● Flexibility The clinician should balance flexibility with consistency. In other words, the clinician should know “when to hold and when to fold.” The clinician needs to be willing and able to think outside of the box for creative solutions. Adjusting the physical space, including seating or lighting, as well as the style of work or methods used in response to the client’s expressed needs around safety and comfort, is respectful and empowering to the client. For example, the clinician should be willing to sit on the floor rather than in chairs, open or close window shades to accommodate anxiety, or even sit back-to-back for part of the session so that the client will not experience feeling shamed while recounting a particularly difficult part of the trauma. ● A moral rather than a neutral stance The clinician needs to be able to address the client’s perceptions of good and evil in the world and be willing and able to take a stand on the client’s behalf when needed. For example, the clinician should be able to say to a client, “That was wrong. It never should have happened to you; it was not your fault.” ● Good resources/sources for personal renewal The clinician needs to have good support systems for professional and personal support, learning, self-care, fun, and leisure. ● A working spiritual perspective The clinician needs to have a way of making meaning for themselves in the world and a traditional or nontraditional place for meditation, prayer, or contemplation. This place can be in nature, in a house of worship, or in a private space. The clinician should have knowledge of their own belief systems to sustain the soul and the psyche, in the face of bearing witness to pain and suffering. Note : Adapted from Schiller, L. (2008, July). Getting unstuck: Using dreamwork to heal traumatic memory. Paper presented at the International Association for the Study of Dreams Conference, Montréal, Canada. PRINCIPLES OF TREATMENT: PHASE-ORIENTED TRAUMA TREATMENT FOR INDIVIDUALS AND GROUPS Experts in the field of trauma agree that the healing
encounter that is encouraged or prolonged. Teaching clients to recognize, differentiate, and control the level of their arousal becomes a form of self-empowerment and self-attunement that, in and of itself, is reparative. Many clients have become so hyperaroused and oversensitized to environmental triggers that they have lost the capacity to differentiate between the feeling states of “uncomfortable” and “unsafe.” This differentiation between safety and comfort becomes the guide on which to base the phase- oriented treatment approach. Although the principle of phase-oriented treatment holds fast, the reality of the therapeutic encounter is actually more of a spiral than a straight line. Real life is never as orderly and neat as a simple, progressive, linear flow. Rather, the work continues to spiral back and forth as more and more material is uncovered and addressed (Ford & Courtois, 2013). With each new traumatic episode or additional aspect of a single episode, a basic phased progression should be followed that, first, ensures safety, then addresses the traumatic material in a resourced and titrated fashion and, finally, reconnects to a more resourced and stable state of being. added to Herman’s reconnection phase (van der Kolk et al., 1996, p. 426). Stage 1: Establishing Safety Components of the safety phase include the establishment of safety, first in the environment and second from self- harming behaviors. The clinician must never assume that a client is safe until the realities of the client’s daily life and extended contacts have been carefully explored. In addition to the obvious need of determining that a client is living in a safe home, clinicians must also assess the reality of the neighborhood and local environment and ascertain whether named perpetrators have access to the client, even if the ostensibly abusive behaviors have ceased (Briere, 2019; Courtois & Ford, 2012).
process for trauma treatment needs to proceed in phases. Phase-oriented treatment approaches are considered the gold standard of care, particularly when treating complex PTSD (Chu, 2011; Ford & Courtois, 2021; Ogden & Fisher, 2015), and recent meta-analyses continue to support the effectiveness of this approach (Corrigan et al., 2020). Each phase builds on the work of the previous one; therefore, inattention to a careful and systematic building of resources, before subsequent arenas of work are opened up, can leave the client at risk for retraumatization. A carefully modulated approach that respects the client’s timing and pacing while providing information, resources, and encouragement for moving forward in the healing process is a combination that appears to be optimal. Respecting the client’s window of affect tolerance is a paramount treatment principle that assists in avoiding excess abreaction (the expression of emotional tension) or the need to withdraw and shut down. Clients often appreciate learning the distinction between the concepts of uncomfortable and unsafe (Schiller, 2008). Feeling uncomfortable at times during the treatment process is probably inevitable; a person who never feels uncomfortable has little reason to effect change. Feeling unsafe, however, should not be a part of the therapeutic Phase-Oriented Healing Judith Herman, in her classic book Trauma and Recovery (1997, first published in 1992), breaks down the central tasks of the healing process into the three stages of: ● Establishing safety ● Remembering and mourning ● Reconnecting Bessel van der Kolk and his colleagues McFarlane and van der Hart (1996) presented more detail in their typology of healing from trauma. They added concepts of stabilization, including “education and identification of feelings through verbalization of somatic states” to Herman’s safety phase. They expanded Herman’s remembrance and mourning phase to include “deconditioning of traumatic memories and responses” and “restructuring of traumatic personal schemas.” Finally, “reestablishment of secure social connections and interpersonal efficacy” and the “accumulation of restitutive emotional experiences” were
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