Overview
Trauma-Informed Stabilization Treatment (TIST), developed by Dr. Janina Fisher, is a phase-oriented, parts-based model designed for individuals with complex trauma, dissociation, and self-destructive behaviors. TIST blends structural dissociation theory, sensorimotor psychotherapy, and mindfulness into a practical, safety-first approach that helps clients develop internal stability before direct trauma processing.
Foundational Principles
- Parts Work as Stabilization: Parts (or self-states) are understood as adaptive survival responses, not pathology. They require recognition and cooperation before trauma work can proceed.
- Mindful Awareness without Flooding: Clients learn to notice and name parts’ thoughts, emotions, and body sensations while staying grounded in the present.
- No Premature Exposure: TIST avoids early direct exposure to traumatic memories to prevent re-traumatization, focusing instead on internal regulation.
- Psychoeducation as Empowerment: Clients are taught the neurobiology of trauma, dissociation, and protective behaviors to reduce shame and increase agency.
Core Components
- Mapping Parts and Functions
- Identify and name different self-states (e.g., protector, avoidant, child states).
- Explore each part’s role in safety and survival.
- Mindful Dual Awareness
- Practice being in the present while noticing the past intruding (“I can notice this and know I’m safe now”).
- Strengthens the ability to witness parts without merging with them.
- Somatic Regulation Skills
- Adapted from Sensorimotor Psychotherapy: grounding, orientation, breath regulation, and movement.
- Reducing Self-Destructive Behaviors
- Understand behaviors (e.g., cutting, substance use) as protective strategies of certain parts.
- Replace them with alternative regulation tools.
Clinical Applications
- Complex PTSD (C-PTSD)
- Dissociative disorders
- Chronic self-harm and suicidality
- Eating disorders with trauma histories
- High-arousal or shutdown trauma presentations
Empirical Evidence
- Practice-Based Outcomes: Agencies integrating TIST report reduced self-harm incidents, fewer hospitalizations, and greater client engagement.
- Theoretical Integration: TIST’s principles are strongly supported by empirical findings from structural dissociation theory, polyvagal theory, and somatic trauma therapy research.
- Current Research Status: While TIST is widely adopted in clinical training and practice, large-scale RCTs are still forthcoming.
Neurobiological Mechanisms
- Down-Regulation of Threat Circuits: Present-moment mindfulness and somatic grounding reduce amygdala hyperactivation.
- Strengthened Prefrontal Control: Naming and observing parts enhances cognitive regulation.
- Autonomic Balancing: Somatic interventions restore sympathetic–parasympathetic flexibility.
Strengths and Limitations
Strengths
- Highly adaptable to outpatient, inpatient, and group settings.
- Effective for clients unable to tolerate standard trauma-processing methods.
- Reduces shame by reframing symptoms as survival adaptations.
Limitations
- Requires clinician training in both dissociation theory and somatic trauma work.
- May take longer to reach memory processing phase in therapy.
- Research evidence is promising but still developing.
Clinical Tips
- Always validate the protective role of each part before suggesting change.
- Use gentle language that fosters cooperation among parts.
- Pace sessions to prevent destabilization—end with grounding.
- Incorporate visual aids (parts maps, grounding lists) for between-session practice.
References
- Fisher, J. (2017). Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation. Routledge.
- van der Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. W.W. Norton.
- Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. W.W. Norton.