Instinctual Trauma Response and graphic narrative

1. Introduction

Version followed: the Individual Intensive Trauma Therapy (IITT) clinic protocol of Intensive Trauma Therapy, Inc., Morgantown, West Virginia (Louis Tinnin MD and Linda Gantt PhD, ATR-BC), as profiled by the California Evidence-Based Clearinghouse (research evidence review dated June 2015). It is supplemented by the current ITR Training Institute descriptions (2024–25), which add grounding, Safe Place, True Self and Parts language, hourly as well as intensive formats, and an ITR web app. Status: the claims below are checked against the CEBC profile, the GWU event page, the psychotherapy.net session pages and the podcast notes. The founders' book (Tinnin & Gantt, The Instinctual Trauma Response and Dual-Brain Dynamics: A Guide for Trauma Therapy, 2013), the ITT programme manual, the ITR Training Institute's own materials and the full texts of Gantt & Tinnin 2007 and 2009 are not publicly available, so the published content of the Safe Place exercise, the guided-imagery script, the anti-regression regimen and the externalized-dialogue procedure is unconfirmed. Step-level detail below is thinner than the manual's and is marked where it is inferred. [uncertain]

What it is. The Instinctual Trauma Response (ITR) is two things. First, it is a model: a stereotyped sequence of survival responses that the founders say occurs in any overwhelming event. Second, it is a method: the client draws the trauma as a series of pictures that follow that sequence (the graphic narrative). A therapist then re-tells the story to the client from the pinned-up drawings (the re-presentation), and dissociated parts are addressed through externalized dialogue. The clinic delivered it as a 1–2 week outpatient intensive, offered as an alternative to psychiatric hospitalisation. [source: CEBC IITT profile; psychotherapy.net session page; GWU event page]

How change is said to happen. The developers hold that traumatic memory stays as fragmented, nonverbal, sensory-motor material, stored in a 'right-brain' or nonverbal mode. In this view it replays as flashbacks and body sensations because the story was never completed. Drawing the whole sequence externalises the memory, which the GWU page describes as moving it "from the mind onto paper". Bracketing it with a 'before' and an 'after' (survival) picture gives it an ending. Hearing it re-told in the client's own words is meant to make it a finished, verbal story that is "truly history". The developers also say the method works without the client reliving the event. [source: psychotherapy.net; GWU; Metacast episode notes; Church4EveryChild summary] The 'dual-brain' neurobiology is the founders' own theory. Treat it as the model's rationale, not as established fact. [uncertain]

Professional frame.

• ITR is a proprietary, trademarked method (ITR®) of the ITR Training Institute, whose co-founder is Linda Gantt and whose Training Director is Danni Davis LCSW. The institute offers ITR certification. Gantt is also co-founder of HelpForTrauma.com, and she closed her long-running intensive clinic to concentrate on training practitioners. [source: GWU; Metacast]
• The IITT training was Part I, a 4-day didactic and experiential course (30 h), then Part II, a 5-day practicum at the clinic following one client through a week of treatment (40 h). A programme manual existed. Clinic staff were Master's-level social workers, licensed professional counsellors and art therapists. [source: CEBC] Current training routes and fees may differ from this. [uncertain]
• ITR is not tied to a single regulated profession. You need a licence to practise psychotherapy (for example LCSW, LPC or psychologist; for art therapists, ATR-BC via the ATCB in the US or HCPC registration in the UK) plus ITR training. Gantt herself is an art therapist (ATR-BC; master's in art therapy from GWU, doctorate in interdisciplinary studies from the University of Pittsburgh; co-developer, with Carmello Tabone, of the Formal Elements Art Therapy Scale, FEATS). [source: GWU; CEBC] A past AATA presidency is sometimes stated. [uncertain: secondary, unverified]
• Do not run trauma graphic narratives without ITR training, trauma-therapy competence and supervision. A related single-event method, Trauma Art Narrative Therapy (TANT), developed by Lyndra J. Bills MD (co-author with Tinnin and Gantt in 2002), likewise requires a competency test. Its organisers state that the training does not replace ongoing clinical supervision. [source: TANT training page; CEBC]
• Materials: letter-size (8½ × 11 in) paper and coloured markers, one drawing per sheet, plus a wall or bulletin board to pin drawings on. The clinic also used video cameras and TV monitors. No toxic or sharp materials are needed. Use non-toxic, low-odour markers. [source: GWU; CEBC; synthesis for the safety note]

