Understanding Trauma Recovery: A Guide to the Three Phases of Healing

Trauma deeply affects individuals by disrupting the vital social systems of care, protection, and meaning that underpin human life. In this blog post, we will explore the recovery process, which centers on empowering survivors and rebuilding relationships to reconstruct these essential systems. Recovery generally progresses through three stages: establishing safety, retelling the story of the traumatic event, and reconnecting with others. To effectively treat post-traumatic disorders, interventions must be tailored to each survivor’s stage of recovery. Additionally, therapists require a robust professional support system to manage the psychological consequences of working with trauma survivors. Comprehensive treatment is crucial, as trauma impacts every aspect of human functioning, necessitating a holistic approach that addresses the biological, psychological, and social components of the disorder.

In this blog post, I endeavour to present an accessible and informative introduction to the three phases of trauma recovery, as outlined by Dr. Judith Herman, MD in her seminal 1998 publication. Through a detailed case example, my goal is to offer valuable insights into the distinctive features and progression within this three-phase recovery model, benefiting both fellow professionals and potential clients seeking to better understand the process.

Introduction

The Three-Phase Trauma Framework is a comprehensive approach to addressing complex trauma and fostering healing and recovery. By incorporating a trauma-informed perspective, this framework acknowledges the unique and non-linear nature of each individual’s journey through trauma recovery. In this blog post, we will provide an overview of the Three-Phase Trauma Framework, emphasizing its importance in therapeutic practice.

Phase I: Safety, Stabilization, and Engagement

The first phase of the Three-Phase Trauma Framework focuses on establishing a strong therapeutic alliance between the client and therapist. This relationship is crucial in creating a safe and stable environment, both physically and psychologically, for the client to begin addressing their trauma-related issues.

During this phase, the therapist provides psychoeducation about trauma, its impacts, and common difficulties experienced by survivors. This helps the client develop a deeper understanding of their own experiences and the potential consequences of their trauma. Additionally, the therapist works with the client to develop coping strategies and skills for managing overwhelming emotions and memories related to their trauma.

It is essential not to rush through Phase I, as building a solid foundation of trust and safety is crucial for the success of the subsequent phases of the framework. By taking the time to establish a supportive and trusting relationship, the therapist can ensure that the client feels secure enough to explore and address their trauma reactions in a safe and therapeutic manner.

Case Example: Jane and Her Therapist

Jane, a 32-year-old woman, has sought therapy due to her struggles with anxiety and depression, stemming from a history of childhood abuse. She begins working with a trauma-informed therapist who is well-versed in the Three-Phase Trauma Framework.

Establishing Trust and Safety

During the initial sessions, the therapist focuses on building rapport and establishing trust with Jane. They spend time discussing Jane’s current life context, her relationships, and her goals for therapy. The therapist ensures that Jane feels comfortable, heard, and understood, emphasizing the importance of creating a safe and non-judgmental space for her to share her experiences.

Psychoeducation

As the therapeutic relationship strengthens, the therapist introduces Jane to psychoeducation about trauma, its impacts, and common difficulties faced by survivors. They discuss the potential long-term effects of childhood abuse, such as difficulties with trust, intimacy, and emotional regulation. This information helps Jane to better understand her own reactions and behaviors, as well as to recognize that her experiences are not uncommon among survivors of trauma.

Developing Coping Strategies

The therapist works with Jane to develop a range of coping strategies for managing overwhelming emotions, memories, and triggers related to her childhood abuse. They explore grounding techniques, self-soothing activities, and mindfulness exercises that can help Jane regain a sense of control when faced with distressing thoughts or feelings. They also discuss the importance of self-care and maintaining a support network to help her navigate through challenging moments.

Building a Solid Foundation

Throughout Phase I, the therapist remains attentive to the pacing of therapy, ensuring that Jane feels secure and supported before moving on to the next phase. They frequently check in with Jane to assess her readiness and comfort level in addressing her trauma more directly. By taking the time to build a solid foundation of trust, safety, and emotional stability, the therapist helps Jane feel more prepared to engage in the deeper work required in Phase II of the Three-Phase Trauma Framework.

Phase II: Processing of Traumatic Memories and Meaning-Making for Self

The second phase of the Three-Phase Trauma Framework focuses on helping the client process their traumatic memories and find meaning in their experiences. This phase requires a delicate balance between drawing attention to traumatic memories and managing the associated emotional distress and physiological arousal.

