The Process of Therapy

But What are We Going to Actually Do?

Trauma Therapy Explained

People tend to know they need counselling for a long time before they reach out to start it up. Making that initial phone call can stir up fear and uncertainty. And once an appointment is scheduled, actually attending it can stir up anxiety and doubt. I believe it does take a tremendous amount of courage to start up counselling: to entrust your story to a stranger invites vulnerability. Yet for each courageous soul that takes the first step, there is hope. Hope says “This will help”, and “I can get through this”.

So for all the folks out there wanting to take that first step but feeling weighed down by uncertainty, I’d like to demystify the counselling process.

When it comes to working with trauma, I use the Three Stage Trauma Recovery Model, which was developed by Judith Herman in the 1980’s. I use the model as a framework within which all therapeutic interventions launch from.

Please Note: Each client is unique, and therefore counselling is not a one-size-fits-all service. While you read the following information, please know that it might look a little different for each person. Also, rarely do we move through the model in a fully linear manner, (stage 3 often initiates during stage 2 work).

Stage 1 – Safety and Stabilization

Counselling often begins with history taking. I typically ask about what brings a person in for counselling, and gain an idea of their history in a “newspaper headline” manner. I use the newspaper headline approach because at this point, I am still a stranger to the client, and he or she may not yet feel comfortable sharing a detailed portrait of their life. Then, we collaboratively develop treatment goals.

Within the first stage, the focus is on safety and stabilization. That refers to external (living environment) and internal (emotional safety). Elements in this stage may include:

  • External safety: advocacy, growing a support network, information-sharing on topics relevant to the individual client
  • Internal safety: Resourcing to tap into and foster inner strengths to shift out of strong emotion. This involves learning to regulate emotion and manage symptoms that may be causing suffering or causing a person to feel unsafe
  • Information sharing to assist folks in understanding symptoms, their felt sense of emotion, and the effects of trauma
  • Exploring impacts to core beliefs
  • Developing and strengthening skills to manage painful and unwanted experiences, and minimizing unhelpful responses to them.

According to Judith Herman (1982) the goal of stage 1 trauma work is to create a safe and stable life-in-the-here-and-now, which can enable folks to safely remember the trauma, and not continue to re-live it.

I often have folks tell me they want to jump right into trauma processing. They feel a sense of urgency to “feel better” or to “heal this right now”. However, there is great importance of stage 1 work, and we can not skip over it. Think of it this way: If you had a car with shoty brakes, no seatbelts or airbags, no horn, bald tires, and a foggy windshield – you could still get from point A to point B. However, you would likely feel terrified the entire way. The resourcing and affect regulation strategies of stage 1 are like the safety features in a car: they enable you to get from point A to point B without full-blown panic and emotional overwhelm.

Stage 2 – Coming to Terms with Trauma

Once an individual has developed the ability to regulate emotion and achieve a level of internal emotional safety, trauma processing can begin. As we work through a trauma, I keep a keen eye on resourcing to ensure a client isn’t become too flooded with emotion. Techniques are used to modulate this process, and I employ several end-of-session strategies to assist folks in stabilizing emotion prior to leaving the office. Here are some elements stage 2 may include:

  • Trauma processing using EMDR
  • Art, play or sand tray-based approaches (for children and teens)
  • Exploring and re-working the inner trauma narrative
  • Working with negative cognitions resulting from trauma and movement towards installing positive adaptive beliefs and cognitions

Stage 3 – Integration and Moving on

As we work through trauma processing, elements of the third stage begin to show up. Some of these elements include:

  • Working to decrease shame
  • Developing a new narrative and life goals that reflect post-trauma meaning making
  • Working to foster a greater capacity for healthy attachment and decreasing alienation

As a result of doing the work of trauma therapy, the trauma starts to feel farther away, as something that happened but that is no longer a daily focus disrupting life.

If you are thinking of starting up therapy, and have some questions, please feel free to reach out and ask. The decision to move towards self-growth and healing can be empowering and freeing. I hope you give it a go!


If you’d like to learn more about the Three Stage Trauma Recovery Model by Judith Herman, check out these resources:

Affect Regulation

Visualizing a Safe Place

flower gardenOur imagination is a powerful tool in our repertoire of resourcing strategies. An imaged safe place is one of these. Everyone needs a place where they can feel safe and each person’s safe place makes perfect sense just for them. It could be in the Swiss Alps, in a quiet country house, an beach beside the ocean, a peaceful garden, or a cozy room. While these lovely places of comfort aren’t usually physically available to us when we need them most – we can still create a mental haven,  accessible through imagery, and available to you whenever you need it. Having an inner safe place has proven effective in helping people cope with stress and increasing their sense of safety and comfort.

The use of an imagined safe place is especially helpful for people who have experienced trauma. When fear, panic, or self-destructive thoughts become over-whelming, you can use your imagination to go to a restful inner sanctuary – a personal haven from the effects of trauma and other life stresses – to regain a sense of safety, to restore strength, and to achieve a renewal of spirit. Once you have grounded yourself with your safe place, you will find yourself feeling more equipped to deal those tough emotions or memories.

Resources:

Cohen, B. M., Barns, M. M., & Rankin, A. B.  (1995). Managing Traumatic Stress Through Art: Drawing from the Centre.

Miller, K. (2012). Mind-body attunement therapy: Clinical Strategies. Mind-Body Attunement Training Centre