Great Model from a Classic Book
In Trauma and Recovery, Judith Herman presents a model which describes in detail the healing process of people who struggle with a combination of problems related to unwanted, abusive, or traumatic experiences in their past.
The problems may include:
- Difficulty regulating emotions and impulses
- Emotional numbing
- Anger and aggression
- Substance addictions
- Behavioral addictions (porn, anonymous sex, gambling, etc.)
- Self-harming behaviors (cutting, burning, etc.)
- Dissociation (spacing out, blanking out, losing time, etc.)
The first stage of dealing with and overcoming such problems, and of any helpful therapy or counseling, is about:
- Getting a ‘road map’ of the healing process.
- Setting treatment goals and learning about helpful approaches to reaching those goals.
- Establishing safety and stability in one’s body, one’s relationships, and the rest of one’s life.
- Tapping into and developing one’s own inner strengths, and any other potentially available resources for healing.
- Learning how to regulate one’s emotions and manage symptoms that cause suffering or make one feel unsafe.
- Developing and strengthening skills for managing painful and unwanted experiences, and minimizing unhelpful responses to them.
Most important, the key to healing from traumatic experiences is achieving these ‘stage-one’ goals of personal safety, genuine self-care, and healthy emotion-regulation capacities. Once these have become standard operating procedures, great progress and many new choices become possible.
Importantly, the first stage of recovery and treatment is not about discussing or ‘processing’ memories of unwanted or abusive experiences, let alone ‘recovering’ them. (For more on how the stages of recovery are related to memories of abuse, particularly recovered memories, see Personal Concerns & Questions on Dr. Jim Hopper’s web page, Recovered Memories of Sexual Abuse.)
Of course, everything is not always so perfectly ordered and sequential.
For example, during the first stage it may be necessary to discuss the contents of disturbing memories that are disrupting one’s life. This may be required to help manage the memories, or to understand why it is hard to care for oneself (e.g., the abuser acted like or even said you were unworthy of care or love). However, in this case addressing memories is not the focus of therapy, but a means to achieving safety, stability, and greater ability to take care of oneself.
Depending on the person, the first stage of treatment may also involve:
- Addressing problems with alcohol or drugs, depression, eating behaviors, physical health, panic attacks, and/or dissociation (e.g., spacing out, losing time).
- Taking medication to reduce anxiety and/or depressive symptoms, for example serotonergic reuptake inhibitors (SSRIs) like sertraline (Zoloft) or paroxetine (Paxil).
- Participating in Dialectical Behavior Therapy (DBT), a treatment for people having serious problems with tolerating and regulating emotions, interpersonal effectiveness, and/or self-harming behaviors.
Common to All Stages
Throughout all stages of treatment, it is often necessary to address psychological themes and ‘dynamics’ related to one’s history of unwanted or abusive experiences.
As discussed in Principles of Therapy or Counseling, some of these are core issues that should determine the very nature and structure of treatment. These include:
- Shame and guilt
- Reenacting abusive patterns in current relationships
In the first stage of treatment, these themes and dynamics must be addressed when they are obstacles to safety, self-care, and regulating one’s emotions and behavior. Therapy can help with recognizing habitual behavior patterns, beliefs, and motivations that maintain self-defeating and self-destructive behaviors outside of conscious awareness or reflection.
Increased awareness of these themes and dynamics brings greater understanding, greater ability to take responsibility for them, and greater capacities to choose new, healthier responses and actions. (Mindfulness meditation practices can also help cultivate such awareness and freedom; see Mindfulness and Kindness: Inner Sources of Freedom and Happiness.)
This stage of recovery and treatment is often referred to as ‘remembrance and mourning.’
The main work of stage two involves:
- Reviewing and/or discussing memories to lessen their emotional intensity, to revise their meanings for one’s life and identity, etc.
- Working through grief about unwanted or abusive experiences and their negative effects on one’s life.
- Mourning or working through grief about good experiences that one did not have, but that all people deserve.
After establishing a solid foundation of understanding, safety, stability and self-regulation skills one can decide – mindful of the potential pain and risks involved – whether or not to engage in the work of stage two.
In fact, once the first stage of recovery has provided such a foundation, some people realize that thinking and talking about painful memories is not necessary to achieve their goals, at least in the short term. Some find that the memories are no longer disrupting their life and no longer of much interest to them. (And sometimes people need to teach their therapists about this!)
For those who choose to focus on disturbing memories, including because those memories are still disrupting their lives, several ‘memory processing’ methods can be used during this stage.
In general, these methods involve re-experiencing the memories within a safe and healing therapy setting. They can be very effective at ending the influence of such memories in one’s daily life.
Most importantly, there are very effective therapy methods that have been proven, through years of clinical experience and research, to bring great relief and healing by transforming memories and responses to reminders of harmful experiences.
(Please note: none of these methods ‘erase’ memories, and they are not designed to ‘recover’ memories. If you have personal questions about this issue, see Words of Caution II on Dr. Jim Hopper’s web page, Recovered Memories of Sexual Abuse.)
One of the most research-supported approaches for processing traumatic memories is EMDR. This method can rapidly transform traumatic memories into non-traumatic ones – and you don’t have to talk about them in detail, if at all, making it a great option for many men.
Again, the main point here is that there are effective and relatively rapid methods for dealing with intensely distressing memories. People do not have to be tortured by them for years.
The third stage of recovery focuses on reconnecting with people, meaningful activities, and other aspects of life.
We will not go into that stage here, but recommend reading Trauma and Recovery, which describes all three stages of recovery in depth and detail.