The Phase Oriented Model of Recovery, Part II

Last week I introduced Pierre Janet’s Phase Oriented approach to the treatment of trauma. Although Janet published his model around 1898, it’s still considered the “gold standard” for the treatment of trauma.⁠1 It’s also an excellent personal guide for recovery.

Janet identified three phases of treatment:

Phase I: Reduction of symptoms and stabilization

Phase II: Treating traumatic memory

Phase III: Personality integration and rehabilitation

In the previous post, I discussed how the primary goal of Phase Oriented treatment is integration, and that the process of recovery occurs in a spiral fashion (rather than linearly). This week I share a bit about each of the three phases and how to use the Phase Oriented model as a personal guide to recovery.

Phase I: Reduction of symptoms and stabilization

Phase I focuses on creating stability by increasing safety in the environment and in oneself. Sometimes we need to change where we live, the people in our lives, and even the work we do to create genuine and lasting stability. However, for most, if not all, persons troubled by histories of sexual abuse, even if their lives are relatively stable they have to work with inner experiences to create safety in mind and body.

By focusing on creating safety early in recovery — especially how one responds to posttraumatic stress and trauma-related memories — less energy is needed to regain stability after feeling triggered. Consequently, more energy is available for reaching goals, including whys for recovery. Furthermore, when less time is spent recovering from memories of sexual abuse (including unconscious emotion and body memories), there is more opportunity for genuine self-expression.

Much of Phase I involves developing skills that increase regulation of emotions, body sensations, thoughts, and fantasies, while also improving problem-solving and relationship skills. According to a survey of therapists who utilized the Phase Oriented model in their work with clients, material addressed in Phase I is most often returned to throughout the recovery process.⁠2 This material is the ground beneath explorations of selfhood following sexual abuse. Furthermore, without healthy ways to create safety and stabilization, there is greater likelihood of relying on unhealthy ways to regulate inner states, such as addiction, self-harm, or engaging in risky behaviors.  Because Phase I work is so important, I’ll spend the next five weeks looking at ways to increase inner states of safety and well-being.

Phase II: Treating traumatic memory

Traditionally, the focus of Phase II has been consciously remembering the traumatic event(s), if not also mourning the past. For some, this continues to be the preferred method. However, treatments such as exposure therapy, in which the goal is to become desensitized to traumatic memories by remembering every aspect of what happened, have come under criticism. Studies have shown many find the process overwhelming and destabilizing, which can lead to the loss of gains made in Phase I, if not prematurely ending therapy.⁠3 For women who have responsibilities like school, raising children, and/or working, exposure therapy can interfere with meeting daily commitments.

Instead of engaging in painful recollections of the traumatic event(s), it can be more reparative to construct a new narrative that focuses on strengths and overcoming the affects of abuse. Such a narrative can be life changing, especially given many of the common beliefs and emotional reactions to sexual abuse, including feelings like shame, rage, and bitterness.  Constructing a new narrative is joined with learning to experience one’s body, emotions, thoughts, and imagination in ways that support feeling confident, resilient, and safe. Furthermore, the nature of memory is such that we rarely remember the past exactly as it occurred. Thus concentrating on creating a better life in the present is often more realistic than attempting to recall the details of a past trauma. As trauma-focused psychologist Janina Fisher wrote:

“Modern views on memory emphasize its unstable nature: that is, the brain seems to be organized to update and rewrite past experiences, integrating them with prior and subsequent events. Rather than focusing on desensitizing the event memories, experts now advise prioritizing transformation or repair of trauma-related states through the cultivation of new experiences. Instead of focusing on developing a trauma narrative, clients are instead advised to rewrite their ‘self-defeating’ stories and create a healing story that allows them to make meaning of what happened.”⁠4

Addressing trauma-related memories is still part of Phase II, since memories of sexual abuse naturally arise and can be destabilizing when they do. Furthermore, not knowing when and if memories of the abuse will emerge can cause fear of one’s own mind and body. Psychologists refer to this as phobic avoidance of traumatic remembering. Phase II is an opportunity to move beyond phobic avoidance, which is a necessary precursor to the work of integration that is a focus of Phase III.

Especially when troubled by memories of sexual abuse, it’s important to seek support from a trauma-trained psychotherapist. (Although, all stages benefit from the support of a good therapist trained in the treatment of trauma.) As mentioned in Week 1, I worked with an EMDR specialist to address my flashbacks. Much later, I trained in Sensorimotor Psychotherapy to help clients work through their intrusive memories as well as cultivate new experiences with present moment awareness. I recommend both approaches for addressing traumatic memories. They support both the brain-body’s natural attempts at integrating traumatic memories and letting go of defeatist narratives about the traumatic event(s).

Often when people seek psychotherapy, memories of the abuse are breaking through despite efforts to wall them off. Old defenses may be breaking down, or have broken down. When this happened to me, I just wanted to get rid of the memories and get on with my life. If you are like me, don’t be surprised if you need to make a number of Phase I changes, and later work towards greater integration, in addition to addressing traumatic memories. Keep in mind recovery is much more than overcoming traumatic memories. It’s also about creating a meaningful life centered on wholeness. Feeling whole and stable is infinitely more rewarding than just ‘forgetting’ the past!

