The 3-Phase Treatment Approach for Complex Trauma

A ‘three-phase’ treatment protocol is considered the gold standard in working with complex trauma. A phase approach provides a framework for designing trauma treatment, but it doesn’t provide the how. It’s tempting to expect a standardised protocol will provide a magic cure, but when it comes to complex-PTSD, developmental trauma, and attachment ruptures, ‘relational’ interventions are the bedrock upon which all successful treatment is built. ‘Relational’ is, by definition, two-person centred, interdependent, dynamic, unexpected, and at times, unpredictable.

When it comes to complex trauma, we are more often creating ‘missing’ relational experiences in our work with clients rather than completing ‘incomplete’ experiences, which we are most often doing with single episodic trauma like an accident or fall.

I’d like to offer an analogy to explain this process.

Our early experiences of attachment are supposed to create a ‘mattress’ upon which all our future experiences of relating can be analysed, interpreted, and understood. If our caregivers didn’t love us when we were young, our physiology doesn’t easily join the dots when it comes to sensing - actually feeling and knowing in our bodies - that we are loved.

Similarly, if no-one could be trusted to consistently meet our needs when we were an infant, then there is a blank spot in our body where ‘trust’ is supposed to exist.

Although we can teach ourselves to know and recognise love through our mind, and we may even be able to coach ourselves (or be coached) to trust someone else, our default neural programming exists that tells us we are unlovable, we can’t trust anyone, and perhaps, if we have been senselessly and needlessly abused, we will expect people to attack us.

These core beliefs about our loveability and others’ trustworthiness are established before we are able to use language, and therefore they are stored in the body. We can’t access these core beliefs through mindset work. This applies to all pre-verbal trauma.

Working With Complex Trauma - sketch of tiger — Nervous system specialist

Phase 1: Safety, stabilisation, resourcing and self-regulation

The first phase of safety and stabilisation is central and foundational to trauma counselling. It must be the focus of treatment before any work progresses to phases 2 and 3. The safety and stabilisation of Phase 1 also needs to be established time and again, repeatedly throughout the work. The 3-Phase Treatment Approach is not linear (albeit organised into three phases).

The primary task of this phase is building the client's ability to tolerate emotion and developing the capacity to self-regulate. This includes discovering, developing and refining strategies for the client to become mindful when they are overwhelmed and how to implement self-regulation strategies to calm their dysregulated nervous system.

Phase 1 is also about learning to understand the effects of trauma through psycho-education. The client learns to recognise some of the symptoms and meanings of their body sensations, their emotions, and their thoughts.

The client works with their therapist to build safety and stability by:

Learning to feel safe in their own body
Learning how to calm their body and self regulate, gaining emotional stability
Establishing a safe living environment
Building stable relationships, career and supports

The goal of this stage is to create more safety and stability in the client's world, this supports them in being able to safely remember the trauma instead of re-experiencing it. Attempting to ‘process’ trauma without having first established the ability to self-regulate can move a person into overwhelm and re-traumatisation.

The ability to access both internal and external resources is central to wellbeing and is radically impeded by unresolved trauma. Self-regulation depends upon the capacity to access internal resources and is also the pre-condition for trauma processing.

When we consciously and deliberately engage in practices that produce physical calmness, we signal the limbic brain that we’re safe at a physiological level.

Phase 2: Processing of traumatic memories

Processing complex trauma is a Phase 2 task and is never entered into without doing the groundwork of Phase 1.

During the processing trauma phase, the emphasis is on the impact the trauma has had on the person in contrast to the content or narrative, or explicit details of the trauma. It’s not the details of the memory that are important; it’s the effect of what happened to them. Somatic and neural processing are key to this phase of treatment, the capacity to do this has been gradually built during phase 1. Some attention is given in this phase to supporting the client to overcome the fear of traumatic memories so they can be integrated, allowing appreciation for the person the client has become as a result of the trauma.

Phase 3: Integration and Meaning-making; Consolidation of treatment gains

After processing trauma from the past, survivors can begin the task of integrating their experiences and creating a new future with trauma resolution therapy.

This phase of treatment involves developing a new self. It focuses on decreasing feelings of shame and alienation. As the person further enters into day to day life, they work towards overcoming normal fears in life, navigating healthy challenges and change, and moving towards creating intimacy. As their life becomes reconsolidated around a healthy present and a healed self, the trauma feels farther away, part of an integrated understanding of self, but no longer a daily focus. They can acknowledge the ways that trauma has changed them as a person and begin to move forward with who they are now - with the trauma a part of their history, but not defining how they respond to their present circumstances.