frequently asked questions about seeking safety
How was Seeking Safety developed?
The model 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.
Who is it designed for?
Seeking Safety can be used with any client from the start of treatment. It has been successfully implemented with adults and adolescents (ages 13 and up); diverse ethnicities and cultures; all types of trauma, all types of addiction; and for clients who many have neither trauma or addiction, but need help to improve their coping skills. It was designed for all genders-- the first study was on women, but by the time the book was published it had been written and evaluated on males, females, and across gender identities. It has been conducted successfully in single- and also mixed-gender groups. Clients can be in any level of care (e.g., outpatient, inpatient, residential) and do not have to meet criteria for PTSD or substance abuse. Seeking Safety is known for its relevance in particular to vulnerable populations including homeless, criminal justice, domestic violence, people living with HIV, severe and persistent mental illness, veterans, military, and others.
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. You can read more about these ideas if desired.
Additional 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. See also 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.
Who can conduct Seeking Safety?
Anyone can conduct Seeking Safety. It does not require any specific degree, licensure, or certification (unless a research study is being conducted; if that is the case, please contact [email protected]). Seeing Safety is an extremely safe model that teaches present-focused coping skills. It has been successfully implemented by professionals of all sorts, paraprofessionals, advocates, and peers. We are happy to report that we have never heard of adverse events related to Seeking Safety in the over 20 years of its having been used in settings all over the U.S. and internationally. Moreover, training is available in many forms, but is not required (unless research is being conducted on it). We take a very strong public health approach to treatment and strive to create models that can be widely used, at low cost, and with few obstacles to implementation. [Read here about Guilford Press statement, if needed.]
Is Seeking Safety evidence-based?
Yes. In fact, it is the only model for co-occurring PTSD and substance abuse currently classified as "strongly supported by research." See the summary of research. The evidence base includes pilot studies, controlled trials, multisite trials, and dissemination studies. The studies address various populations and formats (both group and individual treatment), and are notable for including highly complex populations that are typically excluded from PTSD studies (e.g., people with homelessness, domestic violence, substance dependence, drug use disorders). Other research is underway. Note: if you hear someone say Seeking Safety is not evidence-based, please have them contact us-- they are not current on the state of the evidence. We are happy to help provide them with up-to-date information.
What is the content?
Seeking Safety offers 25 treatment topics, each with a clinician guide and client handouts.But you don't have to do all 25 (see next FAQ). Also you can conduct each topic in a session or more than one (e.g., spread over two sessions). 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. The four combination topics are Introduction to Treatment / Case Management, Safety, The Life Choices Game (Review) and Termination. You can read a brief description of each topic; and examples of the full 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 time allow. Each of the 25 topics is independent of the others so you can decide which ones to conduct, in any order and 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. You can also decide to do Seeking Safety in segments, such as offering the first 4 topics (or 8 or 12), then clients decide if they want to do the next 4 (or 8 or 12), etc.
If I have time for only a few topics, which would be best?
Any that you select are fine. It time is limited, some of the key topics are: Safety; Detaching from Emotional Pain (Grounding); Asking for Help; Honesty; Taking Good Care of Yourself; Compassion; Recovery Thinking; and Healing From Anger. Depending on the client, PTSD: Taking Back Your Power or When Substances Control You may also be key topics. For a brief treatment, try to choose topics that the client is not receiving elsewhere. For example, Coping with Triggers can be helpful, but if the client has other substance abuse treatment, triggers may be covered there.
Can it be conducted in large groups?
Yes, any group size is possible. For very large groups (too many to do the check-in and check-out with all of the clients), use this procedure: ask the first check-in question and then say, "Who would like to answer?" and allow just 2-3 people to respond. Then ask the second check-in question, and now have several other clients respond, and so on with all check-in questions. This keeps the check-in and check-out present so clients will still focus on these important questions, but without having everyone have to answer.
Can it be done in telehealth (virtual) delivery?
Yes, it lends itself well to telehealth and has been done in that way for over 20 years. It is an extremely safe model and can be delivered in person or online. If you obtain the Seeking Safety ebook you can share the handouts by email with your clients (all providers need their own book for their clients).
