IRRT stands for Imagery Rescripting and Reprocessing Therapy. It is a technique for processing trauma memories that mainly uses imagery and self states to resolve situations that are stuck. Instead of blunt exposure we change the story in our head and take care of our younger self to achieve changes in our symptoms. IRRT can be used to treat complex trauma. Therapists who want to use and adapt the technique need a solid foundation in trauma treatment and the treatment of dissociative disorders. The stabilization phase cannot be skipped because it is where we learn skills that are essential for success.
There are 3 steps in IRRT for regular trauma:
Step 1
Our T will ask us to share the story of the traumatic event as we experienced it. They will pay special attention to ‘hot spots’, moments that are especially hard or bring up the most intense response. A lot of techniques focus on these hot spots because resolving them often leads to an integration of the memory. We pick a scene with a hot spot and continue to work with that picture instead of the full memory. The people we look at right now are our Past Self and the abuser within the scene.
Step 2
We then enter the scene with our Present Self that comes to intervene. The task is to somehow overcome the abuser. We can follow our own impulses and wisdom in how this is achieved. The goal is to realize that the abuser is inferior to us and that we defeated them. They can’t harm our Past Self any longer. This Past Self is watching our actions, even if we are too busy to notice them and they see exactly what we are doing and who we are. We are strong and capable now. Some feel a need to engage in violent imagery here and that is ok as long as it is helpful. For some people it is healing to see the fear in the abuser’s eyes. Violence is not needed to rise above abusers though. There are other creative ways that can help us defeat our enemy within the imagery.
Step 3
Once the abuser has lost their power we turn to our Past Self and take care of them. We can imagine meeting their needs in every way. Whatever was missing, whatever need was not met, whatever their wishes are, we engage and take care of them. There is a lot of emotional repair happening so that the young side of us that had been rejected can be accepted and connection can be restored. That usually leads to a reduction of trauma symptoms.
Adapting IRRT for DID
Step 1
We begin by identifying the parts who hold trauma from this specific scene. They might have different hot spots but in my experience it can often be processed together. They share their story while others in the system listen. That way we can achieve synthesis. The puzzle pieces of memory are put together. It is useful to have a T who asks questions to make sure we get all the puzzle pieces. Then we decide who will enter the scene to intervene. It makes sense to work as a team and allow several parts to engage.
Step 2
We can then find a way to stop the abuser, they are outnumbered already. I would not recommend using violence in this case because the Littles are watching and if we behave like abusers ourselves they might lose trust. That is just a personal opinion though. Please note that a lot of inner work must have happened leading up to processing. It should not be the first time younger parts meet the older ones. We need to establish communication and cooperation and possibly co-consciousness first to be able to work together in this. Our younger parts will have to build up trust in us to actually come and help them when they willingly enter a trauma scene and they need grounding skills. That makes work exponentially easier and safer. We shouldn’t jump into work like this without the proper foundations. Experiencing the situation from the point of view of the adult can lead to the realization, that these things really happened and personification, where we realize that the young part really is us.
Step 3
Once we somehow overcame the abuser we can move the Littles to a better place. Maybe that is their Safe Place or some other meeting place the system is using. That way we move the experience to our inner world and our present situation. Sometimes they express a special wish where they want to go and we can create that picture in our imagination. Now we are within our domain that is safe and not a trauma scene anymore. It changes how the Littles tell their story. Their memory used to have no ending, they were stuck in a scene that never changed. Now the story continues as one where they were rescued and brought to safety. The past is moved to the past and there is a present that is different. Presentification happens.
Maybe there are parts inside who are especially good at taking care of younger parts. It won’t have to be the same parts who came to rescue them. It is in the nature of DID that protectors operate within action systems of defense and not caretaking and that is ok. We have more than one Present Self to get us through all the steps. Others can focus on meeting the needs that came up in the specific scene we worked with. The needs will probably match something from the hot spots that came up when sharing the story. Young parts can have all kinds of needs from a multitude of scenes but we focus on the scene we worked through today to avoid overwhelm and distractions.
To make this work we need to be able not to stay present, share an inner picture with other parts and have communication and cooperation so that we can coordinate our intervention. We also need a T who can guide through this. The steps sound easy but once the scene is activated it becomes too hard to think of everything. Difficult emotions will come up and we need someone who asks the right questions and knows how to get around roadblocks. So, like all other processing techniques, you can’t do this with yourself. It might be possible to engage in step 3 alone and make some progress, but you should not attempt to explore a new trauma scene or confront the abuser without support from outside.
I have seen this used in situations where the main problem was neglect and the abuser was either not even present or just felt like a passive ghost. In these cases it is still important for younger parts to share their story and their pain about the neglect situation in detail. It needs to be heard and validated. A confrontation might not be needed or it can be limited to expressing anger about bad caregiving. We can move on to comforting and meeting needs quickly. In this case someone who is familiar with the technique might be able to use it themselves, if the adult part is very stable and present and doesn’t get overwhelmed by trauma-related neediness.
From what I can see, techniques that use imagery are pretty similar. This one comes with a lot of structure, which can make it easier to follow. Strict steps can also limit options and I would always recommend following your own wisdom and needs over a technique. There is plenty of room to adapt it. Some things taught in IRRT are not useful for DID treatment.
CN self-harm
They claim that self-harm is an act of hurting the Past Self and that is the reason why the Past self rejects care from us. Opinions like that can be extremely harmful when we apply them to child parts because they lead to blaming and shaming us for our coping behavior and increasing tension inside by communicating to child parts that we are their abusers, making it impossible to reconcile.
IRRT that is not properly adapted jumps into processing way too fast because longer stabilization is considered overrated. It really is not when we are dealing with (structural) dissociation. On the other hand, dissociation and DID are considered reasons not to use IRRT at all when in reality it can be easily adapted and turns out to be rather useful. So it is always important to use your own brain and have a T who uses theirs and be very critical about weird claims that are not in line with a basic understanding of our problems. This technique was created for simple trauma, it needs changes to work for us.
Nevertheless, I think this is a neat little tool that can change inner beliefs and give a new ending to a story that had none in our memory. It has to be clear that we are not changing the past, we just change our inner reality. Very small studies found that IRRT has a similar effect as EMDR when it comes to reducing symptoms in PTSD. It is more gentle on patients and therapists than blunt exposure therapy and better at resolving emotions that are not fear. That could be especially interesting for complex trauma, where shame and helplessness are very dominant emotions. It is easy to see how defeating the abuser would dissolve chronic helplessness and reconciling with the hurting child can make a difference in our shame. IRRT is often used for single trauma or other problems that have nothing to do with PTSD like persistent grief. That is why it is important to find a T who is actually trained in trauma treatment that goes beyond this one technique. It is just one tool and complex trauma needs the whole toolbox. The Ts I personally know who use IRRT have learned it as their 3-4 technique for trauma processing and picked it specifically because it is simple and gentle compared to other techniques.
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