Interviews with Practitioners, Developers, & Researchers
The views and opinions expressed in these articles and interviews are those of the individuals speaking, and do not necessarily represent those of Applied Metapsychology International or the TIR Association.
TIR & Rational Emotive Behavioral Therapy (REBT)
Dr. Bob Moore, 17 years director of the Institute for Rational Emotive Therapy in Florida (now the Albert Ellis Institute), is also a 16 year practitioner of Traumatic Incident Reduction (TIR). I caught up with Dr. Moore on July 13th, 2003 and discussed how TIR has affected his practice, how he integrated it with his use of Rational Emotive Behavior Therapy (REBT).
VV: Can you give me a timeline of your career and positions?
Bob: I taught for a year right out of college. I had had a mentor by the name of A.S. Neill. He was a wonderfully maverick English schoolmaster, best known for "Summerhill" and several other books that started the "free school" movement. Neill and Carl Rogers made a huge impact on me in the early years that actually turned me from teaching to counseling. Looking back on it, they gave me my first exposure to what we now call the person-centered viewpoint which, of course, is bedrock for many of us.
But I date my main career track from 1965 when I got my Master's in counseling. This was in Pennsylvania. I worked at a hospital and a couple of mental health clinics for a few years after that while I continued graduate study at Lehigh. It was during this period that that loveable scoundrel, Albert Ellis, came into focus for me, and I began making regular training trips to his Institute in New York.
A few years later, in 1973, when Al told me there was a move on to open a branch of the Institute in Clearwater, Florida and suggested I go down and "do it", I jumped at the chance, even though I hadn't quite finished my doctoral program. My wife, Erica, was about eight months pregnant at the time, but we started packing and moved practically the day after our daughter was born. I took a position on the Hillsborough County (Tampa) school psychology staff to get us started and worked at the Institute evenings and weekends. I managed to get my dissertation written by 1976. Those were busy years.
In the early 1980's, I met Sarge [Dr. Frank Gerbode] and others who were putting Applied Metapsychology together and it knocked my socks off. It produced such a quantum leap in my continuing education that, in 1990, I turned the Institute over to one of my REBT associates, Vince Parr, and shifted my focus almost totally to trauma-related studies and TIR. And that's pretty much where my head's been ever since.
VV: For what diagnoses have you found TIR to be most effective?
Bob: Just so you know... I don't bother too much with formal (multi-axial) diagnosis, unless I'm working with an insurance company that requires it. But to speak to the spirit of your question in a nutshell... TIR is applicable to anyone whose problem has some experiential "roots". It's almost an axiom, of course, that emotional or psychological problems have roots of some sort. So one could, I suppose, use it with almost anyone. In actual practice, though, it's not entirely practical to do that.
Certainly when someone presents with anxiety or panic, though, which is very communication, there's rarely a better approach than TIR. There are very few anxiety problems that don't have specific historic roots. In fact, there very often is a fairly clear-cut before and after, and many clients recognize the fact. Most of them understand that they weren't born with the problem. It usually came along at some point in their lives or, occasionally, snuck up on them over time. In either case, TIR sorts it out better than any other technique I know of.
Of course anybody who presents with an actual trauma, that is who walks in and says, "Hey, I've never been the same since the day I dropped a brick on my foot" (or whatever happened) is announcing candidacy for TIR right from the start. But presentations of this sort actually are in the minority of cases, because people don't typically announce the roots of their presenting problem. They more often announce the current symptoms and/or the circumstance in which those symptoms occur. It does happen occasionally, though, that they just hand the key historic events to you on a silver platter: "I've never been the same since I was divorced", " ...since the accident", "...since the rape", whatever.
Chronic anger and depression also generally have accessible historic roots, sometimes multiple losses that can be addressed with TIR. I'd say most presenting complaints involve at least some unresolved prior experience worthy of a client's review. But it's really up to the clients whether addressing background of that sort is a priority. If they're interested in it, we do it. Otherwise we do something else. That's what person-centeredness is about, isn't it? But it really is remarkable how easy it is for people to observe, on their own, the connection between the problems they're having in present time and certain unresolved, past, personal experience. So the truth is, it's not hard to find opportunities to use TIR. The logic of it has a lot of appeal to the layman. And the results are outstanding!
VV: Are there cases for which you wouldn't use TIR?
