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The Basic Framework of Trauma Treatment and Recovery

Jamie Marich, Ph.D., LPCC-S, LICDC-CS, RMT, edited by C. E. Zupanick, Psy.D.

open book with eyeglassesThe 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.