Materials
The three-stage recovery model
A review of ASCA’s twenty-one steps in three stages—remembering, mourning, and healing
Dr. Patrick Gannon
In this video, the author of Soul Survivors and co-founder of ASCA discusses the recovery model used in ASCA, providing a comprehensive overview and a summary of each stage and their seven steps. The video is 32 minutes. Transcript included.
Transcript
I wanted to talk a little bit about the three-stage recovery model because I think that’s where this program is the most unique. And, when I brought the book to The Morris Center and we thought, “Hey, maybe this would be the format of a recovery program specifically targeted for adult survivors,” we wanted it to be comprehensive, we wanted it to be specific, and we wanted it to provide a clear pathway—a road to recovery—that people could easily understand and work at. The idea being that: When people accomplish a particular step or a task, they feel some sense of empowerment. So, their self-agency goes up and that can lead to more self-confidence and even improved self-esteem.
But going back to the beginning, when I first started doing the groups for male survivors and hearing people’s story about how they first figured out that they’re in what we call a breakthrough crisis—when the memories from the past started coming up in the consciousness for the first time and there was a gradual awareness that developed that pointed to the fact that they had been mistreated as children, I wanted to give them a certain amount of structure that would help them manage the initial anxiety and disequilibrium that happens when people realize that what they thought about their childhood was actually incomplete—it was not as accurate as they might’ve thought. And now, their childhood is recast in a different light because of what these emerging memories were telling them.
The Stage One recovery. I’ll just go through some of the steps. The first step is really what we found when people first came into recovery.
We’ve written these steps similar to the steps in A.A., and it was done for a reason because the A.A. model is very, very effective. Obviously, it goes back to Bill W.’s work in the ’30s, and obviously it’s a worldwide phenomenon—incredibly successful—responsible for helping millions and millions of people to recover from the drinking problem, the alcoholism, or the alcohol abuse. And so, we wanted to start at the very beginning.
The first one is: I have resolved the breakthrough crisis regaining some control of my life.
People would talk about the fact that they went through this period of destabilization and probably some of that involved some—what we call—dissociation, which is a psychological defense. But if they stay with it and they start talking to people about it—maybe reach out to a therapist or talk to somebody that has been through this thing before, they can actually regain a sense of control over their life. Basically thinking, “Okay, well, this happened to me. I can figure this out. It’s different. It’s upsetting. It makes me angry. It makes me scared. But I know other people that have gone through it and I can survive as well.”
And then it’s really, really important, the second step of this first stage, it’s really important that they gain information that allows them to determine intuitively or objectively whether they were physically, sexually, or emotionally abused or neglected as a child.
They need to really apply some of these definitions that I was offering in the book to figure out, “What was my abuse profile? What exactly happened? What category does it fall into?” These different types of abuse is going to require different approaches—to some degree different approaches—and different emphasis. So that again is an example of self-empowerment through gaining information and figuring out, from their own point of view, what happened. And that also offers a sense of empowerment.
And then Step Three. I’ve made a commitment to recover from my abuse.
Making a commitment. Recovery does take a lot of energy. It does take a tremendous commitment. It’s not something that you’re going to think about occasionally or just talk about when you’re with your therapist for one hour a week. Recovery is really ongoing. It’s almost like a lifestyle issue for a while. During the heavy-lifting stages of recovery, you’ve got to be working even between sessions and between ASCA groups. You have to be writing and reading and working things through, and that takes a big commitment. So, you almost have to formalize the commitment in order to give yourself the support and the direction to follow this recovery program through to the end.
And then Step Four. It’s really, really critical that you are able to re-experience each set of memories of the abuse as they surface in your mind.
Now, dissociation and repression are psychological defenses that have held this information down at an unconscious level for many years. In fact, many as survivors, it’ll be years into their adult life before they become aware of what happened and what specifically was done to them. So, as each memory floats up into consciousness, they need to figure out, “What does this mean? What does this say? What does this suggest about the way that this affected me? And what actually was being done to me?”
We move on to Step Five, which is: I accept that I was powerless [over my abuser’s] actions, which makes them, not me, responsible for the abuse.
