This pamphlet is the third TRT instructional aid for combat veterans. It explains how to do both the third and fourth phases of TRT. The pamphlet number is:
This material is for TRT participants. It also provides family members and friends information about the TRT program so that their support for the participant may be enhanced. The TRT Educational Program, including this material, is not intended for general interest reading. It is not a solicitation to engage in TRT. Neither is it authorization to provide TRT to anyone. TRT is authorized for use only under the supervision and facilitation of a Certified TRT Counselor. The authors of TRT, and or their designates, are the TRT certifying authority.
Proficient training, courage, the dedication to one’s job, individual will, and the belief in God and Nation, are reported as having the most profound influence upon the veteran’s ability to survive the trauma of combat. Some aspects of survival, however, are not so helpful. In fact, many survival responses to trauma can even cause additional conflict. The purposes of TRT Phases Three and Four are to help you to identify any such conflicts and then to reconcile the loss which may have resulted from them.
TRT Phase Three
Phase Three functions almost the same as Phase One. However, whereas that phase identified the source of the behaviors that precipitated the original loss, Phase Three identifies the survival behaviors and thoughts that have fostered the additional hurt.
There are several other differences between the two TRT phases that must be kept in mind. First, Phase Three does not require as extensive concentration of thought or profound introspection as did Phase One. All that is necessary now is that the list of survival responses (both thoughts and behaviors) be copied as written from the fifth column of the Matrix. The writer may add optional descriptions of survival response if he or she desires (an example will be provided later). Second, you should not add times, feelings, emotional states or places to your writing as you did in Phase One. Phase Three is only a transitional stage in which you are assisted in framing your responses, not a time to dwell on or emphasize them for the purpose of improving your aware- ness of how you act so that you can change your behavior. If we try to improve our “awareness” for purposes other than loss resolution at this point in the program, the tendency is to begin to blame ourselves. As you may be starting to see, blame and judgment are anathemas to loss resolution.
The third difference between Phases One and Three involves writing format and workspace. Be sure to copy the survival-response list onto a separate worksheet. (An example of Phase Three is demonstrated in the next instruction on how to use the worksheet to complete Phase Four.) List one experience under the other so that considerable margins remain to the right of each” entry. We will use those margins in Phase Four.
Once the list is completed, check with your TRT counselor for an appropriate time to read what you have written. In addition, as we have said before, be sure always to check with your counselor if you have any questions about this or any phase of TRT.
The fourth phase of TRT is similar in some respects to the second phase in that the matrix format is again used. However, instead of five columns, the matrix for this phase has only three. They are, from left to right:
TRT Phase Four
We ask you to begin Phase Four by turning your list of survival responses described in the previous phase into a worksheet. Writing on the form again should pose no problems.
For a sample of how to use the worksheet, we are going to borrow material for the third and fourth phases from the book, Trauma Resolution Therapy (TRD: A Structured and Experiential Approach to the Reconciliation of Loss. In that book (primarily written for counselors) composite examples of people affected by different kinds of trauma-causing events were followed. The one we are reprinting here is from the work of the veteran also described in Phases One and Two of this pamphlet series. The veteran’s worksheet was developed from a list of survival responses taken from the fifth column of his Matrix. The Matrix itself was a reflection of twenty original trauma-causing episodes similar to the example related in the pamphlets for Phases One and Two. To summarize his work, the trauma which he described came from his experiences as both an infantryman for four months and a part of a helicopter medical evacuation, resupply and strike unit for nine months. Included in the last descriptions, are instances of trauma experience upon his return home. The first column of his worksheet as developed from his third-phase work follows:
I became extremely paranoid and afraid of everyone.
I believed I might be killed even by accident. I watched everyone so that they wouldn’t shoot me.
I constantly stayed on guard. I dug deeper holes.
I withdrew from others.
I didn’t talk about the deaths.
I believed more intensely that it was just part of the job.
I blamed the men killed.
I kept doing my job even though I could have been killed.
I talked only with the chaplain. Then I stopped talking with him.
I learned to be tough and act as if the damage was no big deal.
I began to believe I was above it all. I quit caring about people.
I withdrew from everyone and didn’t talk with anyone about what was really happening to me.
I quit believing in God and decided life had no meaning.
I hated the NVN and wanted to kill them.
I began to play like I was invincible and reflected to everyone that I was very strong and afraid of nothing.
I did my job in spite of throwing up and in spite of my fear.
I believed more intensely that life was a random event and that God did not exist.
I believed concepts of destiny or future meant nothing.
I decided God was a fabrication to protect other people against the reality of what I was experiencing.
I did my job and decided life would only be a short term experience.
I tried my best to kill the NVN.
I became more intense at doing my job so that I could stay alive.
I began to believe that war and killing were natural.
I took pride in my ability to keep other people alive.
