The Phases of Trauma Therapy

Written by Lauran Hahn, LMHC,
Founder of Mindful Living Counseling Orlando

You want to start trauma therapy, but you're afraid to pick up the phone. You've spent years avoiding anything that reminds you of the trauma, so the last thing you want to do is call a trauma therapist. As a trauma therapist in Orlando, I understand. Many of my clients are often fearful of coming to trauma therapy and actually facing it.

At Mindful Living Counseling Orlando, we help people heal from trauma at a pace their nervous system can handle, so they can go through life without carrying the heaviness of their trauma.

Often the biggest fear is not being able to handle going back through the trauma. That fear makes a lot of sense. It's very likely that you have been trying to avoid thinking about or remembering aspects of the trauma, because it can be very overwhelming to the nervous system. That is where the phases of trauma therapy come in.

What Are the Three Phases of Trauma Therapy?

The three phases of trauma therapy are stabilization, processing, and integration. This phase-oriented approach is based on psychiatrist Judith Herman's three stages of trauma recovery, and it is considered the cornerstone of complex trauma treatment. It's how we work in our practice. One of the ways I describe phase-oriented treatment to my clients is that phase one is like Band-Aids, phase two is like surgery, and phase three is integrating back into life and starting to trust yourself again.

Phase One: Stabilization

Why We Start With the Nervous System

When we have a traumatized nervous system, we can feel dysregulated, because aspects of that trauma are living in the brain, the body, our memories, and our emotions. When something consciously or subconsciously reminds us of that earlier event, our nervous system can start to activate as if that trauma were happening now.

So the first thing we do in phase-oriented trauma therapy is stabilization. We learn how your nervous system is regulated, and we identify specific tools that will help you regulate your own nervous system. In this phase, we use a lot of mindfulness and grounding techniques, orienting to safety, and ACT and DBT skills. If we're working with attachment trauma, we'll also use parts work informed by Internal Family Systems (IFS).

Getting to Know Your Nervous System

The first part of stabilization is getting to know your nervous system: understanding how it responds to certain triggers and stressors, and learning how to regulate it. The first step is understanding when you're dysregulated. When we can start to observe ourselves and understand that these intense feelings are about nervous system dysregulation, then we can say, "OK, now I need to bring in some of the tools that help."

When Your System Runs High: Hyperarousal

Hyperarousal is a lot of energy and a lot of activation in the nervous system. It can look like anxiety, fear, or anger. If you tend toward hyperarousal, we need to use interventions that down-regulate the nervous system and develop tools that can bring that energy down.

When Your System Shuts Down: Hypoarousal

The nervous system is actually seeking equilibrium, but it cannot sustain hyperarousal long term. When it jolts up into hyperarousal and stays there for a long time, it can jolt down into hypoarousal, a shutdown state where you feel stuck in the mud. For some people, shutdown is the first response, because that is how they learned to survive. It was safer for them to submit to what was happening in the environment.

For people who get stuck here, stabilization is really individualized. We look for the things that bring your energy up, whether it's being outside, music, exercise, or any other activity, and we use those as resources. Then we have you engage in those activities outside of session too.

What I have found over the years is that people in this group have often lost touch with themselves and the things that bring them joy, because it was safer to completely disconnect from themselves. They've lost connection with their own thoughts, voice, preferences, and boundaries, and with the ability to assert themselves and to enjoy. The first step is learning how to connect back with themselves and the things that bring them joy. Then they can learn to have boundaries in order to protect that sense of self.

The Band-Aids

The skills we learn in stabilization are the Band-Aids: learning how to cope and how to regulate. They are great for the short term, but they are not long-term solutions.

Building Capacity Before Processing

One of the things I say to my clients is that we have to create enough space in your nervous system so that you have the capacity to feel a little worse before you feel better. If you don't have the capacity yet, then therapy focuses on extending your window of tolerance to prepare you for processing.

Phase Two: Processing

When we get into processing, we are actually excavating, working at the root level. This is the surgery. In this phase, we process the actual wounds, or the difficult moments in your life. At Mindful Living Counseling Orlando, we use specific trauma processing models such as EMDR, Sensorimotor Psychotherapy, and Internal Family Systems (IFS).

This is the part of therapy where we work to desensitize the nervous system response in the body. We work through the nervous system response, the emotional response, and how the difficult time has impacted what you perceive through your five senses.

Often after a traumatic event, we have somehow personalized something that was, for the most part, out of our hands, and turned it into a negative belief about ourselves. One step in processing is identifying those negative beliefs.

Physical Trauma and Attachment Trauma

How we approach processing also depends on the kind of trauma. Physical trauma is often a single event: an immediate threat to the safety of yourself or others, when you are fearful of being physically harmed, or of a loved one being harmed. Attachment trauma is relational trauma.

There is a distinct difference in how we process these. Physical trauma typically impacts our five-sense perception: what we saw, heard, smelled, tasted, or felt. Attachment trauma is more about our emotions, our view of ourselves and others, how safe we feel in relationships, and our confidence.

You can have both. If there was abuse inside the family system, that is complex trauma, where there is both physical trauma and attachment trauma. That's why it's important to make sure you're working with a skilled trauma therapist before you begin processing.

Phase Three: Integration

In integration, we take what we have learned about ourselves and the world, and how our nervous system has become regulated, and we start to integrate this new way of being into our lives: into our belief system, our worldview, and our trust in our ourselves and others. Where processing works with negative beliefs, integration is about adaptive beliefs. We are able to assign the appropriate responsibility and start to see ourselves from a neutral to positive place.

In integration, people begin to do the things they avoided before therapy with neutrality and ease. There is a freedom that comes with being able to go through life without carrying the heaviness of their previous trauma. Many times, people move from a disempowered place to an empowered place, and they recognize the resilience that actually carried them through the trauma, which they couldn't see before. Now they embody their own resilience.

How Long Does Trauma Therapy Take?

People very often want to know how long trauma therapy takes, but it really is individualized. It depends on many things, such as the complexity of your trauma history and your sense of safety, resources, and community in your present-day life. If you're under a tremendous amount of stress right now, we have to slow things down. For someone with a complex trauma history, it could take longer.

Starting Trauma Therapy in Orlando

If you're scared to pick up the phone, know this: at Mindful Living Counseling Orlando, before you start any processing, we'll help you create resources so that you can cope better with your daily life now and have strategies for when you start processing. We will not bypass your fears. We'll slow down, address your fears, and set the pacing of therapy in a way that honors your nervous system's capacity.

Wherever you seek therapy, look for a trauma therapist who will build resources with you first and pace the work to your nervous system.

If you're ready to start, our trauma therapists in Orlando will get to know your nervous system, help you build the resources you need, and pace the work in a way that honors your capacity. If past experiences are still showing up in your body, your emotions, or your relationships, EMDR therapy may be part of that work.

About Trauma Therapist Lauran Hahn, LMHC

Lauran Hahn, LMHC (FL License #MH15246), is the founder of Mindful Living Counseling Orlando and a licensed therapist who understands the challenges of coping with trauma and anxiety, and helps clients move through trauma therapy at a pace their nervous system can handle. As a Certified EMDR Therapist and EMDRIA-Approved Consultant and a Certified Sensorimotor Psychotherapist, she is dedicated to guiding individuals on their healing journeys.