Therapy on the Cutting Edge

​A Career in Trauma Treatment and the Trauma Informed Stabilization Treatment (TIST) for PTSD and Complex PTSD

Therapy on the Cutting Edge

Show Notes

In this episode, Janina discusses her career in learning, treating, and teaching about PTSD and Complex PTSD. She discusses being inspired when hearing Judith Herman talk about how that the events in one’s life shape our experiences, as opposed to just being driven by childhood sexual fantasies as was the main viewpoint based on Freud’s work. She explained how the prevailing thought in treating trauma for decades has been that the client needed to tell the story of the trauma, but we have no research that proves that view. Instead, she proposes that the way to treat trauma is to change one’s relationship to the symptoms, rather than re-live the event. She discussed her experience working with Bessel Van Der Kolk, and how he encouraged her to teach about working with PTSD. Additionally, he encouraged all of his clinicians to be trained in a Somatic approach, which lead her to Sensorimotor Psychotherapy training and to EMDR. She discussed her work and how she helps clients to engage their frontal lobes, the thinking brain, and works with clients as fragmented, incorporating Internal Family Systems and working from a Structural Dissociation perspective. We discussed how she treats suicidality in trauma clients as a part trying to protect the client from being overwhelmed by vulnerability. She discussed how her model, Trauma Informed Stabilization Treatment (TIST) is an integrative approach, incorporating parts work, EMDR, somatic, and Structural Dissociation, and she is training others in her model throughout the world. Finally, we discussed the clients’ experience in therapy and working with them where they are, as the client who has experienced trauma may not be able to “trust” the therapist enough to try something new.

Janina Fisher, Ph.D. is a licensed clinical psychologist and a former instructor at the Harvard Medical School and former instructor at The Trauma Center, a research and treatment center founded by Bessel van der Kolk. She is known as an expert on the treatment of trauma, and has also been treating individuals, couples and families since 1980. She is past president of the New England Society for the Treatment of Trauma and Dissociation, an EMDR International Association Credit Provider, and Assistant Educational Director of the Sensorimotor Psychotherapy Institute. Janina lectures and teaches nationally and internationally on topics related to the integration of the neurobiological research and newer trauma treatment paradigms into traditional therapeutic modalities. Janina is the author of Healing the Fragmented Selves of Trauma Survivors: Overcoming Self-Alienation (2017), Transforming the Living Legacy of Trauma: a Workbook for Survivors and Therapists (2021), and The Living Legacy Instructional Flip Chart (2022). She is best known for her work on integrating somatic interventions into trauma treatment, and the development of her approach Trauma Informed Stabilization Treatment (TIST), which one can be trained in by going to https://therapywisdom.com/healing-the-fragmented-selves/. You can learn more about Janina at her website, www.janinafisher.com.

More from Therapy on the Cutting Edge

Oct 5, 2026

In this episode, I speak with Fred Rabinowitz, Ph.D., Professor Emeritus of Psychology at the University of Redlands, about his nearly 40-year career at the intersection of psychology, masculinity, and men's mental health. Fred shares his personal journey, from growing up as the oldest of three boys with a father who was both a traditional male and an artist who encouraged emotional openness and close friendships, to a pivotal experience in first grade when hugging a friend led to being ridiculed. He discusses how that early moment shaped his understanding of how boys are socialized to suppress their emotional lives, shifting from open and affectionate to competitive and emotionally guarded. We discuss how Fred and his colleague Sam Cochran established one of the first university-based therapeutic men's groups at the University of Missouri in 1982, and the critical role that positive older male figures can play as mentors, helping young men feel less alone and creating a constructive cycle of emotional openness. Fred explains that therapy with men requires a different approach given the gender norms they have internalized, emphasizing the importance of entering with empathy and curiosity rather than judgment, building trust, and helping clients reflect on the underlying reasons for their behavior rather than simply naming symptoms. We discuss loss as a primary wound that often brings men into therapy, and how avoidance behaviors such as substance abuse serve as coping mechanisms. Fred describes how intimacy is frequently conflated with sex, and how emotional closeness between men is often perceived as threatening despite being a fundamental human need for connection. He also addresses the post-pandemic cultural landscape, critiquing the manosphere's emphasis on physical appearance and wealth as paths to fulfillment, and the need for greater empathy toward men within feminist movements. Fred shares stories from his latest book, Deepening Group Psychotherapy with Men, which chronicles the group dynamics of ten men in therapy and represents his favorite blend of storytelling and clinical practice. We also discuss Men and Depression, which examines black-and-white thinking, suicide risk, and the emotional disconnection that can leave men uncertain of their own emotional states. The conversation then turns to a forthcoming book on the psychology of poker, co-authored with Darren Elias. Fred recounts how their collaboration began when, as Dean, he mentored a young Darren through academic difficulties stemming from his lucrative online poker play, supporting his transition to a creative writing major. Fred discusses poker as a metaphor for how men conceal their emotions in everyday life, navigating vulnerability and alliance without revealing their hand. We also discuss his upcoming project Strength with Heart, a self-help book and workshop series designed to help men develop self-awareness and reflect on their experiences, and the broader challenge of reconciling strength with emotional openness and compassion.