2. Framework

Format (clinic version). [source: CEBC]

• Marathon intensive of about 7 hours a day, Monday to Friday, with 30–35 hours of individual therapy per week, for one or two weeks. Clients may return later for another course. Out-of-town clients stayed in a local hotel.
• 3–4 rotating Master's-level therapists, with team morning rounds and an afternoon wrap-up.
• The daily cycle was morning rounds → guided imagery → art therapy (graphic narrative) → re-presentation → externalized dialogue → wrap-up.
• No homework.

Current formats. The developers state that ITR is now used in hourly sessions as well as intensive formats, in individual and group settings, and with children as young as three. They describe it as combining "parts psychology, art, narrative, and somatic therapies". [source: Metacast episode notes] No published hourly-session structure is available; a workable adaptation is given below. [uncertain]

Phases (clinic version). Phase boundaries are reconstructed from the CEBC component list. [source: CEBC; partly synthesis]

1. Pre-admission screening and preparation (several weeks before; by phone or video).
   • Goals: take trauma, family, medical and psychiatric history; screen for dissociative regression; consult the referring therapist; compare the client's DES, Trauma Recovery Scale and Dissociative Regression Scale scores with those of past completers.
   • Moving on: no active substance-use disorder; able to manage activities of daily living (if regressed, an anti-regression regimen first, and admission only once the regression is reversed); age 18–80 in the adult programme.
2. Orientation and psychoeducation (day 1).
   • Goals: teach the ITR model (by video at the clinic), establish safety resources (Safe Place) and the team routine. [source: CEBC; GWU]
3. Trauma processing cycles (bulk of the week).
   • Each cycle covers one trauma: guided imagery with a 'hidden observer' → graphic narrative → re-presentation → externalized dialogue with the parts involved.
   • Order: 'foundation' (often preverbal) traumas first, then the others in chronological order.
4. Consolidation and discharge.
   • Goals: re-measure; write a treatment summary and follow-up recommendations for the hometown therapist.
   • Discharge targets: SCL-45 ≤ 80, TAS ≤ 74, DES ≤ 20.
   • If targets are not met, a later return course is an option.

Adapting to weekly 50–90 minute sessions. [synthesis]

• Plan 1–3 sessions of preparation (model, Safe Place, parts mapping).
• Allow one longer session (90+ min) per graphic narrative where possible, so that drawing and re-presentation fit in the same sitting and no story is left open overnight.
• Close every session with the 'after' picture and grounding. Re-assess dissociation before each new trauma.

3. Guiding principles

• The model holds that every trauma follows the same instinctual sequence: startle → thwarted intention (fight or flight blocked) → freeze → altered state of consciousness → body sensations → automatic obedience → self-repair. [source: CEBC] Practice: use the sequence as the scaffold for both the drawings and the re-telling.
• Symptoms are an incomplete story, not illness. Practice: normalise reactions (freezing and compliance were survival responses, not weakness or consent). [source: psychotherapy.net; Church4EveryChild blog: uncertain: secondary, unverified]
• Picture first, words second. The emphasis is on "doing the drawings first" and then putting words to them. [source: psychotherapy.net] Practice: do not ask for a verbal account before the drawings exist.
• Externalise, don't relive. Guided imagery uses a 'hidden observer' stance so the client watches rather than re-experiences. [source: CEBC; Metacast] Practice: keep the client in observer position and stop or ground if they slip into reliving.
• Give the story a beginning and an end. Every narrative is framed by a 'before' and an 'after' drawing. [source: psychotherapy.net] Practice: never finish a session without the 'after' (survived and safe) picture.
• Foundation traumas first, then chronological. [source: CEBC; psychotherapy.net] Practice: on the trauma timeline, start with the earliest (often medical or preverbal) event, not the most distressing recent one.
• The therapist re-presents, the client witnesses. [source: CEBC; psychotherapy.net] Practice: you tell the story in the client's own words while they watch and listen. You don't add interpretations.
• Dissociation is reversed through dialogue with parts. The aim is the True Self helping 'hurt, stuck or left-behind' parts. [source: CEBC; GWU] Practice: map parts before processing and check in with them afterwards.
• Screen for regression before processing. [source: CEBC] Practice: stabilise first; regressed clients are not processed until the regression is reversed.
• Measure and hand back. Use standard measures at intake and discharge, and send a written summary to the ongoing therapist. [source: CEBC] Practice: intensives sit inside continuing care.
• Memory caution. ITR promotional material speaks of "uncovering dissociated memories" and of prenatal and preverbal experience. [source: GWU; Metacast] Practice: treat drawings of early or preverbal events as the client's present-day representation, not as verified history or evidence. Don't suggest content, and don't use narratives forensically. [synthesis]