Is it a stand-alone treatment?
It can be used alone or in combination with any other treatments. The Case Management and Community Resource topics help refer clients to additional treatments that may be beneficial.
Is the goal abstinence from substances?
Seeking Safety provides various options for reducing use, in keeping with current research and understanding about addiction. You can use an abstinence approach (clients give up all substances), harm reduction (decreasing use, perhaps with an ultimate goal of abstinence), or controlled use (decreasing use to a safe level). Your approach will depend on your and your program's philosophy, 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. Clients name their traumas as part of Seeking Safety and explore in depth how it impacts them in the present. 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 find that Seeking Safety helps client tolerate past-focused models as it strengthens their ability to cope. One study in fact successfully combined Seeking Safety and Exposure Therapy (Najavits et al., 2005_); and another combined it with EMDR (Susan Brown, unpublished).
Is there a new edition?
Although the book is not currently updated for DSM-5 criteria, this impacts just 2 pages of the 400-page book: the top half of page 118 (PTSD criteria) and page 151 (substance use disorder criteria). You can simply replace these with updated criteria updated criteria for PTSD and for substance use disorder. Within a few years there will also be a new edition of Seeking Safety but the exact timing is not clear as yet. In the meantime please know that all of the chapters and coping skills do remain current. Also Lisa's most recent book may be of interest to you. It was published in 2019 called Finding Your Best Self. It is a completely separate model from Seeking Safety but also addresses trauma and/or addiction.
Can the language be adapted?
Yes! For example, the term substance abuse can be replaced with substance use disorder. Gender-based terms can be replaced with non-binary terms. Keep in mind that Seeking Safety was written in the 1990s/2000s and reflects the language of that time period. In our training on the model and website articles, we're explicit that counselors should adapt language as needed to be sensitive to their clients. When a new edition of SS comes out, it will use language of the current era. Lisa's newer books, such as Creating Change, have updated language.
See also questions/answers by Lisa on PsychWire (2022) here
The model 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.
Who is it designed for?
Seeking Safety can be used with any client from the start of treatment. It has been successfully implemented with adults and adolescents (ages 13 and up); diverse ethnicities and cultures; all types of trauma, all types of addiction; and for clients who many have neither trauma or addiction, but need help to improve their coping skills. It was designed for all genders-- the first study was on women, but by the time the book was published it had been written and evaluated on males, females, and across gender identities. It has been conducted successfully in single- and also mixed-gender groups. Clients can be in any level of care (e.g., outpatient, inpatient, residential) and do not have to meet criteria for PTSD or substance abuse. Seeking Safety is known for its relevance in particular to vulnerable populations including homeless, criminal justice, domestic violence, people living with HIV, severe and persistent mental illness, veterans, military, and others.
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. You can read more about these ideas if desired.
Additional 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. See also 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.
Who can conduct Seeking Safety?
Anyone can conduct Seeking Safety. It does not require any specific degree, licensure, or certification (unless a research study is being conducted; if that is the case, please contact [email protected]). Seeing Safety is an extremely safe model that teaches present-focused coping skills. It has been successfully implemented by professionals of all sorts, paraprofessionals, advocates, and peers. We are happy to report that we have never heard of adverse events related to Seeking Safety in the over 20 years of its having been used in settings all over the U.S. and internationally. Moreover, training is available in many forms, but is not required (unless research is being conducted on it). We take a very strong public health approach to treatment and strive to create models that can be widely used, at low cost, and with few obstacles to implementation. [Read here about Guilford Press statement, if needed.]
Is Seeking Safety evidence-based?
Yes. In fact, it is the only model for co-occurring PTSD and substance abuse currently classified as "strongly supported by research." See the summary of research. The evidence base includes pilot studies, controlled trials, multisite trials, and dissemination studies. The studies address various populations and formats (both group and individual treatment), and are notable for including highly complex populations that are typically excluded from PTSD studies (e.g., people with homelessness, domestic violence, substance dependence, drug use disorders). Other research is underway. Note: if you hear someone say Seeking Safety is not evidence-based, please have them contact us-- they are not current on the state of the evidence. We are happy to help provide them with up-to-date information.
