James Fitzgerald Therapy, PLLC
Seeking Safety Treatment Program (Lisa M. Najavitz)
MAIN MENU
CHECK-IN AND CHECK-OUT | SESSION FORMAT | CORE CONCEPTS OF TREATMENT | LIST OF TREATMENT TOPICS
COMMITMENT TO RECOVERY | END OF SESSION QUESTIONNAIRE | PRACTICAL INFORMATION ABOUT YOUR TREATMENT
GET THE MOST OUT OF SEEKING SAFETY | TREATMENT AGREEMENT | SAFETY & CONNECTION FIRST | SAFE COPING SKILLS | COMMITMENT IDEAS
WHAT IS PTSD? | PTSD AND SUBSTANCE USE | COMPASSION – TAKE BACK YOUR POWER | LONG TERM PTSD PROBLEMS | 10 MINUTE GROUNDING
USING GROUNDING TO DETACH FROM EMOTIONAL PAIN | WHAT IS SUBSTANCE ABUSE? | HOW SUBSTANCE ABUSE PREVENTS HEALING FROM PTSD
CHOOSE A WAY TO GIVE UP SUBSTANCES | CLIMBING MOUNT RECOVERY | MIXED FEELINGS | SELF UNDERSTANDING OF SUBSTANCE USE
SELF-HELP GROUPS | COMMON QUESTIONS | ASKING FOR HELP | APPROACH SHEET | SELF CARE QUESTIONNAIRE | HARSHNESS VS COMPASSION
Core Concepts & Principles
The treatment is based on five central ideas:
(1) Safety as the priority of treatment.
The title “Seeking Safety” expresses its basic philosophy: when a person has both substance abuse and PTSD, the most urgent clinical need is to establish safety. Safety is a broad term that includes discontinuing substance use, reducing suicidality and self-harm behavior, ending dangerous relationships (such as domestic abuse and drug using friends), and gaining control over symptoms of both disorders. In Seeking Safety, safety is taught through Safe Coping Skills, a Safe Coping Sheet, a Safety Plan, and a report of safe and unsafe behaviors at each session, for example.
Read More: Safety as the Priority of Treatment
(2) Integrated treatment of PTSD and substance abuse.
Seeking Safety is designed to treat PTSD and substance abuse at the same time. An integrated model is recommended as more likely to succeed, more sensitive to patient needs, and more cost effective than sequential treatment of one disorder then the other [32, 33]. In Seeking Safety, integrated treatment includes helping patients understand the two disorders and why they so frequently co-occur, teaching safe coping skills that apply to both, exploring the relationship between the two disorders in the present (e.g., using a substance to cope with trauma flashbacks), and teaching that healing from each disorder requires attention to both disorders.
Read More: Integrated Treatment of PTSD and Substance Abuse
(3) A focus on ideals.
Both PTSD and substance abuse individually, and especially in combination, lead to demoralization and loss of ideals. Thus, Seeking Safety evokes humanistic themes to restore patients’ feeling of potential for a better future. The title of each session is framed as a positive ideal, one that is the opposite of the pathological characteristic of PTSD and substance abuse. For example, the topic Honesty combats denial, lying, and the “false self”. Commitment is the opposite of irresponsibility and impulsivity. The language throughout emphasizes values such as “respect”, “care”, “integration”, and “healing”. By aiming for what can be, the hope is to instill motivation for the hard work of recovery from both disorders.
(4) Four content areas; cognitive, behavioral, interpersonal, and case management.
While originally designed as a cognitive-behavioral intervention (a theoretical orientation that appears well-suited for early recovery stabilization), the treatment was expanded to include interpersonal and case management domains. The interpersonal domain is an area of special need because PTSD most commonly arises from traumas inflicted by others, for both women and men [34]. Interpersonal issues include how to trust others, confusion over what can be expected in relationships, and the need to avoid reenactments of abusive power. Similarly, substance abuse is often perpetuated in relationships. The case management component offers help obtaining referrals for problems such as housing, job counseling, HIV testing, domestic violence, and child care.
(5) Attention to clinician processes.
With this dual diagnosis population, who are often considered “difficult”, it is a challenge to provide effective therapy. Clinician processes emphasized in Seeking Safety include compassion for patients’ experience, using coping skills in one’s own life, giving the patient control whenever possible (to counteract the loss of control inherent in both trauma and substance abuse), meeting the patient more than halfway (e.g., doing anything possible within professional bounds to help the patient get better), and obtaining feedback about how patients view the treatment. A balance of praise and accountability are also suggested. The opposite of such positive therapist processes are negative processes such as harsh confrontation, sadism, difficulty holding patients accountable due to misguided sympathy, becoming “victim” to the patient’s abusiveness, and power struggles.
Read More: Attention to Clinician Processes
Additional Features of the Treatment.
In addition to the five main principles above, several additional features of the treatment can be described.