4. Intervention inventory

The inventory covers the components named in the public sources. The founders' manual will hold more detail, such as exact imagery scripts and the anti-regression regimen; those items are marked [uncertain] where no published content exists. [source: CEBC; psychotherapy.net; GWU]

4.1 Pre-admission screening and baseline measurement

• Purpose: decide whether the client is ready for trauma processing, especially an intensive. Set baselines for judging the outcome.
• Steps: [source: CEBC; synthesis for order]
  1. Take trauma, family, medical and psychiatric history.
  2. Screen for dissociative regression (loss of adult functioning, child-like states taking over).
  3. Give the Dissociative Experiences Scale (DES), the Trauma Recovery Scale and the clinic's Dissociative Regression Scale. Compare the scores with the range of past completers.
  4. Consult the referring therapist.
  5. Hold several phone or video interviews with the clinical coordinator.
  6. Exclude or defer clients with active substance-use disorder, or who cannot manage activities of daily living.
  7. Do a standard suicide and self-harm risk assessment, with a safety plan. [synthesis]
• Example language (illustrative): "Before we do any trauma work, I want to know how you're managing day to day and what support you have at home."
• Watch for: high DES scores combined with regression or chaotic functioning signal that stabilisation is needed first. [source: CEBC; synthesis]
• Measurement limits: CEBC lists the Trauma Recovery Scale and the Dissociative Regression Scale (the latter an "IITT program assessment") at intake. It gives no developer, reliability or validity data for either, or for any other measure it names, and no published psychometric study of the two programme scales is known. [source: CEBC; uncertain] A Trauma Recovery Scale (TRS) by J. E. Gentry (1999, poster at the International Society for Traumatic Stress Studies convention) is distributed by Blueprint in an 11-item form, each item rated 0–100%, higher scores meaning more recovery; that page gives no reliability or validity data, and whether the IITT clinic used this instrument is [uncertain]. [source: Blueprint TRS help page] Treat their scores as clinic-internal benchmarks, not validated cut-offs. Use the DES, SCL and TAS (the last two named for discharge) or equivalent validated measures at baseline as well. [synthesis]

4.2 Anti-regression regimen

• Purpose: reverse dissociative regression before admission to processing.
• Steps: CEBC states only that the regimen is provided for people who cannot perform activities of daily living, and that "a person is not accepted into the program until the regression has been reversed". [source: CEBC] Its content is not published. [uncertain] Until you are trained, use standard phase-1 stabilisation: adult-routine structure, grounding, crisis plan, liaison with the treating team. [synthesis]
• Watch for: the readiness signs are restored self-care, orientation, and a stable adult presence in sessions. [synthesis]

