Therapy for abuse, combat, or other forms of trauma
The research literature for helping adult survivors of traumatic events suggests that you and your therapist should consider a different treatment approach depending on whether you are coming to therapy to work through a single traumatic event that occurred one time versus multiple traumatic events in your past.
For adults who are coming to work through multiple past traumatic events, Christine Courtois and Julian Ford have done research for several years about how to best help adult survivors of repeated trauma. They propose a 3 stage process for therapy with adult survivors of this kind of trauma or abuse. The 3 stages are:
- Phase one: Working on issues of personal safety, stabilizing current symptoms, and engaging in treatment
- Phase two: Working on emotional processing of the trauma
- Phase three: Consolidating treatment gains
For many adult survivors, this form of therapy will take between one to two years to complete.
There are several evidence based therapies that are geared more toward processing a single event. Cognitive processing therapy (CPT), Prolonged Exposure Therapy (PE), and Eye-Movement Desensitization Reprocessing (EMDR) are all evidence based practices. We prefer the use of Cognitive Processing Therapy due to its substantial evidence based, its emphasis on correcting trauma-related cognitive errors, and the relatively less stressful nature of CPT compared to PE. In CPT, after learning some techniques to help you cope with the stress of talking about past trauma, your therapist will ask you to write out your narrative of what happened. Then, you will be asked to journal about the event repeatedly, and to take the journal into session for help in working through the trauma.
Many times survivors of trauma need additional help in learning coping skills for dealing with the stress of talking about before trying to do. This idea is explicitly addressed in Courtois and Ford’s model for treating survivors of complex trauma. We frequently recommend Skills Training in Affect and Interpersonal Regulation (STAIR) as an evidence based treatment for dealing with trauma related symptoms. STAIR can be particularly helpful if completed before attempting CPT or another therapy geared toward trauma processing. In STAIR, your therapist will help you learn coping skills for trauma related symptoms without asking you to talk about the traumatic event or events themselves. For most adults, this serves to reduce their traumatic stress symptoms without creating stress to participate in the therapy.