The 5 Stages of Healing from Trauma

“The 5 Stages of Healing from Trauma” Original post first published on my blog

copyright Licia Berry 2013, All Rights Reserved

rosietheriveter_youcandoit
While organizing my local One Billion Rising event in Tallahassee in 2013, I was reminded of the different stages of the process of healing after trauma because I saw women in every stage attracted or repelled by the event, based on where they appeared to be in their recovery.

I’ve healed myself from a lot of things, including physical, sexual, verbal and emotional assault, as my readers know. My recovery process began when I was 23 years old in a therapist’s office in Atlanta, where I first learned the name for what had happened to me. It’s been a long journey of 25 years since that day; I’m going to be 48 years old in April, and I’m happy to say that I am at the other end of a spectrum that I have developed in my practice of observing and recording my healing. I wrote about this spectrum of healing after trauma in my 2012 book SOUL COMPOST (available for purchase here).

After a diagnosis of PTSD in 1990, I began my long process of climbing the rungs of the ladder to wholeness and a happy, actualized life. I’m happy to say that I am now an expert in PTG, or Post Traumatic Growth, defined as positive psychological change as a result of one’s struggle with a highly challenging, stressful, and traumatic event. We all know the old saying, “what doesn’t kill me makes me stronger”; as it turns out, there is a scientific term for this phenomenon that is measurable. “This growth is measured by the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996), a 21-item instrument for assessing positive outcomes in people who have experienced traumatic events. Five domains or factors are contained within the larger construct of PTG and are measured on subscales within the PTGI. The five factors include Relating to Others (greater intimacy and compassion for others), New Possibilities (new roles and new people), Personal Strength (feeling personally stronger), Spiritual Change (being more connected spiritually), and a deeper Appreciation of Life (Tedeschi & Calhoun, 2004).” (quoted from SOUL COMPOST, 2012 by Licia Berry)

I developed this spectrum of healing after trauma only after living through each of the 5 stages:

Victim  >  Survivor  >  Thriver  >  Server  >  Empowered Server
A short (and incomplete) description of each stage follows:

Victim
I call this the “Puddle on the Floor” stage. After a traumatic experience, the person who lived through the trauma may feel paralyzed, lifeless, as if there is no energy or will in them. From a shamanic perspective, it is the stealing of the life force from the victim that creates the sensation of lifelessness. From a psychological perspective, the shattering of the person’s well-being creates a schism in their psyche that renders them temporarily powerless. This is a dangerous stage because the Victim is very vulnerable, and it is essential that they seek assistance immediately from a qualified helper or someone who genuinely loves them. If they do not seek help, a pattern of learned helplessness can settle in and the person can feel powerless as they remain stuck in this stage.

Survivor
I call this the “Fight to Live” stage. In this second stage of healing from trauma, the fight begins to start to live again. There is a spark, however small, to integrate the scattered parts of self that were blown apart by the trauma. The puddle on the floor grows teeth and fingernails, and there is a mobilization of energy that can feel like gritting those teeth and crawling across the ground. An active determination to heal, as well as anger and rage identify the fight present in this stage. This is an important and difficult stage; it is easy to revert back to Victim if the Survivor does not have adequate help and resources to keep them moving forward in their healing. It can also be easy to get stuck in identifying with the Survivor stage because it feels so good to have energy after being a Victim.

Thriver
The fight to heal gains momentum and starts to propel itself forward of its own accord. The good will generated within the person who is healing starts to carry them, and the joy that is inherent in life returns. The Thriver thinks less and less about the trauma, focusing on other blessings in their life. The sun shines again. This happens in short bursts at first, when the Thriver can be triggered back into Victim or Survivor stage, but bounces back fairly quickly to thriving again.

Server
A determination to make good of the experience, to offer the lessons learned and the well-being gained to others who have experienced challenge or trauma in their life. This stage can include the Survivor and Thriver stages. Frequently a Survivor will feel the energy of the anger about their trauma and use this to become a healer or practitioner of some kind, resulting in a wounded healer who has not completed their recovery process; however, because of their stage, they may positively impact victims by mobilizing them into Survivors. A Thriver who has become a Server has a better chance of positively impacting

Empowered Server
The Empowered Server has completed enough recovery work that she feels the ground solidly underneath her, even if she is triggered by an external stimulus. She can see the trigger point and knows what is happening without falling from her confident stature into Victim or Survivor. This confidence enables her to present as a person who didn’t encounter trauma (even though she did), and to be fully present to her desire and commitment to be of service to others.

Of course, I will never be “done” healing…I find there are times I can revisit any of the 5 stages depending on the situation. However, the vast majority of the time now I spend in Empowered Server….and I find this is what changes over time….the percentage of the pie in the more joyous sections increases the more healing that I experience. May you, too.

