The Three Stages of Healing and Trauma Recovery
What to expect on your healing journey.
By Robin Arnett, LCSW
When you first start therapy or are thinking about getting started, it can be intimidating to consider what is to come. Different therapists will take different approaches, and you may have little to no idea what to expect. It is true that therapists trained in different modalities will sometimes take vastly different approaches - for example, a somatic therapist will focus on processing trauma by connecting to the body, while a Freudian psychoanalyst will focus on interpreting dreams as well as transference and counter-transference between the therapist and the client.
Still, regardless of the approach, most mental health clinicians will follow the same basic steps in their process. One of my all-time favorite books is Trauma and Recovery: The Aftermath of Violence - From Domestic Abuse to Political Terror by Dr. Judith Herman. I learned so much from this book, most especially the concept of the “stages of trauma recovery.” Being familiar with these stages can help you to know what to expect when you’re getting started with therapy,or with a new therapist or modality.
Stage 1: Safety and Stabilization
Many people come to therapy in a state of crisis; they are struggling to manage daily life, and are overwhelmed with their mental health symptoms. These folks are often managing significant challenges like substance abuse, relationship dysfunction, and burnout. When someone comes to therapy in this level of distress, the most important task for the therapist is to help them to access safety and stability.
Safety looks like -
Getting substance use under control.
Accessing resources to help meet basic needs like food and housing.
Developing mindfulness practices that help to manage anxiety and panic attacks.
Establishing a safety contract for clients with suicidal ideation or self-harm.
Finding shelter and protection for people in abusive relationships.
Revisiting traumatic memories should not be taking place in this stage. You can’t process an abusive relationship when someone is still living with the abuser, nor can you fully dive into the roots of substance abuse while there is an active threat of overdose. Common approaches that are used in the safety stage include dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), motivational interviewing, and engagement in support group communities like Alcoholics Anonymous. Interventions at this stage can also be very practical, and include case management around basic needs and safety.
Stage 2: Processing
When a reasonable degree of physical and emotional safety have been established, we can begin to move into trauma processing. This could look like processing a single traumatic event, but, more often, it looks like a comprehensive exploration of events leading back to early childhood. Even without the occurrence of a “big T” traumatic event like the death of a family member, consistent experiences in the family environment like parentification, enmeshment, or frequent criticism can all add up over time to result in attachment trauma that affects everything from relationships to self-care in adulthood.
In Stage 2, we begin to revisit those experiences. This stage is also referred to as “remembrance and mourning.” The primary goal of processing is to decrease the disturbance related to traumatic memories, and develop new and adaptive perspectives. Processing is not just talking about bad things, but is literally rewiring neural pathways through reparative experiences and neuroplasticity.
Part of why we revisit past memories is to orient the client into the present moment so they can understand that they are no longer living in that reality. Once we have established present safety and reduced disturbance, it is important to mourn the fact that these events did happen. There is significant grief that comes up here, and this is where the therapeutic relationship becomes so important.
Approaches to processing are almost innumerable, but some common modalities used for processing include EMDR, narrative therapy, Internal Family Systems therapy (IFS), and sensorimotor psychotherapy. Somatic modalities will focus on healing by allowing the body to process and complete natural responses that were stifled during the traumatic event, while narrative approaches focus on meaning making through story telling. Other therapies like EMDR and IFS work with subconscious beliefs and schemas. There is no “right way” to approach processing. The best fit will depend on you and what resonates. It can be helpful to try a variety of approaches and see what fits. Remember, too, that the therapeutic relationship is an essential component to the healing process.
Stage 3: Reconnection and Integration
Stage 3 is where we make meaning of the processing that has taken place. Integration is often overlooked for its importance as a part of the healing journey. The therapeutic relationship should include regular check-ins about the work that is taking place, what has changed or what hasn’t and what still needs to happen going forward.
Here are some questions that we ask in this stage:
What did I learn from these experiences? How did they shape the person that I’ve become?
What lessons am I taking with me from my healing journey? How does my life look different?
What do I want my life to look like going forward? How can what happened to me be a part of my story and not its defining feature?
You’ll know you’re entering the integration stage when you notice that you respond to triggers differently, that you feel more peace moving through your life, and that you have a different perspective on events from the past, often with greater compassion and less activation.
Therapy should not last forever. When I hear about someone that has been with the same therapist for 20 years, I see a red flag. We are not meant to regurgitate the same stories over and over without being able to eventually move on. Furthermore, the relationship with the therapist should be understood to be temporary. One of the most healing parts of therapy can be the experience of a healthy ending. If you are feeling stuck with your current therapist, consider switching it up. You may need to start meeting with someone that takes a different approach, and a fresh start can be helpful.
Non-Linear Healing
Healing is cyclical. While there is a general flow to these stages, it is extremely common to return to earlier stages at many points in your process. We also see that healing happens in layers. You will be able to access greater levels of depth in your processing after you have integrated a piece of what you’ve learned. Whatever stage that you find yourself know that healing, growth, and change are absolutely possible. Your intention is what will carry you through. I wish you nothing but love on your healing journey.
