This piece explores the interrelationship between trauma and recovery in psychotherapy. While it does not discuss any specific details of traumatic events, it is important to acknowledge that the topic itself may bring up unwanted memories or reflection.
I n my office, I have a framed quote by the poet Morgan Harper Nichols hanging on the wall: “I am remembering to breathe right here in the chaos of things.” While it escapes the gaze of most of my clients, I like to highlight it when we begin to discuss coping skills. “It may feel silly to do this,” I tell them, “but let’s take a couple of moments and sit with these words.” We both, then, take a deep breath.
I am a new psychotherapist. After seven years working in other parts of social work, I decided to make the professional leap to trauma-focused therapy last year. I am still figuring out if I had the courage to make this shift in spite of the COVID-19 pandemic or because of it. On the one hand, I’ve been drawn to work as a therapist since my own healing experiences in therapy as a survivor of trauma. This recognition, in concert with my skill set in clinical work, made the career move to psychotherapy seem like an inevitability. On the other hand, the pandemic shed light on the magnitude of mental health needs and how urgently people needed support. I knew I had the capacity to help. Either way, I entered into the world of my clients at a time when crises of all sorts were coming to a head.
The past year left many of us feeling whiplashed, our nervous systems vacillating for months between anxiety and dissociation. Furthermore, physical distancing stripped us of typical coping strategies, especially our in-person social interactions. In my work, I find that one of the most detrimental, but often overlooked, effects of this pandemic is how it forces us to view other people not as sources of comfort and community, but as potential threats to our wellbeing.
The polyvagal theory of psychiatrist and neuroscientist Dr. Stephen Porges posits, among many other claims, that safe relationships are a necessary part of our ability to regulate emotions and stay calm. In isolation, we lose these regulatory abilities. Hypervisibility of systemic injustices paired with additional hardships brought on by the pandemic, like economic uncertainty and shifting relational dynamics due to increased time at home, exacerbated underlying wounds and insecurities. My clients, recognizing the weight of this awareness, sought out my help and invited me into their lives.
When faced with tragedy, initial responses are often: How do we recover from this? How do we get back to the way things used to be? What I have found in trauma work, however, is that these questions fall short. A return to “how things used to be” would fail to address the gravity of the harm committed and does nothing to center the experiences of those most impacted. In the therapeutic process, we push beyond these initial questions to gently explore the transformative potential of trauma recovery.
“Trauma, at its core, is about feeling powerless. Reclaiming power is at the core of the healing process.”
This exploration requires an understanding of the nature of trauma. The Substance Abuse and Mental Health Services Administration (SAMHSA) in the US defines trauma as "an event, series of events, or set of circumstances” that overwhelms an individual’s ability to cope. There is no threshold for how “bad” something needs to be for it to be considered traumatic. A trauma response is completely individualized: two people can go through the same exact event and one can go on to experience it as traumatic while the other does not. Trauma, at its core, is about feeling powerless. Reclaiming power is at the core of the healing process.
In 1992, American psychiatrist Dr. Judith Herman, whose work wrestles with questions of trauma, published Trauma and Recovery. It was one of the first books to comprehensively conceptualize and explore the process of trauma recovery. Among those working in psychiatry, Dr. Herman is best known as the developer of the complex post-traumatic stress disorder diagnosis (C-PTSD) and for laying the groundwork for the practical application of trauma theory.
Her aforementioned book introduces the three stages of trauma recovery: establishing safety; remembrance and mourning; and integration and reconnection. These stages are not meant as checkpoints in a linear process. Rather, by categorizing the type of healing work happening in each phase, we come to understand recovery as a process of transformation, rather than one of trying to return to a pre-traumatic state.
In order to embody this exploration of trauma recovery, let’s use a case example.
Meet Rita. She’s in her mid-30s, lives in the suburbs, works for city government, and is a single mother to two school-aged children. Like many of my clients, she reached out to me because she felt overwhelmed, exhausted, and disconnected in her relationships. As with many people, Rita had managed these problems for some time before the pandemic brought them to a head. I asked if she sometimes felt powerless over her emotions, as if we were stuck on “autopilot.”
She nodded. When faced with a problem, she told me, she rarely knew whether she would fight back or completely shut down. Ten minutes later, she was holding back tears. She stumbled through her responses. She kept apologizing.
