The Three Stages of Trauma Recovery
Adapted from Herman, 1992
Anyone who has experienced trauma or suffers from PTSD (post-traumatic stress disorder) wants to recover and move forward. So do their families, their friends, and their health care providers. However, despite what many might think, recovery won’t completely “free” people with trauma from all post-traumatic effects. Trauma recovery is an individual experience that will be different for everyone. Generally, successful trauma recovery is thought of as living in the present without being haunted by the past.
Judith Lewis Herman, a psychiatrist and a professor of clinical psychiatry at Harvard University Medical School, is perhaps most famous for her contributions to the study trauma and the expansion of trauma treatments. Many healthcare professionals hail her second book, Trauma and Recovery, as one of the best classic studies of PTSD. This book details the complex healing process of individuals who suffer from PTSD, broken down into three distinct stages of trauma recovery.
Stage One: Safety and Stabilization: Overcoming Dysregulation
There are several main objectives for the client during stage one of trauma recovery. These include:
- establish a safe environment including a secure living situation, non-abusive relationships, a job and/or regular income, adequate support
- establish bodily safety including abstinence of self-injury
- understanding how to process and express emotions in a healthy way
- distinguishing between healthy and unhealthy behaviors and tendencies
- cultivating an effective routine of psychological and emotional self-care
- practicing forms of self-love and self-appreciation
- uncovering and exploring sources of inner strength
- developing coping mechanisms and life skills that effectively manage “triggers”
- working with the therapist to develop a personalized treatment plan
Once the client successfully completes these objectives, she will be able to work through painful memories in the following stages of trauma therapy with less mental and emotional difficulty.
Stage Two: Coming to Terms with Traumatic Memories
Once the client has developed a stronger sense of overall functionality and safety, she can move on to stage two. Stage two of trauma recovery works to address any painful and/or repressed memories that the client may have and does so within a judgment-free, therapeutic setting. The main objectives for the client in the second stage of trauma recovery include:
- working with the therapist to evaluate painful and traumatic memories
- redefining the role that certain events play in his or her life thus far
- exploring and mourning any losses associated with the trauma in question
- permitting the self to grieve as needed in a safe space
- working through the grief with the therapist and identifying what caused it
- identifying any previously repressed unsolicited or abusive incidents
- determining the impact that such incidents might have had on his or her life
- mourning the loss of good experiences or opportunities that were not realized due to trauma or trauma-related hindrances
There are certain misconceptions about this step in the trauma recovery process that should be addressed. Stage two is not structured to force the client to relive the trauma. And the client isn’t expected to deliver his or her story with no emotions, either. Stage two of trauma recovery may be analytical, but it isn’t robotic or unfeeling. This is why pacing and timing are so crucial during this particular stage. If the client in therapy becomes overwhelmed by talking about the traumatic memories, then the sense of safety and stability she built in stage one is rendered moot. In a sense, rushing or botching stage two of trauma recovery will bring the client and therapist back to square one.
Stage Three: Integration and Moving On
The third and final stage of trauma recovery focuses on the client’s reinvention of the self and establishment of a bright, hopeful future. You can now begin work on decreasing shame and alienation, developing a greater capacity for healthy attachment, and move toward personal and professional goals that reflect post-traumatic meaning-making. By this stage, the trauma no longer has power over or defines the client’s life. Trauma, after all, is only part of a much larger picture; it may be part of the client’s life story but it’s certainly not the only part. By the end of stage three, the client recognizes the impact of the trauma but is now ready to leave it in the past in the pursuit of empowerment and living in the present.