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In this episode, I speak with Julian Ford, Ph.D., A.B.P.P. who discusses his work with PTSD, Complex PTSD, Developmental Trauma Disorder and the T.A.R.G.E.T. Model for treatment. Julian shared that he had started out working as a line staff in a state psychiatric facility, then went on to working with the Veteran’s Administration. He discussed working with Veterans with trauma and seeing that they struggled with much more than just the symptoms of PTSD. He explained that he worked with the National Center for PTSD, which is part of the VA system, then got connected to a Child Psychiatry working group through Darmouth. He shared that they had found that clients diagnosed with ADHD and many with ODD, also had trauma, that was undiagnosed. We discussed what CPTSD is and how the nervous system reactivity is central to the diagnosis. Julian discussed how their model starts with psychoeducation, and explaining to the client they have an “alarm” in their brain, which is what leads to this reactivity. Understanding that can help access the frontal lobe to be able to understand and decrease the reaction to the reactivity. He explained that he works with clients and their nervous systems in various ways, depending on what the client’s entree is, whether it be emotional, cognitive, somatic or other. He shared that the model he uses also helps the person connect to their values, and seeing the values in their stories about past and present events. In reflecting these values to the clients, it helps them to see their self and symptoms having protected them during these times of survival, and they can still live guided by those values, although without the context of threat. He shared that he helps clients to connect with that sense of self that is values driven, which helps to alleviate the trauma narrative that the client is broken, defective, unlovable or other forms of shame. We discussed the difficulties related to sense of self that is part of the CPTSD diagnosis. We also discuss the work from 2000 in identifying trauma in cases of ADHD and ODD, and how the diagnosis of trauma maybe missed sometimes. He shared that it is “both and”, where the child may also have those diagnoses and trauma, although identifying the trauma allows the therapist to bring in trauma informed or trauma focused therapy.

