Sanctuary Model

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Sandra L. Bloom, Joseph Foderaro, Ruth Ann Ryan · 1980

What it is

The Sanctuary Model is not a session-based psychotherapy. It is a whole-organisation, trauma-informed model of culture change for human-service settings. Sandra L. Bloom (psychiatrist), Joseph Foderaro and Ruth Ann Ryan developed it from 1980, starting on an adult acute inpatient unit, and later…

Format

• Format at client level: daily community meetings (start and end of day, often also at shift changeovers); personal safety plans; a weekly psychoeducation group (the 2003 version had 12 sessions; a 2017 agency handbook describes six topics, two sessions each: trauma theory, S.E.L.F. overview,…
• What it is. The Sanctuary Model is not a session-based psychotherapy. It is a whole-organisation, trauma-informed model of culture change for human-service settings. Sandra L. Bloom (psychiatrist), Joseph Foderaro and Ruth Ann Ryan developed it from 1980, starting on an adult acute inpatient unit,…

Who practises it, and how they are trained or regulated

• Typical duration is 30–36 months of consultation; the NCTSN fact sheet says full implementation may take 2–5 years. Licensing: ANDRUS is the only licensed US provider, and MacKillop Family Services is the licensed subcontractor in Australia. Costs and contacts in that document are dated.
• Version note: the 2001–2003 trial used eight hours of initial staff training plus ongoing consultation and later booster training, unit mission statements, twice-daily community meetings, and a 12-session weekly psychoeducation group. It tracked progress with a "Sanctuary Milestones" checklist.
• No formal criteria for moving between S.E.L.F. domains are documented. Practical guide: work on loss only when the client has a working safety plan, can name feelings and use one or two regulation skills, and has no acute risk; return to safety whenever an incident, placement change or anniversary destabilises them.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• 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

• supervision used only for compliance checks.
• rules imposed by staff and labelled "democratic".
• a Core Team made up only of managers; tools that exist in policy but not on the floor.
• S.E.L.F. used as a label-filling exercise. Signs it is working: the plan changes because of what the analysis found.
• staff splitting into "rescuers" and "enforcers" around one client. This is a common sign of reenactment at team level.

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.