Atlas›Domain VI · Brief, integrative, trauma, hypnosis & coaching›Guide 070
Guide VI-070

Trauma Resiliency Model

Elaine Miller-KarasClaremont, California
A 26 · L 35 · M 3922 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the clinician-delivered Trauma Resiliency Model (TRM) of Elaine Miller-Karas and the Trauma Resource Institute (TRI, Claremont, California), in its current ten-skill form as Miller-Karas presented it in 2025: six wellness skills plus four reprocessing skills (titration, pendulation, completing survival responses and integration). The older and still widely published nine-skill form (Grabbe & Miller-Karas, 2018; the CEBC profile; TRI's TRM Level 2 page) has no separate integration skill; the difference is noted where it matters. The treatment manual named by CEBC is Miller-Karas (2023), Building Resilience to Trauma: The Trauma and Community Resiliency Models, 2nd ed. (Routledge). The manual's content is [uncertain] (only catalogue and vendor records), and Grabbe & Miller-Karas (2018) is drawn on from the abstract only [uncertain]. Sources include TRI's own material: the skill list and the Survival Response Continuum (Grand Rounds 2025), the three gesture types (TRI/Miller-Karas CRM slides, 2020), the TRM Level 2 training objectives (TRI Level 2 page), and dosing and release sensations (CEBC). No source publishes step-by-step procedures for titration, pendulation or completing survival responses, so those steps remain [synthesis] [uncertain]. TRI publishes no contraindications. [source: Grand Rounds slides 2025; CEBC TRM profile; TRI training pages]

TRM is a somatic, "bottom-up" trauma treatment for children, adolescents and adults. It teaches clients to read their own nervous system by tracking body sensations and telling sensations of distress apart from sensations of well-being. The clinician then uses that capacity to reprocess traumatic experience in small amounts, without the client having to tell the trauma story. The core idea of change: trauma symptoms are biological survival responses that got stuck, not weakness or pathology. Deliberate attention to sensations of well-being (resources, grounding, gestures) widens the client's "Resilient Zone". Within that zone, interrupted survival responses can complete, the nervous system settles, and new meanings emerge. The guiding slogan is "Adversity is not Destiny". [source: Grand Rounds slides 2025; JAPNA abstract; Psychology Today 2023; CEBC TRM profile]

Origins named by Miller-Karas: her early-1980s Lamaze and doula work (observing the body's own rhythms); Somatic Experiencing (Peter Levine), which is the source of the reprocessing skills; and the work of Pat Ogden, Babette Rothschild and Judith Herman. She also names solution-focused therapy, Gendlin's Focusing ("felt sense") and Ayres's sensory integration theory ("gravitational security"). The CRM skills were originally developed by Miller-Karas, Genie Everett and Laurie Leitch. TRM began as a rapid intervention after natural disasters. [source: Grand Rounds slides 2025; CRM handout 2017; Mad in America summary]

Relationship to CRM. The Community Resiliency Model (CRM) is the six wellness skills taught to lay people and communities. TRM is those same six skills used by a licensed clinician plus the trauma-reprocessing skills. This guide covers the six skills only as a clinician uses them. Lay and community delivery is in the Domain V guide 153 (Community Resiliency Model). [source: CEBC TRM profile; TRI training page]

2. Framework

Format. TRM is delivered in individual or family sessions, and the wellness skills also in groups. It can be used on its own or combined with other treatments; Miller-Karas describes adding somatic monitoring to EMDR. In the CEBC-reviewed child version, parents or caregivers learn the skills alongside the child. [source: CEBC TRM profile; Psychology Today 2023]

Dosing reported by the developer (CEBC profile).

  • Early sessions on psychoeducation and the wellness skills run 15–60 minutes. Trauma-reprocessing sessions run 1–1.5 hours. Group sessions on the wellness skills run 15–90 minutes.
  • A course is typically four or more sessions, depending on symptom severity and how complex the trauma is.
  • Some clients need only one 60-minute session on the wellness skills plus app-based home practice.

[source: CEBC TRM profile]

The model is a scaffold, not a fixed sequence. Miller-Karas states that the skills form a scaffolding and that the process is not necessarily sequential: the clinician moves among skills as the client's state requires. The phases below are the order the sources describe for introducing them. [source: Grand Rounds slides 2025]

Phase A: Psychoeducation and mapping

  • Goals:
    • Reframe symptoms as normal biological stress and survival responses.
    • Teach the simple brain model: thinking cortex, emotional and attachment limbic area, and a "survival brain" for fight, flight and freeze.
    • Teach the three zones: Resilient Zone ("Okay Zone" for children), High Zone and Low Zone.
    • Distinguish positive, tolerable and toxic stress.
  • Tools: workbooks and pocket cards.
  • Moving on: the client can name their own zone signs and is willing to try noticing sensations.

[source: CRM handout 2017; CEBC TRM profile; Grand Rounds slides 2025]

Phase B: Wellness skills

The client learns the six wellness skills:

  • Core three: Tracking, Resourcing and Grounding.
  • Further three: Gesturing, Help Now! and Shift and Stay.

Practice runs in session and daily at home, using the iChill app and the TRM Workbook.

Miller-Karas's pre-reprocessing sequence:

  1. Give psychoeducation on the key concepts.
  2. Explain the three basic skills.
  3. Invite tracking while introducing a resource.
  4. Invite a grounding exercise.

[source: Grand Rounds slides 2025; CEBC TRM profile]

Readiness criteria for reprocessing

All three should hold:

  • The client can experience neutral or pleasant sensations.
  • The client has confidence that they can rebalance body and mind during distress.
  • The client is ready to work on a specific event they choose to share.

If the client is reluctant or fearful, or cannot sense pleasant or neutral sensations, the clinician stops introducing TRM skills and works on safety and the relationship first. [source: Grand Rounds slides 2025; Psychology Today 2023; CEBC TRM profile]

Phase C: Reprocessing

The clinician uses titration, pendulation and completing survival responses (adapted from Somatic Experiencing), plus integration in the ten-skill version.

