The Five Stages of Trauma Therapy

You may have heard the phrase “It gets worse before it gets better”. While this is not always the case, trauma therapy is a winding path, and it can feel like you are going backwards when you really are progressing.

The overall goal of trauma therapy is to help your body and mind understand that the threatening situation has passed and that you are now in a different context and capable of keeping yourself safe.

Drawing on my extensive experience, I offer an overview of the five stages of trauma therapy to help clients understand what is happening and where they are headed. While those with an acute trauma from a single event may find their progress to be more linear, those with complex trauma will find that they will oscillate between stages and go through them multiple times with different aspects of their traumas.

Please keep in mind that these experiences and treatment goals are not exhaustive or universal, but the most common across my clientele. Treatment should always be personalized to your unique presentation and needs.

Here are five stages of trauma recovery you can expect to encounter in therapy from the start of treatment to remission:

Stage 1: Unconscious Avoidance

Some clients are already somewhat aware of their trauma and its impact when they start therapy. Others will come in with multiple, seemingly unrelated issues, not understanding the common denominator.

The experience:

The client sees their thoughts and behaviours as character traits or external problems rather than trauma adaptations and survival strategies.
The client will often seek help to fix others or believe they are unlucky or cursed.
The client finds that life and relationship patterns repeat themselves, and they can’t stop them.
The client may briefly recognize that their behaviour is out of character or uncontrolled but doesn’t know what is causing it.

The Treatment Goals:

We will work on building trust and safety, building awareness of repeating patterns, and helping you recognize the emotional impact of your past.

Stage 2: Conscious Avoidance

In this stage, clients become aware of the actual issues and their origins. Yet, facing them may feel too daunting or difficult to confront. This is a stage of preparation and stabilization for the work ahead. It is often hard work in itself, and some may stay in this stage for an extended period.

The experience:

The client is aware of their defences and their negative effects, but is unable to shake them.
The client may build coping skills to better tolerate their current symptoms.
The client becomes aware of deeper issues, but they feel too difficult to address.
The client may feel stuck or at a stalemate.
The client may avoid thinking about the trauma or the work ahead, which can cause a spike in anxiety and dissociation.

The Treatment Goals:

We will work on building safety and stability in your immediate life, ensure you feel safe in the co-created therapeutic space, and gather skills and resources to help you feel more confident on your journey. Communication, feedback and attunement are key in setting a safe and comfortable pace.

Stage 3: Grief and Re-experiencing

Coming face-to-face with the trauma is a taxing process and is titrated to ensure safety and prevent burnout. Clients may admit something they have never admitted before, face how painful a situation truly was, or re-experience the event in flashbacks.

The experience:

The client feels the unprocessed emotion and may fear becoming overwhelmed.
The client may feel fear, panic, or a sense of danger.
The client may feel the desire to make drastic changes to their life to cope.
The memories are processed safely under the therapist’s guidance.

The Treatment Goals:

We will work closely to keep you in touch with the safety of the present moment and take breaks when you need them. Using attunement and communication, we process experiences in manageable portions.

Therapists may have different approaches to moving through this stage, using narrative, EMDR, somatic or cognitive approaches.

Stage 4: Tolerance and Active Coping

As the client begins to understand what is happening and why, they also learn to manage their symptoms in more effective, healing ways. The traumas are not only being managed but are also being resolved bit by bit.

The experience:

The client gains confidence in their ability to use learned coping skills to soothe their symptoms.
The client’s coping skills become more effective in gradually processing trauma.
The client’s coping shifts from managing symptoms to healing from trauma.
The client discovers a sense of agency and self-efficacy that they may never have had before.
The client begins to develop a balanced understanding and narrative of the traumatic event.
The client has goals for the future and believes a life without trauma is within their reach.

The Treatment Goals:

We will guide and encourage you to take more of the lead in trauma processing as you gain confidence. We will keep an eye on the pace of trauma processing and any resurfacing issues. Additionally, we’ll help you discover and trust your feelings of safety and contentment.

Stage 5: Remission

Reaching this stage makes the traumatic experience feel more like a past memory rather than a present threat. Life feels lighter, simpler, and less exhausting. While traumas can resurface, clients understand what is happening and handle them with newfound confidence. The experience often makes them realize how far they’ve come, and they are more likely to grow and derive meaning from the challenge.

The experience:

The client feels a general sense of well-being and safety.
The client trusts and accepts the ease of daily life without obsessing over the past or future.
The client sees challenges as transient and trusts their ability to “figure it out”.
The client has access to a full range of emotions and does not feel threatened by strong emotions.
The client feels more focused, motivated and free to pursue their wants and needs.
The client does not have frequent stress from past experiences and understands that they have grown since then.
The client can easily dismiss thoughts and memories related to the trauma.
Memories carry less weight, and the present feels more real.
The client may experience post-traumatic growth, learning and deriving meaning or purpose from an otherwise terrible experience.

The Treatment Goals:

If there are other traumas, they will become the main focus of the therapy. Otherwise, therapy will shift and focus on building a more desirable life.

Concluding words

Trauma recovery can be challenging, and not knowing what is happening or where you are headed makes it more difficult to stay on course. However, with enough time and support, many clients experience “post-traumatic growth,” finding invaluable meaning and skills along the way.

We approach your journey with patience and compassion. Your voice is always valued in therapy. Communicating your needs and fears about the process will help your therapist adjust the pace to one that is right for you. We do not see your avoidance as a personal failing but as a sign that you don’t yet feel safe enough.

This model is based on the patterns I have observed in working with clients who grapple with trauma. It integrates and expands on several established models of therapy and trauma recovery in a way that is useful to the client. If you are interested, you can find other models and perspectives in the Further Reading list below.

Stage 1: Unconscious Avoidance

The experience:

The Treatment Goals:

Stage 2: Conscious Avoidance

The experience:

The Treatment Goals:

Stage 3: Grief and Re-experiencing

The experience:

The Treatment Goals:

Stage 4: Tolerance and Active Coping

The experience:

The Treatment Goals:

Stage 5: Remission

The experience:

The Treatment Goals:

Concluding words

Further Reading:

Take the first step toward healing

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