I explained that this space could be whatever she needed it to be.
I nodded and reaffirmed her choice to spend our time together however she needed. In that moment, my work as a therapist entailed validating her emotional response and creating containment. Therapeutic containment is not about ignoring or limiting emotions, but creating a space where the client knows their pain will be held safely with another person in a certain context. I pointed to the quote on my wall and discussed how our breath can help us regulate our emotions when we feel overwhelmed. We started breathing together until she felt calm enough to speak again.
At our next session, I circled back to this interaction. She shared how she spent her whole life repressing her feelings because, as she said, “showing my emotions never got me anywhere.” Rita explained she experienced abuse and violence throughout her life. The people around her often minimized, dismissed, or exploited her. Rita also named her frustration with feeling stuck on “autopilot.”
I validated these feelings, sharing that they were common for people who have experienced trauma. Although our nervous system is designed to help keep us safe from harm, I explained, after a traumatic experience, the nervous system can activate survival mode even in non-threatening situations. In Dr. Herman’s words, “the human system of self-preservation seems to go onto permanent alert, as if the danger might return at any moment.”
Is this phenomenon always helpful to us? No. But it is understandable.
It’s important for Rita to feel safe in our relationship before we can really process her story together. For some clients, this may take a couple of sessions, whereas for others, this can take months, even years. As the therapist, I support her by staying consistent, by giving her decision-making power as often as I can. I also pay attention to her nonverbal cues, being careful not to recreate a dynamic in which she feels powerless. Outside of therapy, we continue to build her sense of safety by working on asserting boundaries with people who often take advantage of her.
This stage of recovery—establishing safety—also necessitates that I, as the therapist, recognize how systemic inequities create obstacles to our goals. It is my responsibility to engage in critical self-work to create safe containment for my clients, including attending to my own trauma story and engaging with my identity and privilege.
Remembrance & Mourning
As our sessions progressed, I checked in with Rita occasionally to see how she felt about moving into the next phase of processing her story. For about four months, she said she felt unsure. But a short time later, she felt ready to move into the next stage of our work together. She shared that the consistency of our relationship made her feel confident enough to trust me with the most painful aspects of her trauma. It was a small but pivotal moment in Rita’s therapeutic journey. She found the courage to reclaim her story. I was honored that she felt safe enough to share.
There are many different evidence-based ways that trauma therapists work in this stage. Key to most of them is reconstructing the trauma story. This entails processing the emotional and physical sensations related to the trauma while staying connected to the safety of the present moment. Trauma’s impact on memory makes this particularly challenging.
Traumatic experiences are stored as fragmented memories and re-experienced as overwhelming emotions or physiological sensations like chronic pain, inflammation, insomnia, nightmares, and even physical distress. Thus, it is often easier to avoid the memories of trauma altogether. Dr. Herman explains this phenomenon when she writes “the conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma.” People often feel stuck between their desire to share what happened to them and their avoidance of the pain, both psychological and physical, that results from doing so. The survivor is torn between their desire to engage with the story and to escape it.
“Grief always hangs out longer than one would like, but does eventually lose its potency.”
Rita mentioned she was tempted to skip sessions and avoid therapy. She came anyway, because she felt strongly that our time in therapy would help her reclaim the power that was taken from her. Hand in hand with the reclamation of one’s story is also the grief that accompanies the realization of what was lost. I describe to my clients this “crockpot of grief.” Its ingredients often include sadness, anger, frustration, guilt, but also self-compassion, relief, joy, and love. The complexity of these emotions can be confusing as they continue to simmer together over time. It is natural to avoid or rush through these confusing feelings. Grief always hangs out longer than one would like, but does eventually lose its potency. While the process of recovery looks different for everyone, there are commonalities. These include validating and accepting the reality of our loss, allowing ourselves to feel the emotions associated with it, adjusting to present challenges, and reimagining our future.
Rita and I started by creating a timeline of her major life events. This helped us organize, contain, and contextualize the traumatic experiences with what was happening at the time they occurred.
We then dug into the sensory and somatic information she remembered from the incidents, the body’s memory, and constructed a narrative. Rita engaged with the most frightening pieces of these memories and regained more control of them. This eventually took some of their emotional sting away. Rita was eventually able to acknowledge and regulate her feelings surrounding the event.
