Phase Oriented Treatment

approaches for complex PTSD and dissociative disorders are typically phase-oriented, are considered the current standard of care, and include the following phases: (1) stabilization and symptom reduction; (2) treatment of traumatic memories; and (3) personality integration and rehabilitation.

Van der Hart identifies phase-oriented treatment as the recognized standard of care for complex PTSD and dissociative disorders, articulating its three canonical phases while emphasizing their flexible, recursive rather than strictly linear application.

Hart, Onno van der, The Haunted Self Structural Dissociation and the Treatmentthesis

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Phase 1 focuses on developing resources to regulate arousal and increase self esteem and competency, Phase 2 on addressing memories, and Phase 3 on exploring relationships and moving on from the past.

Ogden maps the three-phase model onto sensorimotor psychotherapy, specifying the distinct clinical goals of each phase and framing the structure as a guide for thoughtful, client-responsive therapeutic decision-making.

Ogden, Pat, Sensorimotor Psychotherapy Interventions for Trauma and, 2015thesis

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you may discover a few resources in Phase 1 that help you feel ready to address memories in Phase 2, then work with relational issues using interventions in Phase 3—which may evoke intense emotions, sending you back to Phase 1 to develop more resources to regulate those emotions

Ogden illustrates the spiral and non-linear character of phase-oriented treatment, arguing that clients and therapists should move fluidly between phases rather than progressing sequentially.

Ogden, Pat, Sensorimotor Psychotherapy Interventions for Trauma and, 2015thesis

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in the first phase of treatment, interventions must be chosen that facilitate both physiological and psychological homeostasis and that emphasize self-regulatory skills that maintain arousal within a window of tolerance and reduce or eradicate self-destructive tendencies.

Ogden establishes the clinical rationale for Phase 1 priority, arguing that premature memory exploration risks destabilization, and that somatic self-regulation must be secured before later-phase work can safely proceed.

Ogden, Pat, Trauma and the Body: A Sensorimotor Approach to Psychotherapy, 2006thesis

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In phase 3 the therapeutic focus shifts to themes of self-development, adaptation to normal life, and relationships… addressing the profound developmental neglect endured by so many clients whose attempts to engage in normal life activities… bring up unresolved developmental deficits.

Ogden defines Phase 3 as addressing the developmental deficits that persist even after symptom reduction and memory processing, positioning it as indispensable to full engagement in life.

Ogden, Pat, Trauma and the Body: A Sensorimotor Approach to Psychotherapy, 2006thesis

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A major goal of Phase 2 is that of resolving the phobia of traumatic memories among various parts of the personality, so that structural dissociation is rendered unnecessary. This phase of treatment generally requires patients to sustain a higher mental level than the one that existed when they entered treatment.

Van der Hart specifies that Phase 2 targets the phobia of traumatic memory across dissociative parts, and that its success depends on the elevated mental level secured through Phase 1 stabilization.

Hart, Onno van der, The Haunted Self Structural Dissociation and the Treatmentthesis

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The major goal of the treatment of traumatic memories is their integration in the patient’s personality as a whole (synthesis and realization, with the components of personification and presentification). Guided synthesis is the systematic (graduated) exposure of parts of the personality to traumatic memories with prevention of redissociation or avoidance.

Van der Hart details the technical objectives of Phase 2, framing guided synthesis as the graduated exposure technique through which traumatic memories are integrated rather than merely processed.

Hart, Onno van der, The Haunted Self Structural Dissociation and the Treatmentsupporting

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Discussing together that the three phases of therapy occur in a spiral rather than linear fashion will increase clients’ confidence in this model as a framework that is not rigid but holds their treatment flexibly and thoughtfully.

Ogden emphasizes that communicating the spiral nature of phase-oriented treatment to clients is itself a therapeutic intervention that builds alliance and manages expectations about the course of recovery.

Ogden, Pat, Sensorimotor Psychotherapy Interventions for Trauma and, 2015supporting

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attachment issues generally manifest over all three phases of treatment. In early Phase 1, symptom reduction and stabilization, the patient or presenting dissociative parts typically may exhibit varying levels of avoidance.