I ignored the hurt.
I became obsessed with doing my job properly and hoped that would keep me alive.
I was amazed that my body still functioned and at times could not believe that it was even still there.
I believed nothing mattered.
I wondered what my brain blown apart and laying on the ground would look like.
I thought I was going insane.
I began to show no courage and acted like a coward. I wondered if my own stomach would be opened up and left in the dirt.
I began to hate my friends at home.
I began to hate my country that before I loved the same as God and my family.
I withdrew from all people because I believed I was not like any of them and that something was wrong with me.
I began to see myself as less than an animal.
I cried alone.”
After copying the fifth column of the Matrix, the veteran added to the Third Phase (now the worksheet for Phase Four) the following:
“I can see the way I changed and carried those things into the rest of my life.”
“At first, I remember being afraid to drive through an intersection in Houston. I wondered where automatic weapons would be placed for an ambush.
In my first relationship with a woman, although a part of me loved her, I had to leave as I didn’t know how to make a long term commitment.
I no longer knew what long term meant and had no concept of being able to live an ex- tended future. I tried to avoid anything that resembled permanence.
Something always seemed to be missing for me and I felt constantly different.
I started wondering what normal people looked like and why I was such a crazy per-son as to have put myself into the conflict.
I started thinking, with the help of others that
I had not served because I cared about my country, but because there was something wrong with me and I loved violence.
I began to believe I must be a distorted and evil person inside.
I felt like a pin ball bouncing around between partial relationships and different geographical places.
I had a yearning to go back to Vietnam and retake the area in which I had fought and others had died. My greatest regret was that Ho Chi Mien died before I could kill him.
I withdrew from anyone who looked my age. The only people with whom I felt the slightest identification were the older generation that had fought in World War II.
I isolated myself further from the society and poured myself into my job whatever it was.
Later, my ability to do my job began to fall apart as I found myself being stuck in inertia.
Even though I sought help for relationship problems in my first marriage, I could not do the things the other couples seem to be doing.
Real caring and love were no longer in my vocabulary and impossible to either give or receive.
I became a devout atheist. All the while I thought something was deeply wrong.
The most hurting thing that I did, was to decide that I would never fight for my country again, even if it was dying.”
The first column of the Phase Four worksheet then consolidates the individual responses into like groups to create a much smaller listing of various categories of responses. This is done by starting at the top of the worksheet and progressing down the list, placing the responses, depending on their characteristics, into similar categories by assigning numbers in sequence. Each expression that represents a new or different category of response is given a new number.
For example, the first response obviously would be new and so far unduplicated. Consequently, we would place the number (1) in the margin to the right. The second sentence in the first response is at least partially new, so we give it a number also:
“ I became extremely paranoid and afraid of everyone. ” (1)
“I believed I might be killed even by accident. (2)
The third survival response is also slightly different from the first two. At the same time, however, it could be considered as the same as number 1. In such cases you and/or your counselor’s judgment as to what you believe is the most appropriate categorization is all that is required. We do suggest that if you desire less written work in the fourth phase Matrix, that you combine as many such similar responses as possible. You will probably find that there will be no reduction in the thoroughness of your TRT experience. We assign the third reported survival response a number (1).
“I watched everyone so that they wouldn’t shoot me.” (1)
The next responses are more of the same. They are assigned to the first category also.
“I constantly stayed on guard.” (1)
“I dug deeper holes.” (1)
The 6th, 7th, and 8th responses are all new. Again, 6 and 7 could be combined. However, we will not combine them because we usually see the two responses of “not talking” and “withdrawal” as forming groups in which each has their own fairly often repeated constituency.