In retelling the story and reconnecting to the safety of the present moment, she was able to differentiate who she is now from what happened to her in the past. Through differentiation, Rita could remember what happened to her without re-experiencing it fully. She was able to remind herself that she is more than what she experienced and that she has the power to author her own story. “Paradoxically,” Dr. Herman writes, “acceptance of this apparent injustice is the beginning of empowerment.”
Instead of being bogged down by survival mode and its accompanying emotions, Rita felt an increased capacity to engage in her relationships and take ownership of her future. While the remembrance stage was exhausting, Rita shared that it was also energizing to be validated in this way for the first time.
As Rita confronts new challenges in her life, parts of her trauma story will undoubtedly reactivate. Remembering and mourning the harm are not a one-time event. However, Rita will be able to navigate those recurrences while staying grounded in the present moment.
She has successfully gone through the stages of recovery before. She can find peace in knowing she can do it again.
Eventually, Rita reached a place in our work which Dr. Herman described as the endpoint of this stage of recovery: when the individual “reclaims her own history and feels renewed hope and energy for engagement with life.” It was a major breakthrough, a cause for celebration. I brought her favorite snack to our session. Playing “Pomp and Circumstance” on my computer, we both laughed when I described it as her graduation ceremony.
We both knew the process was not over. Nevertheless, I wanted to recognize her efforts, all those months of painful and intense work.
Integration & Reconnection
In the integration and reconnection stage, we focused on replacing her old beliefs that stemmed from trauma with new beliefs that she proactively explored. Primarily, Rita challenged her belief that her emotions and voice do not matter in relationships. This component of her therapeutic recovery was particularly important, as disconnection from other people is core to the experience of traumatization.
“Recovery can only take place in the context of relationships” wrote Dr. Herman. “It cannot occur in isolation.”
As always, the pandemic complicated things; Rita was not able to forge and deepen relationships as easily as she might have in the age before physical distancing. Despite that obstacle, Rita was intentional about reaching out and communicating with her social supports on a routine basis. This routine led to confidence. She asserted herself in conversations. She practiced coping skills in preparation for overwhelming emotions that still lay ahead. She even shared parts of her trauma story with a friend.
With time, Rita deepened her capacity for connection. She no longer feels overwhelmed by all close relationships. Instead, she sees them as a source of hope, something they weren’t before.
Throughout recovery, but especially in the reconnection stage, people often explore the ethical questions of harm, as well as questions of justice: do I want to hold accountable the people who harmed me? How do I want to hold them accountable? How should they be held accountable?
For some people, accountability is achieved through formal or legal routes. Others prefer to engage in social action with others. Some simply want to speak their truth.
For Rita, such questions are pressing and ongoing. To fully explore these questions, Rita must feel in control so she can be empowered to do what she believes is right. No matter what Rita decides, she is reclaiming her story and power.
The Power of Transformation
Recovery is complicated. When taken out of context, the idea of trauma recovery can imply a return to how life was before. However, as Rita’s case has shown, recovery from trauma implies transformation, not return. Transformation does not justify traumatization but it does point to resilience and hope in the face of tragedy and suffering.
Dr. Herman understood that the work of a survivor’s trauma recovery has the potential to transform not only them, but also the therapist and even society. Individual and collective healing are symbiotic and relational.
“Individual and collective healing are symbiotic and relational.”
While I admit I sometimes struggle to see the transformative potential of trauma, especially as I continue to witness the ongoing perpetration of systemic harm, my own humanity deepens when I bear witness to the trauma and stories of my clients. It begs me to ask myself moral questions and forces me to confront my own fragility, privilege, and experiences of trauma. It deepens my awareness of systemic harm and gives me the courage to work towards the disruption of these systems.
And when I feel overwhelmed by the magnitude of the work ahead, I start by remembering to breathe, right here, in the chaos of things.
Note: Case examples used are not based on any individual person, but multiple interactions and stories in my clinical work. This piece is by no means a comprehensive example or representative of what all trauma work can look like. Each person is different and will need a different approach in therapy. Any resemblance to actual people and events is coincidental.
Resources for Support
National Suicide Prevention Hotline: 800-273-8255
For additional resources, go to www.michaelzuch.com/resources