Frequently Asked Questions
Q: What is TIR useful for?
A: It is highly effective in eliminating the negative effects of past traumatic incidents. It is especially useful when:
- A person has a specific trauma or set of traumas that she feels has adversely affected her, whether or not she carries a formal definition of PTSD.
- A person reacts inappropriately or overreacts in certain situations, and it is thought that some past trauma might have something to do with it.
- A person experiences unaccountable or inappropriate negative emotions, either chronically or in response to certain experiential triggers.
Q: How long has TIR been in use?
A: TIR has been in use since 1984 in something similar to its current form. It has undergone minor modifications over the years, mostly in the interest of greater simplicity and teachability.
Q: What is the anticipated outcome of TIR?
A: In the great majority of cases, TIR correctly applied results in the complete and permanent elimination of PTSD symptomatology. It also provides valuable insights, which the viewer arrives at quite spontaneously, without any prompting from the facilitator and hence can "own" entirely as his own.
By providing a means for completely confronting a painful incident, TIR can and does deliver the positive results a person would have had if he had been able to fully confront the trauma at the time it occurred.
Q: What are the contraindications and risks of TIR?
A: TIR is contraindicated for use with clients who:
- Have ongoing problems with street drugs or alcohol. Clients need to be stably off such substances before your work can begin.
- Certain kinds of medications don't work well with our techniques. In general, these fall into the category of sedatives, strong pain-killers, and major and minor tranquilizers. Lithium and selective serotonin re-uptake inhibitors (SSRIs), such as Prozac have been found not to interfere with the work, since they do not tend to reduce awareness.
- Have a psychiatric disorder that interferes with their ability to mentally focus on a specific area.
- Have been sent to work with a facilitator by an outside party, for instance, a concerned relative or the courts, but are not themselves interested in being helped. This is not to say that such clients cannot be worked with, but to make progress with these techniques a client must first be engaged and their willingness to do the work obtained.
- Are in life situations that are too painful or threatening to permit them to concentrate on anything else, such as the work of the session. Such individuals may benefit from Consultation or may need some other kind of intervention before beginning this work.
Q: How does TIR compare with other techniques for addressing traumatic stress?
A: Up until recently, there have been two main approaches to PTSD:
- Coping techniques
- Cathartic techniques
Some therapists give their clients specific in vivo methods for counteracting or coping with the symptoms of PTSD. These clients learn to adapt to, to live with, their PTSD condition. They learn, for instance, how to avoid situations that trigger them, how to distract themselves when they are triggered, how to re-breathe in a paper bag to avoid hyperventilation. Women who have been assaulted or raped may take self-defense classes.
Others encourage their clients to "release their feelings", to have a catharsis. The idea is that past traumas generate a certain amount of negative energy or "emotional charge", and the therapist's task is to work with the client to release this charge so that it does not manifest itself as aberrant behavior, negative feelings and attitudes, or psychosomatic conditions. This notion, derived from Freud's libido theory, is a "hydraulic" theory of psychopathology. Charge generated in past traumas supposedly exerts a pressure towards its expression. If not expressed in affect appropriate to the experienced trauma, it must express itself in inappropriate ways. Therapists espousing this theory use methods such as implosion therapy, psychodrama, and focus groups to help the client release the charge.
Coping methods and cathartic techniques may help a person to feel better temporarily, but they don't actually improve the client's stability. Clients feel better temporarily after coping or having a catharsis, but the basic charge remains in place, and shortly thereafter, they feel a need for more therapy. In cathartic work, the presence of an affective discharge indicates that the client has contacted a past trauma and "worked it through", but not that she has eliminated it. Coping strategies don't provide a permanent solution either. A week, a day, or an hour later, some random environmental stimulus, such as a loud noise or the sound of helicopters can trigger anew the same charge.
TIR could be regarded as a kind of "exposure technique", in that, as with exposure, the point of TIR is to help the viewer become more aware of the traumatic incident. Exposure theorists rely on a desensitization model, in contradistinction to TIR's person-centered model, but the two techniques converge on the need for repeated exposure to the trauma.
(Editor's note: "Direct Therapeutic Exposure", is a tool long used by the VA and others to treat PTSD. Research by Lori Beth Bisbey has shown DTE to be more effective than no intervention at all, but not as effective as TIR.)
