A Stages Model

The most common approach to thinking/feeling about the process of recovery from trauma or abuse is to conceptualize it as working through a series of stages. Herman summaries several such models in a helpful table (Judith L. Herman, Trauma and Recovery, BasicBooks, 1991, p 156]

Syndrome Stage One Stage Two Stage Three
Hysteria(Janet 1889) Stabilization, sympton-oriented treatment Exploration of traumatic memories Personality reintegration, rehabilitation
Combat trauma(Scurfield 1985) Trust, stress management, education Reexperiencing trauma Integration of trauma
Complicated post-traumatic stress disorder (Brown & Fromm 1986) Stabilization Integration of memories Development of self, drive integration
Multiple personality disorder (Putnam 1989) Diagnosis, stabiliation, communication cooperation Metabolism of trauma Resolution, integration, development of postresolution coping skills
Traumatic disorders (Herman, 1992) Safety Remembrance and mourning Reconnection

 

Others have produced models involving many more ‘stages.’ For example, Bass and Davis suggest the following 14 stage model: (Ellen Bass and Laura Davis, The Courage to Heal, Harper and Row 1988 pp 58-59)

1. The Decision to Heal. Once you recognize the effects of sexual abuse in your life, you need to make an active commitment to heal. Deep healing happens only when you choose it and are willing to change yourself.

2. The Emergency Stage. Beginning to deal with memories and suppressed feelings can throw your life into utter turmoil. Remember, this is only a stage. It won’t last forever.

3. Remembering. Many survivors suppress all memories of what happened to them as children. Those who do not forget the actual incidents often forget how it felt at the time. Remembering is the process of getting back both memory and feeling.

4. Believing it Happened. Survivors often doubt their own perceptions. Coming to believe that the abuse really happened, and that it really hurt you, is a vital part of the healing process.

5. Breaking Silence. Most adult survivors kept the abuse a secret in childhood. Telling another human being about what happened to you is a powerful healing force that can dispel the shame of being a victim.

6. Understanding That It Wasn’t Your Fault. Children usually believe the abuse is their fault. Adult survivors must place the blame where it belongs – directly on the shoulders of the abusers.

7. Making Contact With the Child Within. Many survivors have lost touch with their own vulnerability. Getting in touch with the child within can help you feel compassion for yourself, more anger at your abuser and greater intimacy with others.

8. Trusting Yourself. The best guide for healing is your own inner voice. Learning to trust your own perceptions, feelings and intuitions forms a new basis for action in the world.

9. Grieving and Mourning. As children being abused, and later as adults struggling to survive, most survivors haven’t felt their losses. Grieving is a way to honor your pain, let go, and move into the present.

10. Anger. The Backbone of Healing Anger is a powerful and liberating force. Whether you need to get in touch with it or have always have had plenty to spare, directing your rage squarely at your abuser, and at those who didn’t protect you, is pivotal to healing.

11. Disclosures and Confrontations. Directly confronting your abuser and/or your family is not for every survivor, but it can be a dramatic, cleansing tool.

12. Forgiveness? Forgiveness of the abuser is not an essential part of the healing process, although it tends to be the one most recommended. The only essential forgiveness is for yourself.

13. Spirituality. Having a sense of a power greater than yourself can be a real asset in the healing process. Spirituality is a uniquely personal experience. You might find it through traditional religion, meditation, nature or your support group.

14. Resolution and Moving. On As you move through these stages again and again, you will reach a point of integration. Your feelings and perspectives will stabilize. You will come to terms with your abuser and other family members. While you won’t erase your history, you will make deep and lasting changes in your life. Having gained awareness, compassion and power through healing, you will have the opportunity to work toward a better world.

The whole concept of ‘stages’ implies that the process of recovery has texture — something that is helpful at one stage of the process may not be helpful (or as helpful) at another stage. For example, the kind of group process that is helpful in the earliest stages of recovery may not be optimal in later stages. This will have very significant implications for any ministry strategy.

It is important to emphasize that most people who conceptualize recovery as a series of stages do not think of recovery process as linear. The work that needs to be done in one stage may need to be revisited as part of later work. The process may need to be repeated multiple times. The boundaries between stages may be quite fluid. Many other kinds of complications are possible. It is also important to emphasize that ‘stages’ does not imply a gradual movement from ‘easier’ stages to ‘difficult’ stages. All the stages are demanding, challenging.

My instincts are that the three-stage model has some advantages. Longer lists may provide a more comprehensive list of the tasks that need to be done — but they don’t usually help much in figuring out which things are best done first and which things might be better to do later.