by Carol Fredrek

This article summarizes the 3 Stages of Recovery that Judith Herman outlines in her book “Trauma and Recovery” and how this model is used in therapy. I will also provide a brief example of how I have work with therapy clients using this model.

Trauma is often caused by natural disaster, war combat, rape, childhood sexual, physical or emotional abuse by a parent, spouse, or anyone else.  It can also be caused by witnessing someone’s else’s abuse, an accident, or sudden death of a loved one.

Chronic trauma can occur when several traumatic incidents happen over a period of time.  An acute traumatic event is a one-time incident. The severity of impact you experience from the trauma will be partially dependent on your history, temperament, and previous trauma.

In a previous blog post 5 Things You Need to Know About Eating Disorders and Trauma I discuss the symptoms for post traumatic stress disorder (PTSD).  PTSD is the psychological impact of trauma.

Symptoms of PTSD:

  1. You have directly experienced a trauma or have witnessed a trauma
  2. You persistently re-experience the trauma
  3. You avoid any stimuli related to the trauma
  4. You have negative thoughts or feelings that began or worsened after the trauma
  5. You experience hyper-arousal & reactivity related to the trauma that began or worsened after the trauma

As a result of the trauma, you may experience a betrayal of the relationship with family, friends, love, or community.  Traumatic events have significant effects on how you feel about yourself, on your relationships, and the beliefs you have about yourself and your community.  For example, issues of trust, your feelings of safety, and intimacy in relationships.

Judith Herman’s 3 Stages of recovery are not a simple linear process as it may appear. Every client moves through these stages at a different pace.  It can be complex and emotionally difficult.

You might revisit the first stage at any point in the process if you need to re-establish safety as you work through the trauma in Stage 2. You may have moved to the third stage which is Reconnection and find that you have more to process so you go back to the Remembrance & Mourning stage.

3 Stages of Recovery in Therapy

Stage 1: Establishment of Safety

A traumatic event can destroy your assumptions about safety. Herman talks about this as the negative impact you place on how much you value yourself.  Shame and guilt often fuel this negative experience of yourself.

According to Maslow’s hierarchy of needs your sense of safety and trust is established early in life and trauma shatters that safety and trust.  The purpose of this first stage is to help re-establish your basic sense of safety and trust.

At this first stage it is important to share with your therapist your history of traumatic events, your family history, and your relationships.

Your relationship with the therapist is critical to successful therapy.  You need to feel comfortable with the therapist.  You need to feel a sense of safety and trust which was taken away from you due to the trauma.

At this beginning stage you are working towards feeling more stable in your life and not feeling so chaotic and out of control.

Not only is a good history taken but assessments or evaluations to know how much you are dissociating and the severity of the PTSD.  This is important so that you and your therapist can set the pace, determine the need for stabilization, and determine how to move towards the second stage which is Remembrance and Mourning.

Often clients want to move through this first stage quickly and get to the healing but safety and stabilization are critical to having success with resolving the trauma(s) later.

At this stage you and the therapist will begin to work on strategies that will help you feel less overwhelmed and more likely to stay within your Window of Tolerance.  Being outside of your Window of Tolerance is when you get triggered and feel overwhelmed with panic, anxiety, anger or depression.

The strategies commonly used by therapist’s who have experience with trauma recovery include going into your imagination to create a place that feels safe & calm for you.

The container is another strategy where you create a box in your mind to put your memories or feelings in to so that you can come back to them at a later time when you are ready.  This box might be made of wood, steal or plastic.  It might have a latch or a large lock and only you have the key.

The strategies available to you are many and varied depending on what works best for you.

These strategies can help you feel grounded, calm, and hopefully put some distance between yourself and the feelings or memories.

To determine which strategies will be most helpful to achieve this sense of control over your emotions and memories is a collaborative effort between the client and therapist.

These strategies will help you stay within that “Window of Tolerance”.  Once you have established a readiness to do the deeper work you will move into the Second Stage. This second stage is an empowering stage in your recovery.

 

Stage 2: Remembrance & Mourning

According to Herman, “trauma resolves only when the survivor develops a new mental ‘schema’ for understanding what has happened”.

During Stage 2 you tell your story of trauma to the therapist.   You have probably recounted the traumatic events with a lack of feeling, partial memory, or a series of still snapshots.  It is important that you begin to put words or feelings on the memory, if you can. Perhaps you can name the sensations you feel in your body.