During Phase II, the therapist supports the client in exploring their traumatic experiences and addressing feelings of responsibility, shame, guilt, grief, and loss. The goal is to help the client develop a coherent autobiographical narrative and make sense of their experiences in a way that fosters healing and growth. The therapist also helps the client maintain an established lifestyle and ongoing relationships while working through this phase.

It is important to note that processing traumatic memories goes beyond simple remembrance and mourning, particularly for survivors of childhood sexual abuse. The meaning-making process can have a profound impact on the client’s sense of self, as it allows them to reevaluate their cognitive and emotional reactions to the abuse and construct more adaptive meanings for their experiences.

Case Example Continued: Jane’s Journey through Phase II

Exploring Traumatic Memories

Now that Jane feels safe and secure in her therapeutic relationship, she and her therapist begin to gently explore the impact of her past traumatic experiences on her present emotional state during Phase II. They approach this process cautiously, ensuring that Jane feels in control and can manage the emotional intensity that may arise as they delve into her past experiences, all while remaining rooted in the present moment.

Addressing Feelings and Making Meaning

As Jane shares her feelings about her past experiences in the present moment, the therapist helps her address feelings of responsibility, shame, guilt, grief, and loss. They work together to challenge Jane’s self-blame and to reframe her understanding of the abuse as something that was beyond her control. By examining the impact of the abuse on her present life, Jane begins to make sense of her experiences and integrate them into a coherent autobiographical narrative.

Maintaining Balance in Daily Life

Throughout Phase II, Jane’s therapist encourages her to maintain balance in her daily life and to nurture her ongoing relationships. They discuss strategies for managing the emotional and physiological reactions that may arise as she processes her trauma, such as seeking support from friends and family, engaging in self-care activities, and using the coping skills she developed in Phase I.

Moving Towards Healing and Growth

Over time, Jane starts to notice a shift in her perspective on her traumatic experiences. She is better able to separate her sense of self from the abuse she endured and begins to see her survival as a testament to her resilience and strength. Through the process of meaning-making, Jane starts to develop a more adaptive understanding of her experiences, which ultimately fosters healing and personal growth.

By the end of Phase II, Jane has made significant progress in acknowledging and understanding the impact of her traumatic memories on her present emotional state, without needing to recall the specific details of her past experiences. As she moves into Phase III of the Three-Phase Trauma Framework, she will focus on further developing her sense of personal and relational integrity and well-being, as well as integrating the skills, knowledge, and self-awareness gained throughout her therapeutic journey.

Phase III: Developing Personal and Relational Integrity, Well-being, and Integration

The final phase of the Three-Phase Trauma Framework focuses on integrating the skills, knowledge, and self-awareness gained throughout the previous phases to enhance the client’s personal and relational well-being. The goal is to help the client build a sense of personal and relational integrity, allowing them to live a more fulfilling life despite their traumatic experiences.

During Phase III, the therapist supports the client in enhancing their emotional literacy and building connections with themselves and others. This phase also addresses the relational impacts of the trauma, such as developing trusting, respectful, and caring relationships with partners, family, and friends. The client is encouraged to nurture closeness, intimacy, and a satisfying sexual life, as well as to develop a clear sense of self and purpose.

This phase also offers an opportunity to explore post-traumatic growth. The client may find that their resilience, survival skills, self-knowledge, empathy, and overall perspective on life have been broadened and enriched by their experiences. By focusing on enhancing overall quality of life rather than merely managing symptoms, Phase III promotes long-lasting healing and recovery for trauma survivors.

Case Example Continued: Jane’s Journey through Phase III

Enhancing Emotional Literacy and Building Connections

As Jane progresses into Phase III, she and her therapist focus on deepening her emotional literacy and helping her build stronger connections with herself and others. They explore how Jane’s past experiences have influenced her present relationships, and they work together to identify ways she can build trust, respect, and care in her connections with partners, family, and friends.

Addressing Relational Impacts and Developing Trust

During this phase, Jane’s therapist supports her in understanding the relational impacts of her trauma and guides her in developing trusting, respectful, and caring relationships. They discuss strategies for nurturing closeness and intimacy, as well as ways to create a satisfying sexual life that feels safe and consensual. Through this process, Jane starts to develop a clearer sense of self and a stronger connection to her personal values and goals.

