When Phase 1 Is Not a Phase: Rethinking Stabilization, Capacity, and “Resistance” in Trauma Treatment

When Phase 1 Is Not a Phase: Rethinking Stabilization in Trauma Treatment

Phase 1 trauma treatment is often taught as stabilization: a time focused on symptom management, affect regulation, and skill or capacity development. This framing is clinically useful. Structure matters. Orientation matters. Clear phases help therapists avoid premature depth work and ethical missteps.

And yet, in practice, Phase 1 rarely unfolds as cleanly or uniformly as it is taught.

For many clients—particularly those with histories of early, chronic, and relational trauma—Phase 1 work emerges in complex, recursive, and deeply relational ways. When this complexity is not named, both therapists and clients can be left feeling confused, ineffective, or discouraged.

This post offers a broader way of thinking about Phase 1: one that supports clinical discernment, calms the therapist’s nervous system, and creates space for difference rather than deficit.

Phase 1 Depends on What Is Already There

Phase 1 models often assume that clients have some access to adaptive information and experience—particularly in the areas of affect regulation, attachment, and relational safety.

For some clients, Phase 1 involves adding skills to an already existing internal frame. For others, that frame does not yet exist.

Clients with early attachment injury, developmental trauma, or pervasive neglect adapted to environments that required survival-based strategies rather than regulation, trust, or interdependence. In these cases, Phase 1 work is less about adding skills and more about building foundational capacity, often through relational experience over time.

This distinction matters. It shapes pacing, expectations, and how therapists understand what is unfolding in the room.

When Difficulty Is Labeled as Resistance

When clients struggle to engage in grounding, stabilization, or structure, this difficulty is sometimes understood as resistance or lack of motivation. In more concerning cases, it may lead to labels such as “treatment resistant” or “treatment failure.”

What is often missed is the developmental meaning of these struggles.

For clients whose early environments required hypervigilance, dissociation, or compliance for survival, Phase 1 tasks may feel unsafe rather than supportive. Difficulty engaging does not necessarily signal unwillingness; it may reflect a nervous system responding to perceived threat.

From this perspective, difficulty is not an obstacle to treatment—it is essential clinical information.

Broadening Phase 1 Without Losing Structure

Rethinking Phase 1 does not mean abandoning structure, models, or phases. It means holding them with flexibility and allowing developmental and relational context to inform how they are applied.

Phase 1 may include stabilization, relational safety-building, capacity development, and meaning-making—but these processes do not unfold sequentially or predictably. They emerge through each client’s unique history and adaptive strategies.

When therapists are supported in holding this complexity, Phase 1 becomes less about “doing it right” and more about staying oriented to what is actually happening.

Closing Reflection

Phase 1 is not a checklist to complete or a hurdle to get past. It is an ongoing, individualized, and relational process that asks therapists to tolerate uncertainty and remain grounded in curiosity. These reflections will continue to unfold over time, offering space to think more deeply about how Phase 1 work emerges in practice, how therapists are impacted internally, and how relational context shapes what becomes possible. In the coming weeks, we’ll be sharing additional reflections that build on these ideas.

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For therapists seeking additional support organizing the what of Phase 1 work—without reducing it to steps or protocols—this free reflective checklist Organizing the Ongoing Work of Phase 1 Treatment may be a helpful companion. Click Here to Access Checklist

References & Further Reading

Courtois, C. A., & Ford, J. D. (2013). Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach. Guilford Press.

Herman, J. L. (2022). Trauma and recovery: The aftermath of violence — from domestic abuse to political terror. Basic Books.

Liotti, G. (2004). Trauma, dissociation, and disorganized attachment. Journal of Trauma & Dissociation, 5(4), 55–75.

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. Norton.

Schore, A. N. (2012). The Science of the Art of Psychotherapy. Norton.

Van der Kolk, B. (2014). The Body Keeps the Score. Viking.