The Three Stages of Healing Trauma and Abuse
This three stage model of trauma recovery is borrowed from Judith Herman’s stages of recovery as well as EMDR best practice. My approach in treating trauma is also informed by the work of internationally recognised trauma experts Dr. Janina Fisher, Dr. Peter Levine, Dr. Bessel van der Kolk & Dr. Dick Schwartz. It is not necessary to tell the story of the trauma. See the full explanation below the image.
Trauma will visit each of us at some stage of life. “Trauma is a fact of life. But it doesn’t have to be a life sentence.” Dr. Peter Levine – developer of Somatic Experiencing therapy.
“People can leave the trauma behind if they learn to feel safe in their bodies—they can feel the pleasure to know what they know and feel what they feel. The brain does change because of trauma and now we have tools to help people be quiet and present versus hijacked by the past. The question is: Will these tools become available to most people?” – Dr. Bessel van der Kolk – author of The Body Keeps the Score.
Stage One of Healing Trauma: Education, Stabilisation, Safety and the importance of Self-Soothing.
Depending on the severity of complex trauma a person can remain in this stage for a while.
Education helps normalise what you’re experiencing. It helps you know you’re not crazy. What’s happening is your nervous system and brain are responding exactly the way they were designed to respond after having survived repeated traumatic experiences.
Stabilisation helps you learn ways to manage urges to abuse substances, alcohol and to self-harm, like cutting and suicide attempts. Find a therapist that understands trauma treatment and doesn’t just treat substance abuse or mental health issues.
In this stage it’s important to learn skills to contain and manage distressing emotions. This is called learning to self-soothe. Without you having confidence in yourself to do this, and feeling safe in your body and world outside of therapy, we can’t proceed to stage 2.
Safety is about feeling safe with your therapist and in your life outside the therapy room. This is very important for healing to happen. It’s also about having supports to help with crisis situations. This can be a therapist, a crisis line, a friend/family member, a spiritual community and also creating a support plan. This includes phone numbers of people you will call and services you will reach out to if you are feeling distressed or suicidal.
In some cases medications can be helpful. These medications are meant to be temporary and work best when combined with therapy.
Stage Two of Healing Trauma: Processing, Remembering and Mourning.
This stage of recovery is about making sense of what happened.
In fact, once the first stage of recovery has provided a good enough foundation, some people realise 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. And sometimes people need to teach their therapists about this!
Processing does not begin until you are able to self-soothe and self-regulate any overwhelming emotions. Beginning processing too early can be unhelpful and re-traumatising. This is very important to remember.
Dr. Peter Levine says the aim of this stage of therapy is not to tell the story. “It is to work with body sensations…because the overwhelm and the fight-or-flight are things that happen in the body…the golden route is to be able to help people have experiences in the body that contradict those of the overwhelming helplessness.” There are many ways to do this. Many therapists also will recommend that their clients do things like yoga or martial arts.
For those who choose to work on disturbing memories, because those memories are still disrupting their lives, several ‘memory processing’ methods can be used during this stage.
Evidence Based Treatments for this stage are:
- Somatic Experiencing – Peter Levine. The aim is to help you access the body memory of the event, not the story. So we don’t discuss what happened if you don’t want to.
- EMDR – Francine Shapiro – This method can transform traumatic memories into memories that no longer create the distress that you have become used to. You don’t have to talk about them in order for this therapy to work.
- Blue Knot Foundation’s Best Practice Guidelines – for trauma-informed service delivery.
- Understanding Trauma and Its treatment – Janina Fisher
- Internal Family Systems – Dr. Dick Schwartz
- RET – Radical Exposure Therapy – Laurie McKinnon
- ART – Accelerated Resolution Therapy – Laney Rosenzweig
The main work of stage Two involves:
- Recognising that the abuse is not who you are (you are a worthwhile being) but rather what happened to you.
- Deconstructing and letting go of shame, guilt and disgust that is often passed on from the perpetrator to you. Knowing who you are (a unique being) not what the perpetrator told you who you were.
- Mourning the loss of a happy childhood/relationship that you didn’t get.
- Choosing and working with your therapist to get help with distressing memories that may be affecting your quality of life, i.e, sleep disturbances, night terrors, flashbacks, ruminations, dissociation, hyper vigilance, anxiety & depression.
- Working with a therapist who is trained to deal with dissociative disorders.
Stage Three of Healing Trauma: Meaning and Re-connection
This involves making sense of your past, present and future through exploring meaning. It’s also about reconnecting to others in meaningful and healthy relationships – friends, partners, family and work. For some people this also involves spirituality or religion. For others it may be using philosophy or mythology to make sense of existential questions such as “Why did this happen?” “Why am I here?” and “What does it all mean for me?”
This stage is also about reconnecting to your community. For some people it’s about giving back in some way or focusing on dreams and goals for the future. Now that you feel lighter, moving forward with your goals and dreams is possible.
Remember that recovery is not linear. Your journey will probably not follow a straight line, but instead might be circular, moving in and out of stages until you feel you are ready to move forward and reconnect with your goals and dreams.
- Waking the Tiger: Healing Trauma – Peter Levine
- Transforming The Living Legacy of Trauma: A Workbook for Survivors and Therapists – Janina Fisher
- The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma – Bessel van der Kolk.