strong desire for closeness and intense fears of abandonment, which alternate with fears of closeness and deep mistrust. Patients with disorganized attachment often experience conflicting emotions, such as separation anxiety and the need to distance themselves from others.

These opposing tendencies can be confusing and overwhelming for patients, and they can create strain in therapeutic relationships. In this module, we’ll tackle the topic of traumatic attachment and its impact on treatment. We’ll explore strategies to help patients better understand and manage their attachment patterns, promoting greater trust and more positive relationships with others. With this deeper understanding, patients can begin to heal from the effects of childhood trauma and build healthier relationships moving forward.

This is a clinical discussion in the case of Marco*, 48, who grew up in a family environment of chronic terror, alternating with outbursts of frightening aggression from his father.  During his sixth attempt at therapy, the patient sought out a trauma expert for the first time. However, despite this new approach, he found himself repeating familiar “drama triangle” dynamics with his new therapist. These patterns put a strain on the stability of their therapeutic relationship.

* To protect the privacy of individuals involved in this vignette, names and identifiable traits may have been altered. However, these changes do not affect the integrity of the vignette, and the content remains an accurate representation of the situation

This will be release for viewing on Tuesday, December 19, 2023

In the next stage of treatment, we focus on developing internal collaboration between conflicting survival responses. While self-destructive behavior is often addressed behaviorally, high relapse rates highlight the importance of treating trauma and traumatized parts as well. To start, we’ll teach patients how to change their relationship with dangerous thoughts and impulsive actions. Then, we’ll work on building a capacity for internal dialogue and negotiation, leading to greater empathy and creative, compassionate solutions for all parties involved. By establishing a sense of security as a common ground, we can create a safe space where all parts can be accommodated.

In this case study, we will explore the journey of Filippo*, a 35-year-old man whose childhood was marked by frequent disruptions in attachment (mother, maternal grandparents, abusive stepfather). This resulted in a complex and multifaceted legacy that he struggled to accept and understand. Through his clinical journey, we will see how he learned to develop compassion and acceptance for the different parts of himself, some of which he had disowned or deemed unacceptable due to confusion and fear.

* To protect the privacy of individuals involved in this vignette, names and identifiable traits may have been altered. However, these changes do not affect the integrity of the vignette, and the content remains an accurate representation of the situation

This will be release for viewing on Tuesday, January 16, 2024

In this final module, we will shift our focus towards repairing the past rather than simply remembering it. Our goal is to help patients address the fragmented legacy of trauma that exists within various parts of themselves. By nurturing bonds of kindness and compassion within, patients can decrease the intensity of reactivity within these parts. This, in turn, allows them to create a safe and loving internal environment where previously disowned parts can be welcomed and accepted. Instead of prioritizing “integration,” this model emphasizes internal collaboration and closeness, and builds capacities for internal acceptance, forgiveness, and security. By cultivating a secure attachment to each previously rejected and disowned part with warmth and loving kindness, patients can experience a healing antidote to trauma.

In our concluding clinical discussion, we will bring together all the topics covered by Janina Fisher, including revisiting the cases previously presented, as well as introducing new clinical vignettes from Giovanni Tagliavini and Maria Paola. As with previous discussions, we encourage participants to share their own clinical cases, creating opportunities for real clinical supervision.