There are certain features of TIR that do not form part of the DTE approach, however:
- TIR embodies the concept of an "end point", with certain particular characteristics. DTE's "end point" occurs when the client feels little or no distress as a result of confronting the incident. In TIR, we usually await the onset of positive emotion, not just the absence of negative emotion. Plus there are the other components of an end point, as described in TIR: insight, extroversion, and frequently, the expression of what the intention was that the viewer made in the incident.
- TIR is stricter about not permitting any input from the facilitator concerning detail or content of the incident. In DTE, the therapist reads a script to the viewer, and the viewer goes through at the therapist's pace. In TIR, the viewer confronts only what she feels comfortable confronting on any particular run-through. Exposure in TIR is client-titrated, rather than therapist-titrated.
- In TIR, we endeavor to reach an end point in a single session; in DTE, working on a given incident typically takes a few sessions.
- TIR includes specific ways of checking for earlier and similar incidents that might be triggered when running through a later one. A sequence of incidents can be traced back to its root in a single session and resolved.
- When the client suffers from unaccountable uncomfortable feelings, emotions, sensations, psychosomatic pains, and unwanted attitudes, but there are no obvious major traumas in evidence that could be addressed, a type of TIR called "Thematic TIR" can be used to trace these "themes" back to the incidents they came from and eliminate them, also in a single session.
More recently, proponents of certain techniques have claimed that they can permanently eliminate the effects of PTSD. Charles Figley and Joyce Carbonell at Florida State University have studied these techniques -- TIR, Francine Shapiro's Eye Movement Desensitization and Reprocessing (EMDR), NLP's Visual / Kinesthetic Disassociation (VKD), and Roger Callahan's Thought Field Therapy (TFT) -- to determine what the active ingredient was. Although their study wasn't designed as an outcome study, it suggests that all four techniques are effective.
Like TIR, EMDR, and VKD contain elements of exposure, but they also contain other elements, such as inducing eye movements or producing other repetitive, bilateral stimuli (as in EMDR), or creating a deliberate state of dissociation (as in VKD). Otherwise they differ from TIR in the same ways that DTE does. TFT is utterly different from TIR, relying, as it does, on manipulating acupuncture meridians.
Q: How is TIR similar to something like EMDR?
A: Both are direct "exposure" techniques, meaning that they get results by having trainer practitioners help the client resolve the negative effects of past experiences by looking at them, being "exposed" to them. Besides the differences in how each is done, one main difference is that while EMDR can leave a client in a triggered state at the end of a session, due to many traumatic incidents having been touched upon, TIR has the client focus on one incident or series of closely related incidents in one session. In the great majority of cases, a TIR session ends with the client feeling complete and satisfied that what has been opened up in that session is complete.
Q: What research exists to support the effectiveness of TIR?
A: Visit our Research & Publications page.
Q: Does TIR have anything to do with Mindfulness?
A: Although TIR has not generally been described as a mindfulness therapy, the TIR approach does place great emphasis on the detached non-judgmental observation of inner experience through disciplined repetitive practice. It therefore has a great deal in common with mindfulness. TIR is designed to enable clients to be more open to and mindful of their inner experience. This is done in a great many exercises that train the client to focus attention on one thing at a time repetitively, noticing more and more details and subtleties, increasing the client's willingness to face more and more challenging feelings and thoughts. TIR could also be described as a technology for enabling clients to 'dis-identify' with thoughts, emotions, and any other inner experience, seeing inner experience as separate from the self. Like Gendlin's Focusing and Gestalt, TIR is a structured methodology for applying a mindful philosophy to one-on-one therapeutic practice.
Q: What books and videos are available about TIR?
A: Visit TIRBook.com
Q: How can I find out more about TIR?
Q: Who is recognized to practice TIR and Applied Metapsychology techniques?
A: Applied Metapsychology, including TIR and LSR, is a highly disciplined and structured practice. This creates the many safeguards built into the work, and provides the level of success we have come to expect.
Applied Metapsychology International (AMI) and the TIR Association, recognize people who have successfully completed one or more of the AMI professional skills workshops with a Certified/Accredited Trainer. AMI maintains a Certification/Accreditation Program for facilitators as well as trainers, to give special recognition to those who have completed an internship at one or more level of training, as these people have furthered their knowledge and have demonstrated a professional level of competence
Q: I understand that TIR is not done in a "50 minute hour". How long does a TIR session last?
A: Both the facilitator and the viewer need to schedule sufficient time for TIR to be taken to an end point. One and half to two hours is about average, though the sessions can be much longer or shorter than that. After you have some experience, you and your facilitator will often have a better idea of what is a normal session length for you. Session length also depends upon the severity or complexity of what is being addressed.