Trauma Healing: Using Perry’s 3Rs Model

Trauma healing is a vital component of therapy for intimate partner abuse survivors.

Trauma symptoms interfere with partner abuse survivors’ healing. During my therapy practice, I developed Journey to Healing interventions for survivors fostered by my social work training and numerous trauma workshops. When I discovered Bruce Perry’s 3Rs of Trauma Therapy: Regulate, Relate, and Reason, I found my interventions fit within these concepts.

Perry originally wrote about the 3Rs to show how to work with traumatized children. His neuro-developmental approach works from an understanding of how trauma affects the brain. Healing begins when they develop a safe relationship with you and regain their emotional equilibrium. Subsequently, they find therapeutic cognitive-oriented techniques more beneficial.[i]

I believe Perry’s concepts also apply to adult victims. The following examples illustrate how to apply Perry’s 3Rs with survivors using Journey to Healing interventions.

Regulate, Relate, and Reason Trauma Interventions

Regulate Interventions

Regulate interventions address difficulty managing emotions, otherwise known as dysregulation. Dysregulation frequently occurs during and after abusive episodes, but over time, it can also interfere with a survivor’s general functioning.

Self-regulation techniques offer survivors ways to feel in control of their emotions so they can access the reasoning parts of the brain. Journey to Healing contains handouts that educate and encourage clients. This example is one quick experiment to try in session.   

Intervention Example

During a therapy session, Terry says, "Abuse sends me reeling for days. I have trouble focusing on my work and I'm really short with the kids."

The therapist says, “Let’s try an experiment. We’ll both focus on our breathing, just noticing it. Take a breath and notice the rising of your chest, the way the air moves through your nose. Breath out and feel your chest deflating. I’ll do this along with you for a few moments.”

After a minute of doing this, the therapist says, “What did you experience?”

Therapeutic Summary

Closing your eyes along with your client reduces their self-consciousness.

Making it an experiment and asking what they experience normalizes that nothing works for everyone, avoiding feelings of inadequacy.

Hearing their response gives you information that allows you to match their needs.  

When your client begins to profit from self-regulating practices, this progress facilitates adding Reason interventions. The time it takes for self-regulation depends upon the client and the degree of trauma.

Relate Interventions

Humans require connection for healthy functioning. Survivors vary in the amount of isolation they experience, but they all have partners who attempt to dominate:

• what they know,

• their perceptions,

• how they feel, and

• what they can do.

An abuser’s success at gaslighting and dominating injures survivor self-esteem, trust, and sense of agency. Healing is facilitated by connecting to healthy, non-abusive people.

Therapy may be the first connection where survivors feel supported and safe. Your ability to empathize, reflect what they say, validate their perceptions, underscore their strengths, and ask questions that inspire their thinking establishes a safe environment that permits healing. Survivors feel recognized and understood by your responsiveness and helpful guidance. Many have the opposite experience with friends or family. Your supportive relationship opens the door to hope and rebuilding trust in themselves.

Journey to Healing offers two types of interventions that strengthen the therapeutic relationship and promote gaining new perspective on their partner’s behavior:

• End the Silence

• Domination Systems

The intervention demonstrated comes from “End the Silence” materials.

Intervention Example 

Brice says. "I go back and forth about whether this is abuse. Maybe I'm making a mountain out of a molehill."

The therapist says, “It sounds like you doubt whether it’s okay to call your partner abusive. Let’s look at a checklist that might help you to decide.”

The “Coercive Behavior Checklist” is given and time devoted to Brice’s response.

Therapeutic Summary

Naming abuse when you hear it is valuable to survivors. Two other resources encourage connections:

• When survivors see their experiences mirrored in a checklist, their doubt often evaporates. The “Coercive Behavior Checklist” names twelve types of coercion for how they affect their victims. The checklist enables discussions about how abuse affects them, which strengthens the bond you’re forming with your client.

  
  

• Group therapy and support groups benefit survivors by showing them they aren’t alone. The feedback gained from other survivors counteracts the gaslighting and denial from their partners.  

It’s important to make space for processing survivors’ sadness and grief, a normal response to facing their abuse.      

Reason Interventions

Regulate and Relate interventions enhance survivors’ ability to use Reason interventions, which use the cognitive parts of the brain. Cognitive behavioral therapy gives tools for healing that empower survivors throughout their lives. Journey to Healing offers four Reason interventions for use as survivors become ready:

• Mind Mastery

• Boundary Repair

•  Assertive Skills

• Post-traumatic Growth

All should be employed while also considering safety. The intervention demonstrated below is part of the Mind Mastery skills.

Intervention Example

Riley discloses, “I still hear Frank’s voice every time I do anything like self-care or buying myself something.”

The therapist says, “I know it’s distressing that their derisive messages keep popping into your mind. Coercive control over a long period of time is like water getting inside of you when you can’t swim. It’s called internalization and the result is feeling you still need to abide by their restrictions. This takes time to change. Would you be interested in looking at a handout that increases awareness of self-defeating beliefs and how you can change them?”

Therapeutic Summary

The handout "Thought Empowerment” educates about thinking and gives clues to identify self-defeating  and self-enhancing thoughts. Written material helps many to process and understand.

Changing behavior also facilitates changing their thinking, but that is often complicated by not believing they have the right to behave assertively.

This handout complements working with other Reason interventions, such as assertive skills.  

Additional Trauma Resources

Partner abuse healing resources and the full Journey to Healing curriculum are available on the Find Your Voice website.

You will also find links to current workshops.

[i] A brief formulation of Perry's work: https://beaconhouse.org.uk/wp-content/uploads/2019/09/The-Three-Rs.pdf It includes this statement: "Heading straight for the 'reasoning' part of the brain with an expectation of learning, will not work so well if the child is dysregulated and disconnected from others." This is also true for adults.