4.3 Psychoeducation on the Instinctual Trauma Response

• Purpose: give the client the map that the drawings will follow. Reframe symptoms and survival behaviour (freeze, compliance) as instinctual rather than shameful.
• Steps: [source: CEBC; GWU; further detail from the Church4EveryChild blog: uncertain: secondary, unverified]
  1. Show the programme's ITR video (clinic) or explain the model.
  2. Name the seven components with everyday examples: startle; thwarted intention to fight or flee; freeze; altered state of consciousness (watching from outside, feeling like a shell); body sensations; automatic obedience (complying to survive); self-repair (sleeping, eating, rocking, washing, seeking comfort).
  3. Link each of the client's symptoms to an unfinished component, for example flashbacks of body sensations, or shame about complying.
  4. Check understanding, and ask the client to name the components back. The GWU objectives expect learners to be able to name them.
• Example language (illustrative): "Doing what you were told wasn't agreement. That's automatic obedience, the body's way of getting through."
• Watch for: relief and less self-blame are signs it is landing. If the client becomes activated by examples, slow down and use neutral ones such as a near-miss in a car. [synthesis]

4.4 Safe Place

• Purpose: a resource for grounding and for closing sessions. It is a named ITR learning objective ("how to create a Safe Place"). [source: GWU] The ITR-specific method is not published. [uncertain]
• Steps (generic, until trained): [synthesis]
  1. Invite an imagined or real place of safety.
  2. Have the client draw it on its own sheet.
  3. Enrich the sensory detail.
  4. Agree a cue word.
  5. Practise returning to it.
  6. Keep the drawing visible during processing.
• Example language (illustrative): "Let's put your safe place on paper so it's in the room with us."
• Watch for: if the safe place turns unsafe (intrusive images), change it to a neutral or present-day place.

4.5 Sequencing traumas: foundation traumas first, then chronological

• Purpose: process the earliest 'foundation' traumas, usually preverbal and often medical (Gantt's demonstration client began with a tonsillectomy at about age two), before later events. Then work in chronological order. [source: CEBC; psychotherapy.net]
• Steps:
  1. List the known traumas with approximate ages. [synthesis]
  2. Identify likely foundation events from what is known: family report, medical records, the client's own knowledge. [synthesis]
  3. Start there.
  4. Proceed in chronological order.
• Example language (illustrative): "We'll start with the earliest event you know about, even one you only know from what your family told you, and work forward."
• Watch for: do not invent or suggest early traumas to fill the 'foundation' slot. Use only events the client already knows or that are documented. [synthesis]

4.6 Guided imagery with the 'hidden observer'

• Purpose: access the memory from an observing stance so the client does not relive the trauma. [source: CEBC]
• Steps: after grounding, lead an imagery exercise in which the client stays as an observer of the event, then moves to the drawings. The ITT imagery script is not published. [uncertain] The programme can run without guided imagery for clients who object, including on religious grounds; go straight to drawing. [source: CEBC]
• Example language (illustrative): "You're watching from a safe distance, as the adult you are now. You can pause it any time."
• Watch for: abreaction, loss of orientation, or the client speaking as if it is happening now. Stop, ground, and return to the Safe Place. Imagery near hypnotic trance raises memory-suggestibility concerns. Avoid leading questions and don't introduce content. [synthesis]

4.7 Graphic narrative (drawing the trauma)

• Purpose: externalise the whole event as a complete, ordered sequence: "a trauma story done in a series of drawings on separate pieces of paper". [source: psychotherapy.net]
• Steps: [source: CEBC; psychotherapy.net; GWU; synthesis where marked]
  1. Lay out letter-size paper and coloured markers. Stick figures are fine and artistic skill is irrelevant. [synthesis]
  2. 'Before' picture: a moment just before the event, when things were still all right.
  3. Draw the event through the ITR sequence, one sheet per moment: startle; thwarted intention (what the client wanted to do but couldn't); freeze; altered state; body sensations; automatic obedience; self-repair.
  4. 'After' picture: the point at which the client survived and was safe. It is often drawn as the present-day adult. [source: psychotherapy.net for before/after framing; 'present-day' detail is synthesis]
  5. Drawings come first and words second. Keep verbal processing minimal while the client draws.
  6. Reorder: because trauma memories are fragmented and "do not follow a linear sequence", help the client rearrange the sheets into order. Insert sheets for gaps.
  7. Add brief words or captions only after all drawings exist. [synthesis about captions]
  8. The drawings can be made on paper or in the ITR web app. [source: GWU]
• Example language (illustrative): "Draw the moment just before it happened." … "What did you want to do that you couldn't?" … "Now draw the moment you knew you'd survived."
• Watch for:
  • Gaps in the sequence (often freeze, altered state or obedience). Prompt with the component name rather than content. [synthesis]
  • Rising distress. Return to observer stance or the Safe Place.
  • It is working if the client completes the sequence including 'after', and distress falls by the end.
  • Never treat the drawings as diagnostic or forensic evidence of abuse or of what happened. No validated manual supports that use. [synthesis; Domain VIII rule]

