“Recovery cannot occur in isolation” — these are the words of Dr. Judith Herman, a psychiatrist and author whose stages of trauma recovery serve as a roadmap for many therapists and trauma recovery programs invested in the healing of their clients. Much of what follows in this post is summarized from Dr. Herman’s work. Dr. Herman has already done such an effective job of outlining these stages that this article is really intended to honor her original ideas as much as possible while still sprinkling in some original insight and anecdotes throughout. If you are interested in directly engaging with Dr. Herman’s ideas, check out her book, Trauma and Recovery or this recorded interview from The University of California’s Conversations with History.
Let’s begin with Dr. Herman’s quote: “Recovery cannot occur in isolation.” This is something mentioned often in previous posts, that healing happens as part of a community and with the love and support of friends, family, mental health providers, fellow survivors, and others who are a part of the “team” that makes recovery possible. This is especially important because disconnection from others can be a huge part of the impact of trauma. Counteracting this disconnection means creating new connections, though getting to this point can take a long time and a great deal of hard work. The other “core experience” of trauma that Herman talks about is disempowerment and as such, recovery also means focusing on the opposite of that: empowerment.
The goal here is that through connection and empowerment, survivors learn to regain control. This means, and this is crucial, survivors must have power and control during their treatment process. The therapeutic relationship has a natural power dynamic that cannot be ignored. A client comes to a mental health provider for treatment and the provider, who holds some authority here (whether we are comfortable admitting it or not), helps the client. But that helping does not happen (successfully anyways) if the provider is imposing a treatment plan — all work needs to be done in collaboration, especially with trauma survivors. It is that collaboration that gives power and control back to the survivor which in turn gives them a genuine sense of safety and autonomy.
A final note on the broader recovery process before outlining the three specific stages: transparency is key. Survivors deserve to know and to understand their diagnosis (if they have one) and they deserve to understand their treatment plan: what is working, what is not, and why. To any survivors who may be reading this, it’s okay to ask questions, it’s okay to ask A LOT of questions. You are the expert of your own experiences and you are entitled to understand how trauma is impacting you and what your healing journey might look like. This being said, self-advocacy and asking for help is difficult and sometimes scary for trauma survivors (for everyone really!). So to any mental health providers reading this, please listen to your clients and be open and honest with them; let them know that they are not alone.
Stage One: Establishing Safety
The first, and perhaps most important stage of trauma recovery is about establishing safety. This stage might last a few days or it might take years depending on the level of trauma. Everyone’s journey and timeline is different. Often, if the trauma is complex and the result of long term abuse, especially abuse that began in childhood, there is a lot of “unlearning” that needs to happen and so this stage can take longer. The goal in this stage is for survivors to first feel comfortable and safe within their own bodies and within their own nervous systems. For those whose body boundary has never been violated, the idea of feeling unsafe in one’s own body may be a difficult thing to conceptualize, but this is what often happens for trauma survivors who have experienced violence. Imagine feeling unsafe in your own body; it is a form of imprisonment. It is for this reason that safety starts with the body and only when the body feels safer can survivors move on to establishing safety within their physical environment.
Stage Two: Remembrance and Mourning
In this next stage, survivors may begin to tell the story of their trauma. Survivors choose when they are ready for this step (remember, empowerment and control are key to recovery) as it usually involves recalling the trauma in detail to a mental health provider. Within the safety of the therapeutic alliance, survivors share their trauma and their emotional responses to their trauma. This process can be very intense and at times, terrifying, but it is important to process the trauma in order to move on to the next stage. However, given the delicate nature of this step, safety has to be maintained and if things begin to feel extremely unsafe again, it might be necessary to shift back into stage one. Recovery is NOT linear.
Once the challenging work of sharing the trauma has happened, there may be a process of grief and mourning. Survivors often have to mourn the many things, people, and experiences they have lost. Ultimately, this grief and mourning leads to acceptance and in many ways, liberation.
Stage Three: Reconnection with Ordinary Life
This stage is exactly as it sounds — it is in this phase of recovery that survivors are ideally feeling more comfortable with trust and intimacy and more prepared to start building new relationships and rekindling old ones. New friendships might be made, the possibility of a romantic partnership may emerge, and survivors may find themselves reconnecting with loved ones they have previously been unprepared to engage with. There can be a great deal of personal resolution in this stage — some survivors will join social and political movements while others may go on to help others heal from their own trauma. Still, the majority of survivors in recovery will simply go on to live their everyday lives with less fear and more meaning and presence — this in itself is beautiful and profound.
Trauma Recovery at Sanctuary
You’ll find that Sanctuary’s levels of support closely mirror the stages outlined in this article. We also prioritize safety before the hard work of processing can begin, and our goal for the survivors that we work with is that they reach a place of reconnection and integration where they can begin planning for the future, making meaning out of struggles, and engaging more fully in relationships and life activities. You can read more about Sanctuary’s levels of support here.
Recovery Coach, Sanctuary Healing NYC
Herman, J. L. (1998). Recovery from psychological trauma. Psychiatry and Clinical Neurosciences, 52(S1), S98–S103
Trauma and Recovery: The Aftermath of Violence — from domestic abuse to political terror by Judith Herman, M.D.
Conversations with History: Judith Herman, presented by UCTV
Sanctuary Healing Levels of Support