Trauma Therapy – The First Steps

Trauma can be a one-time event or a long-lasting series of events. In some cases trauma can lead to negative effects, but it also can help you learn valuable lessons and develop strength from the struggle.

Immediate reactions to trauma can include feelings of exhaustion, confusion, fear, agitation and numbness. Delayed responses may include avoiding people, places and activities that trigger traumatic memories.

Phase 1: Re-establish Safety

The first step in Trauma Therapy is about re-establishing safety—both within oneself and with the therapist. This is a crucial and often challenging phase of treatment. This is because it requires attention to regulating and soothing difficult emotions (such as anger, fear, and guilt) in everyday life that aren’t related to the trauma. It also involves learning to trust others and build healthy relationships.

Re-establishing safety can take days, weeks, or even years. It’s important that this work is paced carefully and that it is done with the help of an experienced therapist. This is because avoiding the traumatic memories leads to stagnation in recovery, while approaching them too precipitously risks a damaging and fruitless reliving of the trauma. The therapist and client must learn to navigate between these twin dangers of constriction and intrusion.

This stage also allows the survivor to begin reclaiming her hopes and dreams from before the trauma. She can revisit old hopes and dreams while re-establishing a sense of safety. This is important because trauma can make it seem as though time has stopped or that there’s no future for the person.

In addition to this, in this phase the therapist can teach a variety of skills for regulating and stabilizing distressing reactions such as anger, anxiety, and depression. These may include grounding techniques, distress tolerance and increasing the window of tolerable discomfort; mindfulness and coping skills; body awareness, self-regulation and modulation; and EMDR.

Phase 2: Reprocessing

The next phase of Trauma Therapy focuses on processing traumatic events in order to make sense of them. In this way, clients can understand the underlying issues contributing to their symptoms and develop adaptive coping strategies. This phase focuses on the bulk of trauma processing and is based on EMDR, which is an evidence-based method that helps people process distressing information until it is no longer psychologically disruptive.

During this phase, a counselor will ask the client to identify their most distressing memories. Then the therapist will organize these life events in a targeting plan for EMDR processing. Then during a treatment session, the client will focus on one of these distressing memories (including thoughts, feelings and body sensations) while paying attention to an external stimulus such as therapist-directed bilateral eye movements, hand tapping or audio bilateral stimulation. This is a powerful but non-invasive technique that has been shown to have significant clinical benefits for trauma victims.

During this phase, the client may also be taught some self-calming techniques to help them maintain stability and safety between and during sessions. It is important that they continue to focus on safety and stability as they process their trauma and avoid re-experiencing it in the form of hyperarousal. During this time, it may be helpful for the client to keep a journal or log where they write down any related memories and feelings they experience.

Phase 3: Integration

The task shifts to processing the trauma, putting words and emotions to it and making sense of what happened. This is usually done in individual or group therapy. The therapist may also use creative strategies and activities.

This is a painful process and may take time. It is important that safety continues to be attended to throughout the work. This may include building skills to regulate difficult and overwhelming emotions. It may also be helpful to create a support system for the client – both outside of the therapy room and within it – to help them with the normal anxieties of daily life as well as emergency situations that may arise.

A survivor needs to realize that the abuse they experienced is not who they are. They need to reclaim a healthy self in the context of relationships. This often requires overcoming the fears of everyday life and navigating change. It may take some time before the trauma feels farther away and is no longer a central focus of their daily life.

This stage is where the recovery from complex trauma really starts to show. It is here that survivors are able to reclaim hope for the future, build a strong support system and find meaning and purpose in their lives. Survivors can also start to recognize the role that their unresolved trauma plays in their leadership styles and develop more sustainable and healthier ways of meeting their emotional needs.

Phase 4: Empowerment

At this stage the trauma becomes integrated as just one chapter in a survivor’s life story. The traumatic experience no longer defines them, and they have the ability to make their own choices and take action towards empowerment and self determined living.

During this phase, the healthcare provider helps the client make positive choices about how they want to live their life going forward. This includes learning how to regulate difficult emotions and coping with them using new skills, such as mindfulness, deep breathing or yoga. It also includes considering ways to be a more empowered version of themselves in their relationships with others and developing a healthier sense of self-esteem.

Often people become easily overwhelmed and emotionally flooded when talking about their trauma memories, which is why it is important that safety and stability are always first priorities during the trauma therapy process. This is because reprocessing the memory can trigger the fight, flight or freeze response in some people. The healthcare provider will ensure that safety and stability is re-established before moving on to the next part of this process.

The therapist will then work with the survivor to “install” (deeply embed) a positive belief into their thought processes and help them strengthen it. For example, if they believe they are powerless against assault, the therapist will help them to realize that they actually have the capacity to defend themselves.