Exploring Post-Traumatic Growth

Throughout Phase III, Jane’s therapist encourages her to reflect on the ways in which her experiences have contributed to her personal growth. They explore how her resilience, survival skills, self-knowledge, empathy, and overall perspective on life have been broadened and enriched by her experiences. By recognizing the positive aspects of her journey, Jane begins to see her trauma not as a defining characteristic of her life, but as a part of her larger story that has contributed to her growth and resilience.

Focusing on Long-lasting Healing and Recovery

As Jane moves through Phase III, her focus shifts from managing symptoms to enhancing her overall quality of life. She starts to see the progress she has made and the skills she has developed throughout her therapeutic journey, and she begins to integrate these lessons into her everyday life. By emphasizing personal and relational integrity, well-being, and integration, Jane’s therapist helps her build a foundation for long-lasting healing and recovery, allowing her to live a more fulfilling life despite her traumatic experiences.

By the end of Phase III, Jane has come a long way in her journey of healing from trauma. Through the Three-Phase Trauma Framework, she has developed a deeper understanding of her experiences, built a strong foundation of coping skills, and learned to foster meaningful connections with herself and others. As she continues to grow and heal, she is better equipped to face the challenges and joys of life with resilience, courage, and hope.

The Importance of Flexibility in the Three-Phase Trauma Framework

While the Three-Phase Trauma Framework is presented in a hierarchical and linear structure, it is essential to recognize that the process of trauma recovery is inherently non-linear. Clients and therapists alike must be prepared to constantly move through and between the different phases, adjusting their approach as needed.

Adapting to Individual Needs

Therapists should be aware that clients may require more time in one phase than another, and that they may need to revisit earlier phases at different points in the recovery process. It is crucial for therapists to be patient and flexible, tailoring their approach to the individual needs of the client. Each person’s journey through the Three-Phase Trauma Framework will be unique, and therapists should be prepared to adapt their strategies and techniques to best support the client’s healing process.

Embracing the Non-linear Nature of Trauma Recovery

The non-linear nature of trauma recovery also means that clients should not expect a smooth and uninterrupted progression through the phases. Recovery can be a long and challenging journey, characterized by moments of progress and setbacks. Clients may experience fluctuations in their emotional states, symptoms, and ability to cope with daily life. It is essential for both clients and therapists to maintain a realistic perspective on the recovery process and to be prepared for the potential need to revisit earlier phases.

The Role of Support and Understanding

With the right support and understanding, it is possible to heal and grow from traumatic experiences. The Three-Phase Trauma Framework provides a solid foundation for guiding clients through their recovery journey. By acknowledging and embracing the non-linear nature of trauma recovery, therapists can better support their clients in achieving a greater sense of personal and relational well-being.

The Most Effective Treatment for Trauma: Prolonged Exposure Therapy

When it comes to treating trauma, one intervention stands out as particularly effective: Prolonged Exposure (PE) therapy. This evidence-based treatment method has been shown to significantly help individuals confront and work through their trauma. The central principle of PE therapy is to gradually expose individuals to the feelings, thoughts, sensations, memories, places, and images connected to their traumatic experiences. By doing so, the individual can begin the process of desensitization, reducing the intensity of their emotional reactions and decreasing their avoidance behaviours.

The American Psychological Association (APA) strongly recommends PE therapy for the treatment of post-traumatic stress disorder (PTSD). This therapy involves a series of structured sessions in which the individual revisits their traumatic experiences in a safe and controlled environment. Under the guidance of a trained therapist, the individual is encouraged to face their fears and engage with the emotions and memories associated with their trauma. Over time, this process allows the individual to regain a sense of control over their reactions, empowering them to move forward in their recovery journey.

PE therapy is not only effective in treating PTSD but also has been shown to improve other trauma-related symptoms, such as depression and anxiety. By directly confronting the aspects of the trauma that cause distress, individuals are better equipped to understand their reactions, challenge negative beliefs, and develop coping strategies for managing their emotions. With the support of a skilled therapist, Prolonged Exposure therapy can be a powerful tool in facilitating healing and growth for individuals recovering from trauma.

Incorporating Prolonged Exposure Therapy in Trauma Treatments

Prolonged Exposure (PE) therapy is an evidence-based treatment specifically focused on addressing post-traumatic stress disorder (PTSD). Though PE therapy is distinct in its approach, some elements of exposure therapy are incorporated into other trauma treatments, either directly or indirectly. This section explores the relationship between PE therapy and other trauma treatments.

