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Frequently Asked Questions

Etiotropic Trauma Management

 

Q: What does Etiotropic mean?

A: It means that the assessment and treatment activities all focus on the "etiology" of the trauma.  "Etiology" means the source or cause of a disease or problem.  In this case, ETM theory states that the etiology of the trauma is contradicted existential identity.  Your "existential identity" is made up of your values, beliefs, image and reality.  So for example, if my husband gets drunk and acts like an idiot in public, many of my values, beliefs, images and reality will be contradicted.  I believe that getting drunk is dangerous and wrong.  My image of my husband is of a steady, sober man who also believes that getting drunk is wrong.  I value trustworthiness, stability and the opinions of others.  Therefore, my husband's toxic (drunk) behavior contradicts my existential identity.  If it goes unresolved, this will be the continuous source or etiology of my trauma.

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Q: What is Trauma Resolution Therapy (TRT)?

A: Trauma Resolution Therapy (TRT) is the application of ETM theory.  It is a five phase structured process for resolving trauma at the source.  All aspects of TRT support keeping the focus of the work on the etiology until the etiology is reversed i.e., the trauma is resolved.  The five written phases can be completed in individual or group settings.  There is a long form and a short form of TRT.  The long form (five structured phases) is applied to long term trauma.  Long term trauma refers to trauma or a series of related traumas that occurred at least more than 90 days ago, but usually many years ago.  The short form is applied to near term trauma which has occurred within the last 90 days.  It involves using only phases 1,2 and 5.  There is also a crisis management tool used with crisis managers who have experienced on the job trauma either directly or indirectly.

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Q: How long has ETM been around?

A: ETM was created in the early 1980s by husband and wife team Jesse Collins and Nancy Carson while they were developing and managing several substance abuse treatment facilities in Texas.  It grew out of their need to find a more effective way of treating the addicted patients and their family members.  Through much study and research the Five Phase Model of TRT evolved.  In the mid-1980s, the oil bust caused them to lose funding for their facilities and they transitioned into training.  Craig Carson, a therapist working with them at the time, took on the task of training while Jesse and Nancy developed the curriculum.  Over a thousand counselors, social workers, and other personnel have been trained in this method in Texas, Louisiana and Georgia.

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Q: How does the TRT approach to treating trauma, or PTSD, differ from other approaches?

A: All aspects of TRT keep the focus on the etiology or source of the trauma rather than the symptoms.  The opposite of etiotropic is nosotropic.  Nosotropic means the focus is on the reduction of symptoms.  While all treatment occurs on a continuum, TRT is the only fully Etiotropic method for resolving trauma.  Behavioral methods include behavior modification, medication and systematic desensitization.  All of these are fully nosotropic in that their only goal is to reduce the symptoms of PTSD or chronic stress responses.  Cognitive-behavioral methods spend some time on developing insight into the source of the symptoms but only to figure out a way to reduce the symptoms.  Psychodynamic models start out by delving into the etiology, but again to identify symptoms that need to be changed.  TRT, on the other hand, maintains the focus on the etiology, even precluding attempts to change symptoms, until the etiology is fully reversed.  ETM theory sees symptoms as a normal and necessary response to trauma and believes that the focus on reducing symptoms not only does not work in the long-run, but can increase etiology or damage to the existential identity.  It can actually make things worse!  You can read more thoroughly about the differences in "Stop Treating Symptoms and Start Resolving Trauma!" by Denice Adcock Colson and in "The Integrated Trauma Management System" (available at training conferences only at this time) by Jesse Collins.  These books go into much more detail about the differences and the TRT/ETM method. 

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Q:  Can this be used in couple’s therapy?

A:  ETM/TRT can be used conjointly with couple’s therapy and in unique cases, directly in couple’s therapy. Let me explain. The sole purpose of TRT is to resolve trauma. Not to increase communication effectiveness, teach appropriate boundaries, etc. These are the goals of traditional couple’s therapy. Following the guidelines, couples can participate in their separate TRT processes and come together on a more sporadic schedule for basic couples counseling.  The guidelines are that the individual TRT must always take precedence and limited progress can be expected in couples counseling until the individual TRT processes have moved past phase 2.  On certain occasions, assessment shows that a couple is experiencing current or recent trauma from the same source, usually a teenage or adult child with some type of addiction.  In these cases, the couple can move through the five phase TRT process, both focusing on the child (or source of trauma) and do so together in a joint session. In other words, they form their own little two person TRT group.

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Q:  Not to be selfish, but as a Counselor, how can adopting the TRT/ETM methods help me?

A:  Not a selfish question at all.  We should use methods that work for us as well as our clients.  It has many benefits. I discovered all of these when I started using TRT in my private outpatient practice and inpatient practice in 1991. 