What is the content?
Seeking Safety offers 25 treatment topics, each with a clinician guide and client handouts.But you don't have to do all 25 (see next FAQ). Also you can conduct each topic in a session or more than one (e.g., spread over two sessions). 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. The four combination topics are Introduction to Treatment / Case Management, Safety, The Life Choices Game (Review) and Termination. You can read a brief description of each topic; and examples of the full 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 time allow. Each of the 25 topics is independent of the others so you can decide which ones to conduct, in any order and 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. You can also decide to do Seeking Safety in segments, such as offering the first 4 topics (or 8 or 12), then clients decide if they want to do the next 4 (or 8 or 12), etc.
If I have time for only a few topics, which would be best?
Any that you select are fine. It time is limited, some of the key topics are: Safety; Detaching from Emotional Pain (Grounding); Asking for Help; Honesty; Taking Good Care of Yourself; Compassion; Recovery Thinking; and Healing From Anger. Depending on the client, PTSD: Taking Back Your Power or When Substances Control You may also be key topics. For a brief treatment, try to choose topics that the client is not receiving elsewhere. For example, Coping with Triggers can be helpful, but if the client has other substance abuse treatment, triggers may be covered there.
Can it be conducted in large groups?
Yes, any group size is possible. For very large groups (too many to do the check-in and check-out with all of the clients), use this procedure: ask the first check-in question and then say, "Who would like to answer?" and allow just 2-3 people to respond. Then ask the second check-in question, and now have several other clients respond, and so on with all check-in questions. This keeps the check-in and check-out present so clients will still focus on these important questions, but without having everyone have to answer.
Can it be done in telehealth (virtual) delivery?
Yes, it lends itself well to telehealth and has been done in that way for over 20 years. It is an extremely safe model and can be delivered in person or online. If you obtain the Seeking Safety ebook you can share the handouts by email with your clients (all providers need their own book for their clients).
Is it a stand-alone treatment?
It can be used alone or in combination with any other treatments. The Case Management and Community Resource topics help refer clients to additional treatments that may be beneficial.
Is the goal abstinence from substances?
Seeking Safety provides various options for reducing use, in keeping with current research and understanding about addiction. You can use an abstinence approach (clients give up all substances), harm reduction (decreasing use, perhaps with an ultimate goal of abstinence), or controlled use (decreasing use to a safe level). Your approach will depend on your and your program's philosophy, 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. Clients name their traumas as part of Seeking Safety and explore in depth how it impacts them in the present. 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 find that Seeking Safety helps client tolerate past-focused models as it strengthens their ability to cope. One study in fact successfully combined Seeking Safety and Exposure Therapy (Najavits et al., 2005_); and another combined it with EMDR (Susan Brown, unpublished).
Is there a new edition?
Although the book is not currently updated for DSM-5 criteria, this impacts just 2 pages of the 400-page book: the top half of page 118 (PTSD criteria) and page 151 (substance use disorder criteria). You can simply replace these with updated criteria updated criteria for PTSD and for substance use disorder. Within a few years there will also be a new edition of Seeking Safety but the exact timing is not clear as yet. In the meantime please know that all of the chapters and coping skills do remain current. Also Lisa's most recent book may be of interest to you. It was published in 2019 called Finding Your Best Self. It is a completely separate model from Seeking Safety but also addresses trauma and/or addiction.
Can the language be adapted?
Yes! For example, the term substance abuse can be replaced with substance use disorder. Gender-based terms can be replaced with non-binary terms. Keep in mind that Seeking Safety was written in the 1990s/2000s and reflects the language of that time period. In our training on the model and website articles, we're explicit that counselors should adapt language as needed to be sensitive to their clients. When a new edition of SS comes out, it will use language of the current era. Lisa's newer books, such as Creating Change, have updated language.
See also questions/answers by Lisa on PsychWire (2022) here