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Stage-Based Trauma Treatment
In Trauma and Recovery, Dr. Judith Herman presents a model which describes in detail a pathway toward healing for people who struggle with a combination of problems related to unwanted, abusive, or traumatic experiences in their past.
The problems may include:
- Difficulty regulating emotions and impulses
- Emotional numbing
- Anger and aggression
- Substance use problems
- Behavioral problems and addiction
- Dissociation (spacing out, blanking out, losing time, etc.)
Throughout all stages of treatment, it is often necessary to address psychological themes and ‘dynamics’ related to one’s history of unwanted or abusive experiences. These may include:
- Powerlessness
- Shame and guilt
- Distrust
- Reenacting abusive patterns in current relationships
In the first stage of treatment, these themes and dynamics must be addressed when they are obstacles to safety, self-care, and regulating one’s emotions and behavior. Therapy can help with recognizing habitual behavior patterns, beliefs, and motivations that maintain self-defeating and self-destructive behaviors outside of conscious awareness or reflection.
Increased awareness of these themes and dynamics brings greater understanding, greater ability to take responsibility for them, and greater capacities to choose new, healthier responses and actions.
The first stage of dealing with and overcoming such problems is about:
- Getting a ‘road map’ of the healing process.
- Setting treatment goals and learning about helpful approaches to reaching those goals.
- Establishing safety and stability in one’s body, one’s relationships, and the rest of one’s life.
- Tapping into and developing one’s own inner strengths, and any other potentially available resources for healing.
- Learning how to regulate one’s emotions and manage symptoms that cause suffering or make one feel unsafe.
- Developing and strengthening skills for managing painful and unwanted experiences, and minimizing unhelpful responses to them.
The key to healing from traumatic experiences is achieving these ‘stage-one’ goals of personal safety, genuine self-care, and healthy emotion-regulation capacities. Once these have become standard operating procedures, great progress and many new choices become possible.
While the goal of Stage I is not focused on traumatic memories or experiences, the process is not always perfectly ordered and sequential. For example, during the first stage it may be necessary to discuss the contents of disturbing memories that are disrupting one’s life. This may be required to help manage the memories, or to understand why it is hard to care for oneself (e.g., the abuser acted like or even said you were unworthy of care or love). However, in this case addressing memories is not the focus of therapy, but a means to achieving safety, stability, and greater ability to take care of oneself.
Depending on the person, the first stage of treatment may also involve:
- Addressing problems with alcohol or drugs, depression, eating behaviors, physical health, panic attacks, and/or dissociation (e.g., spacing out, losing time).
- Taking medication to reduce anxiety, depressive, or other symptoms.
- Participating in skills-focused treatments.
After establishing a solid foundation of understanding, safety, stability and self-regulation skills one can decide – mindful of the potential pain and risks involved – whether or not to engage in the work of stage two. In fact, once the first stage of recovery has provided such a foundation, some people realize that thinking and talking about painful memories is not necessary to achieve their goals, at least in the short term. Some find that the memories are no longer disrupting their life and no longer of much interest to them.
This stage of recovery and treatment is often referred to as ‘remembrance and mourning’ or trauma-processing.
The main work of stage two involves:
- Reviewing and/or discussing memories to lessen their emotional intensity, to revise their meanings for one’s life and identity, etc.
- Working through grief about unwanted or abusive experiences and their negative effects on one’s life.
- Mourning or working through grief about good experiences that one did not have, but that all children deserve.
- Identifying trauma-related beliefs about yourself, other people, and the world and finding/practicing more balanced, adaptive ways of thinking.
For those who choose to focus on disturbing memories, including because those memories are still disrupting their lives, several ‘memory processing’ methods can be used during this stage. The same is true for people struggling with thoughts and beliefs that are disruptive.
The third stage of recovery focuses on reconnecting with people, meaningful activities, and other aspects of life that were affected by trauma. It involves learning how to live life without the constant burden of trauma-related and dissociative symptoms. Not everyone needs or wants this stage of treatment, though many find it helpful. This is stage of treatment often involves weekly psychotherapy.
Resources
Learn more about traumatic stress, dissociation, and related topics and explore other educational resources.
