Dr. Mike Dadson identifies:
Research has shown that there’s three primary phases, not stages, but three primary phases or treatment. All three phases all always active in therapy but, one phase will be accented or forefront at different times in treatment. Usually at the beginning of therapy Phase one is more actively present and towards the end phase three is more present.
- The first phase is building the therapeutic relationship and addressing the phobia of one’s self and others. By being fully present, supportive and non-judgemental the therapist role is to help you can lower the anxiety of being in a therapeutic relationship with the purpose of addressing the traumatic event and to lower the anxiety about facing one’s own reactions to the traumatic experience.
- The second phase will be actually going in and processing the traumatic memory which is usually directly through titration and imaginal exposure therapy. Going in slowly, approaching and processing the trauma at the pace of the client is important because it promotes client empowerment, minimizes feeling of intrusiveness and lowers feelings of powerlessness. This is not then an intrusive memory but a memory the person can now choose to engage. As the person, in a controlled empowered way reflects and looks at what happens they are stepping towards the memory so that they can process it, find the pieces that are missing, resolve the defensive responses to the event and begin to move forward.
- Grieving the effect of the trauma on their lives is the third phase of treatment. This involves a recognition and acknowledgement of the losses that the person has experienced as a result of the trauma. This grieving helps orientate the person towards the future as is an indication there is a developing hope and that there is movement away from the past effects of the traumatic stressor. The grief evolves from encountering the things that have been lost and acknowledges the difficulty of what a person has lived through.
Dr. Mike Dadson warns:
- When treating trauma with prolonged exposure therapy without titration, feelings of empowerment and control can reactivate for the person and cause them to re-live the traumatic experience in the moment. That means that a person can be again overwhelmed or distressed and there isn’t really any kind of movement forward, though healing or comfort, but a re-experiencing. This has been referred to as traumatization. I have many clients who have experienced traumatization and the counter therapeutic results can be greater degrees of avoidance and prolonged time in phase one. Re-experiencing trauma in treatment, is not always unexpected, nor is it particularly welcomed.
- Part of the suffering with PTSD is that a person can have a reoccurrence experience of the trauma, again, and again and again. When this happens, it wears on the on the body, the soul and on the mind.
- When prolonged exposure therapy takes these factors above into account, prolonged exposure therapy can be very helpful. However, if a therapist doesn’t take these factors it into account, a person can experience their trauma again, and again, and again. When this happens and if there isn’t a resolution, a counter therapeutic effect happens. More avoidance is created and the distressing can be so great that a person ultimately drops out of and avoids therapy, due to its painful effect. If it is too much too fast, the system is overwhelmed and they cannot engage nor continue to engage in therapy in that form.
Much research strongly supports the need for the therapist to have an awareness, and an acknowledgement of the phases and what phase they are working in during different times of the therapeutic process. “The skilled, experienced, and attuned therapist will take great care to walk alongside a person at their own pace through their painful memories”, concludes Dr. Michael Dadson.
Dr. Mike Dadson accentuates:
The goal of the therapist is to contain and to regulate so that the person can move towards a traumatic experience without having the feelings of being out of control, overpowered or powerless. It is important for a person to have a sense of their agencies on board, to move forward, or move away at their own pace. It is imperative that the therapist stays attuned with the person so that they can titrate their themselves towards the experience.
- Trauma therapies, are circling and moving towards centre of distress in a client We go towards the trauma and then steering away, and then circling and coming back and then steering away. Titrating our way towards the greatest distress but regulating the overwhelming emotions that can be activated. Then when the time is right going through the trauma once then steering away again. Then ultimately as we build on the felt feelings of relief and progress, we stay a little closer a little longer till finally we can sit with this trauma and go into it deeper. We safely process the trauma by finding any unfinished grief and loss. We resolve the defensive reactions and calm the nervous system. Then we are through it.
- We know there is growth and healing when the defensive responses are replaced with a deep feeling of relief and renewed creativity, meaning, purpose and self-compassion. These are indictors that the person has gone through the trauma in a way that leaves them feeling relief, comfort and new life. Spending &me staying with this new way of experiencing the event helps consolidate the changes and deepens new cognitive and emotional patterns. I’ve gone through it in a way that has left me feeling relief, comfort and new life.