Bob: Well, if someone is actively abusing drugs or alcohol, that needs to be the first order of business. We don't do TIR or anything else very usefully until they've cleaned up their act chemically. Then they're become eligible for TIR or other techniques.
VV: As a practical consideration, do you find that the length of the session can be an issue?
Bob: It's more of an issue for the practitioner than it is for the client. Clients don't care much about that. They don't care whether they are in session for 30 minutes, 45 minutes, or an hour and a half, unless it's a payment problem. But of course therapists, themselves, have to reorganize their lives a little bit so they're comfortable giving as much time as is needed to a given client when they're using a procedure like TIR. That doesn't have to mess up their schedule. It just takes a little practice. It's not unusual for therapists just starting out with TIR to schedule people late in the day so they have some elbow room. When you get fairly adroit at it, though, it's not a big issue, you just have to be a little less than compulsive about how you clock people in and out, because that's not the main consideration.
For the client, the time consideration translates into money, and they need to know that up front. They need not only to have enough time on their schedules, they need to have the resources to be able to purchase a service that could be two or three hours this week instead of the traditional one hour. That doesn't usually turn out to be difficult to justify, though. Clients quickly catch on that their problems are finite and that the sooner we address them the sooner the job gets done. It's not as though they're going to be spending more time and money in counseling because they come more often or have longer sessions. They're going to be making progress faster and getting it over with.
That's a new concept for a lot of counselors as well as clients. Especially because in our profession so much maintenance and "management" work passes for therapy. So many things are dealt with just symptomatically that counseling often tends to go on and on with no real resolution or endpoint in sight. When that's the case, there's quite a big difference between seeing someone one hour a week versus two or three hours a week.
TIR and related techniques are very unlike the services that the profession has traditionally provided; those are mainly coping-oriented. There's a lot of long-term, symptom "management" going around in the professional community these days.
VV: Sounds like a there's a presupposition that the symptoms aren't really fixable?
Bob: That's right... much therapy and counseling is based on the idea that, "we'll make you clever at handling your pain (anger, anxiety, or whatever), or minimizing its intrusion into your life; we'll give you a sort of mastery over it; but when all is said and done, you're still going to have it". That's the sort of thing that makes counseling go long term. We meet a lot of clients who've been doing that sort of thing for a long time.
VV: So they must expect that actually getting to the root of it and getting rid of it is going to take a couple of years, right?
Bob: It's kind of nice when you get someone who's come right off the street and who has never been to any therapist and has no such expectation or background, because they tend to believe what you tell them. When you tell that that "it's fixable; we can wind the clock back, and you'll be your old self again and not have to be running maintenance or remedial routines on yourself," they say, "Ok, great, let's do that".
But when they've had a lot of therapy and they've used a lot of medication, and you're the fourth therapist they've seen this year, and you say a thing like that, they go into disbelief. They say "Hey, I've been struggling with this for many years. I've seen all sorts of doctors, tried all kinds of techniques, and used every drug you can imagine. If what you're saying is true, why hasn't somebody said that to me before?"
VV: They believe that they are their condition?
Bob: Yeah... as though it was wired in at the factory. And you couldn't possibly help them, because nobody else they've seen ever has. So you must be an oddball. I've actually been fired by clients on day one because they were so attached to the idea that they couldn't possibly be helped that they wouldn't trust anyone who said they could. Makes you wonder what they were doing in my office, doesn't it? Anyway... off they went, I suppose, to find someone who would agree they couldn't be helped.
VV: How has Applied Metapsychology and the entire method that supports the use of TIR affected your practice?
Bob: It has affected it enormously, particularly my professional priorities. I had been involved in the practice of cognitive psychology for almost 20 years. So it shifted my attention dramatically. I transferred certain roles and responsibilities I had had for years to colleagues, so I could give my full attention to developing the new specialty.
In that sense, it had a remarkable effect on my professional growth and direction. In consequence of that, I developed a domestic violence program... not something that everyone involved with TIR does, of course. But at that time I was looking for trauma-related things to do. I would happily take on any kind of program or role that called for addressing trauma. I'm in a different phase of my career now. It's called... approaching retirement. So I've just recently passed the domestic violence program to another of my colleagues. But I'm still doing corporate crisis management, another aspect of trauma work that I've been enjoying for the last several years.
VV: Tell me something about your involvement in corporate crisis management?