  • Pacing: practitioner-initiated Resiliency Pauses.
  • Story: the client chooses how much of the story to tell.
  • Questions: strength-based questions that expand the resilient parts of the story.
  • Assessment map: the four-phase Survival Response Continuum (see 4.12) shows where the client is stuck.

[source: Grand Rounds slides 2025; CEBC TRM profile]

Phase D: Integration and ongoing practice

The clinician tracks the sensations that accompany resolution and the new meanings that emerge, and the client returns to the Resilient Zone. Wellness-skill practice continues throughout and after therapy. Other modalities (e.g., EMDR) may be added once the client can reach embodied well-being on purpose. [source: Grand Rounds slides 2025; Psychology Today 2023; CEBC TRM profile]

Ending a course [synthesis]: TRI publishes no formal discharge criteria [uncertain]. Practical markers are:

  • More time spent in the Resilient Zone in daily life.
  • The client uses wellness skills on their own when knocked out of the zone.
  • Recalling the worked-on events no longer pushes the client into the High or Low Zone.
  • Symptoms are reduced on whatever standard measure you use.

Training and certification. Training is in levels, and published formats differ:

  • TRI training page (Belfast 2026 programme):
    • Level 1 (2 days): foundations and the six wellness skills.
    • Level 2 (2 days): the three reprocessing skills and nine-skill treatment planning.
    • Level 3 (2 days): polyvagal theory, attachment, dissociation and expressive arts.
  • TRI's general TRM Level 2 page (prerequisite: TRM Level 1) lists these as Level 2 objectives: the survival responses, including tend-and-befriend; ways to restore the survival response; the four phases of the Survival Response Continuum; the orienting response; the SENSIMAP for exploring implicit memories through the sensory portals; using the nine skills; attachment theory; polyvagal theory; expressive arts with TRM skills; working with dissociative parts using TRM skills; and CRM. [source: TRI TRM Level 2 page]
  • CEBC profile: Levels 1 and 2 at 3 days (23 hours) each; the prerequisite is being a licensed mental health professional in good standing. [source: CEBC TRM profile]
  • [uncertain] The formats, and which topics sit in Level 2 or Level 3, differ between these pages and have changed over time. Check the current syllabus with TRI.

Certified TRM Practitioner status (2021 requirements) requires:

  • A mental-health or medical licence and two years' experience.
  • Levels 1 and 2.
  • At least 23 consultation hours with a TRI-approved consultant.
  • 20 case vignettes across 10 or more clients.
  • Practice in both client and practitioner roles.
  • A reading list that includes Miller-Karas (2015).
  • A final skills demonstration.

[source: TRI training page; TRI certification requirements PDF; CEBC TRM profile]

3. Guiding principles

  • Adversity is not destiny. In practice: hold and convey the expectation that the nervous system can return to balance. [source: Grand Rounds slides 2025]
  • Symptoms are biology, not weakness. In practice: explain symptoms as survival responses to reduce shame and stigma before asking for any change. [source: Psychology Today 2023; CEBC TRM profile]
  • Bottom-up first. In practice: begin with sensation rather than cognition or narrative, and let meaning follow body change. [source: JAPNA abstract; Grand Rounds slides 2025]
  • Tracking goes with every skill. In practice: after any intervention, ask what the client notices inside. [source: CRM handout 2017; Psychology Today 2024]
  • Well-being before distress. In practice: no reprocessing until the client can find neutral or pleasant sensations; resources are the safety net. [source: Grand Rounds slides 2025; Psychology Today 2023]
  • The story is optional and chosen by the client. In practice: say the client can tell as much or as little as they want; pressing for recall may reinforce embodied fear. [source: Grand Rounds slides 2025; Mad in America summary]
  • Gentle and invitational. In practice: offer, never instruct; use open-ended questions. [source: JAPNA abstract; Grand Rounds slides 2025]
  • Stay "a half a step behind the client." In practice: follow the client's sensation and pace rather than leading toward an expected release. [source: Grand Rounds slides 2025]
  • Pleasant, unpleasant or neutral. In practice: this is the core question for sorting any sensation. [source: Grand Rounds slides 2025]
  • Do not interpret. In practice: reflect the client's words for sensations; do not assign meaning to a tremor, posture or gesture. [source: Grand Rounds slides 2025]
  • Do no harm; honour the client's needs. In practice: if the client is fearful or cannot sense well-being, stop adding skills and build relationship and safety. [source: Grand Rounds slides 2025]
  • The practitioner regulates too. In practice: you must be able to sense your own body and find neutral or pleasant sensations, and you should consult when unsure how TRM fits your scope. [source: Grand Rounds slides 2025]
  • The zones are not judged. In practice: present the High and Low Zones as normal human states, not failures. [source: Psychology Today 2024]
  • The client has wisdom (solution-focused influence). In practice: ask what has already helped and build on it rather than importing techniques. [source: Grand Rounds slides 2025; Psychology Today 2024]
  • Three portals. In practice: change can enter through sensation, cognition or emotion, but sensation is the default entry. [source: Psychology Today 2023]
  • Scaffold, not script. In practice: move freely among skills according to the client's state. [source: Grand Rounds slides 2025]
  • Shared language across a system. In practice: where an agency is trained, use the same zone and skill words in therapy, care and school settings. [source: CEBC TRM profile]
  • Memories are the client's experience [synthesis, per trauma-practice standards]. In practice: work with present sensations linked to what the client reports; never use the method to search for or "recover" unremembered events.

