TIST brings together parts work and body awareness, treats symptoms such as dissociation and self-destructive impulses as survival responses rather than defects, and builds stability before any work with traumatic memories.
At Seattle Trauma Counseling it is provided by Wendy Flores, MA, LMHC, who trained directly with Dr. Fisher and holds the highest level of TIST certification.
TIST integrates techniques from Internal Family Systems and Sensorimotor Psychotherapy to address the symptoms of complex trauma, such as self-harm, aggression and dissociation. Dr. Fisher describes it as a trauma-informed parts model that also draws on clinical hypnosis, mindfulness and cognitive approaches.
TIST focuses on treating the effects of traumatic events rather than the events themselves. It helps you manage unsafe and addictive impulses by understanding these behaviors as driven by trauma, rather than as manipulative in nature. It often sets aside unhelpful diagnoses you may have been given in the past, such as borderline personality disorder, and instead looks at the behavior as survival-based.
For people who have struggled with severe or long-standing trauma symptoms, that shift can make therapy feel less threatening and more compassionate.
One of the important differences in TIST is that symptoms are not simply viewed as problems to be eliminated. They are understood as adaptations that developed for a reason. Self-harm, shutting down, emotional withdrawal, intense anger, addictive behaviors or dissociation may have originally helped you survive experiences that were overwhelming or impossible to escape.
When these responses are understood in that context, you can begin to move away from shame and self-blame and toward curiosity about what your nervous system, and the different parts of you, are trying to accomplish.
TIST was designed for people who have experienced prolonged or early trauma and who struggle with emotional flooding, shame, dissociation, internal conflict, self-destructive behavior or difficulty trusting relationships. It is especially relevant to developmental and attachment trauma, and to dissociative symptoms up to and including dissociative identity disorder. Many of the people who come to us for TIST have already done years of therapy that helped in some ways but did not reach the core of what they were living with, because those symptoms cannot always be adequately addressed through talk therapy alone.
TIST emphasizes stabilization first, followed by carefully paced work with traumatic memories and greater psychological and somatic integration. Importantly, this process respects your readiness and your ability to remain present, rather than assuming that remembering or retelling traumatic experiences must be the first step in healing.
Stabilization is the first phase of trauma treatment, and in TIST it is the heart of the work rather than a preliminary to be hurried through. It means building enough safety and regulation, inside you and around you, that the nervous system can begin to come out of survival mode: fewer episodes of flooding or shutting down, earlier recognition of triggers, a steadier daily life, and less of the crisis-to-crisis pattern that many people with complex trauma know well.
In practice, stabilization draws on grounding and orienting to the present, breath and body awareness, mindful observation of what is happening inside you without being swept away by it, resourcing, which means identifying what steadies you and who you can turn to, and learning to recognize the part of you that is driving an impulse before it becomes an action. None of this is about suppressing feelings or avoiding the past forever. It is about developing the capacity that makes deeper work possible, so that when traumatic memories are eventually approached, you can stay present rather than being pulled back into them.
The main way TIST works is by helping you become aware of the fragmentation, or parts of the personality, that formed because of trauma. These parts can drive dissociative symptoms that become chronic and extremely difficult to live with day to day.
Rather than treating these parts as pathological, TIST helps you understand them as survival responses that may still be reacting as though the danger of the past is happening now. One part may become frightened and want to disappear. Another may become angry or defensive. Another may feel intense shame, hopelessness, or a need to please other people in order to stay safe. Still another may desperately seek attachment or reassurance. The goal is not to get rid of these parts. The work is to develop a different relationship with them.
Dr. Fisher’s model names these parts by the survival response each one carries: a fight part, a flight part, a freeze part, a submit part, and an attach part that cries for help and reaches for connection. If you have read about the four F’s of trauma, fight, flight, freeze and fawn, this is the same territory seen from the inside. What is popularly called fawning, TIST would recognize as a submit or attach part doing its job. Naming the response a part is carrying is often the first step toward relating to it differently.
An important component of TIST is learning to notice a feeling, thought, body sensation or impulse without becoming completely identified with it. Instead of experiencing an overwhelming impulse as "this is who I am" or "this is what I have to do", you gradually learn to recognize that a part of you is having that reaction. This small but significant change creates enough psychological space for curiosity, compassion and choice. Over time you become increasingly able to respond to frightened, angry, ashamed or overwhelmed parts without automatically being controlled by them.
TIST also places considerable importance on developing an internal sense of safety and attachment. Many survivors of complex trauma learned very early that relationships could be both necessary and dangerous. The people they depended upon may also have been the source of fear, neglect, unpredictability or harm. Healing therefore involves more than processing individual traumatic memories. It also involves developing a safer relationship with yourself and with the parts of you that continue to carry the emotional and physical effects of those early experiences.
These techniques are crucial for helping you stay in the present moment. Grounding exercises such as breathing, sensory awareness, orienting to the environment and visualization help you reconnect with your body and surroundings, reducing the tendency to dissociate.
