Stages of Trauma Therapy
Wednesday, July 15, 2009
The trauma therapy model: Three stages of treatment

Most therapy professionals agree that the standard and best approach for working with trauma survivors should follow these three stages:

1. stabilizing and managing responses
2. processing and grieving traumatic memories
3. reconnecting with the world

Abuse survivors need to find ways to manage their reactions to trauma before they can start to look at the causes of the trauma. This is the first stage of therapy and is normally the longest. Some abuse survivors may decide to stop therapy after this step.
Trauma therapy

Trauma therapy

In the second stage, survivors begin to explore their childhood traumatic memories. Even after survivors move to the second stage of trauma treatment, they often still need to return to some of the skills that they learn in the first stage of treatment.

In fact, survivors will often return to stage one of the therapy during stages two and three. This is natural and you shouldn’t see it as a step back. If you try to complete stage two before completing stage one, you will not be prepared for the emotions that come with stage two. This may be harmful.

The third and final stage of trauma treatment begins after the traumatic memories have been processed. This stage deals with any issues relating to daily life, relationships and being connected with the world.
First stage

The first stage of trauma therapy will teach you about trauma and therapy. In this stage, you will create more effective strategies to manage the effects of trauma on your life (sometimes called “symptoms”). These new skills and knowledge should help you to feel more stable and better able to function in your life.

The first stage of trauma treatment does not involve looking at or dealing with early experiences of abuse. However, it’s important for the abuse survivor to acknowledge any experience of abuse or neglect. That way the therapist and client can begin a process of helping the client understand how the past affects the present.

The three key tasks of first stage trauma treatment are: establishing safety, psychoeducation and managing trauma responses.

Establishing safety

The first step of stage one is for the therapist to address any safety issues in your life, including:

* find safe housing (if you are emotionally/ physically/sexually abused)
* setting safety rules with the therapist
* checking to see if you are actively suicidal or need protection from harming yourself
* arranging a referral to a physician to check for any medical conditions (such as a thyroid problem) that could be making your physical responses worse, and to assess the need for medication, should you have depression, anxiety and fatigue
* making a treatment plan that helps you with any problems of alcohol or other drugs


Much of the focus in the first stage of trauma therapy is on psychoeducation. You learn how trauma affects how you think, fee and act. You may also learn about flashbacks, dissociation or numbing.

Managing trauma responses

The first step in managing your traumatic stress responses will be for you and the therapist to decide which trauma responses are the most painful and which interfere most in your everyday life. You can then work together to rank your responses from those that cause you the most problems to those that hurt you the least.

The therapist should use various ways to help you manage your traumatic stress responses and adaptations. These strategies will help you feel stronger and better able to cope, and find ways to care for yourself. While you may not stop or get rid of all your negative responses, these strategies should help you to control them better.

It is important to understand that the coping behaviours you developed to deal with traumatic stress (such as the use of alcohol or other drugs to block the pain) are typical behaviours that people use. These coping behaviours may temporarily help you avoid painful, disturbing feelings or thoughts but they will also interfere with your healing.

The therapist should explain the purpose of the techniques and strategies you learn about in therapy, so that you understand them fully and can practice them on your own.
Second stage

The second, or middle stage of trauma therapy involves looking at past experiences of trauma. It explores how the trauma has affected you in the past and how it continues to affect you.

Processing and Grieving Traumatic Memories

Processing traumatic experiences can be difficult and requires special methods. The most effective methods for dealing with traumatic memories are:

* cognitive-behavioural therapy (CBT)
* eye movement desensitization reprocessing therapy (EMDR)
* body-psychotherapy and Sensorimotor Psychotherapy.

With both CBT techniques and EMDR techniques, survivors are asked to remember all aspects of the incident(s) as vividly as possible, including aspects that involve the senses (sight, smell, touch, hearing).

Many survivors instinctively avoid memories, thoughts and feeling related to the abuse they suffered, but avoiding these things prolongs the trauma responses and prevents survivors from getting over trauma-related difficulties.

Facing painful experiences instead of avoiding them lets survivors process the traumatic experience, and then the pain and anxiety will gradually lessen. Many women find that they have more intense feelings and reactions to the abuse when they are confronting their memories. However, you should not be in a constant state of crisis. If this happens, the therapy should return to the first stage of helping you feel more stable and able to manage reactions.
Third stage

The third and last stage of trauma therapy involves addressing any remaining difficulties in your life, as well as working on ways to connect fully in your relationships with others.

Reconnecting with the world

The third, or final stage is about dealing with the issues of daily life for survivors who are doing well, but who are still struggling with certain issues.

For example, you may feel pretty good, but have a hard time reconnecting with friends and family, have trouble finding work you enjoy, find it difficult to get involved in activities you used to enjoy or struggle to maintain healthy relationships.

As in stage two, survivors will continue to change the way that they look at their lives. They will continue to find new meaning and new ways to understand the past, and bring optimism, hope, spirituality and creativity to their future.

While clients will have already dealt with the trauma, effects of the abuse may still come up in new situations they are dealing with in their lives. This is normal and not uncommon.
Source: Centre for Addiction and Mental Health