Psychotherapy for Attachment, Trauma and Dissociation

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Stages of trauma therapy

Phased oriented approaches to the treatment of trauma is nothing new.

Pierre Janet's (1889) Staged Model for the Treatment of Traumatic Stress has stood the test of time, partly because it holds a great deal of understanding from the developed knowledge about what works in ensuring the safe progress in the integration of trauma memories.

This could be viewed as the first therapeutic approach to the treatment of traumatised clients which was was the first systematic, phase-oriented approach. Regardless of the particular method your therapist may use, most therapies are structured around a sequenced process that has three distinct phases: beginning, middle, and end stages. 

The three stages originally proposed by Janet:

Stage I: Stabilisation - symptom-oriented treatment, and preparation for liquidation of traumatic memories. 

Stage 2: Identification - exploration, and modification of traumatic memories.

Stage 3: Relapse prevention - relief of residual symptomatology, personality reintegration, and rehabilitation.

Integration of memories.

Many approaches to modern day treatment of trauma disorders have at there Core the integration of the traumatic experience (EMDR, TF-CBT). 

Similarly Janet, considered the inability to integrate traumatic memories as being the core issue which requires to be addressed. He viewed this as always requiring an focus on the details and experiences associated with the trauma and then the integration of the memories.

This harnesses the concept that in my opinion it's not about getting back to normal. Not about being able to get back to the time before and starting off where time stood still (trauma time), but about getting to a new place.

A place where the events have not been able to be emotionally integrated and processed due to still being in a situation for many which is unsafe. These ongoing events and those afterwards in many circumstances do not allow for breaking the bonds that bind (having to remain in repeated cycles of abuse).

Therefore frequently a step early on in the therapeutic process in terms of safety is the understanding of the interpersonal relationships with connect the survivor to the past and whether this situation in fact is a situation they wish to change. This journey to a new place can on its own create a significant change in wellbeing and functioning, but can be extremely challenging from both an attachment perspective (trauma bonding) and more so if traumatic events occurred within say a family system.

"Fear can keep you prisoner, Hope can set you free".


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