Phase-oriented trauma treatment

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Janet, Judith Herman · 1992

What it is

Phase-oriented (phase-based, sequenced) treatment is a framework for ordering therapy for complex trauma. It is not a single technique set. Clients with prolonged interpersonal trauma often have PTSD plus problems with emotion regulation, relationships, attention and consciousness (dissociation),…

Format

• Format: individual therapy is preferred; a therapist-led group is an acceptable alternative. Add medication review for symptom acuity and a safety plan if the client is still in danger.
• Format: individual therapy, alone or combined with a group. Herman's programme uses a time-limited, goal-focused Stage 2 group, the Trauma Recovery Group.

Who practises it, and how they are trained or regulated

• Courtois & Ford: (1) safety, emotion regulation and stabilisation; (2) trauma memory processing; (3) reflective self-discovery, relational engagement and consolidation. They describe the sequence as recursive, not linear.
• Herman: safety includes regulating bodily functions, managing self-destructive behaviour, and gaining control and predictability in the environment. Further work should wait until a reliable degree of safety is reached.
• Janet: relapse prevention, treating residual deficits through skills training, graded practice of neglected activities, and gradual termination.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• perfectionist overloading of tasks.
• the client taking on others' trauma before they are stable.
• the client hearing "damaged for life". Stress adaptation and change.
• termination reviving abandonment themes. Name it and plan it well ahead.
• intellectual agreement without felt change, which needs revisiting later.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.