FAQ -- IMPLEMENTATION 

How do I begin?

     The simplest way is to read chapters 1 and 2 in the Seeking Safety book, and then select one topic that appeals to you. For example, you could select the topic Asking for Help as it is the shortest one in the book and thus a good one to try. Then just conduct it with a client or group and see how it goes. You will find that it is easy to implement, and you can move on to additional topics one at a time. Note: the Seeking Safety book suggests reading the entire book first, but we no longer recommend this; it is not necessary and may be overwhelming on the front end. The key is to just start. Additional steps that may be helpful include watching the training videos or attending a training.

Can Seeking Safety be used with other treatments?

     Yes, it is designed to be used with any other treatment the client is receiving. In fact, the topic Case Management focuses on how to refer clients to additional treatment.  

Can it be used with men?

     Yes. Seeking Safety was designed for both men and women.  

     More:  The book includes examples from both men and women as well as gender-neutral language where appropriate. Because many of the studies on Seeking Safety were conducted on women, it is sometimes assumed that the model was intended for women. This also derives from an early paper on the model  (Najavits et al., 1996), which focused on women in group treatment. However, by the time the model was finalized and published in book form, it explicitly targeted both genders.  Four studies on Seeking Safety have been conducted on men, all with positive outcomes.  An article summarizing the use of Seeking Safety with men is now available (Najavits et al., in press). 

Can it be used with adolescents?

     Yes. Seeking Safety has been widely used with adolescents.  Thus far, it is also the only model designed for PTSD and substance abuse that has shown positive outcomes with adolescents (Najavits et al., 2006; and Hamilton, 2006).   

     More:  The book has been used with adolescents, both male and female. There is no separate version for adolescents, as it has worked as-is with them. However, it is helpful to apply it in ways that are appropriate for that age group. This includes:

w Using examples relevant for them, such as school, parents, dating, sports.

w Adding elements to engage them, such as the Seeking Safety card deck, poster, and/or your own ideas.

w Creating fun exercises. For example, you can have adolescents do artwork for the exercise “Climbing Mount Recovery” in the topic When Substances Control You. You can help them create collages, pictures, and murals to reflect the list of Safe Coping Skills in the topic Safety.

w Having sessions with the adolescent’s parents as needed, using the topic Getting Others to Support Your Recovery.

w Communicating with the school guidance counselor, teachers, doctors, or others as may be helpful, using the topic Case Management.

w Exploring the Seeking Safety topics out loud if an adolescent resists reading the handouts (occasionally some may feel handouts resemble “school”).  

 

Is it relevant for complex trauma / personality disorders?

     Yes. It was developed and tested on clients who typically had multiple traumas, often based in childhood, and often chronic. Moreover, in one study that evaluated co-occurring personality disorders, 65% of the sample met criteria for one or more personality disorders (Najavits et al., 1998).Thus, complexity is often the norm. The format and content of Seeking Safety appear helpful for such clients, and the case management part of the treatment also helps to engage them in additional resources that may be beneficial for them.     

 

How about simple or recent trauma?

     It has been used across the full spectrum of people with PTSD, including recent PTSD, "simple PTSD" (a single incident in adulthood), to complex and chronic PTSD. It has also been used for subthreshold PTSD (people who meet some of the criteria for the disorder, but not all). When used for recent or simple PTSD, the work typically moves more quickly; there may be a need for fewer sessions; and clinicians may choose to emphasize some topics over others. However, the basic elements of the work do not change in major ways.

Is there a self-help version?

     We are currently piloting a self-help version at a program in Florida. The initial pilot went very well and we are continuing to collect data on it. We are also creating a Seeking Safety self-help guide.  

     More:  Within a year we hope to publish our findings on whether Seeking Safety works well in self-help format (peer-led, with no clinician present). We believe this is a promising approach and that various aspects of Seeking Safety may work well in this format (e.g., the handouts are easy to follow, safe, and focused on coping skills in the present).  However, more experience and research are needed to verify this and to complete the Seeking Safety self-help guide.  

Has it been translated into other languages?

     Yes. It has been translated into Spanish, French, German (full versions) and Swedish (handouts only). Other translations currently underway are Dutch and Polish. 

