The Phase Oriented Model of Recovery, Part I

Circa 1898, Swiss psychiatrist Pierre Janet created a three-phase model for the treatment of trauma that is still used today. Although his Phase Oriented approach was originally developed for professionals, it is also a useful guide for one’s own recovery. Since how you use this model is as important as what you do to recover, I will spend two weeks on the topic of Phase Oriented treatment.

As I develop this project on recovery from sexual abuse, I am also working on a research project about the origins of human spirituality. From this research, I have come to believe there is an innate drive towards recovery from trauma that has evolved over hundreds of thousands of years. When sexual abuse happens, regardless if the abuse was a violent assault or coerced by a trusted family member, mentor, neighbor, or ‘friend,’ we find ourselves at a crossroad with parts of ourselves defending against memories of what happened while other parts attempt to recover the sense of wholeness lost through sexual abuse. Both drives are largely unconscious. Both, I believe, emerge at the moment of subjugation. Nevertheless, most modern societies obstruct the wisdom and societal conditions necessary for activating the natural drive towards recovery.

I think of Janet’s Phase Oriented model as a method for regaining the innate human drive towards wholeness. According to Janet, the three phases of treatment are:

  • Phase I: Reduction of symptoms and stabilization
  • Phase II: Treating traumatic memory
  • Phase III: Personality integration and rehabilitation

Judith Herman, in a more modern appropriation of Janet’s work identified the phases this way:

  • Phase I: Safety
  • Phase II: Remembering and mourning
  • Phase III: Reconnection⁠1

Others have made minor variations to the model, but generally witness the same objectives for treatment as Janet, in part because of a shared understanding of the primary goal of trauma treatment: integration and regaining a sense of wholeness. Next week I’ll examine Janet’s three phases, what they entail, and how to use them to guide your recovery. This week my focus is on the innate human drive toward integration.

When we are integrated, all aspects of ourselves — emotions, thoughts, memories, body sensations, and imagination — work seamlessly to create an experience of selfhood that supports genuine self-expression and generally feeling at peace with oneself. Yet when trauma is unresolved, we are often burdened by the need to compartmentalize memories of what happened, if not parts of ourselves, to avoid suffering.

All people, traumatized or not, have different aspects of their personality, and more or less fluidly shift between them according to emotions, relationships, and context (e.g., home versus work). However, following trauma, especially when it was ongoing and is unresolved, parts of the personality that hold memories of trauma become rigid rather than fluid. Fragmented traumatic memories, along with parts of the self experienced as intrusive, are alternatively avoided or obsessed over. As anyone with a history of trauma eventually learns, such compartmentalization is unsustainable. What has been split off or dissociated naturally seeks integration. This is part of the innate drive towards recovery. Granted, the experience can be painful and disorienting. Nevertheless, our reactions to traumatic reminders are signals from the body and unconscious that we need support and opportunities to overcome sexual abuse.

Unfortunately, we don’t live in a world in which flashbacks and intrusive memories are interpreted as opportunities to recover. We live in a world that cherishes progress and denigrates whatever interferes with advancement. We also live in societies that have historically denied the pervasiveness of sexual abuse and blamed victims. Consequently, many lack the social support and opportunities necessary for recovery and integration, as witnessed in the chronic lack of mental health resources throughout the world. We must get creative in our efforts to recover, which in large part is why I am creating Ambivalent Goddesses — to help address the limited (and often inappropriate) resources that have resulted in too many suffering chronic demoralization rather than full recovery.

One way to creatively work towards integration is by broadening your understanding of how the human brain reacts to trauma. Certainly we are not our brains, and the consequences of sexual abuse cannot be understood solely in terms of how it influences the brain. Yet with regards to recovery work, understanding how the brain functions is one way to improve integration, including resolving intrusive remembering of traumatic experiences.

Some of the difficulty with memories of sexual abuse — whether those memories take the form of an image, a body sensation, an emotion, or a belief about ourselves or the world — is our relationship with time. Especially in the West, we tend to hold rigid beliefs about time, including that it progresses from past to present to future. However, time is a concept and cultural construct, not a reflection of biological reality. Not surprising, as neuroscientists Gÿorgy Buzsáki and Rudolfo Llinás determined, “Half the world’s languages do not have grammatical tense to specify past or future.”⁠2 Yet in the West we tend to berate ourselves for not getting over something that happened long ago, or only lasted briefly relative to all our other experiences. Yet from the brain’s perspective — especially the 95 percent devoted to unconscious processing — there is no past, just one timeless moment. For the brain, recovery from trauma relies on the capacity to dwell in this timeless moment without avoiding or obsessing over internal or external stimuli — including our own beliefs about when we should get over the sexual abuse.

