Seeking Safety

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Lisa M. Najavits · 2002

What it is

Seeking Safety is a present-focused coping-skills therapy for people with trauma and/or substance use problems (including co-occurring PTSD and substance use disorder). It is delivered individually or in groups, by professionals or peers, and alongside other treatment. Its overarching goal is…

Format

• Seeking Safety is not organised into fixed phases. It is a menu of 25 stand-alone topics that can be done in any order and in as many sessions as time allows.
• Format and dose

Who practises it, and how they are trained or regulated

• Fidelity and training: training is optional for clinical use but required for research. Fidelity tools include a long Seeking Safety Fidelity (adherence) Scale, a brief clinical fidelity form, a Session Format Checklist and a Supervisor Certification Scale. One county system required trainees to score at least 2.0 on each adherence-scale section, held monthly supervision using the model's supervision format, and…
• Version followed: adult Seeking Safety as published in Najavits, L. M. (2002), Seeking Safety: A Treatment Manual for PTSD and Substance Abuse (Guilford; 25 topics, each with a clinician guide and client handouts; the 2021 Guilford e-book is the same book, and no later edition was found). The session format (check-in, quotation, relating the topic, check-out, with timings), the handouts for Introduction/Case…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• over-scheduling; perfectionism.
• asking unsafe people; help-rejecting patterns.
• supporters who use with the client or are abusive.
• competitiveness or shame in groups; keep it light.
• sheet becoming paperwork; keep it to one situation.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.