Sensorimotor Psychotherapy

Sensorimotor Psychotherapy is a body-oriented approach to trauma treatment that integrates cognitive, emotional, and physical aspects of the individual’s experience. While it does not explicitly incorporate PE therapy, it includes elements of exposure by encouraging clients to safely explore and process trauma-related physical sensations, emotions, and memories. However, its main focus is on utilizing the body’s innate wisdom and resources to facilitate healing.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is another evidence-based treatment for trauma that focuses on processing and integrating traumatic memories. While EMDR does not directly incorporate PE therapy, it shares similarities in its approach, such as asking clients to confront and process trauma-related emotions, thoughts, and memories. The primary difference is that EMDR employs bilateral stimulation, typically through eye movements, to facilitate the processing of traumatic memories.

Trauma-Informed Stabilization Treatment (TIST)

TIST is a comprehensive, integrative approach to trauma treatment that combines elements of various evidence-based therapies, including Internal Family Systems, Dialectical Behavioural Therapy, and Attachment Theory. Although TIST does not explicitly incorporate PE therapy, it includes elements of exposure in its parts-based approach to helping clients face and process traumatic experiences. TIST emphasizes the importance of first establishing safety and stabilization before processing traumatic memories.

In conclusion, while PE therapy is a distinct treatment approach, elements of exposure may be present in various trauma treatments to varying degrees. Each therapy has its unique focus and methodology, and the choice of treatment depends on the individual’s specific needs and preferences.

Recommended Core Reading List

The development of the Trauma Informed Practice builds upon the wealth of existing knowledge by many individuals who have contributed significantly to the field of treatment and support for individuals who have experienced complex trauma and childhood sexual abuse. The following core reading list is recommended for practitioners and clients who wish to further their understanding of the Three-Phase Trauma Framework and trauma-informed approaches:

• Briere, J., & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluations, and treatment. California: Sage Publications, Inc.
• Courtois, C., & Ford, J. (2013). Treatment of complex trauma: A sequenced, relationship-based approach. New York: The Guildford Press.
• Fisher, J. (2017). Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation. New York: Routledge.
• Fisher, J. (2021). Transforming The Living Legacy of Trauma: A Workbook for Survivors and Therapists. Eau Claire, WI: PESI Publishing. ISBN: 9781683733485.
• Follette, V., & Pistorello, J. (2007). Finding life beyond trauma: Using acceptance and commitment therapy to health from posttraumatic stress and trauma-related problems. California, USA: New Harbinger Publications, Inc.
• Herman, J. (2001). Trauma and recovery: From domestic abuse to political terror. London: Pandora.
• Herman, J. (1998). Recovery from psychological trauma. Department of Psychiatry, The Cambridge Hospital, 1493 Cambridge St, Cambridge, MA 02139, USA.
• McMackin, R., Newman, E., Fogler, J., & Keane, T. (2012). Trauma therapy in context: The science and craft of evidence-based practice. Washington, DC: American Psychological Association.
• Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. New York: W. W. Norton & Company.
• Royal Commission into Institutional Responses to Child Sexual Abuse. (2015). Consultation Paper: Redress and civil litigation. New South Wales: Commonwealth Government.
• Sanderson, C. (2006). Counselling adult survivors of child sexual abuse. London, UK: Jessica Kingsley Publishers.
• Van der Kolk, B. (2014). The body keeps the score: Brain, mind and body in the healing of trauma. New York, USA: The Penguin Group.

Conclusion

The Three-Phase Trauma Framework provides a comprehensive and flexible approach to addressing complex trauma and childhood sexual abuse. This framework emphasizes the importance of creating a safe environment, processing traumatic memories, and integrating new skills and knowledge to enhance personal and relational well-being. By acknowledging the non-linear nature of trauma recovery, therapists can better support their clients through the healing process.

It is crucial for practitioners to remain patient, empathetic, and open to adjusting their approach as needed to meet the unique needs of each client. By staying informed and utilizing trauma-informed practices, therapists can help survivors build resilience, develop healthy relationships, and ultimately improve their overall quality of life. By acknowledging the work of experts in the field and staying up-to-date with the recommended reading materials, practitioners can ensure they are providing the most effective support and guidance for their clients on the journey to recovery and healing.