The 3 Phases of Therapy 2: Trauma Work

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

1. Stabilization
2. Trauma work
3. Integration

 

The separation in phases is an artificial one. In reality some of phase 1 work can blend into phase 2 and during phase 2 you will often return to working on stability and grounding.

Only for the sake of structure and simplicity we will look at the process as if it was separated.

 

Some Ts have a tendency to jump into trauma work quickly. Because we are looking at cPTSD and possibly DID, we can’t follow all the rules for “normal” PTSD and single trauma. Our problems go deeper and moving too fast will only harm us. Even Ts discuss about the right timing for trauma work a lot. So here are some rough guidelines (not intended to be exhaustive)

 

You cannot start to work on traumatic memory if:

• you are still in contact with your abusers. In that case you still need the dissociative protections you have built and working on memories will harm you. Your T will support you to change your life situation. If you are still in contact with your abusers you should tell your T.
• you dissociate a lot and struggle to stay grounded. If you cannot stay within your window of tolerance in your normal life, you will definitely not be able to do it during trauma work. And your hard work is worth nothing, if you dissociate it because it was too much.
• you lack skills in emotional regulation. You will be confronted with strong emotions. They should not overwhelm/flood you or send you into extreme hyperarousal and possibly self-harm.
• you lack overall stability in yourself and your life. The foundation of good trauma work is a safe home, daily functioning, a social network of friends and helpers etc. If your life is a constant crisis you don’t need to add trauma work to it.
• you lack personal resources and good memories. Some people with developmental trauma have no good memories at all, and nothing to remind them that life can be good, too. We believe it is dangerous to work on even more horrible things and suggest a focus on resources instead.
• you are not ready to let go of the trauma. For some, trauma is all they know and the pain is such a familiar friend, that they can’t let go. That is ok too. Nobody is forcing you. Sometimes there are financial benefits of keeping the trauma. You should only do what you are ready to do.
• if you can’t express boundaries and say “no” and “stop” or if you are ignorant of the possibility to say no. In that case you can work on exploring your boundaries first and practice a safe “no” with your T.
• you just do it to feel the pain of it. Trauma work is not a purpose in itself, it needs to serve a higher purpose. Trauma confrontation should not be your expression of high-risk behavior, self-harm or your addiction to survival.

 

If you have DID, you can’t do trauma work if

• your system doesn’t agree to it
• your system is lacking skills in communication, collaboration and co-consciousness
• you still experience a lot of sabotage by abuser-oriented parts
• you switch completely uncontrollably
• you are aware of programming. That needs to be solved first

and all of the things mentioned for cPTSD above

 

For some patients this means that they will not do trauma work at all. If that is the case you are not missing out on anything you should have. Any kind of trauma work you would start would have a high risk to re-traumatize you. It is simply not worth it. There are other ways for you to learn how to cope.

 

If you meet the criteria and you want to do trauma work, there are different methods and techniques used for that.

Some techniques work very well for single trauma, some are dangerous to do when you dissociate easily. A lot of successful trauma work is based on the principle of exposure, but there are other approaches that are less extreme and still make a difference. We will explain every technique in a separate article and link them below (please be patient, we are working on it)

These techniques help to integrate traumatic memories. They don’t heal cPTSD, let alone DID. Complex and developmental trauma is more than suffering from flashbacks. “Relational trauma requires relational repair”. Some things heal best in a safe relationship to a trustworthy T, not by looking at tormenting memories. None of the techniques we will share are “trauma therapy”, they only treat a small part of what trauma means. They are only one tool in the toolbox and a lot of others are needed to heal.

All trauma work has to happen within a stable therapeutic relationship. We will inform you about different treatment options so that you know what to expect, not to give you the idea that you could do that for yourself. You can’t. Trying it would re-traumatize you for sure. These posts are meant for educational purposes, not for self-help.

 

The 8 Phases of EMDR

TRIMB: a gentle approach to trauma reprocessing

DBT-PTSD: DBT-supported Prolonged Exposure