Bob: There are a number of companies that specialize in helping corporate clients address unusual problems of one sort or another: threats of violence, robberies, embezzlements, catastrophic accidents, massive downsizings. They use mental health professionals with training in critical incident debriefing and trauma resolution as consultants. I represent several such companies. It's like an Employee Assistance Program focused on the most dramatic and traumatic events that can disrupt the stable operation of a company.
VV: Have you had any opportunity to use TIR in that context?
Bob: It's always phase two, but yes we get to do it or refer people to it occasionally. It's not the entry level thing to do in most situations. We usually do a simpler sort of debriefing and sorting out, identify the people who need various services and, secondarily, and then refer them to whatever services they need: Triage.
VV: Can you compare and contrast TIR with Rational Emotive Behavior Therapy?
Bob: I was a very happy practitioner of REBT (whose broader category is cognitive behavior therapy). It's a very useful construct that gives all of us personal responsibility for our emotional well-being. Clients are taught how to intervene in their own disturbance-causing belief systems. What it doesn't do, of course, is look for the historic roots or acquisition of specific, disturbance-causing beliefs. It just gives people tools with which to combat them in present time. What was delightful for me, personally, as I began to get interested in TIR, Metapsychology, and other trauma-related phenomena was finding that there is no philosophic conflict between the basic principles of the cognitive psychologies and Applied Metapsychology. It was very gratifying to me to realize that the mechanism that puts an emotional problem in place, from the metapsychological point of view, is consistent with what I had learned as a cognitive behaviorist. My new specialty simply expanded my understanding of the disturbance acquisition process. It got me to the core of the matter and gave me additional clinical tools.
TIR and other Applied Metapsychology protocols, of course, are person-centered, whereas REBT and the cognitive psychologies are not... although, quite frankly, a good practitioner of REBT needs to be. I think most of my cognitively-oriented colleagues learn that over time in their practices. A therapist can't push his personal viewpoints and judgments on clients and upstage their understanding of what's going on in their lives and get very far with REBT or any other therapy. To be effective, you really do have to see things from the client's viewpoint, use his terms for his feelings, and acknowledge him as the ultimate authority on his own experience. That makes you a better therapist no matter what clinical approach you use. But if you choose to use TIR and related approaches, you often find yourself addressing the very core elements that constructed the client's problem. At that point, you're not merely combating the problem. You're actually deconstructing it.
I find that training in TIR has made even those of my colleagues who only rarely use it better therapists. They listen better. They have less of a tendency to rely on the one-size-fits-all, disturbance-causing cognition package that is so popular in the cognitive therapies. This is why, as I say, learning something about TIR makes better therapists even of those who use mainly other techniques.
TIR quickly plunges you into the core of a problem without your having to infer the nature and quality of the client's thinking from his emotional responses to a situation. There's nothing generic about it. It's very specific, very personal and very correct in the sense that the client, not the therapist, provides the important data: "This is how I think; this is how I feel", and so forth. Whereas, in REBT, the therapist often fills these blanks in from his own (generic) understanding of the cognitive-emotive connection. It's much more satisfying, to therapist and client alike, for these key observations to come directly from the client... for him to revise his thinking to his own satisfaction on the basis of his own, newly acquired insights.
VV: Are there any other Applied Metapsychology techniques, such as Unblocking, that you use in your practice?
Bob: Yes, we run into people for whom TIR is a bit much, and they need to sort things out somewhat before they can productively address specific incidents. In such cases, there may be too much of a muddle in their lives, at present, to be identifying past traumata or even to be tracing back thematically with TIR. Unblocking is especially useful when clients' present time concerns are in a sort of disarray or confusion... when current events have their attention tied in knots. You may suspect that their personal angst is based in some historic stuff, but they're riveted on the horrible conditions of their relationships today, or getting a job tomorrow, or getting out of a problem this week. When their attention is all tied up with stuff like that, then a gentler approach is more appropriate.
Bottom line... you have to put your attention where the client's attention is. You can't just plunge everyone straight away into addressing their old baggage with TIR. You have to get with their priorities. Unblocking is very useful for sorting things out in this connection.
But I'm doubly blessed. Not only have I enjoyed using these remarkable Applied Metapsychology procedures in my practice, I worked day-by-day for more than twenty years with the superbly skillful TIR trainer, facilitator and technical director, the late David Findlay, at my side. For me, working with him has made all the difference.
For any young person who is coming along into the game, I would recommend establishing such a relationship with a Applied Metapsychology technical director, for ongoing case supervision.
Thanks for the chat, Victor.