     More:  We welcome other language translations of Seeking Safety, but please note that you would need to obtain formal written permission from Guilford Press as they own the copyright.  Lisa is happy to help with this process and has assisted with all prior translations (providing free support to facilitate communications with Guilford Press, to promote distribution of the finished translation from the Seeking Safety website if needed, and to discuss key translation issues that need attention).  Please email info@seekingsafety.org if you are interested in translating Seeking Safety or if you just want to let us know what additional languages you would like to see it translated into.  

Do clients have to meet criteria for PTSD and substance abuse?

     No.  Any client who can benefit from working on coping skills can be included. Clients do not have to meet criteria for PTSD and/or substance abuse.   

     More:  In many settings there would not be enough clients if it had to be restricted just to formally diagnosed PTSD/substance abuse clients. It has been used with very diverse clients including those with other Axis I disorders (including psychotic disorders, bipolar disorder, personality disorders, eating disorder, pathological gambling, depression, dissociative identity disorder, etc.).  It has also been implemented with clients who are sub-threshold on PTSD and/or substance abuse or have a history of these.  There are several reasons why Seeking Safety appears to be helpful across diverse clients: (a) The coping skills are easy to understand and relevant to a wide range of problems (e.g., “asking for help”, “compassion”, “honesty”, “taking good care of yourself”, “creating meaning”). (b) The topic Case Management is used to refer clients to obtain treatments; thus a client with pathological gambling could be referred to Gamblers Anonymous; a client with an eating disorder could be referred to an eating disorder program.

      Suggestions when implementing the model with diverse clients include: (a) tell clients to ignore the term “PTSD” and/or “substance abuse” if these do not apply to them; (b) tell clients to apply the skills to any current issues in their lives where they may be helpful; (c) refer clients to any needed treatments for co-occurring disorders using the topics Case Management and Community Results.

      Research too supports use of Seeking Safety with clients who do not meet criteria for PTSD and/or substance abuse.  Early studies on the model focused on clients who met criteria for both disorders. But later studies (e.g., Morrissey et al., 2005; Desai and Rosenheck, under review (see outcomes) were applied to any clients who needed help with coping skills.   

Can I adapt the treatment for my population?

     It is advised to adapt “within the model.” Seeking Safety was designed to be highly flexible. Thus adaptation is built into it and encouraged--  use examples from client’s lives; use any number and order of topics that you choose; conduct the session for any length of time desired; do group or individual format; go as slow or as fast as needed; use it with any other treatments you choose.  

     More: However, it is not advised to adapt “outside the model” until you have tried it as is.  Sometimes clinicians read the book and say, “My clients won’t like some of these topics”, “They won’t like the format”, “They won’t understand the language”, “I’d like to change the materials”, “My clients are a minority group and they need the materials adapted to their culture”. We strongly encourage you to try the model as is, and only adapt it based directly on clients’ consistent feedback. Use the “End of Session Questionnaire” (in chapter 2 of the Seeking Safety book) and the “End of Treatment Questionnaire” (in the topic Termination).  If clients consistently provide criticism or suggestions based on these questionnaires, then adapt accordingly.  However, in over fifteen years of observing programs and clinicians implement the model, we have never seen nor heard of a need to actually change the materials.  It has gone well just by adapting “within the model.” 

Does Seeking Safety work with minority clients?

     Yes. The studies on the model have included different percents of minority clients (e.g., 77% in Hien et al., 100% in Hamilton, 2006), and all have found positive outcomes and high satisfaction by clients.  Seeking Safety has also been successfully implemented with diverse clients in a wide variety of settings. Click here for more on diversity.  

How do I select clients?

     Be as inclusive as possible, with a plan to monitor clients over time and evaluate whether it is helpful to them.  The treatment has been used with a very wide range of clients, with all types of co-occurring disorders, from the start of treatment. We know of no particular client readiness characteristics or contraindications. 

     More: Read more on client selection. See also "Do clients have to meet criteria for PTSD and substance abuse?"

How can I see what a session of Seeking Safety looks like?

     A video is available of Lisa conducting a session with real clients, unscripted.  

How can I locate Seeking Safety treatment?