4.8 Re-presentation

• Purpose: turn the drawn fragments into a completed, verbal, past-tense story that the client witnesses from outside, making the event "truly history". [source: psychotherapy.net; CEBC]
• Steps: [source: CEBC; psychotherapy.net; synthesis where marked]
  1. Pin the drawings in order on a wall or bulletin board, from 'before' to 'after'.
  2. Seat the client facing them. They watch and listen; they are not asked to narrate.
  3. Tell the story picture by picture, in the past tense, using the client's own words and captions. Name each ITR component as it occurs. [ITR-component naming is synthesis]
  4. End on the 'after' picture: they survived, and it is over.
  5. At the clinic, sessions were video-recorded and parts could be played back (see 4.9).
  6. Close by asking what the client noticed and how their body feels now. Ground. [synthesis]
• Example language (illustrative): "And then you froze. Your body did what bodies do when there's no way out… And then it was over. You got through it, and here you are."
• Watch for:
  • Corrections from the client: accept them and adjust the story. [synthesis]
  • Signs of dissociation while watching.
  • It is working if the client's distress on viewing drops, they see the event as finished, and they report less intrusion over the following days. [synthesis]

4.9 Video playback

• Purpose: used for psychoeducation (the ITR video) and for playing back parts of sessions to the client. [source: CEBC]
• Steps: with written consent to record, film the re-presentation or dialogue, then replay the chosen segments so the client can witness them again. How ITT used playback in detail is not published. [uncertain]
• Watch for:
  • Consent, secure storage, and the client's right to have recordings deleted.
  • Shame on seeing oneself; offer playback as an option, not a requirement. [synthesis]

4.10 Identifying and mapping parts (True Self and parts)

• Purpose: identify dissociated parts linked to traumas. ITR language distinguishes the True Self, which has attributes the client can name, from hurt, stuck or left-behind Parts. [source: GWU; CEBC]
• Steps:
  1. Ask about states the client recognises (ages, roles, feelings).
  2. Draw a parts map on one sheet. [synthesis for drawing form]
  3. Have the client list the True Self attributes, such as calm, compassion and adult perspective. [synthesis for examples]
  4. Link parts to the traumas on the timeline.
• Example language (illustrative): "Which part of you is still stuck back in that hospital room?"
• Watch for:
  • Switching or losing time during mapping means dissociative disorder assessment is needed.
  • In DID-spectrum clients, work with specialist supervision. [synthesis]

4.11 Externalized dialogue

• Purpose: reverse dissociation by putting the inner conversation between the adult/True Self and the parts outside the head. [source: CEBC]
• Steps: the ITT procedure (medium, prompts, sequence) is not published. [uncertain] Before training, a minimal, non-attributed version is: [synthesis]
  1. After the re-presentation, invite the True Self to tell the stuck part that the event is over and what year it is now.
  2. Ask what the part needs.
  3. Record or write both sides.
  4. End with the part "brought forward" or settled.
• Example language (illustrative): "Can your adult self let that little one know it's over now?"
• Watch for:
  • Hostile or persecutory parts.
  • Escalation into reliving.
  • It is working if the client reports the part as calmer and present, and dissociation measures fall.

