Seeking Safety Treatment Manual: Accessible Tools for Work with Trauma by Lisette Lahana, LCSW

November 18, 2012 4:43 PM | Admin EBCAMFT
“You yourself, as much as anybody in the entire universe, deserve your love and affection.” -Buddha

According to Judith Herman (1992), the first stage of recovery from trauma is that of “Safety.”  This key stage can include skill building in order to prepare for the work of “remembrance and mourning,” which may involve exposure therapies.  With the best of intentions, we sometimes rush toward interventions that trigger Post Traumatic Stress Disorder symptoms which can cause people to fall apart in our office or when they return home. I’ll admit that I’ve had the experience of being shocked by what I heard during an intake in response to the routine question “Have you ever experienced any abuse as a child?”   I’ve listened, paralyzed, as the gory details of a rape tumbled into the room.  It can be difficult to stop a client mid story but sometimes that is exactly what we must do, gently, in order to prevent destabilization. Early on I assess what skills clients already possess for self-regulation when they are having overwhelming feelings.  Slowing down before entering into trauma work helps us assess where a client fits into this stage model for trauma, their symptom picture and their expectations of therapy.  

When working on the stage of “Safety” with clients, we encourage them to spend time in therapy learning day-to-day coping skills.  That may mean helping clients decrease or stop using substances, self-harm or other compulsions. We focus on helping clients gain a sense of control or understanding of their symptoms.  Later we may move to help them establish safe environments and relationships with healthy boundaries.   At the core of this stage of recovery is that our clients become skilled at developing a safe relationship with themselves and others. This is where Seeking Safety: A Treatment Manual for PTSD and Substance Abuse (2002) by Lisa Najavits, can become a trusted companion.

The Seeking Safety Program, designed by Najavits, comes in the form of a manual with 25 different topics for clients who have Post Traumatic Stress Disorder and also applies to those with a co-occurring Substance Abuse diagnosis.   Multiple studies have found there is a strong link between PTSD and substance abuse.  In one recent study, between 44% and 56% of women seeking treatment for substance use disorder had a lifetime history of PTSD (Covington, 2010).   The Seeking Safety model has been used in a variety of settings and has been found effective at reducing symptoms of PTSD. After fifteen years of different therapies, one of my clients, “Sharisa” noted that the program finally helped her to understand the connection between her history of incest and her abuse of alcohol.

Seeking Safety is primarily geared toward adults and can be used individually, in groups, with all genders, and without any special training. Training materials and videos are available on Najavits’s website for those who want additional preparation.  It has been tested with a wide variety of populations, from veterans to incarcerated women.  A therapist who has knowledge (but not necessarily a specialization) in trauma and substance abuse will have all they need to use these materials successfully. Abstinence as well as harm reduction principles are promoted in the materials.

The manual provides 25 topics that combine cognitive behavioral therapy, interpersonal skill training and psychoeducation. I appreciate that the program materials address how trauma informs a person’s core values and ways of making meaning of the world.   The topics can be presented to clients in any order.  I often provide clients with a topic list and they can then choose which topics they want to focus on. For some clients, I have presented only one or two handouts in the entire course of individual treatment.  Others take part in my six-month group therapy program.  Clients may work on topics such as “Asking for Help,” “Compassion,” or “Healing from Anger.”

I routinely use these materials with clients who have no substance use issues as the program seems equally effective for them.  When we reach one of the rare sections of the handouts whose focus is primarily on drugs or alcohol, I ask clients who don’t relate to think of things that they do that may be harmful, in order to cope. Most trauma survivors I’ve worked with relate to the idea of having unhealthy compulsions or coping tools such as gambling, smoking, isolation or overeating.  

In a group setting, using Seeking Safety handouts, we begin by listening to a quote, like the one above, about self-compassion by Buddha.  During every check-in period we ask about positive and negative attempts to cope over the week.  For example, last week one client talked about the self-harming behaviors she uses to cope, that of picking at her skin when stressed. I applauded her honesty and helped her analyze the impact of the behaviors.  We brainstormed other ways to manage her distress next week, such as returning to her weekly yoga practice.  All this was approached with curiosity, avoidance of shame and respect for her resilience.

In Seeking Safety, each topic comes with a chapter to prepare therapists and includes handouts for clients.  Chapters, which I like to think of as my cliff notes, give background on the topic as well as tips on how to initiate dialogue and build insight.  One of my most cherished handouts is on “Detaching for Emotional Pain (Grounding)”  which helps clients “…shift attention toward the external world, away from negative feelings.” (p. 125)  The therapist gets a step-by-step ten-minute script to walk clients through physical, mental and soothing grounding skills.  These tools help clients reduce their reactivity and move away from their fight or flight response.  For example, to mentally ground, clients are encouraged to “play a categories game with yourself” and name as many cities or types of dogs as they can.  Or “count to 10 or say the alphabet very s…l…o…w…l…y.” Then they get to take home a trusty handout to practice the three types of grounding in their weekly commitment (homework).

I love leading Seeking Safety Groups because my clients, most of who have complex PTSD, actually notice feeling more stable and using healthier coping skills after six weeks of the program.   However, sometimes giving up the familiar negative coping can lead to an upsurge in trauma symptoms.  Seeking Safety gives therapists and clients a foundation of tools to draw upon as the work challenges and deepens over time.  I encouraged clinicians to take a look at the materials and bring in a model that helps clients, who are often stuck, move toward healing.

Licensed since 1999, Lisette Lahana, LCSW is CAMFT member in private practice in Oakland, CA and has run Seeking Safety Groups since 2008.  She has openings in her current Seeking Safety group in Lake Merritt/Oakland.   LisetteLahana.com. Learn more about Seeking Safety, the topics, the empirical research behind it and how to purchase the manual on SeekingSafety.org.

 

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