Éléments du rétablissement

Au cœur de l’expérience d’un traumatisme, on trouve un état de détresse, un isolement et une perte de contrôle et de pouvoir. Les principes directeurs du rétablissement post-traumatique sont la restauration de la sécurité et de l’autonomisation. Le rétablissement ne signifie pas nécessairement l’absence complète d’effets post-traumatiques, mais de façon générale, il est marqué par la capacité de vivre dans le présent sans être entravé par les pensées et les sentiments du passé.

Dans le domaine du stress traumatique, on assiste à un vif débat : est-il nécessaire de réexaminer les souvenirs traumatiques pour guérir ou est-ce néfaste? Il s’agit évidemment d’une question personnelle. Bon nombre de personnes pensent qu’il peut être bénéfique de raconter à plusieurs reprises leurs expériences traumatisantes, tandis que d’autres croient que cela peut être destructeur pour leur bien-être.

Il est plus approprié de considérer que le rétablissement post-traumatique est un processus qui exige du temps et des étapes intentionnelles. La restauration de la sécurité est la première étape, et la plus importante, du rétablissement, que les détails du traumatisme soient exprimés ouvertement ou non.

Le Dr Pierre Janet a conçu un cadre de travail par étapes pour le rétablissement post-traumatique vers la fin des années 1800 et c’est la Dre Judith Herman qui l’a fait connaître davantage dans son ouvrage précurseur, Trauma and Recovery (1992):

Safety and Stabilization

People affected by trauma tend to feel unsafe in their bodies and in their relationships with others. Regaining a sense of safety may take days to weeks with acutely traumatized individuals or months to years with survivors of chronic abuse. Helping clients to identify what areas of their life need to be stabilized and how that will be accomplished will help them move toward recovery. For example:
  • A person who has experienced trauma may struggle with regulating difficult emotions in everyday life which they might not associate directly to the trauma.
  • A service provider can help the client learn to regulate these emotions.
  • They work together as a team to stabilize the emotions so the individual who has experienced trauma can move on with the recovery process. This process takes time and varies from person to person.
  • Some people who experienced trauma, particularly complex trauma, may find that speaking about their experiences emotionally overwhelming stability throughout recovery.
How to evaluate if the person affected by trauma is stable and safe?
  • Are their basic needs of safe shelter, food, income and supportive relationships met?
  • Are they taking care of themselves and engaging with others?
  • Are they able to do the tasks required for daily living i.e.) making meals, laundry, work, school, cleaning etc.
  • When they are upset emotionally are they able to comfort themselves or reach out for and to someone who can help calm them?

Remembrance and Mourning

This task shifts to processing the trauma, putting words and emotions to it and making meaning of it. This process is usually undertaken with a counselor or therapist in group and/or individual therapy. It might not be necessary or required to spend a lot of time in this phase. It is however necessary to be continuing to attend to safety and stability during this phase. Attending to safety allows the client to move through this phase in a way that integrates the story of the trauma rather than reacts to it in a fight, flight or freeze response. Pacing and timing are crucial during this phase. If the person affected by trauma becomes quickly overwhelmed and emotionally flooded when talking about their trauma memories, safety and stability must be regained before moving further on with the story. The point is not to “re-live” the trauma but nor is it to tell the story with no emotions attached. This phase involves the important task of exploring and mourning the losses associated with the trauma and providing space for the client to grieve and express their emotions.

Reconnection and Integration

In this phase, the client having mourned the losses of her/his old self, must now create a new sense of self and a new future. This final task involves redefining oneself in the context of meaningful relationships. Through this process, the trauma no longer is a defining and organizing principle is someone’s life. The trauma becomes integrated into their life story but is not the only story that defines them. In this third stage of recovery, the person affected by trauma recognizes the impact of the victimization but are now ready to take concrete steps towards empowerment and self determined living. In some instances, people who have experienced trauma find a mission through which they can continue to heal and grow, such as talking to youth, or peer mentoring. Successful resolution of the effects of trauma is a powerful testament to the resiliency of the human spirit.


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