I have spent over a decade researching trauma. My sources have been writings of pioneers in the field, fellow practitioners reflecting on their work, my own life experiences as a survivor of complex trauma, and the experiences of clients and people I have worked with.
From this has emerged a conceptual framework - I call it Expressive Trauma Integration or ETI – that draws on insights from all the above. Since first working with it in 2010, I have formally studied the effectiveness of the ETI model with humanitarian aid workers in the southern Africa country of Lesotho (in individual intervention), the Philippines (group intervention conducted by a national agency). I've also experienced and informally observed its effectiveness in my training and practice in the Philippines, China, Japan, Korea, and the United States.
Central in my thinking in developing the ETI approach has been the conviction that trauma is complex and effects different aspects of our being. Therefore response to trauma needs to be multidisciplinary. I organize what I consider to be the essential elements of such a response around three pillars: Psychoeducation, Experiential Methods and Individualized Sustainability Plan (ISP).
In this post, I share the six steps towards trauma integration that form the heart of the ETI approach. I hope you find it useful with clients in therapy who are trauma survivors, and training and support of human service practitioners who are working with traumatized clients or in high-stress situations. With modifications for the level of exposure and the nature of interactional space available, the model fits a variety of needs.
(1) Grounding. Establishing safety and a sense of stability or grounding in the body and in relationship to surroundings (especially vis a vis other people and safety from physical harm) is an essential starting point.
(2) Psychoeducation about trauma. I.e: education about the biological, emotional and physical effects of trauma on survivors and families (individual trauma) and communities (communal trauma). ETI experiential psychoeducation uses the Triune Brain model and the Six Stage Trauma Integration Roadmap to explain what is happening in the brain during trauma and what are the expected responses to trauma.
(3) Individualized Sustainability Plan (ISP) is set of techniques and practices designed to provide ongoing cognitive, physical, emotional and spiritual maintenance for clients who are facing adversities. Without a clear plan it is very hard for trauma survivors to sustain themselves longterm. ISPs draw from various practices demonstrated to be effective in mitigating trauma symptoms. These include: mindfulness and self-compassion practices, sensory and bilateral integration, cognitive processing, behavioral modifications, stress management, expressive arts, diet, and nutrition.
(4) Connecting with Resources. Connecting to inner resources and/or safe space that existed before trauma is important to sustain the client. If there is none, help build it, using Imaginal Space.
(5) Taking Action. The Six Stage Trauma Integration Roadmap (see image below) provides a conceptual framework (1-Routine, 2-Event, 3-Withdrawal, 4-Awareness, 5-Action, 6-Integration) for exploring steps that could be taken in those stages where the survivor feels frozen. Imaginal Space serves as a powerful tool for interacting with the possible steps.
This Roadmap should not be applied as a linear model. Participants may move from one stage to another, skipping stages and moving back and forth. Any number of triggers, stressful times, even exciting times, can lead a survivor to any of the stages, both “forwards” and “backwards.”
The Roadmap aims to provide information and action methods that will enable survivors to locate where they are in their trauma response journey, where they are headed, what challenges they face, and what strengths they possess as they seek integration of their traumatic experiences.
(6) Trauma Integration – The survivor is supported in reflecting on experiences and insights in the previous stages, with a goal of building a life narrative that incorporates both the trauma experience and personal strengths that enabled surviving it.
Trauma integration is not once-and-done, nor is it linear. It is on-going and sometimes cyclic. But achieving a sense of integration – even just once - establishes the possibility of “breaking the script” of old responses to a traumatic event. Even a single experience of integration opens the door to more new responses. Gradually, experience with new, integrated responses accumulates and the rewards are felt emotionally, cognitively, physically and spiritually.
I think it important to recognize that there are many trauma therapy approaches available, each with strengths and weaknesses. Therapists should not be too attached to any one approach. It is better to encourage clients to listen to and respect their own inner response to whatever approach is being used than for them to blindly accept the guidance of some “perfect model”.
I encourage both trauma survivors and therapists to search for their personal inner compass and follow it to find the path right for them in working for trauma integration.
Click here to download Expressive Trauma Integration Roadmap.