Herman's classic book, Trauma and Recovery, describes in detail a 3-stage model of recovery from traumatic experiences, including childhood sexual experiences.

This model addresses the healing process of people who struggle with a combination of problems related to unwanted, abusive, or traumatic experiences in their past. The problems may include:

• Difficulty regulating emotions and impulses
• Emotional numbing
• Anger and aggression
• Substance addictions
• Behavioral addictions (porn, anonymous sex, gambling, etc.)
• Self-harming behaviors (cutting, burning, etc.)
• Dissociation

• Getting a "road map" of the healing process.
• Setting treatment goals and learning about helpful approaches to reaching those goals.
• Establishing safety and stability in one's body, one's relationships, and the rest of one's life.
• Tapping into and developing one's own inner strengths, and any other potentially available resources for healing.
• Learning how to regulate one's emotions and manage symptoms that cause suffering or make one feel unsafe.
• Developing and strengthening skills for managing painful and unwanted experiences, and minimizing unhelpful responses to them.

Please note that the first stage of recovery and treatment is not about discussing or "processing" memories of unwanted or abusive experiences, let alone "recovering" them. (For more on how the stages of recovery are related to memories of abuse, particularly recovered memories, see Personal Concerns & Questions at Recovered Memories of Sexual Abuse.)

Of course, everything is not always so perfectly ordered and sequential. For example, during the first stage it may be necessary to discuss the contents of disturbing memories that are disrupting one's life. This may be required to help manage the memories, or to understand why it is hard to care for oneself (e.g., the abuser acted like or even said you were unworthy of care or love). However, in this case addressing memories is not the focus of therapy, but a means to achieving safety, stability, and greater ability to take care of oneself.

Most important, the key to healing from traumatic experiences in childhood is achieving these "stage-one" goals of personal and interpersonal safety, genuine self-care, and healthy emotion-regulation capacities. Once these have become standard operating procedures, great progress and many new choices become possible.

Depending on the person, the first stage of treatment may also involve:

• Addressing problems with alcohol or drugs, depression, eating behaviors, physical health, panic attacks, and/or dissociation (e.g., spacing out, losing time).
• Taking medication to reduce anxiety and/or depressive symptoms, for example serotonergic reuptake inhibitors (SSRIs) like sertraline (Zoloft) or paroxetine (Paxil).
• Participating in Dialectical Behavior Therapy (DBT), a treatment designed to help people who are having serious problems tolerating and regulating emotions, interpersonal effectiveness, and/or self-harming behaviors.

Throughout all stages of treatment, it is often necessary to address psychological "themes" and "dynamics" related to one's history of unwanted or abusive experiences. As discussed in Principles of Therapy or Counseling, some of these are core issues that should determine the very nature and structure of treatment. These include:

• Powerlessness
• Shame and guilt
• Distrust
• Reenacting abusive patterns in current relationships

In the first stage of treatment, these themes and dynamics must be addressed when they are obstacles to safety, self-care, and regulating one's emotions and behavior. Therapy can help with recognizing habitual behavior patterns, beliefs, and motivations that maintain self-defeating and self-destructive behaviors outside of conscious awareness or reflection. Increased awareness of these themes and dynamics brings increased understanding, increased ability to take responsibility for them, and increased capacities to choose new, healthier responses and actions. (Mindfulness meditation practices can also help cultivate such awareness and freedom; see Mindfulness: An Inner Resource for Recovery from Child Abuse.)

Even before saying what this stage is about, it is important to note that some people may decide to postpone working on "stage-two issues." Some may decide never to address them (at least in therapy).

• Reviewing and/or discussing memories to lessen their emotional intensity, to revise their meanings for one's life and identity, etc.
• Working through grief about remembered unwanted or abusive experiences and their negative effects on one's life.
• Mourning or working through grief about good experiences that one did not have, but that all children deserve.

After establishing a solid foundation of understanding, safety, stability and self-regulation skills one can decide - mindful of the potential pain and risks involved - whether or not to engage in the work of stage two. In fact, once the first stage of recovery has provided such a foundation, some people realize that thinking and talking about painful memories is not necessary to achieve their goals, at least in the short term, and/or that those memories are no longer disrupting their life and no longer of much interest to them. (And sometimes people need to educate their therapists about this!)

For those who do choose to focus on abuse memories, or need to because the memories are still disrupting their lives, there are several therapeutic methods available for "processing memories" in the second stage of treatment. In general, these methods involve "exposure" to the traumatic memories within a safe and healing therapy setting. These treatment approaches can be very effective at ending the influence that abuse memories have over one's daily life, emotions, and self-understanding.

There are different psychological theories about what is involved in processing traumatic memories, and discussing these in detail is beyond the scope of this section. (One theory is that successful treatment involves "extinguishing" habitual and maladaptive fear responses to trauma reminders, and replacing them with adaptive responses. Another is that treatment "transforms" traumatic memories consisting of intense fragmentary sensations and emotions into more normal and integrated memories, ones characterized by verbal narratives rather than vivid sensations and intense emotions. Also, these theories are not incompatible.)

Theories are much less important than this fact: there are very effective therapy methods that have been proven, through years of clinical experience and extensive research, to bring great relief and healing by tranforming how people experience memories and reminders of unwanted or abusive childhood experiences. (Please note: such treatments do not "erase" memories, and are not designed or used to "recover" memories; if you have personal questions about this issue, see Words of Caution II at Recovered Memories of Sexual Abuse.)

The two most studied and research-supported treatment approaches for processing traumatic memories are:

• Eye Movement Desensitization and Reprocessing (EMDR)
• Prolonged Exposure (PE)

EMDR is a treatment that facilitates the rapid transformation of traumatic memories – without having to talk about them in detail, which makes it very appealing and accessible to many men. It is not yet known exactly which components or combination of components of this treatment are responsible for its effectiveness. But a large body of research has proven the effectiveness of EMDR as a treatment for posttraumatic stress disorder (PTSD).

For more information on this treatment, see >EMDR.

Prolonged Exposure (PE) therapy is the other most-researched treatment for postraumatic stress disorder, and very established in the academic mainstream. (Of course, this does not guarantee it is the best approach for a particular person; this is also true for EMDR, and true of any treatment when it comes to unique individuals rather than groups of research participants.)

For more information on what's involved in PE and the theory behind how it works, see >Prolonged Exposure.

EMDR and PE are two highly-researched treatments for changing one's relationshp to traumatic memories, but there are certainly others that people with histories of unwanted or abusive experiences in childhood have found helpful. One common component is exposure to distressing aspects of the memory in a safe and structured situation.

Again, the main point here is that there are effective and relatively rapid methods for dealing with intensely distressing memories. People do not have to be tortured by them for years.

This stage will not be described further. Instead, we recommend Judith Herman's classic book, Trauma and Recovery, which describes these three stages of recovery in depth and detail.