Since a brain that can recall memories of previous threats increases the likelihood of survival, it makes sense the unconscious would keep bringing up dissociated, split-off aspects of experience if that might lead to reaching the most expansive level of awareness and hence, safety — especially if others observed our symptoms for what they were and responded with needed support. Nevertheless, many of us are quite good at not consciously remembering the trauma at all. Such profound dissociation often has to do with the conditions in which the trauma occurred. For instance, when the perpetrator is a caregiver, there is increased likelihood of amnesia for the abuse, since remembering the trauma would be a greater threat to survival than forgetting. If you have to depend on your caregiver to take care of your needs, it helps to be able to forget they are also your tormentor. There have also been cases of women in combat who endured sexual abuse and experienced complete amnesia during their deployment, only to experience flashbacks once they returned to civilian life and relative safety.

Recovery doesn’t require consciously remembering what happened in order to reach integration. For some, the memories of sexual abuse are so profoundly threatening, so annihilating, they must be forgotten. Then the focus of recovery is unconscious remembering, which can take the form of automatic beliefs that contribute to depression, or feelings of betrayal that precede self-injurious behavior, or a tendency to rage when feeling threatened — among other reactions that I’ll discuss more extensively in the next couple of months. Rather than trying to consciously recall the trauma, the objective becomes developing healthy coping skills and mindfully being with experiences without clinging or pushing away. The objective of recovering may also become living within the window of tolerance, expanding time spent in this region of experience, while lessening time spent in hyperarousal and hypoarousal.

Despite that the Phase Oriented model involves three phases, it does not assume recovery is a linear progression of steps to be completed. Rather, recovery progresses like a spiral: we begin by addressing some issues only to return to them later, albeit with new understanding and coping skills, and hopefully greater self-compassion. This spirilic metaphor of recovery is more similar to the shell of a nautilus than the modern understanding of the human brain as like a computer. At the outer edge of the shell we defend against our own inner experiences, yet as we integrate split off parts and learn to regulate our emotions, we travel towards the center of the shell — and who we really are. Much as CG Jung wrote, “We can hardly escape the feeling that the unconscious process moves spiral-wise round a centre, gradually getting closer, while the characteristics of the centre grow more and more distinct.”⁠3

Instead of thinking of recovery as progressively moving forward to a better version of you, imagine yourself as developing increased comfort with inwardly exploring your experience of selfhood — over and over again — in an effort to accept and love who you are in accord with the timelessness of the unconscious. As the capacity to mindfully dwell inward increases without fear of traumatic reminders, so does psychological integration (more on this in future posts). You also “grow more and more distinct,” as Jung pointed out, and thus become more you. I believe this is the ultimate, integrative goal of the brain. The unconscious is not trying to torture us with traumatic reminders. Rather, it doesn’t want to miss this unique opportunity to be fully alive.

The spiral nature of recovery is distinguished from the rumination that is regularly a response to sexual abuse. Rumination is characterized by self-blame and continued focus on the perpetrator, what happened, and the resulting suffering. The outcome of such rumination is often avoidance of intimacy and general distrust that can lead to bitterness, if not isolation. In contrast, the spiral towards recovery focuses on personal strengths, increasing well-being, and putting the story of trauma within a larger narrative. Thus, the Phase Oriented approach can be thought of as modeling how to continually grow beyond what threatens the preferred state of wholeness, if not how to continually overcome the inevitable losses and traumas that happen to so many of us across the lifespan.

Next week I’ll look more closely at the three phases of treatment. Until then, here are some questions for your reflection: Have you ever blamed yourself for not ‘getting over’ sexual abuse, or thought it shouldn’t take so long? How might such beliefs interfere with your recovery? Do you have experiences or symptoms you associate with your trauma that continually resurface? What are they? What benefit might you gain from accepting the return of these symptoms as a natural part of recovery rather than as a weakness or evidence you are permanently damaged by the abuse? You can also use these symptoms to identify practices found in the Window of Tolerance Guide to help lessen your suffering. 

See you next week,

Laura

 

References

1 Herman, Judith. (1997). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. New York: BasicBooks.

2 Gÿorgy Buzsáki and Rudolfo Llinás, (October 27, 2017), “Space and time in the brain, Science, Vol 358, Issue 6362, p. 482.

3 Jung, Carl Gustave. (1954). “Psychology and alchemy,” in Collected Works, 12, para. 4, pp. 217f.

 

© 2018 Laura K Kerr, PhD. All rights reserved (applies to writing and photography).