The client attended 18 months of integrative treatment and was followed for 5 years. The study included 106 data points of both client and therapist data.
The authors identified three recovery-related phases in the therapeutic process, which were labeled (a) self-acceptance, (b) re-engagement and responsibility, and (c) agency.
First, the therapist’s normalizing behaviors and psychoeducation regarding the impact of trauma led to an increase in client self-awareness and self-acceptance. Alliance formation and normalization appeared as mechanisms, and the client experienced dependence.
Next, the client began to “take in the therapist” and was affected by the working alliance. Thus working alliance and countertransference appeared as mechanisms, and the client experienced reduced gambling and suicidal ideation.
Finally, she built confidence in her environment and started seeking more opportunities and independence. External controls and increased opportunity appeared as mechanisms, and “moving into the world” was the client experience.
The findings give preliminary support to a phase-based constructivist treatment including trauma assessment to normalize self-feelings, countertransference work to support motivation for restraint, and case management principles to support continuity of change efforts.