4.12 Team rounds and daily wrap-up (intensive format)

• Purpose: coordinate rotating therapists and review the day's processing and safety. [source: CEBC]
• Steps:
  1. Morning rounds with the full team: plan the trauma or traumas for the day.
  2. Afternoon wrap-up: check state, plan the evening, confirm that every narrative opened today has been closed. [checklist detail is synthesis]
• Watch for: fatigue across 7-hour days. Schedule breaks, food and grounding. [synthesis]

4.13 Discharge measurement and treatment summary

• Purpose: judge completion and hand back to ongoing care. [source: CEBC]
• Steps:
  1. Re-administer the measures.
  2. Compare with the targets SCL-45 ≤ 80, TAS ≤ 74, DES ≤ 20.
  3. Write a treatment summary with follow-up recommendations for the hometown therapist.
  4. Agree a possible return course for remaining traumas.
• Watch for: if the targets are unmet, list the traumas still unprocessed rather than calling it failure. [synthesis]

4.14 Related method: Trauma Art Narrative Therapy (TANT)

• What it is: a trauma resolution method focused on "one specific traumatic event", developed by Lyndra J. Bills MD. Bills co-authored the 2002 short-term PTSD chapter with Tinnin and Gantt. Training includes the steps, clinical examples, an experiential session and a competency test. [source: TANT training page; CEBC] Its steps are not published, and how far they overlap with ITR is not confirmed. [uncertain]

5. Handling problems

The public sources give only programme-level safeguards: screening, regression reversal, substance exclusion, the hidden-observer stance, opt-out from imagery and discharge targets. Everything else in this section is [synthesis] unless tagged.

• Client cannot or will not draw ("I can't draw"):
  • Stick figures, shapes and colours are enough.
  • Offer the web app or written captions as a bridge. [GWU names the app; rest synthesis]
  • Keep the 'drawing first' order, even if the drawings are minimal.
• Overwhelm or reliving during drawing or imagery:
  • Stop. Orient to the room, date and adult body, and return to the Safe Place drawing.
  • Resume from the observer stance, or skip imagery and draw directly. [CEBC supports going without imagery]
  • Never end a session at a mid-sequence picture. If time runs out, draw a provisional 'after' (safe now, in this room) and pin the story up together. [synthesis]
• Dissociative regression or loss of functioning between sessions: halt processing and stabilise; the clinic would not admit until regression was reversed. [source: CEBC] Coordinate with the psychiatrist or GP and step up support.
• Suicidality or self-harm spike:
  • Re-assess risk using standard practice and update the safety plan, including lethal-means counselling (safe storage or removal).
  • Pause trauma processing until the risk is stable.
  • The programme lists suicidal impulses and self-injury among its targets, but intensives presuppose a contained risk. [source: CEBC]
• Stuck, with gaps in the sequence:
  • Name the missing component ("what did your body do next?") rather than suggesting content.
  • Leave a blank sheet labelled with the component if nothing comes. An incomplete memory can still be bracketed with 'before' and 'after'.
• Memory and suggestion risk:
  • Do not pursue memory recovery, and don't tell clients they have hidden abuse memories.
  • Treat preverbal or prenatal 'foundation' material as the client's representation, not fact.
  • Document neutrally. Refer forensic questions to forensic specialists.
  • The phrase "uncovering dissociated memories" in ITR promotion (GWU) is the developers' claim, as is the claim to reach "prenatal and preverbal experiences" (Metacast). [source: GWU; Metacast]
  • No independent critique or safeguard paper specific to ITR is known. The only published limitations are CEBC's, for the 2007 outcome study (see Limits of the evidence below). The absence of critique is a gap, not reassurance. [uncertain]
• Shame about automatic obedience ("I let it happen"): return to psychoeducation, since obedience is a survival instinct. Re-tell the obedience picture explicitly in the re-presentation. [concept: Church4EveryChild blog, uncertain: secondary, unverified; response: synthesis]
• Rupture with rotating therapists (intensive):
  • Name the client's primary contact.
  • Use wrap-up to repair: ask directly what felt wrong, and adjust pacing.
• Non-adherence (missed days in the intensive, cancelled sessions):
  • Explore whether it is avoidance or exhaustion, then reduce daily load.
  • The intensive has no homework, so adherence is about attendance. [source: CEBC for no homework]
• Persecutory or hostile parts in externalized dialogue:
  • Acknowledge their protective role, slow down, and do not force contact.
  • Seek specialist dissociation supervision.
• Recording concerns: make video optional, get written consent, and specify storage and deletion.
• Children and adolescents (the developers report use from age three; the clinic's adult programme was 18–80):
  • Obtain parental consent and the child's assent.
  • Involve the carer for comfort in self-repair (the child-ITR examples include reaching for a parent).
  • Use a shorter sequence per session and play-like drawing.
  • Follow local safeguarding and mandatory-reporting rules. A disclosure in words or drawing triggers your reporting duty, but the drawing itself is not evidence.
  • [source: Metacast; Church4EveryChild blog: uncertain: secondary, unverified; synthesis for procedures]
• Substance use emerging during treatment: pause processing. Active substance-use disorder was an exclusion criterion. [source: CEBC]
• Physical and material safety: use non-toxic markers, give space to move or pace, and take breaks during long days.