     See the provider listing, but please note that only a few providers are listed. Many more actually conduct the model, so you may also want to check with local agencies.   

Can I be listed as a Seeking Safety provider?

     Yes.  If you or your program provides Seeking Safety and would like to join our listing on the website, we are happy to include you.  

     More: Please email info@seekingsafety.org and include your name and key information (your phone and/or email; what type of Seeking Safety you provide such as group or individual; insurance accepted, if relevant; and any other details you would like to include). 

Can Seeking Safety be applied to addictions other than substance use?

       Yes. For example, it can be applied to pathological gambling, internet addiction, sex or pornography addiction, food addictions, and other behavioral addictions. This is because the principles of reducing substance use generally apply to these as well. However, as part of the topic Case Management you would also want to refer the client to focused treatment for additional addictions, if available (e.g., Gamblers Anonymous, eating disorder treatment).  

Can Seeking Safety be done as a mixed-gender group treatment?

      Yes. It has been successfully run this way. Because it focuses on coping skills in the present, we have not heard of any problems conducting it as a mixed-gender group.  However, it is advised to let clients know in advance that it will be mixed-gender so they can decide whether they are comfortable with this.  

     More: If a client has current and serious perpetration issues (child abuse, domestic violence, assault) this could trigger other clients who may have been victims of such crimes; thus select clients carefully. This would be true for any group, but is especially important for mixed-gender groups.   

For groups, does it need to be co-led?

     No. It can be conducted by one clinician or two, depending on your preference. 

Does the client need to go through stabilization before starting Seeking Safety?

     No. Seeking Safety is designed as a stabilization model. It does not require any stabilization prior to using it. You can start it from the very beginning of treatment.  

Can clients have contact outside of group Seeking Safety?

     There is no rule on this. You can decide based on your program policies.  

Can I conduct Seeking Safety with large groups?

     Yes. Some programs have very large groups of 20-40 clients. For very large groups, you could reduce the check-in and check-out. You could ask one or two questions only, and have just a few clients respond. For the check-in you could say, “Can anyone ‘name an example of good coping’ they did this week?” “Does anyone want to share if they had ‘substance use or other unsafe behavior” this week?.  For the check-out you could say, “Does anyone want to share ‘one thing you got from today’s session?’”   

     More:  If possible, base the size of your groups on how much time you have available so that clients can go through the full check-in and check-out; but if you need to cut these down, you can. You can also model the check-in and check-out so clients see what level of detail you are looking for. 

What if a client can’t read?

     You can still do Seeking Safety. The treatment concepts are easy to understand (e.g., “asking for help”, “compassion,” “honesty,” “taking good care of yourself”). Thus, you can briefly summarize key points for the client and discuss them out loud.  If conducting a group treatment and some clients can read, they might read small sections out loud to help those who cannot read. Also, there is an audio version of the book for the blind available to qualified individuals (see www.rfbd.org).

What if a client is ready to focus on the past?

     Lisa is currently writing a new book on past-focused treatment of PTSD and substance.abuse. It uses the same format and style as Seeking Safety, but addresses the past.  It will be available in early 2009. If you would like to be notified when it comes out, please email info@seekingsafety.org..  There are also various existing models for past-focused PTSD treatment (e.g., EMDR, exposure), but these do not address substance abuse.  

If I email you a description of my client, can you provide feedback on treatment ideas?

     Sorry, but we cannot do this as email is not adequate to gauge a client’s needs.  We can provide case consultation, however, by telephone or on-site (see Training).  

Would it help to go over the ground rules of the treatment at every session?

     No. We do not recommend this. It is not necessary; and it creates a tone that is focused on rules, which can alienate clients. The goal is to create a positive, supportive tone. If a problem arises, you can remind clients of the rules at that point (see the “Treatment Agreement” in the topic Introduction / Case Management).  

Any other suggestions for implementing Seeking Safety?

     Yes—enjoy it. Do it in ways that fit who you are as a clinician as well as your clients’ needs. We sincerely hope that you find the materials helpful and that they make your job easier, better, and more gratifying. Clinical work is some of the most important work one can do. The goal of Seeking Safety is to respect your judgment and expertise and to help empower your best work.  Good luck!

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