another work in progress :)
facilitating trauma treatment is quite a commitment and necessitates a purposeful and intentional stance by the trauma therapist. here are some essential considerations that i have uncovered through my professional journey.
trauma treatment consists of three phases:
(though you may see them worded differently elsewhere)
phase 1: safety and stabilization
tasks: establishing the therapeutic relationship, devising a safety plan, setting and maintaining boundaries, establishing the therapeutic frame, building a working alliance, identifying and stabilizing distressing and dangerous symptoms, developing self-regulation skills, and providing psychoeducation about trauma and recovery, and demystifying the treatment process
phase 2: remembering and mourning
tasks: trauma processing through a modality that is sound and consistent for the person receiving treatment and that the therapist is competent in facilitating; examples: EMDR, somatic experiencing, internal family systems
phase 3: integrating and reconnecting
tasks: putting together a life that is less driven by trauma responses and more driven by connection while continuing to receive guidance, support, and encouragement; support groups, family relationships, romantic pursuits, and widening their friend network; may need to return to phase 2 to revisit their traumatic memories with the help of their new perspective and their expanded access to life; generally functioning well and sustaining life.
boundaries are hard, part 1
... especially for people who have continuously experienced boundary violations, and in some of the worst ways. during phase 1, explicitly defining the therapeutic frame is essential to establish boundaries.
session day/time, location, and frequency
initial paperwork and payment for services
reviewing the phases of trauma treatment
confidentiality and limits to confidentiality
expanding on "what is the purpose of therapy?" and "what does therapy look/feel like?"
developing an adult-adult relationship, that is, one of shared responsibility for tending to the relationship, will emerge during phase 2 and will solidify during phase 3. in the meantime, the trauma therapist sets firmer boundaries that will hold the frame.
boundaries are hard, part 2
... especially for trauma therapists who have not finished their personal phase 2 work. trauma therapy requires us trauma therapists to engage deeply with our own trauma recovery process. moving through our own process does not preclude us from practicing, but it does mean that we need to be more diligent and intentional about professional support. quality, consistent, and affirming clinical supervision with a seasoned supervisor who recognizes the complexity of facilitating trauma work while moving through phase 2 is essential. during supervision sessions, you can expect to discuss the therapeutic relationship just as often as the therapeutic process. the purpose: to ensure that your boundaries are clear and that you are capable of maintaining the therapeutic frame while in treatment. often, i've seen people's boundaries get a bit loosey-goosey, which can lead to harm and unethical practice. i've also seen boundaries get so inflexible that the therapist appears unfeeling, which can be damaging for the therapeutic relationship.
find a supportive, emotionally-attuned clinical supervisor
while this can be quite a difficult task, try your best. most of the time, we feel "stuck" with the supervisor who was assigned to us by our agency. though you'll want to double-check your employee handbook, you are free to hire an external supervisor, that is, a supervisor who does not work at your agency. i found this to be incredibly helpful because the external supervisor had a different perspective and had limited bias about the agency. this enabled me to speak more freely about the trauma work i was facilitating. even if you can only afford it once a month, it's worth the investment!
stay in supervision/consultation for your entire professional life
you may outgrow your clinical supervisor, and that's to be expected. outgrowing your supervisor doesn't mean that you've outgrown supervision, though. it means that you need to find a new supervisor. i've had several supervisors across the years and truly cherish the time we had together. i remember them and what they taught me. now, i meet with a consultant once a month who is specialized in a specific realm of treatment because that's what I need right now to attend to a current client. embrace change and engage with different supervisors as you grow.