Limits of the evidence (for informed consent). According to CEBC, the main outcome study (Gantt & Tinnin, 2007) was a single-group pre/post design. It covered 77 clients with PTSD aged 13–69 in West Virginia (77% female; 76 of 77 Caucasian), with follow-up points at 1 week, 3 months and 6 months. It reported 45% recovered, 44% improved, 8% unchanged and 3% worse. CEBC names the limits: no comparison or control condition, plus performance and selection bias. The sample also included adolescents, outside the adult programme's stated 18–80. [source: CEBC] In practice, tell clients that the evidence is uncontrolled and that a minority got worse. Track symptoms and functioning at each session, and stop processing if they deteriorate. [synthesis] The 'dual-brain' neurobiological rationale (Gantt & Tinnin, 2009) is not drawn on. Present it as the developers' theory, not established fact. [uncertain]

Sources

Web sources:

• Individual Intensive Trauma Therapy (IITT) – CEBC programme profile. This is the main procedural source: components, format, screening, measures, discharge targets, training and the 2007 outcome-study summary with its stated limitations.
• An Archived ITR Graphic Narrative Session – Psychotherapy.net (product description).
• An Archived ITR Graphic Narrative Session – Psychotherapy.net video page. Confirms foundation traumas first, separate-sheet drawings rearranged into order, before/after bookends, drawings before words, and the wall re-presentation in the client's words. Session length 1 h 17 min.
• Instinctual Trauma Response® (ITR) – GWU Art Therapy event page. Covers the grounding, Safe Place, True Self and Parts learning objectives, materials, the web app and the presenters' credentials.
• Instinctual Trauma Response with Linda Gantt, PhD and Danni Davis, LCSW – The Trauma Therapist podcast notes (Metacast)
• The instinctual trauma response – Church4EveryChild (secondary summary)
• Trauma Art Narrative Therapy: Basic Training – CE-Go
• Trauma Recovery Scale (TRS) – Blueprint help page (Gentry 1999 attribution, item format, scoring)
• The Instinctual Trauma Response and Dual-Brain Dynamics – Goodreads listing (year and format of the founders' book)

Books and papers cited (through the sources above) [uncertain]:

• Tinnin, L., & Gantt, L. The Instinctual Trauma Response and Dual-Brain Dynamics: A Guide for Trauma Therapy (2013, paperback, 192 pp., per its Goodreads listing; publisher: uncertain).
• Gantt, L., & Tinnin, L. W. (2007). Intensive trauma therapy of PTSD and dissociation: An outcome study. The Arts in Psychotherapy, 34(1), 69–80. (Design and results as summarised by CEBC.)
• Gantt, L., & Tinnin, L. (2009). Support for a neurobiological view of trauma with implications for art therapy. The Arts in Psychotherapy, 36, 148–153. (Journal and volume per CEBC; pages: uncertain.)
• Tinnin, L., Bills, L., & Gantt, L. (2002). Short-term treatment of simple and complex PTSD. In M. B. Williams & J. Sommer (Eds.), Simple and Complex Post-Traumatic Stress Disorder (pp. 99–118). Haworth.
• The Intensive Trauma Therapy programme manual (CEBC states that a manual describes how to deliver the programme; no title or availability is given). CEBC lists the clinic's website as www.traumatherapy.us, with Linda Gantt as contact.
• The ITR Training Institute site, HelpForTrauma.com (named in the podcast notes).