Recovering from Trauma
Gina Yu, MS, NCC
As a therapist, working with individuals recovering from traumatic relationships or life events is both a challenge and a joy. The journey to healing is a collaboration between therapist and client to form a therapeutic alliance, one that I feel privileged to be a part of. To that end, I connect deeply with the work of Judith Herman in her book Trauma and Recovery (1992). In this seminal work, she articulated a three-stage model of recovery that redefined how we think about and treat victims of trauma, and that was instrumental in my development as a trauma therapist. Herman originally developed this model for survivors of sexual trauma as well as PTSD, though I feel it can be applied to survivors of other types of traumas as well.
The central experience of feeling helpless, meaningless, and disconnected from others is what can bring many individuals to counseling. But where to begin to unpack all the hurts and barriers to healing? Herman’s triphasic model of the recovery process empowers the survivor to address their trauma and bring new meaning and connection to their life. The therapist and survivor work through the phases intentionally and thoughtfully, and the timeline is different for each person. These stages are 1) establishing safety, 2) remembrance and mourning, and 3) reconnection with others.
Establishing safety Feeling intense fear, a loss of control, power, and agency can wreak havoc on a person’s physical, emotional, and spiritual self. The first stage of establishing safety is paramount for trauma counseling. Herman states that the survivor may feel unsafe in their body, emotions, and cognitions, as well as in relation to other individuals around them. The first step to establish safety would be for the survivor and therapist to focus on establishing control of the survivor’s body before moving on to issues of control in their environment. The therapist and client can work together to identify the client’s physical needs before addressing the environment that the client is in. Physical needs may include basic health and hygiene, eating/sleeping habits, and controlling symptoms of PTSD. Additionally, a visit to the primary care doctor is always a good idea, to rule out any medical issues.
Once physical safety issues are addressed, the therapist can move to establishing emotional and psychological safety with the client. Psychoeducation on self-care, safety plans, and coping skills may be shared with the client to maintain feelings of security and wellbeing. Herman emphasizes that the client has full control in therapy over the decision-making process and their own actions in the first stage. How long the therapist and survivor work in this initial stage depends on the degree of traumatization as well as how long it takes to lay the groundwork for the survivor to feel more holistically safe. Once the survivor feels adequately anchored, the work can progress to the second stage.
Remembrance and mourning Herman describes this stage as an opportunity for the survivor to confront their past, mourn their losses, and reconstruct their story. Moving back and forth between present and past, the client and therapist work together to build a new narrative of the traumatic events from the security of the present. The client names and uses language to describe the trauma and shares the emotional burden with the therapist. The therapist’s role is that of an open-minded, compassionate witness who helps construct a new interpretation of the survivor’s trauma that can become their testimony, while providing validation and reassurance along the way (Lebowitz et. al, 1993).
As always, the control in the recovery process resides with the survivor. Herman states that the relationship with the therapist is one of equals, where the therapist serves in the role of an ally, a witness, and an educator on trauma. This deep connection between therapist and survivor provides a safe space to process remembered experiences and rightfully grieve what was lost (time, agency, childhood, safety, etc.) At the appropriate time, the therapist and survivor can move to the third stage of trauma recovery.
Reconnection Herman describes this stage as when the survivor has integrated the traumatic experience into their story and is ready to rebuild their life in the present and look ahead to the future. The survivor can voluntarily put themselves in a “fight or flight” position and elect to fight and thus establish control over their body and emotional responses to restore power to themselves. In full possession of themselves, the survivor can rejoice in their strengths and be aware and care for their weaknesses. Additionally, the survivor can take new initiative in their life and learn how to trust others, withhold trust when warranted, and distinguish between the two (Lebowitz et. al, 1993). The survivor and therapist celebrate small and big wins and create goals to restore meaningful connection with others.
What I appreciate about Judith Herman’s model is the person-centered focus on the survivor. The environment is controlled in therapy, and the client is safe to process their trauma and test out a new way to relate to themselves and the world. Perceptions of the world and of the behaviors previously used to cope with the trauma are examined without judgment and shame. As a trauma therapist, discovering empowerment in a survivor who grows and blossoms with their new perspective on life is deeply satisfying work for me.
One other related method of trauma recovery is the Trauma Information Group (Herman et. al, 2019). The TIG is a form of group therapy based on Herman’s book. For 10 weeks a group of female survivors addresses topics like safety, shame, self-care, and more. The co-facilitators provide psychoeducation on various topics, then members share their thoughts and feelings about the topic. The group experience is powerful, practical, and deeply personal for participants on the road to recovery. Healing connections between members can be made through the shared experience of being trauma survivors.
I have found for myself that Herman’s triphasic model and the TIG model can be highly beneficial to survivors of trauma. The therapeutic journey that the survivor and therapist embark on has its own timeline and characteristics. I see this sacred journey as a progression to establish agency over one’s own life and integrate the trauma in a new, meaningful way.
References: Herman, J.L. (1992). Trauma and recovery. Basic Books.
Herman, J.L., Kallivayalil, D., & Members of the Victims of Violence Program (2019). Group trauma treatment in early recovery: Promoting safety and self-care. The Guilford Press.
Lebowitz, L., Harvey, M.R., & Herman, J.L. (1993, September). A stage-by-dimension model of recovery from sexual trauma. Journal of Interpersonal Violence, 8(3), 378-391. https://journals.sagepub.com/doi/pdf/10.1177/088626093008003006