“I withdrew from others.” (3)
“I didn’t talk about the deaths.” (4)
“I believed more intensely that it was just part of the job.” (5)
As we continue down the worksheet, we discover new categories of response but also find considerable duplication. The completed worksheet from this example might look like this:
I blamed the men killed. (6)
I kept doing my job even though I could have been killed. (5)
I talked only with the chaplain. Then I stopped talking to him. (7)(4)
I learned to be tough and acted as if the damage was no big deal. (8)
I began to believe I was above it all. (8)
I quit caring about people. (9)
I withdrew from everyone and didn’t talk with anyone about what was really happening to me. (3)(4)
I quit believing in God and decided life had no meaning. (10)(11)
I hated the NVN and wanted to kill them. (12)
I began to play like I was invincible and reflected to everyone that I was very strong and afraid of nothing. (8)
I did my job in spite of throwing up and in spite of my fear. (5)
I believed more intensely that life was a random event and that God did not exist. (11)(10)
I believed concepts of destiny or future had no meaning. (11)
I decided God was a fabrication to protect other people against the reality of what I was experiencing. (10)
I did my job and decided life would only be a short term experience. (5)(13)
I tried my best to kill the NVN. (12)
I became more intense at doing my job so that I could stay alive. (5)
I began to believe that war and killing were Natural. (15)
I took pride in my ability to keep other people alive. (16)(5)
I ignored the hurt. (8)
I became obsessed with doing my job properly and hoped that would keep me alive. (5)
I was amazed that my body still functioned and at times could not believe that it was even still there. (16)
I believed nothing mattered. (11)
I wondered what my brain blown apart and lying on the ground would look like. (16)
I thought I was going insane. (17)
I began to show no courage and acted like a coward. (18)
I wondered if my own stomach would be opened up and left in the dirt. (16)
I began to hate my friends. (9)
I began to hate my country that before I loved the same as God and my family. (19)
I withdrew from all people because I believed I was not like any of them and that something was wrong with me. (3)(20)
I began to see myself as less than an animal. (20)
I cried alone. (21)
At first, I remember being afraid to drive through an intersection in Houston. I wondered where automatic weapons would be placed for an ambush. (1)
In my first relationship with a woman, although a part of me loved her, I had to leave as I didn’t know how to make a long term commitment. (11)
I no longer knew what long-term meant and had no concept of being able to live an extended future. I tried to avoid anything that resembled permanence. (11)
Something always seemed to be missing for me and I felt constantly different. (20)
I started wondering what normal people looked like and why I was such a crazy person as to have put myself into the conflict. (20)(22)
I started thinking, with the help of others that I had not served because I cared about my country, but because there was something wrong with me and I loved violence. (20)(22)
I began to believe I must be a distorted and evil person inside. (20)
I felt like a pin ball bouncing around between partial relationships and different geographical places. (3)(18)(11)
I had a yearning to go back to Vietnam and retake the area in which I had fought and others had died. My greatest regret was that Ho Chi Mien died before I could kill him. (12)
I withdrew from anyone who looked my age. The only people with whom I felt the slightest identification were the older generation that had fought through World War II. (3)(18)
I isolated myself further from the society and poured myself into my job whatever it was. (9)(19)(5)
Later, my ability to do my job began to fall-apart as I found myself being stuck in inertia. (18)
Even though I sought help for relationship problems in my first marriage, I could not do the. things the other couples seem to be doing. (23)
Real caring and love were no longer in my vocabulary and impossible to either give or receive. (9)
I became a devout atheist. All the while I felt that something was deeply wrong. (10)(20)
The most hurting thing that I did, was decide that I would never fight for my country again, even if it was dying.”
The way that you consolidate your survival responses may be considerably different from the way we do it, because the division and combination of the responses will depend on their individual meanings to you. Such differences are not a problem. If you have additional questions, be sure to ask your TR T counselor.
Once the consolidation is complete, the next step is to list the different categories in the Phase Four Matrix all the way down the first column. Remember, this matrix is three columns across, rather than five, and focuses only on the initial survival response, the values contradicted by that response and the loss sustained as a consequence of the contradiction. To illustrate, the first five categories of responses in the example we have been using are reduced to simplified descriptions.
Figure TRT Phase Four
In summary, the function of the numerical system is simply to provide a way to identify similar survival responses and to discern the frequency with which each was used. From this identification, the loss resulting from those responses can be identified, setting the stage for its reconciliation.
As you can see, some of the categories, such as (2), comprise only a single response, whereas others, such as (5), are indicated repeatedly. The significance of these differences in terms of loss resolution is that when you begin to work across tile matrix, those responses repeated most often usually will be found to reflect the greatest contradictions and subsequent loss.
Even though Phases Two and Four ‘both identify and help to reconcile loss, there is an important difference between the two. The second phase addresses loss on an extremely specific level: exact trauma-causing behaviors are correlated with the particular emotions experienced values contradicted, loss sustained and immediate survival response made. Through that approach, loss is not only reconciled at individual levels, but also through the wider view that comes from seeing the myriad events as a single life experience. The result of that approach is a rigorous, uncompromising confrontation of the heart of the trauma. In Phase Four, however, we are looking only at the remnants of the trauma. This is what happened to us. Phase Four is about how we adapted and then, how we were changed by the trauma. Had there not been an original trauma, there would be nothing now to write about. Consequently, we approach this phase with special care and ask that you give that same special care to yourself.
The special care (exemplified in the use of “categories” by the fourth phase) is intended to provide you with some distance from the necessary experience of survival change and adaptation by purposefully making the survival behaviors more generalized. Consequently, when you fill in the rest of the fourth phase matrix, think in terms of what values were contradicted. If for example, “pretending the trauma wasn’t happening” was a response of your own, your matrix would reflect a summary or overview of your values and beliefs about the prospective denial of trauma-causing events.
Identification of loss should be handled similarly to that of contradicted values. An example of the category (9)’ s application to the Phase Four Matrix follows.
