The Trauma Model Therapy (TMT) Is a Treatment Developed By Colin Ross and Supported By A Series Of Evidenced-Based Outcome Studies.
TMT is the psychotherapeutic component of this comprehensive trauma model for mental health and addictions. The trauma model is a wide-ranging, scientifically testable theory about the relationship between trauma, mental health disorders, self-defeating behaviors, and addictions.
The TMT basic premise is that trauma is a major driver of mental health listed in the DSM-5. Trauma may include childhood physical and sexual abuse, neglect, domestic violence, severe family dysfunction, loss of primary attachment figures, and severe medical and surgical disorders.
According to the TMT, most mental health symptoms are reactions to trauma, occurring in the context of people’s lives, having a meaning and purpose—they are part of a survival strategy. These survival strategies can include cognitive errors, emotions, and symptoms such as flashbacks, depression, auditory hallucinations, anxiety, substance use, self-harm, eating disorders, obsessions, and compulsions.
There are two core ideas of TMT; attachment to the perpetrator and the locus of control shift. For purposes of discussion, attachment to the perpetrator will be discussed here.
Attachment to the Perpetrator
Mammals are biologically programmed to bond, connect, attach, love, and need to be loved by their adult caretakers. In healthy families, when children feel safe, secure, loved, and special, a secure attachment pattern is formed.
TMT therapy is for those that grew up with variable combinations of physical, sexual, and verbal abuse; highly disturbed family dynamics; neglect; failure to bond and be nurtured by their caretakers; loss of primary caretakers through death, divorce, abandonment, and/or imprisonment; substance use or mental disorders. These children must bond, connect, and attach to caretakers and at other times they fear, flee, avoid their terrifying and abusive caretakers. In this case, a “disorganized attachment is formed for a chaotic, unpredictable, and inescapable pattern. The child feels stuck in a love-hate, approach-avoid, “I hate you, but don’t leave me” pattern of relating, often developing survival strategies of eating or substance use disorders, and depressive shutdown to escape the situation.
This is an observable behavioral pattern of adolescent survivors. Adolescents are likely to be stuck in an attachment pattern that Colin Ross calls “the borderline dance”. From the perspective of the trauma model, being borderline is the logical, predictable, unavoidable outcome of growing up with primary attachment figures who are also perpetrators.
The work of therapy starts with seeing and understanding the problem of attachment to the perpetrator, then realizing the core fact of clients’ childhood, and often their current life: “I love the people who hurt me, and I am being hurt by the people I love. Both things are true, I feel both sets of feelings, and it is intolerable.”
To survive, biologically, emotionally, and spiritually children must protect their attachment systems, at all possible levels.
When this core realization begins to sink in, people are thrown back into the underlying, pervasive reality of their childhood: “I feel small, scared, sad, lost, and lonely.” The fundamental work, then, is mourning the loss of the childhood they never actually had, which is a good, normal childhood. There is a lot of grief work.
In adolescents, these feelings and conflicts exist in the past, the present, and the future. Being trapped in this reality, with no avenue of escape in sight, is deeply depressing and generates hopelessness, despair, and suicidal ideation. Suicide is the ultimate escape, but temporary escape can be found in drugs, alcohol, sexual promiscuity, self-mutilation, eating disorders or any of the many forms of acting out.
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