4. Intervention inventory

TRI's published pages name every TRM skill and describe the six wellness skills in usable detail. For the reprocessing skills (4.13–4.16) they give only names, definitions and the Survival Response Continuum, and no step sequence (Grand Rounds 2025 slides, TRM Level 2 page, CEBC profile, Mad in America summary of Grabbe & Miller-Karas 2018). The procedure is taught in TRI Level 2 and in the treatment manual, Miller-Karas (2023) [uncertain: the manual's step detail is not reflected here]. Titration, pendulation and the completion of defensive responses come from Somatic Experiencing (SE), and the SE Trauma Institute's own glossary supplies their core definitions and one procedural rule (settle before the next piece), which are used below [source: SETI Glossary of Terms]. Beyond that, the reprocessing steps stay marked [synthesis] [uncertain] and should be checked against TRI training. Example language is my illustrative wording unless it is in quotation marks with a source. [source: Grand Rounds slides 2025; TRI TRM Level 2 page; CEBC TRM profile]

4.1 Psychoeducation on the biology of trauma and resilience

  • Purpose: reduce shame by framing symptoms as survival biology, and give the client a map for the skills. Use in the first session, and repeat briefly whenever the client blames themselves. [source: CRM handout 2017; CEBC TRM profile; Psychology Today 2023]
  • Steps:
    1. Draw or show the three-part brain model:
      • Cortex: thinking, language and beliefs.
      • Limbic area: emotion, attachment and risk assessment.
      • Survival brain: automatic fight, flight and freeze, and basic body functions.
    2. Explain that an overwhelmed nervous system can lose its capacity to stabilise itself, and that this is not a choice.
    3. Explain the stress spectrum: positive stress (brief; balance returns quickly), tolerable stress (balance returns with support) and toxic stress (prolonged activation without protective relationships).
    4. Ask the client which reactions they recognise in themselves.
    5. With children, use the TRM workbooks and pocket cards [source: CEBC TRM profile].
  • Example language (illustrative): "What you've been living with isn't a flaw in you. It's your survival brain doing its job a bit too well, long after the danger passed. We're going to teach it that it can settle."
  • Watch for: visible relief (shoulders drop, exhale) or remarks like "so I'm not crazy". Shame reactions or argument mean you should go slower and use the client's own words. [synthesis]

4.2 Resilient Zone mapping (High Zone / Low Zone)

  • Purpose: give the client a non-judging way to name their state, and give both of you a shared language for pacing every later step. [source: CRM handout 2017; Psychology Today 2024]
  • Steps:
    1. Describe the Resilient Zone ("Okay Zone" for children). In it, the client can feel annoyed without losing control, and sad without being overwhelmed.
    2. Describe being bumped out of it by stress or triggers, into either zone:
      • High Zone: sympathetic activation. Examples: edginess, irritability, anxiety, panic, angry outbursts, racing heart, tight muscles, hypervigilance.
      • Low Zone: dorsal-vagal shutdown. Examples: depression, numbness, exhaustion, isolation, collapse.
    3. Have the client list their personal signs for each zone, in body, emotion, behaviour, thinking and spirit.
    4. Have them mark which zone they spend most time in this week.
    5. Link the zones to the autonomic map: Resilient Zone = ventral-vagal and social engagement; High Zone = fight or flight; Low Zone = freeze or collapse.
    Note: the source extractions listed some signs under the opposite zone; the assignment above follows the CRM framework as a whole [uncertain].
  • Example language (illustrative): "When you're in the middle of the zone you can feel upset and still be yourself. Where do you usually go when you're knocked out: up into revved-up, or down into shut-down?"
  • Watch for: the client using the zone words on their own between sessions, which is a sign of uptake. [synthesis]

[source: CRM handout 2017; Grand Rounds slides 2025; CEBC TRM profile]

4.3 Tracking

  • Purpose: the foundational skill of reading the nervous system by noticing sensations as they happen and telling distress from well-being. It is paired with every other skill. [source: CRM handout 2017; Psychology Today 2024; Grand Rounds slides 2025]
  • Steps:
    1. Start tracking on something pleasant: Miller-Karas begins with someone or something that brings calm, joy or peace, or a comforting sound, image or smell. [source: Psychology Today 2024]
    2. Invite inner noticing (CRM wording: "Notice what's happening on the inside…"). [source: CRM handout 2017]
    3. Ask the client to sort each sensation as pleasant, unpleasant or neutral. [source: Grand Rounds slides 2025]
    4. If needed, offer a sensation vocabulary [synthesis]: warm or cool, heavy or light, tight or loose, tingly, still, flowing, breath and heartbeat changes.
    5. Reflect the client's words back without interpreting them. [source: Grand Rounds slides 2025]
    6. Ask about change, e.g. what happens to the sensation as they keep noticing it. Sensations change, so the client is not trapped in distress. [source: Grand Rounds slides 2025]
    7. Also track observable changes yourself [synthesis, consistent with the somatic monitoring described in Psychology Today 2023]: breath, skin colour, posture, eye focus, micro-movements.
  • Example language (illustrative): "As you think of your grandmother's kitchen, what do you notice inside right now? … Is that pleasant, unpleasant or neutral? … And as you notice the warmth, what happens next?"
  • Watch for:
    • The client can name a sensation, place it in the body and notice it change. This is the core readiness marker.
    • Inability to find any pleasant or neutral sensation means staying in Phase B or pausing TRM (see section 5).

4.4 Resourcing: identifying resources

  • Purpose: find people, places, memories, qualities or imagined figures linked to well-being that the client can later call up to regulate. [source: CRM handout 2017; Psychology Today 2024]
  • Steps:
    1. Ask the resource questions. Miller-Karas's prompts are what or who uplifts the client or brings joy, calm or peace, and what or who has helped them through difficult times. [source: Psychology Today 2024; Grand Rounds slides 2025]
    2. Cover three kinds of resource [source: CRM handout 2017]:
      • External: people, places, pets, faith, activities, hobbies, skills, positive memories.
      • Internal: personal qualities such as kindness or humour, and body resources such as strong legs or the body's ability to heal.
      • Imagined: a superhero, a book character, an ideal caring figure.
    3. Use the CRM written sequence [source: CRM handout 2017]:
      1. Write down three resources.
      2. Circle one.
      3. Add three or more details about it.
      4. Read the resource and its details.
      5. Notice what happens inside while reading.
      6. Optionally, share it with someone.
  • Example language (illustrative): "Who or what has helped you get through hard times, even a little? It can be a person, a pet, a place, something you believe, or something about you."
  • Watch for:
    • Resources that carry loss or ambivalence, such as a loved person who died or an abusive parent who was sometimes kind. Prefer simpler resources first. [synthesis]
    • A resource "works" when tracking it produces a pleasant or neutral sensation.

4.5 Resource intensification

  • Purpose: deepen one resource into a rich, multisensory, embodied experience so it can act as a "safety net" during reprocessing. [source: Psychology Today 2023]
  • Steps:
    1. Take one resource.
    2. Ask for sensory detail: what the client sees, hears, smells, touches, and the time of day. [synthesis on the specific senses; the source says multisensory]
    3. After each detail, return to tracking: notice what happens inside now.
    4. Find where the pleasant sensation is strongest.
    5. Invite the client to stay with it for a few breaths (the stay step overlaps with Shift and Stay, 4.9).
    6. Name the resource as one the client can return to at any time, including mid-session.
  • Example language (illustrative): "Tell me more about the lake. What colour is the water that early? What sounds are there? … As you describe it, what's happening inside? … Where is the settled feeling strongest? Let's just stay there a moment."
  • Watch for:
    • Signs of settling: slower breath, softened face, warmth.
    • A slide into sadness or distress means you should acknowledge it, move to grounding (4.6) or another resource, and track again.

4.6 Grounding

  • Purpose: anchor attention in present-moment physical support. It is the main tool when a client dissociates, which Miller-Karas notes is not uncommon during reprocessing. [source: Psychology Today 2023; Psychology Today 2024; CRM handout 2017]
  • Steps:
    1. Invite the client to notice the body's contact with a supporting surface. Positions can be sitting (chair, sofa or floor), standing against a wall, lying down, or walking while noticing the feet on the ground. [source: CRM handout 2017]
    2. Ask them to notice temperature, texture and pressure at the points of contact. [source: CRM handout 2017]
    3. Ask whether the sensation is pleasant, unpleasant or neutral. [source: Psychology Today 2024]
    4. Let the client choose their own variations, e.g. hand on a table or back against the chair. [source: Psychology Today 2024]
    5. Add weight if helpful: a weighted pillow on the lap can help. [source: Psychology Today 2023]
    6. Track what changes.
  • Example language: Miller-Karas's prompt asks the client to notice how the body is contacting the chair or sofa [source: Grand Rounds slides 2025]. Illustrative: "Notice where your back meets the chair and your feet meet the floor… Is that pleasant, unpleasant, or neutral? … What do you notice as you stay with the support?"
  • Watch for: eyes refocusing, colour returning, breath deepening. If contact sensations feel unpleasant (common with body-based trauma), switch to an external focus such as Help Now! (4.8). [synthesis]

4.7 Gesturing

  • Purpose: use spontaneous or intentional movement to soothe, or to express emotions such as joy or strength, and so restore balance. [source: Psychology Today 2024] TRI's CRM teaching slides name three kinds of gesture: protective, joyful and self-calming. The client identifies a self-soothing gesture so they can call it up on purpose to return to the Resilient Zone. [source: TRI/Miller-Karas CRM slides 2020]
  • Steps:
    1. Notice gestures the client makes spontaneously while talking, e.g. a hand on the chest or a push-away motion. Invite them, without interpreting, to slow it down and repeat it. [synthesis: noticing spontaneous gestures fits "spontaneous or intentional" in the source]
    2. Or invite an intentional self-calming (self-soothing) gesture. Miller-Karas: "Can you make a self-soothing gesture that comforts you and is not self-harming?" [source: Psychology Today 2024]
    3. Or invite a joyful gesture or a protective gesture. [source for the three types: TRI/Miller-Karas CRM slides 2020] Examples of a protective gesture, such as a palm raised to say stop or arms marking a boundary, are my illustrations [synthesis].
    4. Have the client make the gesture slowly and track what happens inside.
    5. Settle on one gesture the client can use deliberately when bumped out of the Resilient Zone, and suggest practising it between sessions. [source: TRI/Miller-Karas CRM slides 2020]
  • Example language (illustrative): "I noticed your hand went to your chest just then. Would you be willing to do that again, slowly? … What do you notice inside as you do it?"
  • Watch for: gestures that are self-harming (hitting, scratching, pinching hard), which the source explicitly excludes. Redirect gently to a comforting variant. A protective gesture can stir activation linked to the threat; if it does, track it briefly and return to a self-calming gesture or grounding. [synthesis]

4.8 Help Now!

  • Purpose: quick reset strategies for when the client is stuck in the High or Low Zone and tracking alone is too hard. They mostly use external orienting and simple action. [source: Psychology Today 2024; CRM handout 2017]
  • Steps: offer a menu, let the client pick one, then track. The published options are [source: CRM handout 2017; Psychology Today 2024]:
    • Drink water, juice or tea.
    • Look around the room and notice what catches your attention.
    • Name six colours you can see.
    • Open your eyes if they tend to close.
    • Count backward from 10 (100 for adults), or from 20, optionally while walking.
    • Touch furniture or nearby objects and notice whether they are hard, soft or rough.
    • Notice the room temperature.
    • Notice sounds inside and outside the room.
    • Walk, noticing arms, legs and feet on the ground.
    • Push hands or back against a wall or door and notice the muscles.
  • Example language: Miller-Karas: "Would you like to try it with me?" (for counting down) [source: Psychology Today 2024]. Illustrative: "Let's get your eyes on the room. Can you name six colours you can see? … Now what do you notice inside?"
  • Watch for: the client's eyes and voice returning to the room. Have the client choose one or two Help Now! options as their own go-to strategies for home. [synthesis]

4.9 Shift and Stay

  • Purpose: the integrating wellness skill. The client notices distress, deliberately shifts attention to a calmer or neutral place inside, then stays with the pleasant sensation so that well-being grows. [source: Psychology Today 2024]
  • Steps:
    1. Acknowledge the distress sensation the client reports.
    2. Ask whether there is a place inside that is less distressing or calmer. If none, use a resource, grounding, a self-soothing gesture or a Help Now! strategy to create one. [source: Psychology Today 2024]
    3. Have the client shift attention there.
    4. Invite them to stay with it for several breaths, then track what changes. [source: Psychology Today 2024]
    5. Practise this daily at home (CEBC lists daily practice with the iChill app as homework).
  • Example language: Miller-Karas: "Can you sense a place on the inside that is less distressing or calmer?" [source: Psychology Today 2024]. Illustrative follow-up: "Let your attention rest there… no need to do anything with it… what happens as you stay?"
  • Watch for: attention snapping back to the distress. Shorten the stay, keep the shifts brief and repeated, and praise any small widening. [synthesis]

4.10 Resiliency Pause

  • Purpose: a pause the practitioner starts during any trauma-related talk or reprocessing to stop activation building. The client returns to present-moment awareness through resourcing or grounding. It is TRM's main dosing tool. [source: Grand Rounds slides 2025]
  • Steps:
    1. Before the client begins telling anything, agree that you will pause them from time to time. Miller-Karas's slide wording explains the pauses keep the experience from becoming too much for the nervous system. [source: Grand Rounds slides 2025]
    2. When you see rising activation (faster speech or breath, flushing, bracing) or a drop (flat voice, fixed gaze), pause and ask whether the client would like to use one of their skills. [source: Grand Rounds slides 2025]
    3. Bring them back with a resource or grounding question, e.g. asking what helps during difficult times, or noticing contact with the chair. [source: Grand Rounds slides 2025]
    4. Track until they are back in the Resilient Zone, then offer the choice to continue. [synthesis]
  • Example language (illustrative): "Let's pause here for a moment. Would it help to go to the lake for a bit, or to feel your feet on the floor? … What do you notice now? … Would you like to go on, or stay here a little longer?"
  • Watch for: pause early rather than late. Clients often do not notice escalation from the inside at first. [synthesis]

4.11 Client-chosen telling with strength-based questions

  • Purpose: let the client share as much or as little as they choose, while the clinician expands the resilient elements of the story. Many clients believe they must tell every detail; being offered the choice is itself empowering. [source: Grand Rounds slides 2025]
  • Steps:
    1. State the choice explicitly. Miller-Karas: "You can tell me as much or as little about what happened to you." [source: Grand Rounds slides 2025]
    2. Agree on Resiliency Pauses (4.10).
    3. As the client tells, listen for moments of survival, help, protection, courage or the event ending.
    4. Ask strength-based questions about those moments, e.g. what helped them get through, who was there, what they did to survive. [source: Grand Rounds slides 2025, which names the strength-based step; the example questions are synthesis]
    5. Track the sensations that come with each resilient element.
    6. Do not press for missing details. Pressing for recall may reinforce embodied fear. [source: Grand Rounds slides 2025]
  • Example language (illustrative): "You said your neighbour came over afterwards. As you remember her being there, what do you notice inside?"
  • Watch for: the narrative speeding up or becoming more detailed while the body braces. That is a cue to pause, not to continue. [synthesis]

4.12 Survival Response Continuum assessment

  • Purpose: a map for locating where the client's survival response got stuck, so the clinician can choose the reprocessing focus. [source: Grand Rounds slides 2025]
  • Steps:
    1. Hold the four phases in mind [source: Grand Rounds slides 2025]:
      1. Orienting response.
      2. Mobilisation to tend-and-befriend, fight or flight.
      3. Completion of survival responses; if they are not completed, a freeze response may result.
      4. Nervous-system release, integration, new meanings and return to the Resilient Zone.
    2. As the client tracks a small piece of the event, note where they appear stuck [synthesis on the cues]:
      • Frozen orienting, e.g. a fixed gaze or the head turned toward a remembered sound.
      • Mobilisation that never completed, e.g. tension in the arms or legs, an urge to push or run.
      • Freeze or collapse.
    3. Choose the next intervention from that: titration and pendulation for any activation, completion for thwarted mobilisation, grounding and Help Now! for freeze or collapse [synthesis].
  • Example language (illustrative): "As you remember hearing the noise, what do you notice in your neck and eyes? … And what do your legs want to do, if anything?"
  • Watch for: do not lead the client toward a particular response. Stay a half step behind and follow the impulses the client reports. [source: Grand Rounds slides 2025 for the tenet]

TRI's Level 2 objectives confirm the elements of this map: identifying the survival responses, including tend-and-befriend (singled out for its importance); the orienting response and its importance to treating trauma; the four phases of the continuum; and ways to "restore the survival response". [source: TRI TRM Level 2 page] The Grand Rounds slides add that the practitioner assesses where the client is stuck on the continuum and chooses interventions to match. [source: Grand Rounds slides 2025] The specific cues in step 2 and the matching in step 3 remain [synthesis].

4.13 Titration

  • Purpose: approach traumatic material in small, manageable amounts so the client stays within or near the Resilient Zone. [source: Grand Rounds slides 2025; adapted from Somatic Experiencing per CEBC TRM profile]
  • Readiness: the Phase B readiness criteria in section 2 must hold.
  • Steps [synthesis, except the settling rule in the last step: TRI publishes no TRM step sequence] [uncertain]:
    1. Start from a resourced, grounded baseline.
    2. Invite the client to touch only the edge of the memory: a single moment, a sound, or the time just before or after the event.
    3. Track the sensation for a short period only.
    4. At the first sign of rising activation, pause (4.10) and return to the resource or grounding.
    5. Repeat with the next small piece only once the client's activation has settled. [source: SETI Glossary, which defines titration as breaking activation into pieces small enough to be integrated and waiting for activation to settle before the next perturbation, so arousal comes down in small steps]
  • Example language (illustrative): "Let's touch just the very edge of it, only the moment you heard the car, nothing more. … What do you notice? … Good, let's go back to your feet on the floor."
  • Within-session dosing: sessions are 1–1.5 hours [source: CEBC TRM profile]. In my synthesis, contact with distress should be brief and alternated with longer periods of resource or grounding. Leave the final 10–15 minutes for closure (4.16).
  • Watch for: activation that rises and then falls within each piece is the intended pattern [synthesis]. Activation that keeps climbing means the piece was too big; make it smaller.

4.14 Pendulation

  • Purpose: move attention back and forth between sensations of distress and sensations of resource or well-being. This rhythm can lead to sensory release and settling. Peter Levine developed the concept in Somatic Experiencing. [source: Grand Rounds slides 2025; Mad in America summary] In SE, pendulation is the natural rhythm between constriction and release, and also the movement between the past event (unresourced state) and the present (resourced state). [source: SETI Glossary]
  • Steps [synthesis: TRI and SETI publish definitions of pendulation but no step procedure] [uncertain]:
    1. Identify a distress sensation, e.g. tightness in the throat, and a resource or neutral sensation, e.g. warmth in the hands.
    2. Invite attention to the resource sensation first.
    3. Then invite brief attention to the distress sensation.
    4. Then return to the resource sensation.
    5. Repeat, letting the client set the rhythm, and track what happens to each sensation.
    6. As the distress sensation softens, the swing can widen, still under the client's control.
  • Example language (illustrative): "Notice the warmth in your hands… and now just briefly the tightness in your throat… and back to your hands. … What's happening now with the tightness?"
  • Watch for: the developer's account says reprocessing can bring temporary sensations such as tingling, heat or shaking, described as part of restoring balance [source: CEBC TRM profile]. Prepare the client for these in advance. If shaking becomes frightening or the client loses contact with the room, stop and ground.

4.15 Completing survival responses

  • Purpose: allow defensive responses (fight, flight, tend-and-befriend, freeze exit) that were blocked during the trauma to complete in the body, so the nervous system can return to balance. [source: Grand Rounds slides 2025; CEBC TRM profile] SE, the source of this skill, describes it as restoring physical defences and reflexes that were thwarted during the trauma, and says successful completion brings a sense of competence and security in the body. [source: SETI Glossary]
  • Steps [synthesis: TRI's Level 2 page lists ways to "restore the survival response" as a training objective but publishes no procedure; check against TRI Level 2] [uncertain]:
    1. From a titrated, resourced position, notice any impulse the client reports or shows, e.g. an urge to push away, turn or run, or tension in the arms or legs.
    2. Ask the client's permission to explore it.
    3. Invite the client to let the impulse happen very slowly, as a small movement or imagined movement, e.g. pressing palms into a cushion, or legs pressing into the floor as if running.
    4. Track each moment of the movement.
    5. Pause between movements and track again.
    6. End with resource or grounding.
  • Example language (illustrative): "Your arms look like they want to do something. If you let them, very slowly, what would they do? … You can press into this cushion if that fits. … What do you notice as you push?"
  • Watch for:
    • Do not suggest what "should" have happened in the event. Follow the client's own impulse.
    • Signs of completion may include a spontaneous deep breath, warmth, trembling that settles, or a feeling of strength [synthesis, consistent with the CEBC profile's "nervous system release" and SETI's "sense of competence and security in the body"].
    • Intense rage or panic means titrate further or pause.

4.16 Integration and closure

  • Purpose: in the ten-skill version, integration is a named skill. The clinician tracks the sensations that accompany resolution, new meanings emerge, and the client returns to the Resilient Zone. [source: Grand Rounds slides 2025]
  • Steps:
    1. After release or settling, invite the client to track whatever has changed.
    2. Ask what they now notice or understand about themselves or the event. Do not supply the meaning yourself. [source: Grand Rounds slides 2025, which names new meanings and "do not interpret"; the question is synthesis]
    3. Use "What else is true?" to open alternative perspectives. [source: Psychology Today 2024]
    4. Close every reprocessing session in the Resilient Zone [synthesis]:
      • Use resource intensification or grounding.
      • Check orientation to the room.
      • Agree which wellness skills to use if anything stirs after the session.
    5. Do not let the client leave in the High or Low Zone. Extend grounding and Help Now! until they are oriented, and follow up if needed. [synthesis]
  • Example language (illustrative): "As you think of it now, what's different inside? … What do you know about yourself now that you didn't before? … Before we finish, let's spend a few minutes with your lake and your feet on the floor."
  • Watch for:
    • Spontaneous, self-generated statements of agency or completion indicate integration.
    • Reasoning that is merely compliant or intellectual, with no change in sensation, suggests the work is not yet integrated. [synthesis]

4.17 Home practice: iChill app and TRM Workbook

  • Purpose: daily practice of the wellness skills outside sessions. [source: CEBC TRM profile; Psychology Today 2023; TRI workbook page]
  • Steps:
    1. Introduce the free iChill app; CEBC lists it in English, Spanish and Ukrainian.
    2. Recommend the TRM Workbook, which covers how trauma affects mind and body plus home and work exercises; it was updated in 2021.
    3. Agree a small daily practice, e.g. one Shift and Stay or one resource-tracking round. [the specific dose is synthesis]
    4. Review the practice at the start of each session.
  • Example language (illustrative): "Between now and next week, would you be willing to do one round of Shift and Stay a day, maybe with the app before bed?"
  • Watch for: practice done only in crisis. Encourage practice when calm too, so the skill is available under stress. [synthesis]

4.18 Parent and caregiver involvement (child and adolescent version)

  • Purpose: the CEBC-reviewed version for ages 5–18 teaches parents the skills alongside the child. Parents can then model the skills and recognise and redirect the child's escalation (High Zone) or withdrawal (Low Zone). [source: CEBC TRM profile]
  • Steps:
    1. Teach parent and child the zones and the six skills together, using the youth and parent workbooks.
    2. Have the parent practise the skills for their own regulation.
    3. Decide case by case whether the parent attends reprocessing, based on development and the child's comfort. [source: CEBC TRM profile]
    4. If the parent is not present for reprocessing, teach them the skills in individual or group sessions.
  • Example language (illustrative): "When you see her going into the High Zone, you can say: 'Let's do our wall push together.'"
  • Watch for: a dysregulated parent. Help the parent regulate first, and treat the parent's own trauma or stress reactions (CEBC lists these as target needs). [source: CEBC TRM profile]

4.19 Somatic monitoring when combining TRM with EMDR

  • Purpose: Miller-Karas describes adding TRM to EMDR. The client first learns the wellness skills and can reach embodied well-being on purpose. During EMDR, a somatically trained therapist watches micro-movements and larger movements and can use TRM reprocessing skills to deepen the work. [source: Psychology Today 2023]
  • Steps [partly synthesis]:
    1. Complete Phase B first.
    2. Use resource intensification as the client's safe or calm resource. [source: Psychology Today 2023 describes the resource as a safety net]
    3. During processing, track body changes.
    4. Insert Resiliency Pauses or grounding when there are signs of dissociation.
    5. Follow EMDR's own protocol for everything else; only clinicians trained in EMDR should do this.
  • Example language (illustrative): "Let's stop the eye movements for a moment. What do you notice in your body? … Can you feel the chair supporting you?"
  • Watch for: dissociation, which Miller-Karas says is not uncommon during reprocessing; ground immediately (4.6). [source: Psychology Today 2023]

4.20 "What else is true?"

  • Purpose: a conversational question Miller-Karas uses to open alternative perspectives once the client is regulated. It is the cognitive "portal" used after the sensory one. [source: Psychology Today 2024; Psychology Today 2023 on three portals]
  • Steps:
    1. Once the client is in the Resilient Zone, reflect back a stuck belief.
    2. Ask what else is true.
    3. Track the sensation that comes with the new statement.
  • Example language (illustrative): "You've said you froze and that means you were weak. What else is true about that moment? … And what do you notice inside as you say that?"
  • Watch for: asking this while the client is still in the High or Low Zone tends to produce argument or flat agreement. Regulate first. [synthesis]

4.21 SENSIMAP (sensory portals for implicit memory)

  • Purpose: a TRI Level 2 tool for exploring implicit memories in more detail through the "sensory portals". [source: TRI TRM Level 2 page] Miller-Karas's 2023 post names three portals for change: sensation, cognition and emotion. [source: Psychology Today 2023] Whether SENSIMAP uses these three or a wider set of sensory channels is not stated in TRI's public pages [uncertain].
  • Steps: TRI publishes no SENSIMAP procedure. The map is taught in TRM Level 2 and may be described in Miller-Karas (2023) [uncertain]. Do not improvise a version and call it SENSIMAP. Within the published skills, the nearest practice is tracking (4.3) applied to the sensations, images, emotions and meanings the client links to a cue [synthesis].
  • Example language: none published; use the tracking language in 4.3.
  • Watch for: implicit material (a smell, sound or posture that triggers activation without a clear memory) needs the same small doses and Resiliency Pauses as titration (4.13). Treat it as present experience, never as evidence of an unremembered event. [synthesis, per trauma-practice standards]

4.22 Expressive arts with TRM skills

  • Purpose: TRI lists applying expressive arts, including art, with TRM skills as a Level 2 objective [source: TRI TRM Level 2 page]; the Belfast 2026 programme places expressive arts in Level 3 [source: TRI training page]. TRI publishes no procedure [uncertain].
  • Steps [synthesis]:
    1. Offer drawing as an alternative to talking, e.g. drawing a resource or the client's Resilient Zone.
    2. After each drawing step, invite tracking: what happens inside as they look at it.
    3. Use the finished resource drawing as an external anchor during Resiliency Pauses (4.10).
    4. Keep any distress-related drawing as small as titration requires.
  • Example language (illustrative): "Would you like to draw your lake instead of describing it? … As you look at what you drew, what do you notice inside?"
  • Watch for: drawing that speeds up or darkens while the body braces; pause and return to the resource. Drawing often helps children and clients who struggle to put sensations into words. [synthesis]

5. Handling problems

TRI's published sources give three explicit rules:

  • Stop introducing skills and build safety and relationship when a client is reluctant, fearful or cannot sense pleasant or neutral sensations.
  • Use grounding for dissociation.
  • Consult when TRM does not fit your scope.

[source: Grand Rounds slides 2025; Psychology Today 2023]

Everything else below is my synthesis unless a source is tagged. TRI publishes no contraindications or exclusion criteria: the CEBC profile's developer-supplied information contains none, and the Grand Rounds slides, the TRI Level 2 page and the Mad in America summary list none. [source: CEBC TRM profile; Grand Rounds slides 2025; TRI TRM Level 2 page] The only published cautions are the stop-if-not-ready rule above, the ethics slide (do no harm; the practitioner must be able to self-regulate; consult when challenged), and the statement that the reprocessing skills can unsettle clients and so must be used by a trained clinician within therapy. [source: Grand Rounds slides 2025; Mad in America summary] All screening and deferral advice below is my synthesis [uncertain].

Client cannot find any pleasant or neutral sensation

  • Source rule: do not move to reprocessing; stop adding skills and build safety and relationship. [source: Grand Rounds slides 2025]
  • Responses [synthesis]:
    • Look for neutral rather than pleasant, e.g. "Is there any place that feels just ordinary, like an earlobe or a fingertip?"
    • Use external Help Now! options such as colours or sounds, which need no inner focus.
    • Use an imagined resource if real ones are contaminated.
    • Use the smallest possible units: a single breath, one second.
    • Accept "I don't know" as data, not failure.

Resource turns distressing

Examples: a dead relative, or a place linked to the trauma. [synthesis]

  • Acknowledge the shift.
  • Ground the client.
  • Choose a simpler or imagined resource, or an internal resource such as a body strength.
  • Note the material for later careful work rather than abandoning it.

Flooding into the High Zone

Signs: rapid speech, panic, rage, racing heart. [synthesis]

  1. Stop the content.
  2. Use Help Now! with eyes open and external focus: name colours, push against the wall, sip water, count down.
  3. Then use grounding.
  4. Do not return to the material in that session if settling takes long.
  5. Next session, titrate to a smaller piece and pause sooner.

Dissociation or drop into the Low Zone

Signs: glazed eyes, flat voice, numbness, collapse. [synthesis, with grounding from source]

  1. Speak the client's name and orient them to the room and today's date.
  2. Invite eye contact or ask them to look around.
  3. Have them press their feet into the floor or hands against the chair.
  4. Use a weighted pillow on the lap if available [source: Psychology Today 2023].
  5. Offer standing or walking Help Now! options.

Afterwards, reassess readiness. Repeated dissociation means returning to Phase B and possibly a specialist dissociation assessment. TRI teaches dissociation work in its training: the TRM Level 2 page lists ways to "work with dissociative parts with the TRM® skills" as an objective, and the Belfast 2026 programme places dissociation in Level 3. [source: TRI TRM Level 2 page; TRI training page] Neither page describes the method, and the Grand Rounds slides list dissociation only among common stress reactions, so how TRM works with dissociative parts remains [uncertain]. Until you are trained in it, use the grounding and Help Now! steps above within a standard phase-oriented approach to dissociation [synthesis].

Client insists on telling the whole story fast

[synthesis]

  • Honour their wish to be heard.
  • Explain the Resiliency Pause rationale.
  • Agree a signal.
  • Pause frequently anyway.
  • Remind them that detail is not required for change [source: Grand Rounds slides 2025].

Release sensations frighten the client

Examples: shaking, heat, tingling. [source: CEBC TRM profile describes these as temporary and part of restoring balance; responses are synthesis]

  • Normalise these sensations during psychoeducation, before reprocessing begins.
  • If shaking is frightening, slow it down, ground, and remind the client they can stop it at any time.
  • Never push for release.

Scepticism about body focus, or "this is silly"

[synthesis]

  • Lead with the biology rationale.
  • Use the most concrete skills first: Help Now! and grounding.
  • Invite a short experiment and ask the client to rate it, rather than asking for belief.
  • Offer the cognitive "portal" first if needed [source: Psychology Today 2023 on three portals].

Non-adherence to home practice

[synthesis]

  • Shrink the task to one 30-second skill tied to an existing routine.
  • Use the iChill app prompts.
  • Ask what got in the way without judgement.
  • Practise in session so that the session itself becomes the practice.

Ruptures

Examples: the client feels pushed, watched, or that their gestures were misread. [synthesis, consistent with the tenets]

  • Name the rupture.
  • Take responsibility ("I went ahead of you").
  • Return to "half a step behind".
  • Ask permission before each step.
  • Never interpret the client's body; ask instead.
  • Some trauma survivors experience being observed closely as threatening. Ask how much body-noticing feedback they want.

Self-harm gestures and suicidality

  • Redirect any self-harming gesture to a comforting one [source: Psychology Today 2024].
  • If the client discloses self-harm or suicidal thinking (CEBC/CRM materials list suicidal thoughts among stuck-zone signs) [source: CRM handout 2017], carry out a standard structured risk assessment and safety planning, including lethal-means counselling (safe storage or removal). Postpone reprocessing until the client is stable. [synthesis]

Complex trauma, attachment trauma, severe dissociation, psychosis, active substance misuse

TRI publishes no TRM-specific guidance or contraindications for these groups [uncertain]. In my synthesis:

  • Screen with standard instruments.
  • Extend Phase B substantially.
  • Coordinate with the wider treatment.
  • Defer reprocessing in active psychosis, acute intoxication, current unsafe living situations or unmanaged dissociative disorders until stabilised and specialist input is available.

Children and parents

[source: CEBC TRM profile; responses synthesis]

  • Use the "Okay Zone" language and workbooks.
  • Keep sessions short (15–60 minutes at first).
  • Involve parents in the skills.
  • Decide on parent presence during reprocessing case by case.
  • Treat a dysregulated parent's own stress.

Cultural and faith fit

  • Resources can include spiritual guides and faith [source: CRM handout 2017; Psychology Today 2024]. Ask about the client's own sources of comfort and gestures, e.g. prayer postures, and use their words.
  • TRI materials exist in many languages [source: CEBC TRM profile]; check availability with TRI.

Telehealth

CEBC lists virtual delivery [source: CEBC TRM profile], but TRI publishes no telehealth procedure [uncertain]. In my synthesis:

  • Confirm the client's location and an emergency plan.
  • Ask the client to sit where their feet and back are supported.
  • Have water and a cushion to hand.
  • Rely more on verbal check-ins, because micro-movements are harder to see on screen.

Practitioner activation or vicarious trauma

The source requires that the practitioner can sense their own body and find neutral or pleasant sensations, and recommends consultation [source: Grand Rounds slides 2025]. Use the wellness skills yourself between sessions; TRM is also presented as a clinician self-care model [source: Grand Rounds slides 2025].

Scope and training

  • The reprocessing skills are taught in TRI Level 2 and are described as practitioner-only, not for independent use by clients [source: Mad in America summary; CEBC TRM profile].
  • Clinicians without TRI training should limit themselves to the wellness skills and seek training and consultation before reprocessing [synthesis].
  • For lay or community delivery, use the Community Resiliency Model guide (Domain V, 153).

Sources

Web sources:

Further web sources:

Books and papers cited:

  • Miller-Karas, E. (2015). Building Resilience to Trauma: The Trauma and Community Resiliency Models. Routledge.
  • Miller-Karas, E. (2023). Building Resilience to Trauma: The Trauma and Community Resiliency Models (2nd ed.). Routledge. This is the treatment manual per CEBC.
  • Miller-Karas, E. (2021). Trauma Resiliency Model (TRM) Workbook. Trauma Resource Institute.
  • Grabbe, L., & Miller-Karas, E. (2018). The Trauma Resiliency Model: A "bottom-up" intervention for trauma psychotherapy. Journal of the American Psychiatric Nurses Association, 24(1), 76–84. doi:10.1177/1078390317745133.
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