Phase III: Personality integration and rehabilitation

Phase III focuses on increasing inner states of integration by utilizing the increased stability gained in Phase I and the meaningful narrative and new experiences of selfhood created through Phase II. During Phase III, rather than coping with traumatic stress by walling off parts of the self associated with the sexual abuse, we start relinquishing the old sense of self as burdened by the effects of trauma, and begin taking risks to create a better life, including opening to the possibility of greater intimacy.

Phase III also involves working through grief associated with not becoming who one hoped, or not living a better life, which are perhaps the greatest consequences of sexual abuse. As we begin to integrate all aspects of ourselves, or at least learn to make peace with both the good and the bad, grief signals it is finally safe to let go of the past, and the person one became in reaction to being traumatized by sexual abuse. As Judith Herman wrote:

“The reward for mourning is realized as the survivor sheds her evil, stigmatized identity and dares to hope for new relationships in which she no longer has anything to hide.”⁠5

Of course, we are not “evil” or bad as a result of being sexually abused. Nevertheless, many often feel as if they were, or have treated themselves as if they were. However, during Phase III work, the alienation that is often a reaction to sexual abuse, along with the shame and low self-worth that can incite self-blame, no longer make sense. During Phase III, much like Anaïs Nin’s often quoted phrase, “and the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom,” we begin to consistently challenge perceived limitations as we venture into our authentic selves and the world.

During Phase III we are unencumbered by the need to avoid traumatic reminders of sexual abuse. We increasingly act from a sense of ourselves as a whole person, rather than divided by phobic avoidance of traumatic reminders. Nevertheless, we may not always be filled with joy when we are involved in Phase III work, as Pat Ogden and her colleagues pointed out:

“Phase 3 may contain some of the most difficult work yet. It involves painful grief work that is necessary for deepening realization to occur, relinquishment of strongly held substitute beliefs, and the struggle to engage in the world with new coping skills that require high degrees of sustained mental efficiency and energy …. [along with] overcoming the phobia of intimacy….”⁠6

Yet the feeling that often pervades Phase III is one of being fully alive, fully human, and deeply authentic. Furthermore, because the phases of recovery occur in a spiral, when we come up against experiences we feel unprepared for, we can return to earlier phases of recovery in search of the skills or wisdom needed, or to address memories that sometimes emerge as we begin to live fuller lives. There is no failure in the process, although there are setbacks. Nevertheless, every experience is a lesson and an opportunity.

It helps to notice which phase you are in, not only to take advantage of the moment, but to realize you are changing and growing. It’s easy to overlook times when you are processing experiences with greater integration, or when you have successfully increased safety and stability in your life. Too often, we only notice when we feel like we are losing ground. This is especially true when feeling depressed and life feels bleak, or when feeling so overwhelmed that we can’t make progress on goals. Yet even at those times, there are moments of levity and opportunities to regain balance, which get easier to identify when you know what to look for.

Because many are habituated to thinking in terms of linear growth, it can take time to perceive recovery from sexual abuse as spirilic, continually passing through the same phases, and revisiting old life lessons, if not old memories. To keep the process going requires being gentle with yourself, approaching difficulties with curiosity rather than judgment, and loving acceptance rather than ridicule. Treating yourself gently will make you stronger. Trust me on this.

Throughout my recovery, during which I used the Phase Oriented model as my guide, I began to think of trauma as an initiation into a different way of being — one I would have never hoped for, but nevertheless became the seed for self-compassion and self-awareness that eventually blossomed into genuine self-expression and deep empathy for all suffering. Much as trauma expert Peter Levine wrote, “In virtually every spiritual tradition, suffering is seen as a doorway to awakening.”⁠7 The process of recovery does take time, but can become a way of continually integrating experiences in a traumatizing world. For some, recovery becomes the path of the wounded healer, a subject I’ll address later in the year.

Here are some questions to ponder: Does it help to see your recovery as occurring in stages? Why or why not? If it does help, which phase do you see as dominant at this point in your recovery?  How might you increase safety and stability in your environment? Your body? Your thoughts? Your emotions? Your imagination?

See you next week,

Laura

 

References

1 Fisher, Janina. (2017). Healing the fragmented selves of trauma survivors. New York, NY: Routledge.

2 Brand, B.L., Loewenstein, R.J., Lanius, R., Pain, C., Myrick, A.C., Classen, C.C., McNary, S.W., Putnam, F.W. (2012). A survey of practices and recommended treatment interventions among expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified. Psychological trauma: Theory, research, practice, and policy. Vol. 4, No. 5, 490-500.

3 Kolk, Bessel van der. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking.

4 Fisher, Janina. (2017). Healing the fragmented selves of trauma survivors. New York, NY: Routledge, p. 10.

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

6 Ogden, Pat, Minton, Kekuni, & Pain, Clare. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: W. W. Norton & Co., p. 18.

7 Levine, Peter A. (2005). Healing trauma: A pioneering program for restoring the wisdom of your body. Boulder, CO: Sounds  True, p. 4.

 

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