Strosahl and Robinson’s Five Phase Model
The core dilemma of post-traumatic stress is how to carry painful personal history forward in life. If clients use fragmented attention and avoidance to cope with what has happened, living a vital life is all but impossible. The alternative is to carry the objective reality of the trauma without the all-encompassing negative self-stories that result from the mind’s misguided sense-making operations. Most life traumas simply cannot be understood rationally, so the only option is to drop the quest for sense making and just carry the history itself. Present-moment-awareness interventions with traumatized clients proceed through all five phases: disrupting strategies that involve fragmented attention and avoidance (noticing); helping them create an objective story of the trauma (naming); teaching detachment from evaluations that are nestled within the story (letting go), whether those evaluations are derived from the self, others, or the world; holding the sense of being flawed, to blame, and undeserving softly (softening); and using the experience of being trauma survivor as a powerful motivational force (expanding).
The best way to persistently avoid making contact with painful history is to learn to be very inattentive in general. When post-traumatic stress symptoms are triggered by some internal or external stimulus, these clients’ attention is so fragmented that they only make contact with vague, overly general memories and a jumbled mess of associated private experiences. Part of this problem is due to the excessive dominance of bottom- up attention in clients with trauma. However, selective, scattered attention also serves an important psychological function: if they can’t recall traumatic events with any precision, they may still be distressed when their history shows up, but not as distressed as they’d be if these events were crystal clear in their mind’s eye. Thus, the immediate goal with traumatized clients is to make specific demands of their attention that will result in more clinically useful behaviors. To that end, it’s important not to bounce from one time period to another and from one painful experience to another; this won’t help them integrate and assimilate their trauma history into a coherent self-story. In the following brief dialogue, the clinician will try to help Becky show up and focus her attention on core aspects of her traumatic experiences.
At this point, the objective details of the trauma have been exposed in a safe, permissive, nonjudgmental atmosphere. The associated emotional pain is in the room, so to speak, but in most cases, due to fragmented attention, very little of this private experience has been brought under verbal regulation. This poses a serious risk to clients; their emotional pain can seem so overwhelming that they’re tempted to change the subject or even abruptly leave the session. Thus, it’s crucial to quickly transition from telling the story to eliciting and supplying verbal labels for the wide variety of distressing private experiences contained in the story.
When traumatized clients do make contact with their painful history, one unfortunate result is that it often triggers a very unproductive form of rumination in which they go over the traumatic events again and again because they’re trying to make sense of the incomprehensible. The problem is, it’s impossible to make sense of the incomprehensible by doing anything other than naming it as an incomprehensible event. It happened, and that’s all that can really be said about it. This stance is unacceptable to busy mind, which is absorbed in trying to figure out who’s right and who’s wrong, who’s good and who’s bad, who got treated fairly by life and who got screwed, and, lastly, who’s to blame. Busy mind tells the human that any narrative lacking these important elements is incomplete and must be gone over again and again. This particular form of sense making is responsible for maintaining post-traumatic stress symptoms over time. Thus, it’s essential for clinicians to help these clients learn to recognize this process for what it is, not what it appears to be.
One of the great ironies of being the victim of a traumatizing event is that the person eventually gets to be the one to blame for the event. Because the mind is simply unable to generate a full and coherent story to explain an incomprehensible trauma, it adopts a default rule to plug the many holes in the story. The default rule is that the victim’s real or perceived flaws, as well as the victim’s actions or lack thereof, are ultimately the cause of the traumatic event. Further, the victim’s contemporary emotional or functional problems are explained as a direct result of those same real or perceived flaws. So with traumatized clients, the goal of the softening phase of the present-moment-awareness intervention is to call out the mind and demonstrate the existence of this trick rule that leaves the client holding the bag.
The expansion phase of present-moment processing involves helping clients understand that survivors of trauma possess a deep appreciation for what’s important in life. In part, this is due to the fact that they’ve been exposed to the dark side of humanity, yet they still keep coming back to make their lives meaningful and special. This requires a special kind of resilience that, if put in service of seeking valued life outcomes, produces tremendous motivational force. The goal is to convert the dark energy of trauma into the bright energy of using personal values to create a life that matters.
For more about why the present-moment-awareness intervention is so well-suited with post-traumatic stress, check out our previous article, Using Present-Moment-Awareness with Post-Traumatic Stress (link). For a guide to the intervention model, refer to Inside This Moment: A Clinician’s Guide to Promoting Radical Change Using Acceptance and Commitment Therapy (link), by Kirk Strosahl, PhD, Patricia Robinson, PhD, and Thomas Gustavsson, MSc.