Roadmap After Trauma: Six Stages to Trauma Integration
The cyclic effects of trauma.
Posted Sep 28, 2018
In 2005, as a fellow in a Masters program in Conflict Transformation, I took an Intro to Trauma Healing class. I was thinking about the impact of trauma on conflicted societies when I signed up for the class, not about myself. But in ways I had not anticipated, the class came home to me. For the first time, confounding pieces of my complex life history made sense to me—and they were all about trauma.
Today, I also see that the awakening I experienced had to do with more than the things I was learning in class. For the first time in my life, I was living in a truly peaceful environment with none of the reminders of imminent conflict that were a part of daily life in my homeland. In this safe place, I began to remember and feel traumatic experiences that I had pushed down and far away for years.
I experienced intense anxiety and fear even though there was obviously no threat around me. For the first time, I realized how much fear had been a part of my life, and how much I had internalized fear responses into my daily functioning.
By that time I had done almost ten years of therapy with psychodynamic therapists. No one had ever suggested to me the possibility that I was a trauma survivor. Now, struggling to make sense of intense PTSD symptoms in a setting of zero threat, I realized that I was a trauma survivor myself. This realization helped me make sense of myself and my life. Perhaps even more importantly, it opened up for me an array of self-care strategies that I had not previously thought about.
This experience is one of several that have shaped my thinking about trauma and the Expressive Trauma Integration approach I eventually developed. Accurate knowledge about trauma and its impact—what professionals call psychoeducation—is crucial for survivors.
Like me for much of my life, many trauma survivors don’t understand the connection between their daily emotional struggles and trauma. Absent clear understanding of what is going on, most blame themselves, living with intense shame and guilt. Across all borders, genders, and cultures, I witness self-blame among trauma survivors, most often as shoulda/coulda/woulda. “If only I had done something differently, the outcome would have been different,” is the recurring thought (rumination).
Learning about the neurophysiological mechanisms of trauma was life-changing for me. For the first time, I was able to make sense of a variety of confusing symptoms, reactions, and responses that had persistently troubled me for years.
Another pillar in the Expressive Trauma Integration framework is recognition of the multi-dimensional nature of trauma and the responses necessitated by it (read more about it in this blog).
You can review the Expressive Trauma Integration After Trauma Roadmap below as an infographic. This Roadmap is describing what takes place before, during, and after trauma. Whether you are a trauma survivor, a therapist working with trauma survivors, or a first responder who interacts with survivors in their earliest moments of this journey, this roadmap is designed to guide you in the process of trauma integration.
In my view, the road after trauma is cyclical, not linear. None of the stages is “once and done.” Survivors usually go through each phase more than once (although often with differing durations and intensities). Think of the diagram as a spiral upwards rather than a simple progression.
The cyclical nature of progress is particularly important to grasp in regard to Stage 3, Withdrawal. Withdrawing is an instinctive and essentially healthy human response to difficulties of almost any kind; without it, we’d never remove ourselves from danger. Since it is so much a part of the way human beings are wired, survivors don’t go through withdrawal once and then move on. Most will have at least one big period of withdrawal. Then, they will have many small and medium-sized times of withdrawal, and many more moments when they have a strong instinct to withdraw.
From the perspective of survivors, this is discouraging, for it feels like a return to the same place. Part of proper psychoeducation is about helping survivors recognize it is not. Every human being lives with moments of strong urges to withdraw; survivors will have more of these than normal since trauma strengthens the instinct to withdraw (read more about it in this blog on experiential psychoeducation).
But having these moments does not mean that a survivor is back in the swamp of early post-trauma response. Ordinary day-today living, even when there are routines, brings everyone on a regular basis to stress responses that are very similar, physiologically in how they feel, to post-trauma responses.
Survivors who are psycho-educated can recognize these mechanisms and incorporate routines of self-care that over time enable them to self-sustain (read more in this blog on self-sustainability).
One of my goals in developing this roadmap was to find a way of talking and thinking about post-trauma experience in a way that is both realistic and hopeful. In my experience, the widely used words “healing” and “recovery” are misleading. In reference to illness or injury to the body, to me they often imply that all traces of injury or illness disappear.
To reflect the twin elements of realism and hopefulness that are appropriate after trauma, I use the term “Trauma Integration.” We may not heal in the ways “healing” sometimes means, but we can integrate traumatic experiences into our lives in ways that enable us to live from our highest potential as human beings, while expanding our capacity to endure the pain and the after-effects of trauma.
Trauma integration begins with a decision to take steps, however small, towards it. A professional trauma therapist with a good understanding of the road ahead can be an invaluable resource to a survivor in the journey. Key contributions of the therapist in my view should be: psychoeducation (read more in this blog), helping the client to figure out self-regulation (read more in this blog) and assisting the client to setup and implement daily routines of self-care (read more in this blog).