This article is one of the most visited and popular on my blog. You are welcome to direct readers here, but please do not copy/paste. Copyright Licia Berry 2013, All Rights Reserved

There is much more to say about the 5 Stages of Healing! Read about resilience and the role of spirit in recovery from trauma in Soul Compost, first in the Woman, Awake series.

baby in arms

Also see Embracing the Dark Self (or, there is no such thing as an evil baby) and other posts documenting deep healing

Disclaimer: Licia is not a psychotherapist, but a 25 year veteran educator and facilitator with the same numbers of years of active recovery from violence and trauma. These observations are her own, culminating from her lived experience, extensive research and study, collaboration with psychologists, and observation of her clients.

Licia (pronounced LEE-SHA) Berry believes passionately in women’s innate resilience and empowerment. As an artist, author, educator, leader, mentor, women’s advocate, and compassionate guide, Licia teaches by example that women can claim their life song regardless of their experience. Licia’s visionary leadership was the force behind bringing One Billion Rising to Tallahassee in February, in which 400 women gathered and danced on Kleman Plaza to raise awareness about violence against women. Licia has a global audience of readers and clients who share her commitment to spiritual wholeness. Her personal journey of recovery from violence and post-traumatic growth is chronicled in her 2012 inspirational memoir, SOUL COMPOST.

For more information about her work, please visit www.liciaberry.com.

BUY MY BOOK!   SOUL COMPOST~ Transforming Adversity to Spiritual Growth
“an empowering memoir of unapologetic healing”  5 STARS ON AMAZON

Soul Compost bookmark front     Soul Compost book mark back
SOUL COMPOST by Licia Berry

Trafficking Survivor’s Film Launches UK Campaign

In a world where the trafficking of humans has become the second-largest criminal industry after drug dealing, a child-trafficking survivor launches a campaign for social change, with the screening of her powerfully moving, autobiographical film on 9 April in London.

Raven Kaliana with PuppetsHooray for Hollywood, a film for adult audiences, written and directed by Raven Kaliana, artist, human rights activist, and survivor, utilises puppetry to highlight the intersection of trafficking and familial abuse with organised crime, shown from a child’s point of view. A Talkback Panel discussion, facilitated by Anita Amendra (Project Manager, Sustainable Communities Programme, Initiatives of Change) will follow the film, featuring: Raven Kaliana (Outspiral), Adam Weiss (The AIRE Centre – Advice on Individual Rights in Europe), and Esther Davidson (OXCAT – Oxford Community Against Trafficking).

Kaliana states: ‘It’s my goal to humanize this issue – bring it into public discourse, so that it’s not taboo to talk about this crime… So that the perpetrators, however monstrous their actions, become in the mind’s eye only human… So that the children, however anonymised by the medium of their abuse, become living people with faces, names, families. We can begin to view this as a social problem that people who are also ‘only human’ can address. It is by caring that you unlock the door.’

Trafficking is modern day slavery, with children and adults held captive and sexually exploited in the UK and world-wide. Increased public awareness can help prevent children and vulnerable adults from falling victim and help survivors to safety. Lydia Cacho, international authority on trafficking, states: ‘The global sex industry has HoorayForHollywood-FilmStill(c)2011RavenKaliana,camera by GordonAnderson3-hirescreated a market for sex slaves that may soon outnumber the African slaves sold from the 1500s to the 1800s…The means to fight this crime lie in the hands of the world’s citizens.’

Kaliana established Outspiral in 2011, an organisation which employs puppet-based film and theatre productions for adults, combined with training, to raise public awareness in efforts to prevent the crimes of human trafficking and child sexual exploitation.

Initiatives of Change, Sustainable Communities Programme in collaboration with Outspiral presents Hooray for Hollywood as the first in a series of awareness-raising and skills-building events to build stronger communication between agencies, foster understanding of the effects of trauma, address legal enforcement issues, and enlist members and leaders of spiritual communities to take a proactive approach to protecting children and trafficked adults.

The Sustainable Communities Programme supports, promotes and works with community projects like Outspiral. Currently, the Programme provides practical advice and assistance to a range of community-based organisations, many of which engage in the arts or provide trainings working towards community cohesion, justice and protection of vulnerable people in the UK.

The event will take place at the Initiatives of Change Centre in London at 24 Greencoat Place, Victoria, London SW1P 1RD from 18:00-20:00 on Tuesday 9th April 2013.  Entry is free, but booking is essential – RSVP to reception@london.iofc.org or call 020 7798 6000.

 

EMDR: Questions and Concerns

I’ve already described the role EMDR can play in trauma treatment and given you some specifics about what the 8 phases look like. Even so, maybe you still have some questions or concerns. Let’s face it, EMDR sounds a bit odd when first described! It makes sense to have questions and do your research before considering an unfamiliar technique. If you are already in therapy, this is a good conversation to have with your therapist.

