What Happens in Trauma Therapy?

Trauma therapy can seem confusing at best and terrifying at worst, and many people wonder what happens in trauma therapy. Oftentimes, the unknowns of trauma therapy can make survivors feel hesitant to take steps towards healing.

In this blog post, I’m going to take some of the mystery out of trauma therapy. My hope is that after reading this, you’ll feel more empowered to start your healing journey.

The Three Phases

In 1992, Dr. Judith Herman published her book “Trauma and Recovery.” This isn’t the most popular book about trauma ever written, but Dr. Herman’s writing changed the field of trauma therapy forever. Dr. Herman gave therapists a framework for doing safe and effective trauma therapy which, I would argue, is still the best around.

Dr. Herman created a three-phase approach to trauma therapy. The three phases are Safety and Stabilization, Reprocessing and Mourning, and Reconnection. Dr. Herman used slightly different names to describe these phases, but I use these ones because they’re more concise – what happens in each phase remains the same.

Each phase has its own goals that the survivor should accomplish before moving to the next phase. It’s normal to revisit phases after completing them, and there’s no guideline for how long a phase will take to finish. A survivor’s resources, their readiness to move on, and the amount of trauma they’ve experienced will determine how quickly they progress.

Safety and Stabilization

In first aid training, instructors teach their students to make sure an area is safe to enter before giving aid. The same is true for trauma therapy - step one is to ensure the survivor is reasonably safe.

Survivors should be in an environment where they can eat, sleep, and work without significant threats to their safety. If safety is a concern, the therapist should work with the survivor to identify resources that will help them establish safety.

For example, imagine a survivor coming to therapy for abuse she experienced with her partner. It is imperative that this survivor is no longer at risk of being abused before moving onto another phase. If she is, the therapist should work with her to find resources that will help her stay safe. These resources could include a domestic violence shelter, emergency contact numbers, and/or a safety plan in case things escalate between herself and her partner.

Additionally, survivors should experience a reasonable degree of internal safety. For instance, the therapist and survivor should work together to reduce substance abuse, unsafe sexual behaviors, and self-harm.

It is impossible to fully guarantee a survivor’s safety. Therapists will have to use their best clinical judgment, as well as rely on the survivor’s wisdom, to make sure the survivor is as safe as possible.

Next, it’s time to work on Stabilization. During Stabilization, survivors must learn how to stay within the “window of tolerance.” This figurative “window” is a way of describing how people experience their distress. Exiting the window means going into “survival mode.” Staying within the window means being calm, present, and in control.

During Stabilization, the therapist will teach the survivor skills to manage their distress and model how to use them. Survivors should practice the skills they’re learning both in and out of sessions. The goal is for survivors to be able to recognize when they are exiting the “window” and reenter it quickly and safely.

One of the best things about Stabilization is that there are tons of skills survivors can use. Personally, I like to teach survivors skills from dialectical-behavior therapy (DBT), as well as a few tried and true mindfulness and grounding exercises.

Another important part of Stabilization is helping survivors improve their sleep. Trauma can seriously disrupt sleep, but sleep is one of the brain’s ways of processing trauma. Survivors will struggle to make progress if they aren’t sleeping well most of the time. Simple modifications to sleep routines, like going to bed at the same time each night and reducing screen time, can help survivors achieve better sleep and be more prepared for therapy.

After completing Safety and Stabilization, the survivor will be ready to move onto Reprocessing and Mourning.

Reprocessing and Mourning

The Reprocessing and Mourning phase is what most people think of when they imagine trauma therapy. Many survivors find it to be the most difficult part of treatment, which is why so much preparation needs to be completed in the Safety and Stabilization phase.

In this phase, the therapist and survivor revisit the survivor’s trauma. By revisiting the trauma in a safe and controlled way, the survivor transforms the traumatic memories from events that are alive in the present to something that happened in the past, just like any other memory.

