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 reaching this landmark by remarking, “I no longer define myself in relation to penises anymore.” Continued attention is paid to the prior two stages of the healing work, as pockets of traumatic memory may continue to resurface. New information may emerge, or new stages of life are encountered that trigger other recollections, but these are usually dealt with more quickly and in a less deregulating manner than previous traumatic memories. This is a time for focusing on mastery of fear and perhaps challenging the self physically to reconnect more fully with the body’s capacities for mastery, strength, and pleasure (van der Kolk, 2014). Some survivors take up a sport or participate in outdoor adventure experiences.
It is a time for liberation of the capacity for imagination, for play and fun, and for love and creativity, all of which took a backseat in the psyche while the energy needed for them was bound up in traumatic memory and affect. Reconnection implies increased capacity for intimacy with the self and with others. Intimacy with the self can come in the form of increased self-knowledge and an increased comfort in being alone. Being able to enjoy being alone, in addition to tolerating it, allows the individual to pursue creative endeavors that entail solitary time, such as art, writing, and meditation, for the sake of their calming and regulating functions as well as for the sake of pure enjoyment and creative pleasure. Comfort with self-intimacy also implies greater comfort and ease in the body; no longer feeling like the body is the scene of a crime; and taking pleasure in a sense of aliveness, physical power and mastery, and the enjoyment of sexuality, whether with a partner or with self. Reconnecting with others involves connecting in meaningful relationships with friends, partners, children, family members, colleagues, social groups, spiritual or religious groups, and leisure pursuits. Enhanced intimacy means a greater capacity to enjoy the company of others, without fear of victimization, and having enough sense of one’s own personal power that the client feels comfortable standing up for themselves as needed. Sexuality and love relationships can be enjoyed as well, without issues of basic trust and fear of abandonment being foremost. It is a time of reclaiming pride in the self (Courtois & Ford, 2012). Many survivors adopt a survivor mission as part of their healing processes. After having achieved enough consolidation of self and freedom from the tyranny of intrusive traumatic recollections, they feel the desire to give back in some capacity, often in a sphere that is in some way connected with their previous traumas (Delker et al., 2019). Some survivors get involved in arenas involving social justice, humanitarian endeavors, civil rights, healthcare or mental health care, or helping children in some capacity. While this can be a useful and empowering path for some, it is important to not place this expectation on clients, as it can contribute to a narrative of “redemption” in which something positive follows a negative event and places undue burden on survivors to become advocates (Delker et al., 2020). Case Example Midway through her course of treatment, Katie had a dream about “saving children over the sea.” The dream had a powerful effect on her; however, she did not know for a long time what it meant or whether it was in some way literal or primarily symbolic. Two years ago when one of her sisters, who had also been physically and sexually abused by their father throughout her childhood, died of breast cancer in England, Katie took on the responsibility of staying in touch with her six nieces and nephews, who were 7 through 16 years old. She sent them cards and presents for their birthdays and holidays, visited at length every time she went overseas to visit her family, began an individual email correspondence with three of the six children, and sponsored the eldest to come to the U.S. when he finished his schooling. Later in treatment, she and her therapist recalled the dream and noticed how she was in the process of fulfilling it. She took great comfort and pride in her strength and the capacity for commitment to her sister’s children that enabled her to stand up and volunteer to be there for them “for the long run,” given that she had now displayed that strength and commitment for herself through her long-term therapeutic relationship. This is a time when some survivors also take on the task of confronting others: Their offenders, people who did not protect them, or government agencies that did not provide the needed support or assistance (Herman, 1997). This is not a choice that everyone makes, even if the option exists. (Some offenders may no longer be alive, or the survivor may not know of their whereabouts.) When confrontation is chosen as part of the healing process, careful preparation is necessary (Herman, 1997).
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