So this is a key element in the psychological adjustment that children that are being abused make. Children that are being maltreated often think that there’s something about them, something that they did, something about who they are that made the abuse happen, which of course is a fallacy. The parents were responsible. The parents are the ones that were in charge. But for kids, they tend to internalize this, for a number of psychological reasons, one of which is that they don’t want to think that their parents are out to hurt them, and they have an emotional and psychological investment in giving their parents the benefit of the doubt. Unfortunately, that tends to mean that they tend to internalize the responsibility for the abuse.
We want to, right off the bat in the first stage, we want to challenge that fallacy. We want them to realize that they were kids. They weren’t responsible for what was being done to them. The parents had all the power. The parents and the parents’ pathology and personality were behind the maltreatment. And then we want to begin to address some of the guilt that survivors typically have for themselves.
And then Step Six. I respect my anger as a natural reaction to the abuse, and I’m learning to not turn it against myself or others.
Again, now we’re focusing primarily on the emotional consequences of abuse. Anger is often one of them, one of the feelings. It’s a feeling that has to be addressed early on because so many survivors were doing self-sabotage behaviors or hurting themselves in some way. Anger either gets externalized or internalized. So we didn’t want them to internalize the anger.
We wanted them to manage the anger in a healthy way, not by turning it against themselves or others, but we wanted to put the issue on the table early on. The part of your recovery had to include managing your anger and how you express your anger in the real world because we didn’t want them thinking that just because they were abused and they’re angry, they have a right to take it out on other people because that could be self-destructive on its own. So, we wanted to address that issue about anger.
Now, there are many other feelings for sure that come up: guilt and shame, regret, sadness, disappointment, betrayal. There’s so many different feelings that abuse survivors have, but we were looking at identifying the feelings that could be immediately destructive or threatening to their welfare. We wanted them to immediately have some tools to manage that anger, so they didn’t hurt themselves.
And then Step Seven. This is a step that comes from some of the inner child work that Charles Whitfield wrote about—healing the inner child [v. Healing the Child Within, 1987]. And the step itself says: I’ve reconnected with my inner child whose efforts to survive can now be appreciated.
Adult survivors need to have some compassion for their childhood self and what they went through. And that compassion for that internalized child can be the foundation of a different attitude toward themselves as adults.
It’s really important that survivors recognize the situation that their childhood self was in and appreciate all the things that they were doing to try to survive that—some of which were healthy and some of which were not. But it was an effort to try to manage a very horrible situation. And that credit—crediting yourself with what you’re doing that represents progress and represents moving you along the recovery path—is really critical. You have to develop an empathic voice, an empathic sense, and respect for what you went through as a child.
So, that’s the first seven steps of Stage One, which the ASCA program probably focuses the most on. But that’s where people come in. And generally, they spend a lot of time—usually one to three years I would say—working through this early stage of recovery. And a lot of it has to do with making sense of the abuse and how it affected them and what they need to do to have a different life.
Many of the survivors I worked with, they weren’t really aware when they left home in their early 20s that there were even abuse survivors. It wasn’t until later on in their 20s or even their early 30s, where they saw the repeating patterns of how their life was going and they finally—after many years—connected it to what was being done to them as children. The second stage is really about that. We borrowed Step Four of A.A.—the inventory step.
In Stage Two, Step Eight, we started out with: I’ve made an inventory of the problem areas in my adult life.
So, we wanted people to take stock—which is what taking an inventory is really about—take stock with where you are in your adult life and what are you going to do about it. It wasn’t your responsibility for the fact that the abuse happened, but it is your responsibility to take charge of your life, engage in a recovery program that’s going to help you turn around your life. And we knew that that second stage was really the heavy lifting in recovery.
And then Step Nine. I’ve identified the parts of myself connected to self-sabotage.
This may be one of the most common psychological elements/effects of childhood abuse:
- Making decisions that are bad.
- Putting yourself in dangerous situations.
- Undoing yourself in a variety of ways.
- This feeling that you’re not entitled to take care of yourself or pursue your own interests.
