Have you ever vowed, “Tomorrow I am going to begin a healthy lifestyle” or “Starting tomorrow I’m only eating healthy foods….” and somehow, tomorrow never comes? Or maybe only lasts a few days? Self-maintenance and self-care are hard in the best of circumstances.
Often worse than the difficulties of the present is the baggage of the past that accompanies us wherever we go. For trauma survivors, of course, this is particularly complex.
Two learnings stand out to me from my own experience as a trauma survivor and therapist. One, that it is hard to sustain progress without support from a skilled professional. Two, that several kinds of support are valuable. The effects of stress and trauma are emotional, physical, cognitive and spiritual, and I’ve benefitted in my own journey of trauma integration from support from professionals in each of the three areas.
As a therapist, I therefore try to provide for my clients what I was unable to find during my own difficult times: a comprehensive framework of responses that is well-informed by key insights from several disciplinary backgrounds.
But even when I am at my multi-talented best as a therapist, a third learning stands out about trauma: most people exposed to stress on an on-going basis and most trauma survivors need a day to day routine of special practices in order to maintain progress in the most difficult stages. One of the most valuable gifts we can bring to clients is assisting them in designing “individualized sustainability plan” (ISP) that work well for them.
In other words, help set up life-giving routines that assist the survivor to get through the hardest times. Properly chosen, such routines can rather quickly bring new emotional, physical, cognitive and spiritual strength essential for trauma integration. Difficult times inevitably return in everyone’s life, even in the best of circumstances, so life-giving routines are actually not just for a few months of early recovery. They are an essential ongoing safety net to reduce risk from the hard knocks of life.
Ongoing anchors of stability
A useful question helps to prepare for designing such routines. What are the personal resources that enabled the survivor to survive trauma in the first place? By virtue of being alive and breathing, the survivor possesses evidence of the existence of such resources.
But of course, awareness of such resources dims after trauma; many survivors lose it entirely amidst the mountains of loss (Withdrawal stage on the ETI model). Thus an early task of a therapist, after establishing a sense of safety is accomplished, is to facilitate an appreciative inquiry after such resources. This enables survivors to begin to survey the painful past – not with an anxious agenda of healing, for it is too early to introduce such language – but with an agenda of acknowledgement of personal resources. Many clients find the exercise a useful anchor point for the work ahead and it positions the therapist to assist in creating an ISP.
Individualized sustainability plan (ISP) include a set of techniques and practices designed to provide ongoing cognitive, physical, emotional and spiritual maintenance for clients who are facing adversities.
ISP does not replace therapy, it supplement existing therapy and therapeutic approaches. An analogy: after a devastating storm, homes may need extensive repairs of several kinds. These can take years. But in the meantime, basic maintenance remains essential – quick repair of the roof, restoration of water and electricity, routine weeding and mowing in the yard, etc.
ISP provide basic maintenance for people overwhelmed by stress and or trauma. No matter which therapeutic approach you are using to work on trauma, ISP is necessary to provide a foundation for stability and resilience.
Key Elements of an ISP Plan
Here are the key aspects I work with my clients when designing ISP
Identifying the difficulties particularly faced by the client in maintaining self-care practices (recognizing that these provide clues about some of the work ahead), and seeking life serving alternatives..
Identifying personal stressors and alerts (triggers), and creating practices that employ sensory integration tools and techniques to minimize these. The goal is to recognize the most common triggers (situations, thoughts) and alerts (sensorial) and then to work out strategies to reduce exposure to them and reduce their impact.
Identifying and redirecting trouble-making thought patterns. For example, work on converting self-judging thoughts into self compassion.
Connecting to inner and external resources that support resiliency and identifying activities to enhance access to resources. If the survivor can identify none, create some, using imaginal space.
Introducing the concept of Mindful Expansion and experimenting with physical and mindful activities (meditation, yoga, art expression, dancing and movement exercises).
Learning about diet and nutrition, with a goal of identifying foods that impact the client with a triggering or calming effect.
Encouraging journalling on symptoms, strategies, results, etc. as a tool for reflection and learning about the survivor’s unique requirements.
In my experience, without ISP, clients may benefit from therapy in areas of the counselor’s expertise, but progress remains limited to these because there is no strategy for dealing with the client as a whole. This challenges us as trauma therapists to expand our skills beyond those of traditional practices. To truly serve our clients we have to think outside the box. If we do not, we will be unable to assist the many who remain stuck in Withdrawal (stage 3 in the ETI model) even after years of misery.
In the end, every client faces the problem that started this post, the challenge of maintaining on their own the disciplines that support stress management and trauma integration across a lifetime. Their chances of achieving trauma integration and bouncing back from the adversities of life are far higher if a key part of therapeutic support is devoted to helping them work out an ISP plan that is just right for them.
For an infographic that locates ISP in the context of a wholistic trauma integration approach click here.
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