foreign [Music] everybody my name is Dr Scott giacomucci I'm a trauma therapy practitioner educator and researcher and I'm the director and founder of the Phoenix Center for experiential trauma therapy in Media Pennsylvania so I wanted to create a simple little video here to talk about a three-phase clinical map for working with trauma and so uh this is a way of conceptualizing thinking about uh how to safely and effectively provide trauma-focused services so there's plenty of modalities that you could look into and pretty much every trauma therapy modality operates explicitly or implicitly from a three-phase approach a three-phase model and so this goes all the way back to 1889 with a uh an author named Pierre Janet and Janet uh was the first to propose a three-phase model for safe trauma work this is later articulated by Judith Herman in her famous book trauma and Recovery by courtois and Ford in their guidelines for working with complex trauma complex PTSD they highly recommend a three-phase approach if you are familiar with EMDR therapy it uses a three-pronged approach which is quite similar seeking safety psychodrama most of the trauma therapy approaches and many other therapies just in general are oriented on a three-phase approach and so in terms of working with trauma phase one is focused on safety on strengths on stabilization on psycho-education providing coping skills this is where we're building a therapeutic relationship or in a group therapy context we're developing group cohesion so phase one really is setting the foundation for the future phases it's preventing re-traumatization oftentimes this first phase gets overlooked in like the therapists or the client's eagerness to jump into talking about the trauma telling stories about the trauma uh processing feelings and memories related to the trauma and when we skipped this first phase of the clinical map we really jeopardize the safety of the treatment and there's a real risk for re-traumatizing clients or causing more harm than good so it's really important that we emphasize this first phase of the clinical map that we're helping clients first understand what they're experiencing and make sense of conceptualize what they've experienced what they're currently experiencing to have a better understanding of themselves and so this really helps with normalizing and validating their feelings their responses and how how the traumas impacted them in this first phase it's inherently strengths based that we don't avoid the Trump talking about the trauma or difficult feelings but this first phase is really focused on strengths on resilience what are some of the strengths that that the client brings with them that could help them face the trauma when we get to it this is where we emphasize protective factors this is where we talk about courage where we talk about wisdom as a strength empathy understanding self-awareness and we help clients tap into all the positive internal resources perhaps even positive memories before we activate the the negative and traumatic memories in the second phase so phase one is about safety about stabilization about teaching clients coping skills about practicing self-regulation so that when we finish phase one and move into phase two we can do it in a way that's safe we're prepared for phase two now sometimes we create programs or services that solely focus on phase one uh for example in higher levels of care in hospital settings uh we might not have enough time or we might just might not have you know the right context to do trauma processing work we might only have a client with us for a couple days in a inpatient psychiatric setting or hospital setting and so inherently the work's going to be more focused on coping skills psycho education providing referrals for aftercare although sometimes in our work especially when we're working with complex trauma or clients who are really dysregulated and don't have a lot of internal or external supports and resources I find this especially true with with survivors of complex trauma and folks that have experienced really severe neglect and abandonment that we might need to spend extra time in this first phase of the clinical map uh sometimes that means we might spend months even years focused on the strength based work before moving into trauma focused work and so as practitioners we really have to hold this responsibility and acknowledge that this is this is part of our responsibility in guiding the work in addressing the the importance of safety and stabilization before doing trauma focused work but also in holding the boundary when we have clients who really want to get into the trauma processing work but who might not have the foundation or stability or safety yet in their life or in the therapeutic relationship where we can do that without risking re-traumatization without risking the client becoming overwhelmed without risking creating more harm and so I find this to be one of the most difficult aspects of doing trauma therapy is really holding that boundary with clients in a way that's ethical in a way that promotes safety and in a way that is transparent and so once we've really established safety connected with strengths provided psychoeducation coping skills developed a therapeutic relationship then we can move into the second phase of the clinical map this is this is where we get into the difficult emotions related to the trauma where we get into memory content related to the trauma where we really get into processing the grief and loss related to the trauma the anger the rage the sadness the shame the guilt all the difficult emotions and the traumatic memory itself and so this middle phase is going to look different depending on what modality we're working from if it's a talk therapy approach we might be starting to talk through and remember and and reprocess verbally different aspects of the traumatic memory if it's a EMDR therapy that middle phase is going to be applying the the EMDR protocol in terms of reprocessing the memory if we're using psychodrama as our modality that middle phase might be focused on renegotiating how the trauma lives within us in different trauma-based roles or even getting into uh replaying trauma scenes with safety strengths and support and renegotiating uh our memory of the trauma in action creating new endings to the trauma preventing the trauma from happening psychodramatically uh so this middle phase the trauma processing is going to look different depending on what modality we're working from and we can't stop there we have to give consideration to the third phase of the clinical map and this is where we focus on integration where we focus on transformation on post-traumatic growth this is where we look to the Future so I find many times in trauma work the focus is on that middle phase and we tend to underestimate the importance of that first phase and of the third phase of the clinical map so if we do if we engage in that first phase safety