  1. It makes sense. It is logical and easy to explain to clients. Clients like it.  When I sold my Bellaire, Texas practice in 1998 to move with my family to Georgia, I had 3 outpatient TRT groups running (as well as all of my individual, family and couples work).  Two of these groups were women’s groups and one was a CD men’s group.  I sold my practice to a male therapist who was also trained in TRT.  Since most of my clients were female who had specifically sought out a female therapist you would normally think “Bad move!”  However, we did not lose one client due to the transition from female to male! Why? Because they all believed in the TRT process. They were committed, not to me, but to completing the five phase process. They had seen it work both in their own lives and in the lives of their fellow group members.  Many of my referrals came from satisfied customers. So much so that I had to keep starting new groups or finding some way to keep certain people apart. Finally, I just started telling people you’ll have to be in a group with someone you know from church, Bible study, etc.  I would only keep family members (sisters, spouses) separate.
  2. It’s economical.  While the TRT process starts out in individual sessions, normally it progresses to group.  Group size is usually limited to 6-8 individuals. However, you can charge a much lower fee and still collect more for a 1 ½ hour group session than you would for an individual session.  I had some very low paying clients and occasionally even a pro-bono client.  Putting them into group just made sense.
  3. The client doesn’t become focused on you for all the answers.  Now some therapists like this sense of power. If so, this would be a negative for you, not a positive.  The function of the counselor in the TRT process is one of “facilitator”.  Your role is to keep the client focused on following the structure.  Other than that, you offer encouragement and treatment planning.  In a group setting, clients begin to depend on the structure and on each other.  Clients will call each other to find out how to write a phase 2 incident before calling me, many times.  Clients will offer to help each other write a phase they have already completed.  I do not become the center of their lives. I like that!  By using TRT you are truly working your way out of a job, as it should be in this field.
  4. By becoming certified in ETM, you could market yourself in your community as an expert in trauma recovery. This can open up entirely new referral sources for you. There are planned lectures you can use or adapt for community presentations.  Education is a very important part of the TRT process. While a minimal amount is needed to prepare clients to participate in the group or individual process, the more education you offer, the faster your client becomes committed to the process and the more family members you will have participating.
  5. There is a beginning and an ending.  In grad school, this was a question we all wrestled with. When do you know when you are done?  Usually we leave that up to the client.  If they don’t show up and don’t return your phone calls, they’re done.  Some clients have the means to stay in counseling for the better part of their adult lives.  TRT starts with assessment, moves from phase 1-5 in a logical progression, and when phase 5b is complete, they are done.  They can leave, and they know it.  If they have another source of trauma to work on, you’ll know it and so will they. After a break, they can start again following the same logical process.  Clients like this idea.  I like this idea!

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Q:  How long does the TRT process take to complete?

A:  When people hear that this is a five phase process, they sometimes think “Oh, I can get this done in 5 weeks??” No, TRT is not necessarily quick. The short-form for near-term trauma and the crisis management model are quick, usually less than ten sessions for the short-form.  The crisis management is usually 1-3, 30-45 minute sessions.  For long-term trauma, however, it can take anywhere from 6 months to 2 years.  The longest I have had was 2 ½ years.  It depends on the severity of the trauma, how many incidents the client recalls, how diligently they write, how consistently they attend their prescribed sessions, and the unknown factor.  Will they have to move out of town?  Will they have another baby?  Will they get sick?  Part of the applied structure is that we work on one source of trauma at a time, beginning with the most recent or most pressing.  After completing this, we move in a chronologically descending order, allotting a full 5 phases to each source until they are all completed.  Full recovery from all trauma is finished when all sources or trauma have been completed.

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Q:  Is TRT a Christian Counseling technique?

A:  ETM and TRT are not specifically Christian, just like antibiotics are not specifically Christian.  However, there is nothing in the theory or methodology that contradicts scripture.  In fact, TRT supports many directives of scripture.  TRT goes to the root of the problem rather than dealing only with the fruit, or symptoms.  TRT focuses on changes from the inside, out.  In Matthew 23:25, Jesus said:

“Woe to you, teachers of the law and Pharisees, you hypocrites! You clean the outside of the cup and dish, but inside they are full of greed and self-indulgence.  Blind Pharisee!  First clean the inside of the cup and dish, and then the outside also will be clean.”

Of course, Jesus was talking about sin in the heart.  That we can look great on the outside, but inside have hearts full of hate.  However, this principle of changing from the inside out summarizes the approach of Trauma Resolution Therapy.  First resolve the trauma at the root or source.  The survival responses resulting from the repressed loss and pain will drop away on their own when they are no longer needed.  TRT puts structure to the mandate to “bear one another’s burdens”, and to “weep with those who weep”.  It puts a structure to coming along beside someone and going through the grief and loss with them. Scripture supporting ETM/TRT.

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Q:  How can I become certified in Etiotropic Trauma Management?

A:  You must attend a certification workshop.  You can contact Denice Colson of Trauma Education & Consultation Services at 404-317-3844 or by email at Denice@TraumaEducation.com.   Usually, CEU’s are offered, depending on the location.

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Q:  How can I find out more Etiotropic Trauma Management?

A:  There are several ways to find out more about ETM and TRT:

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