There are lots of therapy models that have been shown to help survivors process their trauma. I won’t go into all of them in this blog post, but I did write an article talking about different trauma therapies. You can check it out here.

During this phase, some therapists will help survivors repair attachment injuries that are part of their trauma. Simply put, attachment is a way to describe the relationships we had with our caregivers when we were children. Having a good attachment with caregivers is crucial for developing a healthy view of yourself, others, and the world. Without working to repair their attachment system, it will be difficult for survivors to view themselves as worthy of love and to relate to others in a healthy way.

Additionally, survivors need to grieve what they lost because of their trauma. For example, a survivor of child abuse needs to grieve the reality that they never had a carefree or safe childhood. It can be a lot for survivors to realize the impact trauma has had on their life, so it’s common for them to experience anger, sadness, and disbelief as they’re mourning.

It’s also normal to return to Safety and Stabilization during Reprocessing and Mourning. Reprocessing trauma is difficult work, and sometimes survivors need a break from being in the trenches to get their feet under them again.

Dr. Herman noted that reprocessing and mourning trauma is not a one-time event. Rather, it’s something that may need to take place throughout a lifetime. As a survivor learns, grows, and changes, their perspective on their trauma may change, leading to a need for more reprocessing. Rest assured, though, that revisiting trauma is rarely as difficult as confronting it the first time.

Finally, it’s time to move to the Reconnection phase.

Reconnection

Reconnection is all about relationships. After reprocessing and mourning their trauma, the survivor is ready to focus on improving his or her relationships with others by deepening these relationships while remaining authentic and autonomous.

It is also during this stage that survivors solidify their connection with themselves. With a mind no longer plagued by trauma, survivors can freely explore their hobbies, passions, and personality without trauma interfering. In doing so, survivors develop a more stable sense of self, meaning they know, and love, who they are.

For many survivors, this is one of the most rewarding phases of trauma therapy. They get to look back and see how far they’ve come while creating a new life for themselves, something which can be incredibly rewarding.

Empowerment and Relationships

In addition to the three phases, there are two overarching principles that also guide trauma therapy: survivor empowerment and a strong therapeutic relationship.

In a recent article, Dr. Herman wrote “The essential features of psychological trauma are disempowerment and disconnection from others. The recovery process therefore is based upon empowerment of the survivor and restoration of relationships.”

Because trauma robs survivors of control, it is crucial that survivor empowerment informs treatment. Therapists should allow survivors to decide which treatments they participate in, when to start reprocessing their trauma, and how much or how little they want to share about their trauma. Even seemingly little decisions, like where to sit during a session, are important in helping survivors feel in control.

Additionally, a strong therapeutic relationship is another foundation on which successful trauma treatment is built. It’s impossible to fully describe how damaging interpersonal trauma can be, but one of its main effects is making it difficult to engage with and trust others. However, healthy relationships are one of the strongest forces when it comes to recovering from trauma. Therefore, a survivor’s relationship with their therapist should be given the highest priority when it comes to making decisions about treatment. This relationship should be marked by empathy, respect, and trust. Therapy sessions should be focused on meeting the survivor’s goals, and their therapist should be someone they feel like they connect with.

Conclusion

In summary, much of trauma therapy is based off Dr. Herman’s three-phase model. Trauma therapy will vary depending on the survivor’s needs, the therapist’s style, and the type of therapy the survivor and therapist use to reprocess trauma, but the overall progression will likely be the same. Survivor empowerment and a strong therapeutic relationship should be two factors which guide therapy as well.

If you’re considering trauma therapy, it’s important to find a therapist who’s a good fit. Ask potential therapists questions about how they work and the types of therapy they utilize. Shop around until you find someone you’re comfortable with and who you believe can help you.

Hopefully this article has given you an idea of what to expect during trauma therapy. Even if you’re feeling scared, you have what it takes to face your trauma and live a life free from it.

I’d be honored to help you start taking steps to overcome your trauma. You can click here to learn more about the therapy services I offer.