A phase orientated approach to working with trauma
Phase orientated approaches to trauma can help demystify the process of trauma therapy. In this vein, they can help you feel as if you have some sense of knowledge, autonomy and control in the process of your therapy. There is an emphasis on the therapeutic alliance and therapeutic relationship, an emphasis on collaboration and dialogue between the therapist and you the client as well as attention to issues of trust and power dynamics within the relationship.
Certainly, it can be very useful to offer you a framework from which to work with in the process of your recovery. This approach is always offered in response to your needs, wants, wishes, goals as they present themselves and respecting your individual pace is essential.
Phase orientated approaches are a popular way of working with survivors of trauma. They were first mentioned by Pierre Janet in (1889) and later developed by Judith Herman in (1992:1997). A three phase approach is briefly outlined below and it is worth remembering that the phases overlap and can be non-linear.
All phases involve psychoeducation and utilise integrative ways of working. Such as the use of creativity, imagination and the use of techniques to help with emotional regulation which aids better cognitive functions.
Phase one - Safety and stabilisation.
This phase works with helping individuals gain some sense of mastery over their bodies and their emotions. This is also true of the other two phases. It is helpful to identify triggers. It can and often does involve a lot of psycho-education. For example facilitating a better understanding about the dynamics of abuse, such as shame, loss of power, control and arousal. It may also involve learning about the brain's responses to traumatic memories, and their impact. As well as education and awareness around post-traumatic stress disorder and it's symptoms. Here it may be necessary to introduce, mindfulness, self-care, soothing and grounding exercises.
Phase two - Recalling trauma memories, loss and mourning.
This phase is about processing the trauma, making sense of it, re-contextualising it. It is still essential to attend to the first stage as and when required as setbacks and pitfalls do and can occur.
Attending to safety and stabilisation allow for individuals to re-integrate the trauma narrative. Respecting the client’s pace of their trauma narrative is an imperative. Increasing self-care and changing and shaping your understanding and awareness of shame, guilt, self-responsibility and self-loathing etc.
Phase three - Reconnection and integration.
This phase has much to do with re-integration of the self, creating new meanings, a redefinition of the self within relationships. Importantly the trauma is no longer the overriding experience, the organising principle. The person recognises the influence that their traumatic experiences has had on their lives and is able to resolve conflicts within themselves. There is often a sense of 'newness' and a sense of self-compassion.
In my experience, a phase orientated approach works well, it requires the establishment and maintenance of good secure therapeutic relationships. It requires the use of empathic communication and understanding and I find that there is definitely a person centred-ness about it. In respecting the client’s pace and space of therapy, a respect for individual uniqueness and autonomy. Whilst developing and working with your needs as they present themselves. This has been highlighted by the ISTSS (2012).
You can gain a sense of control of the overwhelm, sensations thoughts and experiences that have trapped you for so long in the past. You can move beyond mere surviving to thriving, with courage, commitment to yourself, tenacity, better understanding and self awareness change is possible.
Herman, J.L. (1992). Trauma and Recovery. New York: Basic Books. Herman, J.L. (1997).Trauma and Recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.
Herman, J.L. (1997).Trauma and Recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.
Cloitre, M., Courtois, C.A, Ford, J.D, Green, B.L., Alexander, P., Briere, J., Herman, J.L., Lanius, R., Stolbach, B.C., Spinazzola, J., Van Der Kolk, B.A., Van Der Hart, O. (2012). The ISTSS Expert Consensus Treatment Guidelines for Complex PTSD in Adults.