Trauma and DID therapists commonly agree on working with a 3-phase model. It describes an order in which to do work for the best, fastest and safest results. In an attempt to keep articles short we will share about the different phases in separate articles. The 3 phases are
- Stabilization
- Trauma Processing
- Integration
It is hard to find literature about the integration phase, let alone a workbook. Definitions feel vague and even a lot of therapists don’t know what it is supposed to be. I think it is best understood as the processes of arriving in a new life today and adapting to the new situation we are in, both on the inside and the outside. It is not one process. That is why therapists find it so hard to pinpoint the tasks of this phase. I will explain different areas where we will go through personal processes during the integration phase.
Memories and life story
Trauma processing will create a new mental space where we can realize what has happened to us, how long we experienced trauma and that it eventually stopped, how long we experienced the effects of that trauma and that they eventually mostly stopped. We also realize that some of the effects will not go away and that we will have to live with them. That is especially true for physical harm and chronic pain and all the things we missed out on. These realizations cause deep grief. I consider this kind of grief to be a clear sign that trauma processing was successful. Every time we process something it should result in a small step into phase 3 with its grief and realizations. It will be more complete once we can look at the whole story and not just at pieces. Presentification is fully achieved. When we look at a Timeline of our life, the past feels like the past, the present is most present and views into the future are possible but they are not set in stone. It changes how we view ourselves within this timeline.
Parts and personality
Sometimes parts fuse spontaneously during trauma processing. They most commonly start to blend naturally in our efforts to continue with our life until it becomes hard to tell who is currently fronting. Parts at least develop a flexible and fluid way to cope with life. In some cases blending is used as a therapy technique to move into a formal event of fusion. The end goal is up to personal preferences. The common factor is that all parts realize that they belong to one person who tries to live one life. Communication might turn into unified thinking, cooperation into unified actions, the We might turn into an I. It all comes together in some way. Personification is fully achieved.
Actions and functioning
The process of coming together results in less disruptions in the ways we act. Since we have access to all memories and abilities, it becomes easier to make integrated choices for our life as a whole and to act on them without getting in our own way. It means that we can direct our energy towards a collective goal and follow through with it, increasing our ability to function in life or in a job. We can choose new paths for our life, take measured risks, try new things and make use of our chances in life. Integrated functioning creates new opportunities and possibilities for the future. When the system adapts to the demands of the world today it might reduce some of its abilities that helped with survival because they aren’t needed anymore. It can e.g. become harder to dissociate pain.
Relationships [CN mentions sexuality in second paragraph]
In integration we can overcome old attachment wounds and lean into earned secure attachment. We take new steps into the ability to trust others, to allow closeness and intimacy in our friendships and we set new boundaries with people who don’t deserve that kind of closeness with us. It is a time of re-assessment of the relationships we have and the quality of relationship we want for our future. People in our life have to get used to our new ‘Me’ and we have to learn how that new ‘Me’ wants to interact with others. It is common to lose old friends or partners in this phase if they are unable to adapt to the changes in us. It is also common to find new, healthier friends who love and support us and who are ready to face the future with us.
The whole topic of sexuality is often pushed back in therapy to tackle it in this phase. There was too much trauma to figure it out in depth before. The compromises we found in phase 1 to guarantee our safety can now be replaced with a new way to be ourselves during sex. With a new sense for our body, our physical safety and the kind of relationship we want, we can start experimenting with sexuality some more to find what feels good. Some people notice that their confusion over sexual orientation and gender dissolves through the integration process and they gain certainty. With depersonalization resolved, a closer connection to the body offers new challenges and opportunities.
Life and Future
Another big challenge of the integration phase is to adapt to a new life. We have changed. Our life has to follow, otherwise it becomes unbearable. Survival used to be our main focus and in some way, our meaning in life. We have to look for meaning and tasks beyond survival now. We need a new purpose. For some, that is found in helping other survivors. Others choose family life, a job, new hobbies, a community etc. We have to learn how to have a normal life. We are like newborn babies in the ‘normal’ world. It is fair to say that this world is not without struggles and hardship. It is just not our old trauma we will be struggling with. Our new focus is on improving our capacity for fun, to sort out our life situation, find work that suits us, build a family or relationships, work on financial goals, take care of medical things, develop the ability to endure boredom. Having a normal life is surprisingly hard. We might run into new problems that we never faced before. If we were never able to work because we were disabled, we might have to learn what a challenge it can be to do our taxes or how to resolve conflicts with co-workers.
View of the world and self
We used to see the world and ourselves through the lense of our trauma experiences and we are free to keep doing that, if we want to be miserable. And we can also step out of that perspective and see the world and ourselves with new eyes. The topics we are interested in might change and become more grounded in the present. Unless we decide to work in advocacy we can join the masses in their busy-ness, gossip and forgetfulness of all things concerning sexual abuse. It won’t be on our minds daily anymore and the world will not be defined by it. We start to expect different things from the world that are not related to trauma. The way we see ourselves, other people, other survivors and social problems can change. Who we are becomes about something other than trauma. There are few people who are fully integrated or fused who stick around survivor communities for long because they engage with new things in life and their view of trauma has sometimes changed so much that it becomes harder to relate to people who are still working through the first phases. They are not trying to be better than others. The experiences just don’t fit together like they used to. For the first time in our life we may encounter people who are jealous of us and who don’t see us as traumatized.
Stability
Stabilization is not the same as stability. In phase 3 we revisit some of the topics in phase 1 and realize that as we have changed, our needs for coping skills have changed. We need less abilities to manage stress responses because we experience them less often. We need a whole new level of tools for emotions instead. The same can be true for our ability to manage our body and physical needs, our thoughts and impulses or our communication skills. In phase 3 we work hard on learning the skills we need to have a stable, normal life instead of a stabilized traumatized life. It is equally important and if we don’t gain this new stability we might remain unstable, even after processing trauma. Some of the tools we learned e.g. DBT Skills were meant for temporary use only, not as a life-long concept of how to do things. Challenges in normal life often need different coping strategies or solutions. It is surprising how hard it is to learn how to be a normal person with normal actions to resolve normal situations. We simply never operated in such a normal world before. We integrate into that world slowly and with real effort.
It is not possible to work on phase 1 stabilization so hard that it will result in phase 3 stability. It is the trauma processing that helps us to move beyond the things that keep us back. Trying to step into a phase 3 life before we are ready for it can cause a system to come up with a more adapted ANP instead of creating integration. This is a personal observation that I haven’t seen described in books but I promise, there is a good reason for the order of phases and none can be skipped. You can just stop early without finishing them all.
A lot of therapists and patients alike fall into the trap of thinking of trauma processing as the ‘real’ work in trauma/DID therapy and once that is done, everything else should resolve itself. Health insurances sometimes don’t cover this last phase of therapy because it is considered unnecessary. ‘They will figure it out somehow’. While we might get away with that when the trauma is very limited, it becomes a treatment mistake for people who literally never experienced life in a normal world. We might not be able to adapt without extra help or it will cause us unspeakable problems when we have to google everything normal people simply know. It is not rare for ‘new’ trauma memories or ‘new’ parts to come up once we have the free capacity for them. Therapists are advised to at least offer regular check-ins to support integration and some DID therapists never officially end therapy, they just space out the appointments until they see patients once a year for a check-in. Ending therapy can be tricky. I personally like the concept of annual check-ins until the patient terminates because it feels like too much to bother with.
It took me more than 6 years to get to this article because I wanted to have some lived experience with the topic instead of just repeating what books say. You can find a section about all 3 phases in Treating trauma-related dissociation by Steele, Boon, and van der Hart.