INTEGRATING MODELS

Most trauma survivors feel like they are fighting a battle they don’t understand. By integrating the logical architecture of Trauma Model Therapy (TMT) with the biological processing power of EMDR, the combination of models help a person move beyond just managing one's history to actually resolving the root cause of the pain. The model combination provides the safety and clarity to understand one's attempt at survival and the clinical movement to finally leave it behind.

TMT

Trauma Model Therapy

EMDR

Eye Movement Desensitization and Reprocessing

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EMDR Therapy is a memory-network–based model. It is grounded in the Adaptive Information Processing (AIP) model and follows a phased methodology. Present day challenge and difficulty manifests from past unprocessed traumatic experiences.

THEORY OF THE MODEL

The theory of the model for TMT is a trauma-driven, unified theory that views complex psychiatric symptoms as a system of adaptation to childhood trauma and attachment failures. It is a "metapsychology" that bridges biological, psychological, and social domains.

In EMDR, psychopathology, or symptoms and challenges, are conceptualized as manifesting from maladaptively or dysfunctionally stored memory networks.

PSYCHOPATHOLOGY CONCEPTUALIZED AS

In TMT, psychopathology is conceptualized as a logical and adaptive response to an abnormal environment. Initially, the "disorder" is not located within the individual's biology, but in the relationship between the developing child and a traumatic environment. The trauma can then cause biological dysregulation based on fight-flight-freeze physiology. Much of psychopathology is conceptualized as a dissociative compartmentalization of self-states – dissociation is the central organizing principle that results in a fragmented self organized into discrete self-states, alters or parts. A variety of terms can be used to describe parts.

For EMDR, symptoms are time-stamped expressions of unprocessed, maladaptively stored memory & experience.

PERSPECTIVE OF SYMPTOMS

In TMT, symptoms (e.g., self-harm, eating disorders, addictions, voices) are viewed as survival strategies. They are "solutions" to the problem of unbearable pain when no other coping mechanisms are available. Symptoms are often due to the actions, emotions, or beliefs of dissociated parts, each of which may have its own history, feelings, beliefs and functions. Symptoms are seen as solutions, adaptations, and protective strategies that once helped the person but later create problems when the time, context, and circumstances have changed.

In EMDR, the standard procedural steps assume that a person has a cohesive self with disrupted access to adaptive information.

ASSUMPTIONS

TMT assumptions are that most psychopathology is trauma-based. This can involve both Big T and little t trauma. The Locus of Control Shift is a universal cognitive adaptation to abuse. The Problem of Attachment to the Perpetrator is a core clinical conflict. A genuine commitment to recovery is essential. “The problem is not the problem” - symptoms have a function and purpose as survival strategies and defenses.

The mechanism of change in EMDR Therapy does not yet have consensus despite multiple theories being studied through ongoing research. The main working theories are the theory of working memory, the orienting response principle, and the theory of REM sleep.

MECHANISMS OF CHANGE

The TMT mechanism of change involves cognitive restructuring of trauma-based beliefs (dismantling the "Bad Me" identity) combined with the development of healthier self-regulation skills. Change is driven by relational engagement with a client’s system of parts: the therapist plays an active role in this process, emphasizing psychoeducation, grounding, and commitment to recovery as elements of healing. The system of parts participates in treatment and change through recognition, communication, cooperation, and integration of parts.

In EMDR, change can focus on either state change or trait change, based on whether treatment is based on symptom reduction or more comprehensive psychotherapy. In EMDR, state change refers to in-the-moment state shift and leads to a reduction in symptoms and reactions, even when faced with triggers. Trait change refers to both state change and broader, longer lasting changes in how one experiences, understands, and engages with themselves, others, and the world.

HOW IT MEASURES CHANGE

TMT measures change in a few ways. Standardized psychometric testing (e.g., DES, DDIS) are utilized. Clinical indicators such as a reduction in self-blame and dissociative "lost time," and an increase in healthy self-regulation. Diagnosis, treatment planning, and interventions flow from mapping and understanding the internal dissociative structure.

EMDR works through dual attention stimulation which is understood to stimulate our innate neurobiological information processing system. Healing is driven by “unsticking” the client’s intrinsic information processing system through the use of procedural steps that allows the “time-stamped” data to link up to adaptive information and “update” as part of an assimilation and integration process.

HOW IT WORKS

TMT works in simple yet powerful ways. TMT is based on 5 core principles and the three phases of any trauma treatment model. 1. Education and Stabilization: building safety, a map of the system, and clarifying the problems to be addressed in therapy. 2. Trauma Processing: including ambivalent attachment patterns and negative self-beliefs. 3. Resolution and Integration: Consolidating the fragmented self.

In the EMDR framework, dissociation is understood to be a clinical variable that contributes to a person’s readiness, how to approach targeting, and how to pace the 8-phases of EMDR. When working with someone with a dissociated sense of self, internal organization of the self and access to information has a unique function for them and is informed by their history and experiences. While contemporary neuroscience research with dissociative folks is shedding light around neurostructural biomarkers of dissociative amnesia (Dimitrova et al., 2023), we don’t yet have research that positions this within an AIP specific context. This is an area of EMDR that requires further research. EMDR basic training provides attendees brief training on how to screen and assess for dissociation. The EMDRIA stance is that dissociation should be screened by using the self-report measures like the DES II or MID before engaging in EMDR. While dissociation is screened and assessed for, working with dissociation and parts within EMDR therapy comes through advanced training after attending a foundational EMDR basic training. And if there is clinically significant dissociation, EMDR would say to modify the protocol, not abandon the model.

PERSPECTIVE ON DISSOCIATION

The TMT perspective of dissociation is that dissociation is a structural defense used to wall off unbearable affect and memories. Dissociation is understood and treated as a primary focus of therapy.

For EMDR, the term “Integration” means that there is adaptive linking across memory networks. Change occurs when memory networks are reprocessed and integrated with adaptive information, allowing for adaptive resolution.

HOW IT VIEWS INTEGRATION

In TMT, Integration is the blending of fragmented parts of the self. It involves the gradual removal of dissociative barriers so that the Self can act as a unified, conscious identity. Integration = increased cooperation followed by blending and sometimes full fusion of parts when and if desired. Not all individuals want full integration.

~Special thanks to Jill Hosey for her contribution to this chart

For the Clinician:

TMT ensures the client is stable enough to handle the intensity of EMDR, preventing "dissociative crashes" and ensuring a safer clinical outcome.

For the Client or Patient:

This dual approach moves you from understanding your past (TMT) to actually resolving it (EMDR), so you aren't just coping with your history—you are outgrowing it.

"If a person holds onto one particular feeling, be it grief, rage, fear, shame, guilt, or depression, then that person needn't face or feel the complex, multi-level conflicts and paradoxes created by abuse and trauma."

— TRAUMA MODEL THERAPY, LEVEL 2