How was Seeking Safety developed?

     The therapy was developed over a ten-year period beginning in the early 1990’s under a grant from the National Institute on Drug Abuse. Clinical experience and research studies informed revisions of the manual, resulting in the final published version in 2002. 

What are the key principles?

     Seeking Safety is based on five central ideas: (1) Safety as the priority of treatment. (2) Integrated treatment.(3) A focus on ideals. (4) Four content areas: cognitive, behavioral, interpersonal, and case management. (5) Attention to clinician processes.

     Other features include simple, human language and themes (i.e., accessible language that avoids jargon); treatment methods based on educational strategies to increase learning; a focus on potential; emphasis on practical solutions; and an urgent approach to time.   


     More: Click here to read about these in more detail, see also any of the chapters that describe the model. The Seeking Safety book describes how it differs from existing treatments, such as dialectical behavior therapy, relapse prevention, and other therapies.   

Is Seeking Safety evidence-based?

     Yes. In fact, it is the only psychotherapy model for co-occurring PTSD and substance abuse thus far that has enough studies to be classified as “effective”. See the summary of research and also the website section Outcomes.

More: The evidence base on Seeking Safety at this point includes various pilot studies, controlled trials, multisite trials, and dissemination studies. These studies address various populations and modalities. Other research is underway. 

What are the topics?

     Seeking Safety offers 25 treatment topics, each with a clinician guide and client handouts. The seven interpersonal topics are Asking for Help, Honesty, Setting Boundaries in Relationships, Healthy Relationships, Community Resources, Healing from Anger, and Getting Others to Support Your Recovery. The seven behavioral topics are Detaching from Emotional Pain:  Grounding, Taking Good Care of Yourself, Red and Green Flags, Commitment, Coping with Triggers, Respecting Your Time, and Self-Nurturing. The seven cognitive topics are PTSD: Taking Back Your Power, Compassion, When Substances Control You, Recovery Thinking, Integrating the Split Self, Creating Meaning, and Discovery.  In addition, four combination topics are Introduction to Treatment / Case Management, Safety, The Life Choices Game (Review), and Termination.  


     More: See the brief description of each topic; and examples of the topics Asking For Help, Compassion, and Red and Green Flags.  


Do I have to do all 25 topics?


     No. The model was designed so that you can do as many or as few as you have time for.   


     More: Each of the 25 topics is independent of the others and you can decide which ones you want to conduct, in any order and in any number. The model was designed for a very high level of flexibility as clients with trauma and/or substance abuse appear in so many different settings, with varied lengths of stay. Click here for more on this.    

If I have time for only a few topics, which would be best?

     Any that you select are fine.  Some clinicians have conveyed that when they have limited time, they focus on the following topics: Safety; Detaching from Emotional Pain (Grounding); Asking for Help; Honesty; Taking Good Care of Yourself; Compassion; Recovery Thinking; and Healing From Anger.  Also, depending on the client, PTSD: Taking Back Your Power or When Substances Control You may also be key topics.  When choosing topics for a short treatment, try to choose ones that the client is not receiving elsewhere.  For example, the topic Coping with Triggers can be helpful, but if the client has a lot of other substance abuse treatment, triggers may already be covered there.  

Is it a stand-alone treatment?

     It can be used alone or in combination with any other treatments the client is receiving. The Case Management and Community Resource topics are designed to help refer clients to additional treatments that may be beneficial for them. 

Is the goal abstinence from substances?

     It provides various options for reducing use, in keeping with current research and understanding about addiction. You can from an abstinence model (clients give up all substances), harm reduction (decreasing use, perhaps with a goal of ultimately reaching abstinence), or controlled use (decreasing use to a manageable level with a goal of remaining there). The method you choose will depend on the philosophy of you and your program, the client’s needs, and other factors.  See the topic When Substances Control You.  

Is Seeking Safety encouraging people to avoid the past?

     No. Seeking Safety focuses on the present but this does not mean it encourages avoidance of the past. 

     More: Clients are encouraged to name their traumas as part of Seeking Safety and to discuss how it impacts them. The key principle is “headlines not details”—they are simply asked not to go into detailed exploration of it, as that would be a different type of therapy that is not part of Seeking Safety. Seeking Safety can be used with any other therapy or treatment the client needs or wants, including past-focused models (e.g., exposure therapy or EMDR for PTSD). Many clinicians have found that Seeking Safety helps client tolerate past-focused models as it strengthens their general ability to cope. Two studies thus far have used a combination of Seeking Safety and a past-focused model (Najavits et al., 2005; and another by Susan Brown et al. that is not yet released). 

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