It is naming the trauma that may give you  a sense of power which was taken away from you. You can take that power back now.

The degree to which you confront the pain, guilt, and shame is your decision.  Sharing parts of your experiences or being willing to confront them is certainly a very courageous act.

The task of the first stage is to establish safety which may need to be revisited during this stage.  You may find that telling your story brings up uncomfortable emotions. At this point it will be important to go back to the strategies that you learned during Stage 1 to help you feel safe in this process of remembering.  This will help keep you in the ‘Window of Tolerance’ and you will feel more empowered.

There needs to be a balance between feeling safe and facing the past.  You decide the pace of the work together with the therapist.  There is no limit on the length of time you spend in each of the three stages of recovery or how many times you go back to an earlier stage.

There are many aspects to a traumatic memory including your beliefs about yourself such as “I am not worthy of good things”, your feelings of shame, guilt, powerlessness, sensations such as a tightness in your throat, and the image that represents the traumatic event for you.  Some of these aspects of the memory may get stuck in the nervous system.

The goal of this stage of recovery is to begin to heal from your trauma.

Awareness of your current struggles and how they connect back to the trauma is important in this stage.  You have probably told your story many times but still have flashbacks or nightmares or are hypervigilant.

You might feel a moral sense of guilt or responsibility for the traumatic event(s) because you may have been told that it was your fault.  In this stage you will reconstruct beliefs you currently have about the world such as “It’s not safe”, about yourself “I am powerless”, or about relationships such as “I can’t trust anyone”.  Through this shift to new beliefs you will feel more positive about your connection with your world, yourself, and your relationships.

The relationship with your therapist is critical. Your therapist normalizes your responses, gives you a language to use to describe your experience, and listens to your story with no judgement and lots of understanding. For once you feel heard!

Your therapist also helps you construct a new interpretation of the traumatic experience that is not based on shame and guilt.  You no longer feel responsible for what happened.  You begin to like yourself.  You are ready to engage in relationship with the world, yourself and other relationships.

Stage 2 can feel like putting together a difficult picture puzzle.  Patience is important during this stage.  You may feel that you have made some progress and then feel that you are stuck again.  When you are in the midst of the work it may be difficult to see that there has been any movement, yet there most likely has been.

When this stage comes to completion you will need to rebuild your life in the present and pursue your dreams for the future.  This all happens in Stage 3 of the recovery process.  This will be challenging but empowering.

 

Stage 3: Reconnection

In the 2nd stage you will have mourned the old self that the trauma destroyed; now you must develop a new self.  The old beliefs that gave meaning to your life have been challenged and you must now develop new relationships.

It is important during this final stage that you devote time and energy to taking care of yourself.  According to Herman, this means taking care of your body, your environment, your material needs, and your relationships with others.

food, body, peace

The goal is to emerge with a sense of empowerment and reconnection.  In this process you may revisit some issues related to safety that you did in the first stage.  You may need to re-establish a sense of safety as you approach reconnecting with others.

Now there is the capacity to revisit old hopes and dreams.  This is an opportunity to create a new self.

Letting go and forgiving yourself even if you had no control over the event is possible at this time.  The positive aspects of yourself can be embraced now.  They become incorporated into your new self.

You now feel that you can protect yourself.  If you were assaulted, you might choose to take a self defense course.

Erik Erickson developed the Eight Stages of Psychosocial Development.  They include a sense of autonomy, initiative, competence, identity and intimacy. These are all significantly impacted by the trauma which is what contribute to the challenges in recovery.

In Stage 3 of recovery you focus on issues of identity and intimacy.  In Stage 3 the trauma should have receded to the past and there will likely not be barriers to intimacy as there were in the past.

Recovery may not be 100% complete.  Under stress, the PTSD symptoms may recur.  However, with the strategies you have learned in therapy to take care of yourself and stay within your Window of Tolerance will help you tremendously during these times.

For some this may be a time to reconnect with your therapist for a session or two just as a prevention.  It is this help seeking behavior that you are now able to take initiative with.

In this stage you will likely become more focused on the present and the future and not feel so controlled by the past.