Van der Hart demonstrates that attachment phobias are not confined to a single phase but require ongoing attention across all three phases of treatment, beginning with the avoidant presentations typical of Phase 1.

Hart, Onno van der, The Haunted Self Structural Dissociation and the Treatmentsupporting

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the traumatic stress field needs more concerted efforts to study systematically the effectiveness of the principles and interventions of phase-oriented treatment of complex posttraumatic dissociative disorders

Courtois acknowledges phase-oriented treatment as the operative clinical framework for complex dissociative disorders while calling for more systematic empirical research into its efficacy and principles.

Courtois, Christine A, Treating Complex Traumatic Stress Disorders (Adults) supporting

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The three phases begin with learning to identify and develop a variety of resources—strengths, capacities, competencies, and skills—that can fortify your self-esteem and support you in maintaining your arousal within a window of tolerance.

Ogden frames Phase 1 resource-building as foundational for the entire phase-oriented structure, linking somatic and psychological resource development to the capacity for subsequent memory and relational work.

Ogden, Pat, Sensorimotor Psychotherapy Interventions for Trauma and, 2015supporting

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Contacting and expressing emotions requires that clients can utilize Phase 1 stabilization skills as needed… With parts in better communication and more resourced, after completing Phases 1 and 2 work, you can determine if your client is ready to work more directly with emotion.

Ogden illustrates the functional dependency between phases, showing that emotional work in Phase 3 presupposes stabilization from Phase 1 and the animal-defense regulation achieved in Phase 2.

Ogden, Pat, Sensorimotor Psychotherapy Interventions for Trauma and, 2015supporting

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There is no research showing that these approaches represent adequate treatment for survivors of chronic traumatization if they are applied outside of

Van der Hart argues that short-term single-modality approaches are insufficient for chronically traumatized patients, implicitly underscoring the necessity of a comprehensive, phase-oriented framework for such populations.

Hart, Onno van der, The Haunted Self Structural Dissociation and the Treatmentsupporting

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works directly and indirectly with dissociative parts of the individual, and with their major and minor manifestations, neither ignoring nor reifying them, using a systemic perspective to foster increasing integration

Courtois describes the systemic, integration-oriented stance that must be maintained across all phases of treatment when working with dissociative presentations within the phase-oriented framework.

Courtois, Christine A, Treating Complex Traumatic Stress Disorders (Adults) supporting

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The goals include the following: overcoming developmental deficits; acquiring skills for emotion experiencing, expression, and self-regulation; restoring or developing a capacity for secure, organized relational attachments; enhancing personality integration and recovery of dissociated emotion and knowledge

Courtois specifies the multi-domain therapeutic goals that phase-oriented treatment of complex PTSD must address, linking them to developmental, affective, relational, and integrative dimensions of recovery.

Courtois, Christine A, Treating Complex Traumatic Stress Disorders (Adults) supporting

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phase-oriented treatment model, 17, 243, 244, 245, 247–50

An index entry confirming the centrality and sustained treatment of the phase-oriented model across multiple sections of Ogden’s 2015 clinical workbook.

Ogden, Pat, Sensorimotor Psychotherapy Interventions for Trauma and, 2015aside

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It is essential for clinicians to understand whether a dissociative part is primarily mediated by daily life action systems or by defense-oriented ones, because treatment interventions differ by type.

Courtois highlights that differential assessment of dissociative parts—ANPs versus EPs—determines which phase-specific interventions are clinically appropriate, linking structural dissociation theory to phase-oriented clinical decision-making.

Courtois, Christine A, Treating Complex Traumatic Stress Disorders (Adults) aside

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The therapist therefore assists survivors in raising and in developing more balance between their mental energy and efficiency, which enables them to deal more effectively with complex internal and external stimuli.

Van der Hart frames the cross-phase therapeutic aim as the development of mental energy and efficiency, the psychobiological substrate that makes progression through the phases of treatment possible.

Hart, Onno van der, The Haunted Self Structural Dissociation and the Treatmentaside

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