The Basic Framework of Trauma Treatment and Recovery
Jamie Marich, Ph.D., LPCC-S, LICDC-CS, RMT, edited by C. E. Zupanick, Psy.D.The simplest framework for healing trauma is one of the earliest. Pierre Janet's (1889) Stage Model for the Treatment of Traumatic Stress dates back to the late 19th century. It has stood the test of time, partly because it holds a great deal of common sense. Regardless of the particular method your therapist may use, most therapies are structured around a sequenced process that has three distinct phases: beginning, middle, and end stages (often called the maintenance stage). This therapy follows that same pattern.
Here are the three stages originally proposed by Janet (as described by van der Hart, Brown, & van der Kolk, 1989, an excellent article to read more on the model):
- Stage I: Stabilization - symptom-oriented treatment, and preparation for liquidation of traumatic memories.
- Stage 2: Identification - exploration, and modification of traumatic memories.
- Stage 3: Relapse prevention - relief of residual symptomatology, personality reintegration, and rehabilitation.
One of the great misconceptions of trauma treatment is that it's about taking you back to your past, or regressing you. First of all, "regression" is not necessarily a requirement for healing trauma (in many cases, it may make a person worse). Secondly, a certain set of skills are needed to cope with bodily responses to highly stressful recollections. Those skills must be learned beforehand. As Fadalia's example highlighted earlier, Stage 1-Stabilization is about making sure we aren't going to come unglued by what may come up during the identification and exploration of trauma in Stage 2 (Marich, 2010). Even Pierre Janet who originated this approach a century ago, recognized that if a person is not sufficiently stable, taking someone back to the past may worsen a person's symptoms. If a clinician or other practitioner wants to take you back to your past, before you are ready-before making sure you are stable enough to handle it-that should be regarded as red flag.
Another great misconception about trauma counseling is that once trauma is processed or cleared, then it's gone. Voila! You're cured. The slick marketing of some of the newer treatment approaches seem especially prone to this sort of enticement. A healthier and more accurate approach is to view trauma as something that can be healed, but not cured. The distinction between cured and healed is subtle but important. A cure implies you either have a disease or disorder, or you do not. Healing implies various degrees of adaptation and adjustment that occur over time. For instance, some people use assistive devices like a wheelchair or cane. The fact they have successfully and courageously adapted to their crippling condition in no way implies that they are cured. They have learned how to prevent their condition from interfering in their life.
Revolutionary New Treatments For PTSD, Trauma, Abuse, and Other Stress-Related Disorders
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Articles
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Introduction to Trauma and Stressor-Related Disorders
- Introduction to PTSD, Trauma, Abuse and Other Stress-Related Disorders
- What Are Trauma and Stressor-Related Disorders?
- Physical and Emotional Trauma
- How is Trauma Different from Stress?
- What are Adverse Life Experiences?
- Can Grief and Loss Be Traumatic?
- Are Abuse and Neglect Types of Trauma?
- What is Complex Trauma?
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Signs and Symptoms of Trauma and Stressor-Related Disorders
- What are the Signs and Symptoms of Trauma and Stressor-Related Disorders?
- Intrusive Symptoms
- Distressing Images, Thoughts, Memories
- Flashbacks, Dissociative Reactions
- Distressing Dreams and Nightmares
- Intense or Prolonged Psychological Distress
- Physiological Distress or Body Memory
- Intrusive Symptoms: Children's Re-Enactment As Re-Experiencing
- Avoidance Symptoms
- Negative Thoughts and Feelings: The Cognitions and Mood Symptoms
- Arousal and Reactivity Symptoms
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Diagnostic Descriptions of Trauma and Stressor-Related Disorders
- The Trauma and Stressor-Related Disorders: Diagnostic Descriptions
- Post-Traumatic Stress Disorder (PTSD) Criteria
- Acute Stress Disorder Criteria
- Adjustment Disorders Criteria
- Reactive Attachment Disorder & Disinhibited Social Engagement Disorder Criteria
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What Causes the Symptoms of Trauma-Related Disorders?
- What Causes the Symptoms of Trauma-Related Disorders?
- Trauma and the Triune Brain
- Reptilian Brain of Survival and Mammalian Brain
- Trauma and the Neomammalian Brain (Cerebral Cortex)
- Trauma's Physical and Emotional Toll on the Body
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Treatment of Trauma, PTSD, Abuse and Other Stressor-Related Disorders
- The Treatment of Trauma, PTSD, Abuse, and Other Stressor-related Disorders
- Revolutionary New Treatments For PTSD, Trauma, Abuse, and Other Stress-Related Disorders
- The Basic Framework of Trauma Treatment and Recovery
- Finding and Choosing a Trauma Therapist
- Evidence-Based Practices: How Do I Know If a Trauma Treatment Is Effective?
- Traditional Cognitive Therapies
- Hybrid Cognitive Therapies: Mindfulness and Cognitive Therapy
- Exposure and Visualization Therapies
- Eye Movement Desensitization and Reprocessing (EMDR) and Related Approaches
- Body, Movement & Expressive Arts Therapies
- Energy Therapies & Other Innovative Approaches
- Feedback-Informed Treatment
- Medication for Trauma and Stressor-Related Disorders
- Combination Models on the SAMHSA Registry
- A Final Note on Treatment Options
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Conclusion, Resources and References
- Resilience, Resolution, Reconciliation, and Recovery: Some Closing Remarks
- Helpful Websites
- References
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Dealing with the Effects of Trauma - A Self-Help Guide
- Dealing with the Effects of Trauma Introduction
- Help From Health Care Providers, Counselors and Groups
- Things You Can Do Every Day to Help Yourself Feel Better
- The Healing Journey
- Moving Forward on Your Healing Journey
- Further Resources
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Introduction to Trauma and Stressor-Related Disorders
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Book & Media Reviews
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- Children Changed by Trauma
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- New York September 11
- Posttraumatic Stress Disorder
- Posttraumatic Stress Disorder
- Raising Kids in an Age of Terror
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- Remembering Trauma
- Roadmap to Resilience
- Spectral Evidence
- The Heart of Trauma
- The Limits of Autobiography
- The Little Friend
- The Only Girl in the World
- The September 11 Photo Project
- Trauma in the Lives of Children
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- PTSD Warning Signs
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- PTSD: Stress and Resilience
- Bessel van der Kolk on Understanding Trauma
- How to Overcome PTSD
- Cognitive Processing Therapy for PTSD
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- PTSD Treatment: Know Your Options
- What is PTSD?
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More Information
- An Interview with Pat Bracken, MD, Ph.D. on Post-Modern Psychiatry and the Social Context of Trauma
- Wise Counsel Interview Transcript: An Interview with Edna Foa, Ph.D. on the Nature and Treatment of PTSD
- Wise Counsel Interview Transcript: An Interview with Frank Ochberg, MD on Post-Traumatic Stress Disorder (PTSD)
- Wise Counsel Interview Transcript: An Interview with Victoria Lemle Beckner, Ph.D. on Treatments for Post-Traumatic Stress Disorder (PTSD)
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