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Trauma: Is Complete Recovery Possible?
The belief that recovery from trauma is never complete, even after years of psychotherapy, is a pervasive one in the mental health field. However, examining such claims reveals that multiple factors may influence the “reawakening of past symptoms” and this notion may not apply universally to all trauma survivors. Contrary to this pessimistic view, there are compelling reasons to believe that even in complex cases, symptoms can be successfully treated so that they don’t affect the individual again. In this article, I will explore the basis for some of these pessimistic views of therapy outcomes, and suggest methods that may achieve better results.
Trauma Can Never Be Healed Fully
The notion that trauma symptoms may re-emerge years after therapy and that recovery is never complete is prominently featured in Judith Herman’s book, Trauma and Recovery. As a leading expert in this field, Herman provides a comprehensive overview of trauma and its treatment. Her book is essential reading for anyone working with trauma survivors, offering a deep dive into the history, development, and cultural beliefs surrounding trauma therapy. Herman’s work includes valuable insights from case studies and outlines core therapy components, such as establishing safety, processing the trauma story, and providing compassionate support.
Understanding Herman’s Position on Recovery
Herman argues that “resolution of trauma is never final, recovery is never complete…issues sufficiently resolved at one stage of recovery may be reawakened…as the survivor reaches new milestones.” This suggests that recovery is not just challenging but that survivors can never fully process trauma so that it never affects them again. Herman’s perspective seems to generalise this idea across all trauma survivors. In my many years of working in mental health and wellbeing, I have witnessed from my own and other therapists work, numerous cases where individuals have completely healed from prolonged trauma. For this and other reasons I was lead to question Herman’s claims. To my mind, her belief that recovery is never complete appears problematic for several reasons.
The Flooding Technique and Its Limitations
Firstly, it’s important to understand that for Herman, the goal of psychotherapy is for the survivor to tell the trauma story so that “restoration of the social order and the healing of individual victims” can take place. The premise is that unless the trauma story is told, healing cannot occur. To facilitate this, safety with the patient must be established, via various techniques, and once the reconstruction of the story is complete, the survivor can then focus on building reconnection. One of the main methods that Herman reviews for the telling of the story is the Flooding Technique, a form of exposure therapy, which she describes as “highly evolved” and a key treatment for trauma. This method entails patients writing a script for each trauma story and then narrating it to the therapist who encourages the patient to express their feelings as fully as possible. This is then repeated over 12-14 sessions. A similar technique that is presented entails the aforementioned instructions with the addition of a ritual that involves signing the document (trauma story) by the plaintiff (patient), and witness (therapist). Assessing these methods, Judith highlights that they are proven to significantly reduce symptoms in the majority of people that experienced PTSD following torture. However, she admits, relief is only for some symptoms, namely, intrusive memories and hyper-arousal, whilst feelings of numbness and social withdrawal do not change.
Questioning The Efficacy of the Trauma Storytelling Approach
The numerous case studies that Herman draws upon highlights the importance of telling the trauma story for patients. However, it is evident that this approach does not help people fully recover from trauma. Therefore, Herman is right to state that complete recovery is not possible. However, this only applies to the cases Herman reviewed. And it potentially only applies to those patients and therapists that adopt this framework of healing. If the goal is to heal from trauma so that it never effects the individual again, then the telling of the story might be one part of the healing process. Many survivors seek to process their experiences and move on, without the need for the repeated telling of the story or concerns for political change.
Herman’s revised 2022 version does not address other therapeutic methods that could significantly impact treatment outcomes. For example, EMDR, an evidence-based therapy found to successfully treat single and multiple traumas in 6 or less sessions, is not mentioned. Herman highlights a case where a patient experiences a vivid image of the trauma, following years of psychotherapy, that results in the manifestation of the same symptoms. EMDR can address such stuck trauma images and might offer a more comprehensive approach than simply recounting the trauma. Additionally, repeatedly reading a script of the trauma story will not address the felt sense of the trauma symptoms in the body. This is evident because Herman states that no change is observed in emotional numbing. Numbing is often a strategy employed by patients to protect themselves from feeling emotional pain; a great deal of effort is invested in suppressing or unconsciously repressing memories, including what is felt. Consequently, verbal prompts to “express feelings as fully as possible” make little difference. For this purpose, Somatic Experiencing, Somatically informed EMDR, combined with cognitive restructuring techniques can address bodily sensations and negative cognitions, which are crucial for thorough healing.
Beliefs and Recovery
Herman’s claims are based on her clinical experience and case studies from the literature, which do not encompass all available treatments. Moreover, Herman writes from a feminist standpoint which overly focuses on the repeated telling of the trauma story; subsequently only certain modes of treatment are explored. It is important to recognise that different therapies can offer different outcomes. And there are numerous other healing modalities. As such, her statements cannot be generalised.
The recovery framework that Herman promotes for trauma healing appears only to chop the leaves of the tree. To remove the roots requires the integration of or application of different techniques.
The Power of Beliefs
Our beliefs can determine our experiences and recovery outcomes. Therefore, it is essential to question what we consider true. If you believe you can never recover from trauma then reflect on why you hold this belief. Is it because of a suggestion made by a therapist? If so, question the basis of their claims. Once upon a time people believed that the earth was flat; consequently this influenced what they did and the directions they travelled. Until only recently, it was also taken for granted that a chemical imbalance in the brain caused mental disorders, until a review was carried out, and it emerged that there is little evidence in support of this. Yet, for decades, people were, and still are, prescribed prescription drugs to address trauma symptoms on this basis. The prevalence or absence of research studies does not necessarily mean something is not true. However, our beliefs can significantly influence the directions we take and so it is imperative that we question them, be they our own or be they adopted from others.
Judith Herman’s views reflect a specific framework for trauma recovery, which might not align with every individual’s experience. It is crucial to keep an open mind and explore various therapies to find what works best for you. Recovery is a dynamic process, and if traditional methods do not seem effective, it may be time to consider alternative approaches.
Remember, the responsibility for recovery involves not just participating in therapy but also actively engaging with and evaluating the approaches used. If the same symptoms persist or re-emerge after treatment, exploring different modalities could be a key step toward achieving a more complete recovery.
I hope you found this article useful. If you have any questions, or to discuss treatment and support options then feel free to get in touch.
With best wishes,
Sadaf
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