I have had many patients come to therapy with me and say that talk therapy has not been helpful for them. Specifically, I hear the same complaint over and over: I felt like all I did was talk and open up, and I didn’t feel like there was a direction to therapy.
When I hear complaints like this, I always want to start with some education around what trauma therapy looks like. While there are many forms of trauma therapy (such as EMDR, IFS-based approaches, relational therapy, Cognitive Processing Therapy, Prolonged Exposure, Trauma-Focused CBT to name a few), research around treating trauma and PTSD show that across the board, we can map out trauma therapy into three stages. You have a right as a patient to learn about these stages and feel as though your therapist is aware of where you are at any given time of treatment.
These 3 stages of trauma therapy are 1) Stabilization, 2) Reprocessing, and 3) Integration/ Maintenance. The caveat is that these stages are not necessarily linear, because many times, trauma is not a one-time occurrence but rather complex/ repeated. If there are multiple traumas to resolve, such as in abuse scenarios (versus a one-time car accident, for example), healing can look like an iterative process of going between stages. Here is an overview of the stages, and hopefully this will all become clear.
Stage 1: Stabilization
Stabilization is a fancy word to describe establishing safety in your present day-to-day life. I cannot stress enough the importance of establishing stabilization first. We can understand this as allowing for your everyday life to feel less overwhelming or threatening. This can look like building trust with your therapist, learning about and practicing nervous system regulation, setting boundaries with difficult people in your daily life, meeting your basic needs (e.g. establishing good sleep patterns), understanding your own triggers, addressing any suicidal ideation, and learning basic distress tolerance/grounding skills.
The reason why stabilization is important to nail down before moving to the second stage is that the second stage is deliberately distressing. Patients have a right to informed consent about this, because reprocessing usually worsens trauma symptoms short term before it gets better. You have the right to feel as though you can handle the level of stress coming your way for reprocessing.
Stage 2: Reprocessing
Stage 2 is past-focused, meaning that we are going back in time to reprocess the original trauma memories. We can think of this as a form of exposure therapy– we are exposing you to the original trauma not to just trigger you, but rather to heal and resolve them. This last bit is important– we are not just creating suffering in you and triggering you just to expose you, but also to heal you. Think about it like we are cleaning out a wound– it’s going to sting and hurt, but it’s ultimately to facilitate quicker and more effective healing long-term.
Your therapist during this stage will be a safe person and container for you to process, understand, and heal from your trauma as you relive the fear, grief, and shame from your trauma. Ultimately, this stage will increase self-compassion or self-acceptance and allow you to have a more balanced understanding of safety, trust, control/helplessness, and shame/ guilt. This stage has been shown to be particularly effective in decreasing your distress and PTSD symptoms, and is central to trauma treatment.
Stage 3: Integration and Maintenance
Now that we have revisited the past, Stage 3 is all about the present and future. Many times, patients leave stage 2 with a newfound understanding of themselves, others, and the world. This can affect their lives deeply– they may want to set stronger boundaries or connect with more people in their lives, explore meaning/purpose, or seek out a career change. This third stage is all about integrating your new knowledge from stage 2 back into your life and moving forward. Maintenance refers to maintaining this new sense of meaning, purpose, and understanding in your life. This third stage many times I find is quite joyful.
A skilled and attuned therapist will collaborate with you as you walk through these stages with intention and guidance. Now that you know these 3 stages of trauma therapy, my hope is that you can feel like you have more control and predictability in your own healing journey.