We wanted to identify that that had to be identified in terms of: What are you doing to harm yourself in either gross ways or subtle ways?
And then Ten. I’m uncovering my shame and working to transform it into self-acceptance.
Shame became a very popular topic when the [John] Bradshaw workshops were starting to happen in the ’80s and shame was obviously a key element, a key feeling. Shame, of course, is different from guilt. Shame is feelings of self-blame. Survivors that have read books know it well. It’s a very difficult feeling to come to grips with. The closer you get to your feelings of shame, the more it burns away at you inside. But we wanted to address that that shame had to be transformed into self-acceptance. You had to handle shame in a very particular way in order to not continue to harm yourself by holding it.
And then Eleven. I’m able to grieve my childhood and mourn the parents who failed me.
Again, we’re cycling back to what happened during childhood. There’s an element of grieving and mourning the childhood that you never had and the parents that failed you. Obviously, parents that abuse their children are failed parents. Now, the reasons why they failed their children: many of them, as we know, were abused themselves or came from difficult backgrounds. But nevertheless, we know that child abuse is an intergenerational crime and an interpersonal crime. It happens between two people, most likely between the primary caregivers and the child.
But you had to come to grips with the fact that your parents really failed you, and they weren’t what you needed. And maybe they weren’t completely useless or harmful—maybe there were good elements, in many cases—but the fact is that when parents abuse their children, they’re failing as parents. And that might sound judgmental and everything, but the fact is that some things have to be faced. And the fact that parents do certain things to their children just have to be seen as horrible and wrong and represent a failure on the part of their role as parents.
Then, we move on to the latter part of Stage Two recovery with Step Twelve. I can challenge faulty beliefs and distorted perceptions, adopting more healthy attitudes and expectations about myself.
Now, I know that there’s a lot in this one sentence, this one step. There’s a lot of action, a lot of mental attitudes that need readjusting. But you need to be aware that as a result of the way you were treated, you can develop faulty perceptions, especially about yourself and who is responsible. And those faulty perceptions can extend to a wide variety of other topics that are really determinative in terms of the kind of life that you’re going to have. We wanted to identify that, “Hey, take a look at some of the attitudes and the beliefs that you hold about yourself.”
A good example would be for the female survivor that’s been abused by a male. Many times they develop negative attitudes toward men for very understandable reasons because they were abused by males. And yet, not every male is an offender and it’s important, obviously: Female abuse survivors are in the workforce and they’re dealing with both genders and if they have a negative attitude or belief that all men are potential abusers—a very extreme view—it’s going to have consequences on their career success.
We want them to raise a question as to whether some of these beliefs and attitudes and perceptions are accurate or not. We wanted them to test themselves to see whether they were accurate or not.
Now, these are steps that many people in the recovery field might not have thought about considering, but we think we in the mental health field feel that this is really how people make long-term sustained change, is by making certain changes in terms of how they feel, their attitudes, their beliefs, their perceptions, what they project out onto the world. And we wanted people to develop more healthy attitudes about themselves and others.
[Step Thirteen]. I accept that I alone have the right to be the way I want to be and to choose how to live my life.
People that grow up in healthy families, they come out of a family and in the best cases, they feel that they have the right to make choices that they deem to be good for them. They can operate in their own self-interest. But for many survivors, that’s really not the case. People, maybe, have provided more input or influence, sometimes negative influence on who they are, what they should do, or a lot of advice is given to people that are used to taking it from other people.
So, we just wanted to reinforce that you have the right—survivors have the right—to determine who they want to be, what kind of life they want to have, and how they’re going to live that life. And, of course, this extends to today because today we have much more awareness about gay and lesbian and transsexual people and people on the spectrum. There’s a lot more awareness now today that people have the right to pursue who they are and how they want to live in the world and to express their individual identities. So we wanted to reinforce that that is their right. Nobody can take that away from them.
And in many cases, of course, this puts them in opposition to their families, who may judge them for what they’re trying to do in terms of facing their recovery. And we wanted them to know that that right to determine their own identity and who they want to be in the world is their right alone and nobody can take that away from them.
And then finally, the final step of Stage Two is: I can control my abusive behavior and find healthy outlets for my aggression.
Again, we’re going back to the anger issue. And we know that the anger is going to be there at some level if you were abused, in particular, for males who were physically abused. And we know that the prevalence research suggests that boys are more physically abused than girls. Girls are more sexually abused than boys. And that we wanted people to know that the aggressive behavior is going to get them in trouble.
A study was done years ago by Delancey Street, which is a recovery program in San Francisco for people that had been incarcerated, and they found an incredibly high incidence of physical abuse among prisoners. And obviously, they were not in many cases able to handle their aggressive impulses, and they expressed their anger through violent acts or criminal acts, and of course they got caught and put into prison. So, we wanted to address that, put a spotlight on that issue about managing the aggressive behavior, which of course is tied to their own abuse and the anger that they had.
I do want to go through Stage Three, which is really putting together all of the steps prior in Stage One and Stage Two and building a thriver personality. And so Stage Three is really about thriving in the real world. And the first step is: I’m strengthening the healthy parts of myself while reducing maladaptive behaviors and patterns [ASCA Step Sixteen].
So the idea here is that you come through, you do the heavy lifting in Stage Two, you take a look at how the abuse affected you, you identify the areas that need work, you start to do that work in the context of either attending a self-help group like ASCA or individual psychotherapy or just your own personal recovery work. And then you want to build on that new sense of self. That’s really what in many cases it involves cleaving off some of the parts, the damaged parts of yourself that are hurting you and replacing them with healthier parts of yourself based on how you’re living in the world—your daily life, what you do in the world.
Every moment in the world, in your daily life, you have a choice to make about how you’re going to live and what are the values underlying the choices that you’re making. And by doing that day after day after day, you’re growing yourself. We call this neuroplasticity. Your brain is actually growing itself in a new direction that is healthy and is mindful and is supportive and considerate and empathic. Many of the things that you were not exposed to during childhood, but that gets reinforced in who you decide to spend your life with—your intimate partner, your friends, your community members. We want you to be able to gradually reduce those maladaptive patterns and behaviors.
And then Sixteen. I’m entitled to take the initiative to share in life’s riches [ASCA Step Fifteen].
Now, it’s really important that abuse survivors have a healthy sense of entitlement. And when I use that word entitlement, I’m not talking about narcissism. I’m talking about the right for people to pursue their interests, to get their fair share of life’s riches, and to be able to enjoy expressing themselves in the world and receiving the benefits. It could be financial benefits by achieving at a job. It could be the respect of your friends. It could be a sense that maybe the most important thing is when you have children is ending that intergenerational chain of child abuse by treating your children differently, by not being an abuser and by raising healthy children. That may be the most gratifying thing at all for survivors to be able to change what was done to them and to be different parents.
Step Seventeen. I’m acquiring the interpersonal skills to adopt new behaviors at home and at work.
So, interpersonal skills are really critical and because, again, depending on the type of abuse constellation that survivors suffered at home, they need to alter some of their interpersonal skills. They need to reduce the sense of fearfulness, for example, or projecting a sense that they’re not going to be listened to or they’re not going to be valued. They need to give themselves a break, build on the fact that they can recognize some of the changes they’ve made and gratify themselves for the hard work that they’ve done. But they need to be different people in interpersonal situations, not just in their acquired family, but also in their community and in their friendships.
Interpersonal skills that adopt new behaviors at home and at work. They need to function differently, basically, to be successful. To push recovery to the thriver level, they need to be more effective.
Step Eighteen. I’ve resolved the abuse with my parents or offenders to the extent that’s acceptable to me.
At some point, you need to accept what happened to you, and you can choose to forgive your parents. We don’t make it an obvious step because some survivors feel that what was done is basically unforgivable, and I believe that too, having worked with so many survivors and hearing the horrible things that were done. I believe that many of those things were unforgivable.
From a a spiritual level, being able to forgive is probably a higher level of resolution. The minimum, it should be acceptance. You have to accept and not fight what happened to you. You have to accept that, “This happened to me and this affected me, but I don’t have to be living the negative effects for my entire life.”