Figure TRT Phase Four
When the Phase Four Matrix is completed, arrange with your counselor to share it with your group. Of special note, whereas the predominant feelings surrounding Phase Two were of anger and shame, the general experience most often reflected at this juncture of TRT is the deep sadness and sorrow that accompanies all true mourning. Again, it is important to maintain your close contact with your TRT counselor. He or she will assist you in sharing as much of the matrix in each sitting as is believed to be appropriate for your individual needs. Once the reading has been completed, you will be ready to enter the last phase of TRT.
TRT and Behavioral Therapy
TRT does not exist in an information vacuum. There are many other methods of therapy, both professional and self-assistance, available through the various helping elements of society. Almost all of these approaches proliferate within the media as well. We believe each of these methods has value given its own limits and goals. However, each can also create problems when used inappropriately with TRT. One of the most prevalent methodologies, a cognitive and behavioral approach, has a special significance for Phase Three of TRT in that it directly conflicts with TRT’s loss resolution efforts. TRT participants exposed to both TRT and the other approach may become confused unless the differences between the two approaches are explained.
The conflict between TRT’ s third phase and the cognitive-behavioral method comes from the latter program’s interpretation of survival responses as dysfunctions. Unlike TRT, the behavioral approach does not recognize the necessary utility of the survival responses in protecting the Person from the internally retained trauma. In other words, where the trauma is seen as the problem in TRT, the behavioral-cognitive approach argues that the survival responses are or have become the problem. Consequently, from the behavioral-cognitive perspective, survival responses are viewed as character defects, personality disorders, maladaptive defenses, indicators of sickness or improperly learned ways of interacting, depending on the interpreter’s training. A natural objective of that approach, then, is to help people become aware of the different patterns of behavior that are considered to be unproductive (dysfunctional) with the idea that once these patterns of learned dysfunction are understood, the individual can recognize his or her defects or disorders and then change those characteristics or ways of behaving or learn new ways to interact. The goal is an improved quality of life.
Where the behavioral program intends to change the way people act, the single purpose of TRT is the resolution of loss. Phases Three and Four of TRT are no exceptions to this rule, as they are designed only to help resolve the loss resulting from the survival response to the trauma. When survival responses are identified in Phase Three, the intent is to describe instances in which they contradict the individual’s system of values and belief so that whatever loss was sustained can be identified and reconciled. There is no need to change the survival behaviors, as they usually are already beginning to dissipate as a result of the loss resolution process completed in Phases One and Two. In the TR T approach, there also is no therapeutic need to describe the survival responses as defects in character, compulsive disorders, maladaptive defenses, learned dysfunctional interactional patterns of behavior or indicators of sickness. Rather, survival responses can be seen for what they are: an ongoing trauma-caused decision-making process that is naturally born out of the shock of the assault and a process that is always following the unreconciled trauma’s direction. Rather than diverting attention from the trauma to the survival responses by thinking of those responses as bad and subsequently in need of change, the survival responses are seen instead as providing necessary and valuable assistance that paradoxically also tend to pit the person’s best strengths against himself or herself without that person’s permission. In other words, from the unresolved grief perspective, although the victim of trauma is behaving in ways that most probably do not conform with outside perceptions of the norm as measured by those not directly affected by that same trauma, the survival responses most certainly are offering vital aspects of assistance that the individual has to have for himself or herself given the particular trauma’s reality.
In TRT, victims of trauma, through their talents and abilities to survive, are seen as attempting to resist the trauma-causing assault that is still directed to the heart of their beings. Consequently, TRT is always facilitated with the intent to end the assault itself by resolving the trauma directly and never with the intent to alter the natural and necessary protective adaptations to the individual’s experience of the trauma.
The Survivor’s trauma -perpetuated existence is I slowly diminished as the trauma is resolved, but not before it attempts to prevent the trauma’s resolution. During these periods of resolution and less dependence on survival methods, other therapeutic views outside of TRT can affect the trauma resolution process. Specifically, some behaviorally oriented programs tend to focus on the survival responses in a way that is different from TRT’s approach. Conflict may result if the TRT participant does not understand the differences. TRT’s treatment of survival responses is not to see those responses as indicators of sickness or dysfunction, but rather solely as indicators of trauma. In TRT, the Survivor is respected for the help it has given the individual during that person’s incapacitation. If this respect and understanding for the person who has survived is not provided (as it is deserved) along with the recognition of the Survivor’s less-productive role, the trauma and loss discovered in these later phases of TRT will be only partially resolved. Providing this sometimes .difficult understanding of the Survivor’s often simultaneously productive and less productive accomplishments is one of the most important elements of the next and last phase of TRT.
The next pamphlet is the final TRT instructional aid. That pamphlet number is: