Three Phase Trauma Therapy
Judith Herman is a psychiatrist in the Boston area who has written extensive about traumatic response and therapy. She recommended an approach to trauma recovery that includes three stages. The Traumatology Institute most recommends this approach, as seen in the book Trauma Practice: Tools for Stabilization & Recovery (Baranowsky, Gentry & Schultz, 2010, 2nd Ed.)
Using a comprehensive three phase approach, the client is:
- given a sense of emotional and physiological Stabilization prior to moving into
- Remembrance and Mourning, which we will now refer to as Trauma Memory Processing, and then
- Reconnection with communities and with meaningful activities and behaviors.
Phase 1: Safety and Stabilization
The central task of recovery is safety. People who have experienced trauma often feel betrayed both by what has happened to them as well as their own bodies. Their symptoms become the source of triggers that result in re-traumatization. This can leave the individual feeling both emotionally and physically out of control. Getting the right help to regain internal and external control is a primary focus of this phase. This is accomplished through careful diagnosis, education and skills development. The safety section of phase one, is focused on skills development to aid you to practice self-soothing and care skills to increase emotional and behavioral stabilization. In cases where you remain in an unsafe environment, plans to establish personal and practical safety remain the focus prior to delving into trauma memory processing work. The overriding goal is to make a gradual shift from danger that is unpredictable to a situation where you can rely on safety both in your environment and within yourself. Accomplishing this goal depends on the circumstances as well as your internal ability to cope with exposure to trauma memories and may take days, weeks, or months to achieve. In some cases, individuals may remain in the emotional safety and stabilization phase indefinitely while they work on establishing physical safety. Although we do encourage clients to work through their trauma memories this must be done in a respectful manner with the mutual consent of both client and therapist.
Phase 2: Trauma Memory Processing
In the second phase of recovery you will begin to work more deeply with exercises to work-through trauma history bringing unbearable memories to greater resolution. Because of the nature of traumatic memories, this process is rarely linear. Bits and pieces of the traumatic events emerge and can be processed. The objective is to create a space in which you can safely work through traumatic events and begin to make sense of the devastating experiences that have shaped your life. A good therapeutic relationship should provide you with a compassionate companion who will "bear witness" to your experiences, and help you to find the strength to heal. Using exercises that are designed for trauma memory processing.
There are many excellent Cognitive Behavioral Therapy techniques that fit well within this stage of trauma memory processing. In addition, there are newer approaches such as Eye Movement Desensitization and Reprocessing (EMDR), Time-Limited Trauma Therapy (TLTT), Layering, and Traumatic Incident Reduction (TIR) that have proven to be helpful in trauma memory processing.
Phase 3: Reconnection
The final stage of recovery involves redefining oneself in the context of meaningful relationships and engagement in life activities. Trauma survivors gain closure on their experiences when they are able to see the things that happened to them with the knowledge that these events do not determine who they are. Trauma survivors are liberated by the conviction that, regardless of what else happens to them, they always have themselves. Many survivors are also sustained by an abiding faith in a higher power that they believe delivered them from oppressive terror. In many instances survivors find a "mission" through which they can continue to heal and to grow. They may even end up helping others with similar histories of abuse and neglect. Successful resolution of the effects of trauma is a powerful testament to the indomitability of the human spirit. Once Phase 2 of Trauma Practice is completed, personality that has been shaped through trauma must then be given the opportunity for new growth experiences that offer the hope of a widening circle of connections and the exploration of a broader range of interests.