Definitions and labels are important when you are in pain and trying to figure what to do about it. An important step in my journey of trauma integration was to let go of “recovery” and “healing” as my final goal and to seek instead outcomes I could actually achieve.
I share the view of trauma scholar Robert Stolorow, that trauma recovery is an oxymoron. (Stolorow, 2011. p. 61). Things are never really the same after trauma. So what then to name the place that can be achieved, where trauma is no longer the center of experience and yet is acknowledged to be a part of ongoing reality? I call it trauma integration.
Trauma integration is not once-and-done, nor is it linear. It is on-going and sometimes cyclic. If that sounds discouraging, the good news is that movement begets more movement. Achieving a sense of integration – even just once, for just a short while – establishes the possibility of breaking the script of old responses and opens the door to more new responses.
Gradually, experience with new, integrated responses accumulates and the rewards are felt, emotionally, cognitively, physically and spiritually.
Broadening the Treatment Approach of Trauma
But a narrow treatment approach limits progress. A new study from the Journal of the American Medical Association (Kearney & Simpson, 2015) provides evidence of this conclusion and calls for broadening approaches to post traumatic stress disorder and other consequences of trauma.
The two most common treatments for U.S. veterans with PTSD are Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). The study reports that half to two-thirds of the participants experienced at least some improvement in symptoms following treatment with one or both of these approaches.
But in addition to low follow-through and high dropout rates, the study found that about two-thirds of participants studied continued to experience post trauma symptoms so severe that they maintained a diagnosis of PTSD.
The authors point out that trauma affects survivors mentally, physically and emotionally. Thus, they suggest that one strategy for improving the results of treatment should be to address diverse symptoms in a variety of ways. (Kearney & Simpson, 2015).
Establish an Expansive Therapeutic Arch
Diverse approaches exist, of course, across the therapeutic community. There are many different approaches and protocols for trauma therapy, each with particular strengths. But although it is accepted in theory that no one therapy works for everyone, in practice, therapists tend to specialize in one or two approaches and apply them to all clients.
Many therapists operate from a client-centered perspective, of course, which calls for providing therapies that are truly responsive to clients. But how many therapists are well-informed about treatments in the diverse aspects of human functioning that are implicated by trauma ?
Several authors and practitioners have called for integrated approaches to trauma, but few such such approaches are backed by empirical research. One exception is SEE FAR CBT (Lahad et al., 2010), which was studied in a small sample of adults who suffered from PTSD and then received treatment. SEE refers to elements of somatic experience, FAR refers to the use of fantastic reality, specifically, elements of drama therapy and CBT refers to cognitive and behavioral elements.
Lahad compared results of SEE FAR CBT with those of the more widely studied EMDR and found them nearly equally beneficial. SEE FAR CBT was found to be effective one year after therapy whereas the group receiving EMDR experienced a return of some trauma symptoms. This highlights, in my view, the necessity of establishing Cognitive and Behavioral Resolutions at the very core of trauma therapy, in order to sustain the benefits of therapy across time.
Expressive Trauma Integration (ETI)
Convinced that single-strategy approaches are unsustainable, I’ve sought for some years in my practice and research to find a wholistic framework that applies diverse approaches in an integrated way to trauma treatment.
Among the various strategies of treatment for which efficacy has been demonstrated in research, I find three to be particularly complementary: psychoeducation, expressive and experiential therapies and cognitive and behavioral resolutions.
For several years now, I’ve been applying them together in a wholistic approach to trauma I call expressive trauma integration (ETI). While it is too early to make claims about efficacy, initial results show promise.