a sense of moral balance. Examples of individuals who may have harmed others as part of the conditions of their own traumatic circumstances are the survivor of domestic violence who was unable to protect her children from similar abuse and the combat veteran who, while following the orders of a commanding officer, harmed civilians. The role of the clinician during this phase of treatment is to bear witness and provide a therapeutic alliance that allows the client to feel accompanied and cared for on this journey. The clinician also facilitates naming the events and the affect, helping the client to translate the unspeakable into words (Courtois & Ford, 2012). This moves the material from the nonverbal danger response system of the limbic system to the verbalizing cognitive brain of the cortex, with its abilities to reason, reflect, and differentiate. Reconstructing the story, and being able to develop a sense of the continuity of their own history, allows the client to restore a narrative flow to their life so that the past, present, and future flow in a single thread, rather than in multiple fragmented self parts (van der Kolk, 2014). Remembering is also “re-membering”—that is, putting the pieces of something back together again. This stage of the work allows the client to reclaim dissociated and split-off parts of self, affect, and memory, so that their fragmentation, which is so often a function of trauma, heals and they become whole again. The work here also includes learning to accept and integrate the self parts that have been hated and shut off, through nurturance, support, and caring by both the clinician and the client. The goal is to move the client from a victim stance to that of a survivor. This process involves a reconstruction of the events as well as a review and reworking of the meanings that have been made from the events (Courtois & Ford, 2012). These interpretations of past traumas can affect the client’s current view of themselves; the world; and their spiritual framework, beliefs, and values. The sharing of information allows the clinician to help the client explore a new interpretation of the events and validate the reality of things that have happened. The experience of not having reality validated and accepted is maddening, and something that survivors of chronic childhood trauma remember all too well. The denial of the facts of their daily existence by other family members or outsiders leads these men and women to deny to themselves what they know to be true. In recent years, there has been a movement for individuals to share their experiences in more public forums (i.e., the #MeToo movement on social media) as a means of facilitating political and societal shifts (Delker et al., 2020). This has allowed many to fight against long-held beliefs that dismiss a perpetrator as a “bad apple” and draw attention toward larger systems of inequality. The potential impacts of these public disclosures (both positive and negative) have not been well examined. Case Example Janice is a mother who insists that her husband is not an alcoholic or abusive toward the children, while making excuses for him regularly at work, telling her children to wear long sleeves so the bruises will not show, and saying that “Daddy is just a little tired” when he is passed out on the couch with a case of empty beer cans around him on the floor. Janice is denying the reality that she and her children know exists. Mourning Traumatic Loss. The other crucial part of this stage of the work is the mourning of traumatic losses (Herman, 1997). Trauma includes loss at its core. Although traumatic loss does not always include violence, violence always includes loss. Losses include concrete losses, such as a home, car, or loved one, but just as profoundly include
the less tangible losses, such as loss of a sense of safety in the world, loss of personal power, loss of time, loss of a childhood, and loss of faith. Survivors often fear this stage of the work because it can carry a sense of timelessness. Many clients repeat some variation of “I’m afraid that if I start crying, I’ll never stop.” Simple reassurance that this has never actually happened to anyone can help to reduce this fear; however, this gentle humor is not sufficient by itself. The clinician’s help in remembering the little bits of progress from week to week, marking successes, and holding on to the hope and belief that this painful process will diminish, can be a lifeline for survivors who are in the midst of the grieving process. Asking clients to evaluate their progress in small increments and then in weeks and months, rather than in days, can help to reduce and contain the sense of timelessness that grief can hold. It is not unusual to see regression during this phase of the work as traumatic losses are grieved and traumatic memories are re-experienced (van der Kolk, 2014). For this reason, a solid base in internal and external safety is crucial before beginning this process. The goal is not abreaction, per se, but the healing that comes when affect can be tolerated and not separated off from the events that are associated with it (Courtois & Ford, 2012). This stage of the work involves reconnecting the painful affect with the original source of the distress and then, through support, repetition, and desensitization, sufficiently resolving the distressing affect so that the memory remains intact, without causing current distress or functional impairment. The role of the clinician is to normalize the increase of symptomatology at this juncture as temporary and usual and to reassure and facilitate the movement from the intense distress of re-experiencing to acceptance and mourning and then to consolidation, grounding, and empowerment. “The water runs dirty while the well is being cleaned” is a homily that many survivors find speaks to their experience. Stage 3: Reconnection Less has been written about reconnection, the final stage of the work, than the other two stages, perhaps because in many ways this stage of treatment is more similar to work that is done with nontraumatized clients. However, there has been greater emphasis placed on this aspect of trauma treatment in recent years, particularly through research into posttraumatic growth and the emergence of Acceptance and Commitment Therapy (discussed in more detail in a later section). This phase involves reconnecting to self and to others and moving out to participate in the world more fully (Herman, 1997). Muldoon and colleagues (2020) noted that “trauma takes its toll by affecting people’s sense of who they are as group members: it changes ‘children’ into ‘orphans’, ‘soldiers’ into ‘veterans, ‘people’ into ‘victims’” (p. 338). While there is at times debate as to the utility of identifying oneself within a group associated with one’s trauma (e.g., “a sexual assault survivor”), finding a place within a larger collective can be a source of strength. However, development of an identity no longer associated with one’s traumatic experiences is also important in order to facilitate a life based on the present and future rather than solely the past. Rather than solely identifying as a victim, or even as a survivor of trauma, the client can now move into an identity that is based on their relationships, accomplishments, pursuits, and values (e.g., “I am a mother, a wife, a teacher, a good dancer, and a seeker of justice”), for whom traumatic experiences of the past are part of a number of past experiences, no longer define or rule the entirety their life, and may be an aspect that imparts wisdom and values for their future. One client with a history of sexual abuse that led to self-labeled “promiscuity” for many years during her adolescence and 20s humorously described
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