strengths containment coping skills and then trauma processing we can't just end there if we end there we risk the work not having lasting or meaningful change we have to consider how can we integrate these memories these roles how can we transform how the trauma lives within us into something new how can we redefine who we are as trauma survivors and how can we grow from this experience how have we already grown from this experience how can we make sense of and make meaning of the horrific things we've experienced and integrated into a coherent Narrative of who we are and our the timeline of our life so this third phase of the clinical map is where we look to to integration transformation and post-traumatic growth and so my company name the Phoenix Center for experiential trauma therapy is really named after the Phoenix which is a symbol of this third phase of the clinical map the Phoenix being the firebird that consumes itself with its own Flame and rises from its own ashes it's a symbol of growth after trauma of transformation or transmutation and lucky for us there's a whole field of study about post-traumatic growth about the different ways that trauma transforms Us in positive ways in the study of post-traumatic growth they find five different domains which I really cover in another video on the channel here which I encourage you to check out but just the in general these five domains new appreciation for life a new sense of possibility or opportunity in life add a new sense of personal strength After experiencing trauma a new emphasis or sense of importance in interpersonal relationships and finally a new or deepened sense of spirituality or religious connection so these are the five domains of post-traumatic growth and we can really think about the this third phase of the clinical map as embodying those five domains we could think of those five domains of post-traumatic growth as a template for the different themes the different tasks the different goals in this third phase of the clinical map a template for trauma recovery per se that just like in recovery from substance use recovery from depression recovery from medical illnesses recovery from injuries recovery from anything we don't just focus on the problem we also focus on the solution we focus on what recovery looks like and we need to do the same thing in trauma recovery so I like to think of these five domains of post-traumatic growth as a template for what trauma recovery often looks like so I really emphasize them in my work so this third phase of the clinical map provides a sense of integration a sense of completion a sense of how do we take what we've experienced in terms of safety connection to strengths psycho-education coping skills in phase one integrate that with the trauma processing aspect in phase two working through the trauma addressing it head-on and how do we integrate that into the future how do we take what we've learned and experienced into our lives how do we grow from this how do we learn from this how do we help others now that we've worked through how this has impacted us and so these are the three phases of the clinical map phase one phase two and phase three so I really encourage you if you're working with trauma and even if you're not working with trauma that you might consider this clinical map as a way of structuring and pacing your work you could think of this in terms of your work over a longer period of time following these three phases of the clinical map but I also like to think about each session whether it's a individual therapy session a group session even an educational session or supervision session as being Guided by these three phases of the clinical map as well so at this clinical map provides a framework a structure for us in terms of thinking through the logistics and the pacing not just of the long-term trajectory of our work but also in terms of the the timing of our sessions and the way that her sessions are structured so I I really have learned to adopt this clinical map into every aspect of my work and it informs everything that I do from organizational meetings to supervision sessions to the way my syllabus is structured in my classrooms the way that a structure training events uh individual therapy sessions and ongoing group therapy sessions so there's a lot of value and a lot of utility in learning this clinical map and implementing it into your work and if I'm being direct and honest too it also makes planning for a group or planning for sessions a little bit easier because we already have a simple framework where we're starting where we're going to get to and where we need to end and so I find that just thinking about all my sessions through the lens of this clinical map makes it easier logistically for me in terms of planning and setting up the set the session creating outline for a training group or for an ongoing Therapy Group is a lot easier because I already have a framework for it I know I'm starting with safety cohesion strengths education coping skills then I'm moving into the more difficult content the trauma the defenses the difficult emotions and them Ending by focusing on growth and integration so for example if you're facilitating say a a 12-week at group you might break the group up into three different parts four weeks each first four weeks are focused on the first phase of that clinical map that we're going to devote the first four weeks to establishing safety and connection group cohesion focusing on strengths really providing education practicing coping skills tapping into the mutual Aid and peer support within the group then we move into the middle phase of the group for the next four sessions where we really get down to processing the trauma working through difficult experiences and conflict and resistance really getting to and moving towards the purpose of the group and then the last four sessions the last one third of the group would be focused on integration on transformation on post-traumatic growth and how we're going to take everything we learned and experienced into the world when this group ends and so these three phases of the clinical map also mirror and reflect the different phases of group development beginning middle and end in the social work context which is covered in another video on the channel here if you're interested in learning more about that I encourage you to check it out so um I hope you found this video helpful if you did I encourage you to write in the chat what was something you learned from this video it was something that was helpful in this video what was something you think I missed and forgot to mention in this video I want to hear about all of that as well go ahead and write that in the chat if you want to be alerted when a new video on the channel gets released you could hit the Subscribe button below and uh I hope I really do hope that you found this helpful and that you find the other videos on the channel helpful thanks for watching [Music]