There is some need to have a sense of resolution. And sometimes this involves the decision to speak to your offenders. And I have a chapter in Soul Survivors on confronting your offender, confronting the parents. And this is a very tricky issue. And I advise people not to think about that or not to think about taking such action unless you have the support of a therapist because it could be dangerous. Some parents are going to react poorly if you want to talk about what happened in the past and how it affected you.
It can be productive. It’s somewhat controversial within the psychological field. Some therapists think it’s not as important. I think it can be very helpful, but it takes a certain amount of planning and choice. Some situations, like with families that are criminal or violent still to this very day, it’s probably not a good idea to confront them, right? Because you don’t want to put yourself in jeopardy of being harmed. But in some cases, as the abusive parents have aged, they might mellow and they may be open because there’s a lot more understanding in our society today about abuse. And they may have come around a bit and they may have looked at themselves and what they did to their kids and they may be open. And if survivors can have a conversation about what happened with their offenders or their parents, that can be very healing and resolving and may actually help them to move past.
And then Step Nineteen. I’ve developed my own meaning about the abuse that releases me from the legacy of the past.
And again, there’s a lot in this step. But the idea here is that you have to have your own meaning about, “Why me? Why did I get hit? Why was I sexually abused?” You have to have your own meaning of it that allows you to release you from the legacy of the past. That allows you then to move on and having some meaning.
And this is something that Judith Herman in her classic book, Trauma and Recovery—it’s actually an element in a lot of recovery programs is developing a sense of meaning as to “Why something happened? And what it meant to me? And how do I understand it in a way that resolves it?” The more you can understand it and accept it, for better or for worse, allows people to move forward.
And then Step Twenty. I see myself not only as a survivor but as a thriver in all aspects of life.
And here we go back to what Sigmund Freud’s definition of a healthy life was: was success in intimate relationships, work, parenting, and play. So, can survivors actually play? Play takes a lot of… you have to be pretty secure to be able to play, even childlike. So, I see myself not only as a survivor, but as a thriver in all aspects of life—love, work, parenting, and play.
And then finally, Step Twenty-one. I am resolved in the reunion of my new self and my eternal soul.
So the idea here, psychologically, and this is more of a spiritual step, it’s the final step. And the idea here is to reconnect who you become as a person and who your essential soul was, and making that connection. So you have your own narrative thread between your essence as an individual person—one person stepping on the earth every day—and who you are in your new reclaimed self and that sense of reconnecting with your spiritual soul.
It’s why I call the book Soul Survivors because I think ultimately one of the early articles about child abuse was called “Soul Murder” [v. Leonard Shengold, “Child Abuse and Deprivation: Soul Murder,” 1979; and Soul Murder, 1991]. And I wanted to acknowledge some of the early writers in the field that wrote about that concept of soul murder. And I wanted basically to say, “Well, it might have been like a murder of the soul, but there’s actually through recovery you can reconnect with that spiritual side of yourself and connect it to who you’ve become in the world, how you behave, how you treat yourself, how you treat other people.” So I felt like that was the final step.
Everybody circles through these stages and these steps at a different pace. They go through several steps and then they circle back and they do a previous step. But eventually, they cycle through. If they stay with active recovery and if they go deep enough in their spiritual and psychological work to get to Step Twenty-one, they’re going to emerge as a very completely different person.
And so in this case, in this way, this program is really a very detailed psychological recovery program, pointing to some of what I think, based on all the research, are the key steps in rebuilding a sense of self, a new self that’s going to function differently in the world.
CREDITS
Dr. J. Patrick Gannon
Audio excerpt from an interview with the National Association of Adult Survivors of Child Abuse (NAASCA), March 21, 2023
Show: "Stop Child Abuse Now" (SCAN)
Episode: 3141
Hosted on: Blog Talk Radio
Link to show:
https://www.blogtalkradio.com/naasca/2023/03/21/stop-child-abuse-
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Video by
The Morris Center for Healing from Child Abuse
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