Finally, an approach to trauma recovery that is truly different—not just repackaged behaviorism!
Denice Adcock Colson introduces Etiotropic Trauma Management in a very down to earth and practical way. This innovative theory uses a five-phase structured process called Trauma Resolution Therapy to resolve trauma at the source, rather than merely managing the symptoms. This text shows how trauma affects the victim’s identity and why “survival responses”—called symptoms by other theorists—are needed until the trauma is resolved. Counselors who think “etiotropically” are convinced that this totally unique concept in trauma recovery restores the individual’s identity to its pre-trauma state. Stop Treating Symptoms and Start Resolving Trauma! offers hope for both victims and the caregivers trying to help them.
In 1992 Denice Adcock Colson was sitting in her office with a client who said, “You’ve helped me a lot, but I feel stuck”. Denice agreed and added, “Honestly, I don’t know what to do about it.” A week later Denice was introduced to Etiotropic Trauma Management. Since launching her career in 1982, she had searched for a truly effective way of helping clients put their trauma behind them, but could not get beyond merely helping them manage their symptoms. By the second day of training in this innovative technique, she was convinced that her search was over. Denice continues in part-time practice as a Licensed Professional Counselor while also writing, speaking and enjoying her husband and three children.
Chapter One: Introducing Etiotropic trauma management and trauma resolution therapy
“Etiotropic Trauma Management”—quite a mouthful, isn’t it! It’s pronounced “eat-e-o-tro-pic.” Easier yet is “ETM.” When hearing the term “Etiotropic,” people tend to panic and think, “This is too technical! I’ll never be able to understand it!” But wait—it has a very simple explanation. Etiotropic comes from the root word “etiology.” Etiology refers to the source or cause of a disease or problem. This trauma management system is “Etiotropic” because it focuses all efforts on identifying, addressing and resolving trauma at its source. You could say we go to the root of the problem. This is the opposite of traditional counseling methods which tend to be Nosotropic. Nosotropic approaches focus on reducing the symptoms of the trauma.
ETM is a theoretical model – a plan based on a theory – which provides strategies and implementation procedures for addressing all types of psychological trauma and its effects on individuals, families, relationships, communities and organizations. ETM was originally titled in the early 1980’s “Integrated Trauma Management System” by its developers Jesse Collins and Nancy Carson. They changed the name in the mid 1990’s to make it more distinctive from other trauma management systems. ETM is very different from all the others. ETM is the only method that focuses strictly on resolving the trauma at the source (which will be defined later).
- The application or “treatment” part of ETM theory is called Trauma Resolution Therapy. You can read more about the history and development of the ETM Model in Jesse Collins’ book The Integrated Trauma Management System, available through the ETM Training Workshop. The history is also available on line at www.Etiotropic.org.
What Makes ETM Different?
I have chosen to be repetitious just to make my point. ETM is the only treatment approach which focuses exclusively on resolving the trauma at the source rather than managing the symptoms. In fact, ETM goes as far as preventing attempts to change symptoms. Survivors are directly asked not to try to change symptoms until they have completed all five phases of the treatment process. (The only exceptions are the consumption of alcohol, illegal drugs and sedating prescription medications as well as suicide and self-mutilating behavior or physical violence against others.) This is not reverse psychology or a paradoxical intervention.
The structure of Trauma Resolution Therapy (TRT) is also designed to preclude participants from attempting to focus on or change their symptoms. I want to emphasize “attempt” here because, even though we are not focusing on changing symptoms, the symptoms are nevertheless eradicated when a person completes all five phases of TRT.
It is our belief that trauma survivors need their symptoms. Where there is etiology, there are going to be symptoms. In the same manner, where there are live roots, a plant will grow. Symptoms and etiology are forever linked in a paradoxical relationship. When you focus on the symptoms without first resolving the trauma, it can reinforce the symptoms and even create new symptoms and thus more damage. Prior to using ETM/TRT, I became mired in this paradox numerous times with clients. A specific example of this was the whole “Tough Love” movement. In this intervention parents were directed by their therapists to turn their teenagers out on the street if they refused to stop using drugs and alcohol and start following the rules. I told several parents to do this and became frustrated when the parents not only would not do it but the parents continued to also feel very responsible for their teens continued substance abuse. Eventually they would realize that I could not help them and leave feeling hopeless. I would in turn assume that they did not want to stop enabling their child for some secret reason. Looking back now, I can see how absurd this was. I did not realize that I was putting the blame for the trauma they were experiencing (teen’s substance abuse) back onto them. By asking them to do something that went against their own values and beliefs, I was creating more trauma (etiology) for them. By putting them in the position where they had to disappoint their counselor, I was also creating more etiology for them.
It is not that focusing on changing symptoms never seems to work. Quite the contrary. People seem to be able to make progress in changing some symptoms and that makes them feel successful. Counselors and theorists then think that all symptoms should be able to change given the right motivation. However, many symptoms seem to keep people stuck. Sometimes people just “swap” symptoms. They swap an obviously self-destructive behavior for a not so-obviously self-destructive behavior, and that looks better to everyone. Clients and counselors alike, however, become frustrated with this cycle. Worse yet, it leads to a sense of hopelessness. Eventually the client gives up, believing that he has a spiritual or character disorder that prevents him from ever being able to get past the trauma in his life. Therapists also become cynical and begin to doubt the possibility of real and complete healing and hope to just teach their clients to cope.
This is the paradox of focusing on changing symptoms before the trauma is resolved. Not only does it not work but also more etiology is created. When more etiology is created, more symptoms develop. When more symptoms develop, more damage is done to the person and to those around him or her. You see, typical psychotherapy has gradually moved toward the “medical model.” This says that the symptoms are the problem. Since they cannot cure the disease, they treat the symptoms. ETM counselors believe that the trauma’s existence in memory is the problem and the symptoms are the natural effects of the traumatic event.
So, what is the “source” or the “etiology” of trauma? According to ETM theory, the etiology or source of ongoing trauma is the continuous contradiction of existential identity. Existential identity refers to our basic personal identities, which are made up of the sum of our values, beliefs, image and reality. Our values are anything and everything we deem as valuable, such as peace, happiness, love, our bodies, our health, etc. Our beliefs include everything that we believe about ourselves and our world, such as, “I believe my husband should show me love and respect,” or “I believe marriage should be forever.” Image involves self-image as well as our image of others. Reality involves the integration of our values, beliefs and image with what we see, hear and experience.
ETM also theorizes that the continuous contradiction of existential identity is not just psychological, but that it actually has a physiological location in the brain. We believe that actual neurons in the brain are changed as a result of trauma. New memory patterns are developed which override pre-trauma memory patterns. In other words, originally held beliefs which are stored in the brain in the form of patterns of neurons are bypassed or extinguished by newer and stronger patterns of neurons developed as a result of the trauma. These changes occur in the part of the brain that supports memory. It is as if the trauma were recorded in the “present tense” and remains this way until the etiology is reversed. Recent research supports the theory that Post-Traumatic Stress Disorder is a brain-based issue. The debate continues as to which part of the brain is specifically affected. There are several books and articles which discuss this in more technical terms than we will be using in this work. If you want to read more about brain research, be sure to check out the Bibliography.