Internationally there is agreement that there are phases for healing trauma. Three phases are recommended (Cloitre et al, 2011):
- Stabilisation, resourcing and self-regulation
- Processing of traumatic memories
- Consolidation of treatment gains
The first phase (safety and stabilisation) is the most important. (Courtois and Ford, 2013; Blue Knot Foundation (ASCA), 2012). The Blue Knot website notes:
It is important to note that these phases are not linear. Safety needs to be established time and again.
Sounds simple, right? Should be fast, right?
Sorry, not simple and usually not fast!
This is because depending on the type of trauma and what age it was suffered, there may not be verbal memory or narrative that goes with the trauma. Often, recollections are fragmented, and people may experience them in many different ways, eg can’t settle, want to run out of the room, flashbacks, or going blank when they think of something similar. So Freud’s “Talking Cure” is great for some people, but research has shown that for others, talking about the “something” that has no words can re-traumatise by activating the brain and body as if the trauma was happening right here right now (Van Der Kolk, 2005).
This is why even when people want to get straight into talking about the trauma in detail, a responsible therapist should take a detailed SYMPTOM and RESOURCES history and ensure that the person has the ability to mindfully notice when they are becoming activated or distressed (called dual awareness) and well practiced calming and self-regulating skills to manage the activation before they dive in to talking about the trauma (Fisher, 2017).
The Blue Knot Foundation has a guide for Health Professionals on how to take a history safely. They also recommend that therapists learn to work “top down” as well as “bottom up” to be effective in working with complex trauma. This means working non-verbally (somato-sensory interventions) not just talking or using CBT.
Similarly, if you are a therapist reading this, it important to be aware that the standard test like DASS are woefully inadequate for measuring improvements or gains in the work. The recent publication “Humanising Mental Healthcare in Australia” (2019) includes many suggestion on more effective tests and approaches. I will be featuring some of the ideas of the authors of this outstanding publication in future blogs.