 

Case Example: 3 Stages of Recovery with a Client

Stage 1:  Establishment of Safety

With any client I will obtain a good, solid history so that I can assess what the client needs in regards to safety and stabilization.  The client may feel detached from the immediate environment or their feelings.  As a result, they may not be able to assess if they are safe or not or they may experience danger all the time.

One of my client’s, Sue (not her real name) came into my office with feelings of anxiety.  She didn’t know where the anxiety came from.  I took a detailed history when she identified a few incidents that were assessed as trauma.

She described having grown up in a family where her father was an alcoholic and her mother was cold and distant.  She never felt loved by her parents.  A neighbor had sexually abused her at 5 years old and her brother would push and hit her when she wouldn’t do what he asked.

Together we explored how Sue currently takes care of herself when she doesn’t feel safe.

I introduced a number of strategies that she used to stay in her “Window of Tolerance”.  These included Calm Place which was next to the river, Container which was a wooden box with a latch, and a technique called 54321 which helped her with sleep. These would work some of the time and some worked better with specific triggers.

We used a readiness scale to help determine if Sue was ready to move on to Stage 2. She was scared because she would need to confront the pain and shame but

I didn’t feel overwhelmed and felt I had the tools necessary to move to the next stage.

 

Stage 2:  Remembrance & Mourning

Stage 2 was more difficult for Sue. The memories she had were vague and devoid of words or feelings. Her task at this stage was to find themes in her experiences.  She was able to cluster these themes into school age and adolescence.

It was a powerful experience for her when she was finally able to name her memories as PTSD.  She now could see how her current behavior, emotions, and thinking were connected to her past experiences.

Sue began to identify the feelings that were associated with the body sensations she was experiencing.  She was able to do this by using visualization and imagery in the therapy sessions to focus on her body sensations and putting words to those sensations.

Things began to make sense to her.  She didn’t feel so “crazy” anymore.

She remembered being sexually abused when she was 10 years old.  It happened once.  Then when she was in her early 20’s she was raped by a stranger.  In addition, her family dynamics were filled with emotional abuse.

Sue and I decided together what approach would be the most effective.  We decided that EMDR would be most effective to reprocess those experiences.  This is an approach that I use which is further described on my website.

This process took almost a year.  She no longer had nightmares and didn’t react with a feeling of overwhelm to her common triggers. She would often feel immobilized to act which had decreased significantly for.  In addition, she began to feel joy in her life.

I was now ready to move on to Stage 3.  I was not in distress all the time.  I began to connect with my trauma history.  I  was able to regulate my emotions and behavior.

 

Stage 3:  Reconnection

Stage 3 was a difficult stage for Sue as well as it was challenging for her to completely let go of the beliefs that she would never be safe or trust someone.  She felt she was powerless to effect change in her life.

However, Sue was overtime able to connect with others.  We developed a hierarchy of steps for her to begin to spend time with others.  Her feeling safe was key to this process.  To achieve this she used the strategies she learned in Stage 1 to gradually increase her sense of safety with the goal of creating an experience of intimacy in her life.

Over time, she developed a support network for herself which included women’s retreats, reconnecting with old friends through Facebook, and eventually using online dating sites.  These worked for her but she had to pace herself so she didn’t become overwhelmed.

Therapy for Chronic Illness - Calgary, AB - Healing Matters

This is a time that Sue had to go back to Stage 2 for a short time as new things from her past came up and she felt overwhelmed.   We used EMDR to help her process these new traumas.  We were then able to come back to Stage 3.

It was a challenge for Sue to identify the positive aspects of herself.  She couldn’t think of anything positive.  We used a Cognitive Behavioral approach to challenge her negative self-beliefs.

She felt that she was not worthy of relationships.  She felt that she would only do harm to others by not being able to fully engage in the relationship.

By using the Cognitive Behavioral approach, she was gradually able believe that she was strong, courageous and someone that perseveres.

Each time we went back to an earlier stage it was not nearly as difficult and involved less intense emotions.

After 15 months, Sue was able to feel a sense of joy and plan for her future.  The challenges she had in life were all related to her trauma.

I felt I had the tools and support to move through future challenges.  I felt confident and was ready to leave therapy.  

If you have experienced trauma in your life and want to talk with someone you can schedule a FREE 15-minute phone consultation with me or if you are ready to start you can schedule a 60 minute counseling session.