TIST uses mindfulness not simply for relaxation but to help you notice internal experiences without automatically becoming overwhelmed by them.
Sensorimotor Psychotherapy techniques increase your awareness of physical sensation. By paying attention to bodily cues, posture, movement, tension, impulses and changes in the nervous system, you become more attuned to your physical presence.
This helps counteract dissociation and lets you recognize trauma responses before they become overwhelming.
You learn to identify and communicate with different parts of yourself, including parts that dissociate, become angry, shut down, self-harm, seek reassurance or avoid emotional experience in an effort to protect you. Rather than fighting these responses, you learn to understand what these parts fear and what they have been trying to prevent.
This gradually reduces internal conflict and the need for extreme coping strategies.
Understanding the nature of dissociation, traumatic attachment, nervous system responses and the protective function of trauma symptoms can be profoundly important. Many people with complex trauma have spent years believing something is fundamentally wrong with them.
Learning that many of their reactions developed as survival responses decreases shame and helps them recognize dissociative episodes or trauma responses earlier.
These include creating safety plans and developing practical skills for managing the triggers that lead to dissociation, emotional flooding, self-harm or other unsafe behaviors. Self-soothing, sensory grounding, orienting, mindful observation and learning to recognize the needs of different parts help you regain a greater sense of control. Stabilization does not mean avoiding deeper trauma work indefinitely.
It means developing enough internal safety and regulation that deeper work can happen without repeatedly overwhelming you.
Many trauma survivors feel profound self-criticism or self-hatred toward the very symptoms that once helped them survive. TIST works to replace that internal hostility with understanding. You may gradually come to recognize that even a destructive or frightened part developed with a protective intention.
As your relationship with these parts becomes safer, the internal system becomes less polarized.
A strong and trustworthy therapeutic relationship is the foundation for exploring dissociative and traumatic experience. For people whose earliest relationships involved both attachment and danger, trust cannot be assumed.
It develops through consistency, respect, collaboration, appropriate pacing, and your repeated experience that you will not be pushed beyond what you can tolerate.
No. Trauma-Informed Stabilization Treatment (TIST) is specifically designed to help people work with trauma without requiring them to repeatedly relive or retell what happened. In fact, one of the central principles of TIST is that going directly into traumatic memories before a person has enough stability can lead to emotional flooding, dissociation, shame, or intense flashbacks. If you have experienced sexual trauma, for example, the goal is not to put you back inside the experience or ask you to describe painful details before you are ready. Treatment begins by helping you understand how your nervous system and different parts of you learned to survive. Reactions such as shutting down, becoming hypervigilant, feeling ashamed, going numb, or suddenly feeling as though the trauma is happening again are approached as survival responses rather than signs that something is wrong with you.
TIST works by helping you develop the ability to notice these trauma responses while remaining connected to the present. Instead of immediately focusing on the story of the trauma, therapy may begin with recognizing what happens in your body, emotions, thoughts, and impulses when something triggers you. You learn to identify the frightened, ashamed, angry, protective, or disconnected parts of yourself without becoming completely overwhelmed by them. The therapist helps you strengthen what Janina Fisher describes as the capacity to remain grounded in the present while becoming curious about the reactions that developed during traumatic experiences. Over time, a flashback can increasingly be recognized as a trauma response occurring now rather than proof that the traumatic event is happening again. Grounding, mindful awareness, attention to the body, and a compassionate understanding of these survival responses are used to help you return to a greater sense of safety.
When traumatic memories are eventually approached, TIST emphasizes careful pacing rather than emotional immersion. You and your therapist continually pay attention to whether you can remain present and within a manageable level of emotional and physical activation.
Wendy Flores, MA, LMHC specializes in the treatment of complex trauma and dissociative disorders and has devoted more than a decade of her clinical career to working with people whose trauma cannot always be adequately addressed through traditional talk therapy alone. Her work is particularly informed by an understanding of developmental and attachment trauma, including the complicated psychological consequences that follow when the people a child depends on for security are also sources of fear, instability, neglect or harm.
Wendy received direct training from Dr. Janina Fisher in Trauma-Informed Stabilization Treatment and has completed the highest level of TIST training and certification. She is also extensively trained in Sensorimotor Psychotherapy, which gives her an advanced foundation in both parts-oriented and body-oriented approaches to trauma. Her primary therapeutic orientation is somatic psychology, and her clinical work has centered on complex trauma, PTSD and dissociation throughout her career.
That combination matters when treating complex trauma and dissociative disorders, because these conditions involve more than distressing memories. You may experience changes in consciousness, emotional flooding, numbness, memory difficulties, internal conflict, self-harm impulses, intense shame, difficulties with attachment, or the sense that different aspects of you react in dramatically different ways. Treatment requires a clinician who understands not only trauma but fragmentation, nervous system responses, attachment, and the careful pacing that dissociation demands.