I really appreciate that some of my readers have shared their questions about EMDR because I believe they illustrate some common questions others may have as well.  and I plan to answer them here and share concerns of my own too.

As with any type of therapy, EMDR is only as good as the therapeutic alliance. Creating a collaborative therapy relationship requires trust, something that is understandably problematic for many trauma survivors. This is one issue that needs to be worked on before beginning EMDR. Every client is unique; only you know when you are there. If you do not yet feel safe enough in your therapy relationship, it may be premature for you to consider EMDR. What feeling safe means is also a big topic! For our purposes here, consider the following: Can you say no or let your therapist know something isn’t working? Are you able to ask for extra help or contact your therapist if in crisis in between sessions? Are you able to honestly report your feelings, thoughts, sensations in the moment? These are examples of the kind of safety in relationship needed for EMDR.

Good preparation to me means that before starting EMDR I want to work on basic Phase I trauma treatment stuff: safety in the form of establishing a collaborative therapeutic relationship and stabilization in the form of basic  distress reduction/management skills (grounding, relaxation, self-soothing).  Clients who have significant issues with dissociation ( not just but certainly including those who have Dissociative Identity Disorder [DID]) may need to work first on getting and staying present, more internal communication and cooperation between internal parts before considering EMDR.

EMDR can be used to help with some of the stabilization process. Part of the prep work for EMDR involves building coping skills to tolerate the feelings that may get stirred up. One of my readers addressed this issue with the following question:

“I’ve heard that EMDR can sometimes increase the anxiety – short term – of the trauma therapy, possibly overwhelming the patient. Is there any merit to this?”

My answer is that if the client is overwhelmed by anxiety during or in between EMDR sessions, enough preparation may not have been done! It is normal and an expected part of the process that strong feelings, sensations and traumatic images will arise during EMDR.  You may expect to have dreams, feelings, insights occur  in between EMDR sessions and it helps to keep a log of these to discuss. A skilled clinician helps you develop skills for coping with these before you get to the “overwhelmed” level. You will have learned techniques for coping with distress in between sessions. At the end of each session of EMDR, the therapist will help you get some closure:

The Closure ensures that the person leaves at the end of each session feeling better than at the beginning. If the processing of the traumatic target event is not complete in a single session, the therapist will assist the person in using a variety of self-calming techniques in order to regain a sense of equilibrium.

EMDR works best when the protocol is closely followed. One of my concerns is that some therapists may claim to provide EMDR without having completed the training. Or without an in-depth understanding of trauma treatment overall. Ironically, as I started this series I got linked to by a site claiming to provide treatment using “parts of EMDR”. This is a red flag to me and something I’d urge trauma survivors to avoid. If you want EMDR, make sure to ask your clinician if (s)he is using EMDR according to the training standards and guidelines of the EMDR International Association or EMDR-Europe.

Why are establishing a good working therapy relationship, initial preparation and seeing a therapist who has had proper training so important? Because you can have a bad experience otherwise! Another reader illustrates what can go wrong when these things are not in place:

“I’m afraid my experience was not good, although I still believe EMDR would be an appropriate therapy for me. The problem was not the process but the therapist. She was a chronically late person. We never started our sessions on time and would frequently not get started on actual work until my appointment time was half over. Then we would run out of time. So we would have started the process and have me to say 5 on the scale and she’d say, “Oh, I’m sorry. My next client is here. But you can finish this yourself. If you have a crisis, call me any time, you have my number.”

In my opinion, a therapeutic alliance requires that the therapist hold up her/his side of the bargain. Being consistent about the therapy frame is part of this. This example also illustrates for me problems with following the 8-phase protocol: there is no closure! EMDR is not a “do it yourself” sort of technique!

Finally, I think it is crucial that therapists using EMDR have a good overall knowledge of trauma and trauma treatment. Since so many trauma survivors experience dissociation, this includes the ability to at least screen for the existence of dissociative disorders like DID. Another reader asked:

Can you possibly discuss how this might work in a DID patient? There are so many variables in dealing with DID, I can’t seem to wrap my mind around how that might look.

Great question! there is so much to say about the treatment of DID in general I think that needs to be its own series of blog articles. For now, let me say that a therapist providing EMDR to someone with DID needs to be knowledgeable about the treatment of DID overall. Safety and stabilization is crucial in the treatment of DID as with any complex trauma work but with the addition of focus on helping the client gain awareness of their internal system. Developing internal communication and cooperation is crucial before embarking on trauma processing of any kind. In the ideal situation a dissociative client would already have developed the ability to negotiate with other parts to reach consensus about processing a part traumatic event.

I hope this EMDR series answers at least some of your questions about this form of trauma treatment. As always, I welcome more comments and questions on the subject!

Kathleen Young, Psy.D.