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In this episode, I speak with Sharon Martin, LCSW, about her clinical work with adults navigating family estrangement and the complex process of deciding whether to limit or cut off contact with parents. Sharon, a psychotherapist with over 25 years of experience, specializes in working with adult children of alcoholics and individuals from dysfunctional family systems. Her work focuses on helping clients process the long term effects of developmental trauma and build healthier, more authentic lives. Sharon explains that many individuals seeking therapy may initially present with concerns such as anxiety, depression, or relationship difficulties, only to discover underlying patterns rooted in early family dynamics. These experiences often include chronic shame, hypervigilance, perfectionism, and a reliance on external validation, factors that can make navigating family relationships particularly challenging in adulthood. A central focus of the conversation is the decision-making process around estrangement. Sharon emphasizes that, contrary to common portrayals, estrangement is rarely a single, definitive event. Instead, it often involves cycles of limited contact, attempts at repair, and periods of withdrawal, as individuals grapple with both the desire for connection and the need for self protection. She highlights the emotional complexity of this process and the importance of allowing clients to determine what level of contact feels appropriate for them. We also discuss the role of boundaries, including how individuals can begin to define what constitutes a healthy relationship, often for the first time. Sharon discusses the importance of recognizing and naming harmful or abusive patterns, while also addressing the internalized beliefs that can make it difficult for individuals to prioritize their own needs. Building self trust, self worth, and a clearer sense of identity are key components of this work. The conversation further examines broader systemic and cultural influences, including family expectations, caregiving roles, financial dependence, and cultural norms around filial responsibility. Sharon acknowledges the additional layers of guilt and pressure that can arise in collectivist contexts or when aging parents require care, and she encourages a more flexible, individualized approach to navigating these responsibilities. Sharon also shares insights from her book, Cutting Ties with Your Parents, which is designed to support individuals who are considering or have already made the decision to distance themselves from their families. The book outlines a three part process: making peace with the decision, healing from both developmental trauma and estrangement related wounds, and moving forward by cultivating healthy relationships and a more authentic sense of self. Finally, we discuss important considerations for clinicians working with this population. Sharon highlights the lack of formal training in this area and underscores the importance of therapists examining their own biases, particularly the tendency to prioritize reconciliation. She emphasizes the need to support client autonomy, respect the pace of the decision making process, and create a space that is validating rather than prescriptive.

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In this episode, Kara speaks about her work with couples who are struggling with addiction. She discussed obtaining a family systems training in a couples and family clinic in Montreal, and then moving to an outpatient clinic in Vancouver for individual’s struggling with addiction. She explained that many of the clients wanted to bring in their partner and/or family members, so she turned to the research to learn about treatment with couples with addiction. She found that most of the research was on a behavioral approaches, but not on the approach she was using, Emotionally Focused Couples Therapy, until she came upon a theoretical extension that had been proposed using EFT. She decided to go back to school and get her PhD, and do research on the use of EFT with couples in the context of substance use and addictions. She shared that colleagues expressed concerned about whether it was ethical to work with couples and addiction, and she explained that this perspective often coming from behavioral models of addiction, rather than looking at attention through the lens of attachment. She discussed how people don’t set out to become addicted, but usually use substances to manage suffering or pain, and by strengthening the attachment relationship, it can lessen the dependence on the substance. Through her research, she found that there needs to be some level of stability around the substance use for the couples work to make sense because the individual(s) need to be functioning to engage in couples work. There also needs to be some core connection that is worth working on, which through the work, can lessen the distress and even the hyperfocus on the addiction. She explained that all of the couples she worked with in the study were in early recovery. She shared that when there was a partner who wasn’t addicted, they were often having an inner conflict, having been told to not be codependent, to detach, but at the same time to love their partner, seeing them as more than an addiction. She discussed how Sue Johnson, Ph.D. discussed dependency, and how we have to have "effective dependence" in relationship, rather than dependence being synonymous with codependency. Learning how to depend on another in a healthy way, that is functional rather than having someone else take over for you. She shared that starting with the relationship, and helping that be solid, can then even be a resource for the person to go off and take steps in their individual life. She shared the common pattern is that the person in recovery is the withdrawer and the partner not having addiction, often being in the pursuer position. She shared that the EFT approach is helpful in understanding that cycle, and helping the partner to turn to the other, when feeling like turning towards substance use, and the partner can be there, without becoming fearful of their partner’s struggling. Often the withdrawn partner doesn’t share this, for fear the partner will freak out, or become hyper vigilant. She explained that partners who are in recovery should have lots of different tools and supports, in addition to the relationship, while having the relationship be a safe haven for them to turn for support. We discuss working with clients with active addiction and working with them when they maybe didn’t come in due to substances, but not turning them away as they’re seeking help. She explained that when coming to therapy, often the therapist assumes the addiction is the problem, although the couple may be wanting to work on other additional issues, and couples have reported to her that other therapists have only focuses on the addiction, and it was not a good fit for what they were looking for. She discussed working with couples where abstinence is the goal as well as working with couples using a harm reduction model. Lastly, Kara discusses her current research with couples where one partner has started adopting conspiracy theories or misinformation and therapy options that help c

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