Wendy’s approach emphasizes helping you understand why your symptoms developed rather than simply trying to suppress them. For someone who has spent years feeling ashamed of dissociation, emotional instability, avoidance, self-criticism or other trauma responses, learning that these reactions may have begun as attempts at survival can fundamentally change the experience of therapy. The aim is never to force you to revisit traumatic experiences before you are ready, but to help you develop enough safety, awareness, internal cooperation and nervous system regulation that healing becomes increasingly possible.
For people living with complex trauma or dissociative symptoms, the depth of a therapist’s specialized training matters. Wendy’s direct training with Dr. Fisher, her advanced work in TIST and Sensorimotor Psychotherapy, and her years of clinical experience provide a particularly strong foundation for working with people whose symptoms have persisted despite previous attempts at therapy.
Trauma-Informed Stabilization Treatment, or TIST, is an approach to complex trauma developed by Dr. Janina Fisher. It combines parts work from Internal Family Systems with the body awareness of Sensorimotor Psychotherapy, treats symptoms such as dissociation, shutting down and self-destructive impulses as survival adaptations rather than defects, and builds stability before any work with traumatic memories.
TIST was designed for people who lived through prolonged or early trauma and who struggle with emotional flooding, shame, dissociation, internal conflict, self-destructive behavior or difficulty trusting relationships. It is particularly suited to complex trauma, developmental and attachment trauma, and dissociative symptoms, including for people whose symptoms have persisted despite earlier therapy.
Stabilization is the first phase of trauma treatment: building enough internal safety and nervous system regulation that you can stay present, recognize triggers earlier and step out of crisis-to-crisis patterns before any work with traumatic memories begins. Common stabilization techniques include grounding and orienting to the present, breath and body awareness, mindful observation of internal states, resourcing, and learning to notice which part of you is driving an impulse. In TIST, stabilization is the center of the work, not a box to tick before the real therapy starts.
TIST follows the phase-based model most trauma specialists use, with its own emphasis. First, safety and stabilization: regulation skills, grounding and recognizing triggers. Second, working with parts: learning to notice, understand and communicate with the protective parts of you rather than fighting them. Third, and only once stability holds, carefully paced work with traumatic memories and greater integration. Progress is rarely a straight line, and returning to stabilization when life gets harder is part of the process, not a setback.
No. TIST does not require you to repeatedly retell or relive traumatic events. The early work is about understanding what is happening now, how the past lives on through your body, emotions, relationships and survival responses, and building enough internal safety that you can stay present. Direct work with memories comes later, only when it is safe and productive, and at your pace.
Often, yes, particularly with complex trauma or dissociation. EMDR and other processing methods work with traumatic memory directly, and doing that before a person can stay present and regulated can flood or destabilize them. TIST builds that foundation first, and many clients go on to combine it with EMDR, Sensorimotor Psychotherapy or other approaches once stability holds. The sequencing is decided with you, based on what your nervous system can tolerate rather than on a fixed schedule.
No, though they share the idea of parts. TIST is a trauma-specific model that draws on Internal Family Systems, Sensorimotor Psychotherapy, clinical hypnosis, mindfulness and cognitive approaches. Its distinctive emphasis is on stabilization, on the body, and on understanding parts as survival responses that may still be reacting as if the danger of the past were present.
Yes. Trauma-informed care is a general approach that any clinician or organization can adopt, built on principles such as safety, trustworthiness, choice, collaboration and empowerment, and on the commitment to realize how common trauma is, recognize its effects, respond to them and resist re-traumatizing people. TIST is a highly developed, profound clinical treatment system, developed by Dr. Janina Fisher for complex trauma and dissociation, that is trauma-informed in that sense and adds a structured method: stabilization first, parts work, body awareness and paced memory work.
They are the same survival responses, understood as parts of the personality rather than passing states. Dr. Fisher’s model describes a fight part, a flight part, a freeze part, a submit part and an attach part that reaches for connection, and what is popularly called fawning maps onto the submit and attach responses. In TIST, recognizing that a part is carrying a survival response, rather than believing this is simply who you are, creates the space to relate to it with curiosity instead of shame.
TIST looks at behaviors such as self-harm, intense anger, shutting down or a desperate need for reassurance as trauma-driven survival responses rather than as manipulation or character flaws, and it often sets aside diagnostic labels that have not helped. Many people with a borderline diagnosis have a history of complex trauma, and in our experience that lens can make therapy feel less threatening and more compassionate. A free consultation is the place to talk through whether it fits you.
The two are frequently confused, because they share emotional flooding, unstable relationships, dissociation and a history of trauma, and because complex PTSD is not a separate diagnosis in the DSM-5, so people with complex trauma are sometimes given other labels instead. A diagnosis is a conversation to have with a clinician, and TIST does not depend on settling it. Whatever the label, the work is with the survival responses underneath it, and those can change.
Wendy Flores, MA, LMHC, who trained directly with Dr. Janina Fisher and holds the highest level of TIST training and certification, alongside advanced training in Sensorimotor Psychotherapy. Wendy specializes in complex trauma and dissociative disorders and sees clients in person and online across Washington.