That’s because for many trauma patients, sometimes even a friendly face or a gesture of compassion can feel unsafe, even threatening.
So what are some key ways we can avoid triggering clients and foster stronger feelings of safety?
In the video below, three leading experts share their strategies. Check it out – it’s about 3 ½ minutes.
Dr. Buczynski: Re-establishing a sense of choice and control can be critical for people who’ve experienced trauma. Now, there’s a lot we can do to reinstate choice and control for our clients. In fact, how we arrange the office can make a big difference.
Dr. Levine: One of the things that I generally do is I have my seat and the client’s seat at right angles, actually. And the reason for that is so they don’t have to look at me if they don’t want. They also know that they can go inside, and I’ll be here. If they need me, then we can make contact this way. I find it gives a lot of flexibility.
Dr. Buczynski: There’s one more critical piece to consider when thinking about choice and safety, and that’s the office door. This is another place where treatment can go wrong because the way that we set up our office can inadvertently put our clients in a defensive state.
Dr. Levine: One of the things I also discovered – and this was when I was working with a lot of Vietnam vets in the 70s and 80s – I realized it by making the mistake. If I was in the way of a client coming to the door to the room, that would be experienced as extremely dangerous. I mean, you don’t necessarily think about that. So, I made absolutely sure that they had a clean way to the door, even if I had to rearrange where I was sitting.
Dr. Buczynski: Now this isn’t only for veterans, we need to keep this in mind when we’re working with anyone who’s felt trapped in a moment of danger. In so many of my conversations with trauma experts, they emphasized how important it is to uncover and work with our clients’ strengths. In fact, Ruth Lanius actually takes a strengths inventory.
Dr. Lanius: I usually ask, “Tell me about your strengths.” And usually people will say to me, “I have none.” I will say to them, “Well, what I’ve noticed with you, just being here for half an hour, is that you seem to be incredibly persistent. Tell me about that persistence.” Then usually, that gets them talking a little bit, and as they talk about one strength, often that leads to the next.
Dr. Buczynski: Now I’d like to hear from you. How will you use these ideas with your clients today? Please leave a comment in the comment section right below this video, and I’ll be back soon, and thanks for watching.
What strategies have you found effective for helping clients feel safe after trauma? Please share your comment below.
Nice to see that the strategies that I instinctively use (client that doesn’t look at me directly, always letting the client to start the session with their own subjects, having free way to the door) are also being taught in this video! That reassures me.
The tip for looking for the strength is very useful.
Thank you very much!
How would you reassure an easily triggered patient on the phone?
The sense of control is so good. I also liked active listening to uncover person’s strengths
Thank you so much for these videos . They are greatly appreciated
How can we attune to these ideas in a virtual environment? Many of us have developed virtual practices during the pandemic.
I give clients a choice as to using zoom or phone for a session and, if the client chooses zoom, whether or not they want to appear on camera. They can instead use a photograph of themselves or just a blank icon image. I have also found that it is often important to them whether or not I am on camera.
Hello! I am so grateful for your videos. One question I have is regarding the clients ability to have control but not at the risk of our own safety. Where can I sit so I am still closest to the door but not make the client feel trapped?
I hope NICAMB will consider adding a course on how to treat patients who suffer PTSD during or after medical treatment.
The idea of offering choice is a great one especially where the choice is a small one – one that is unlikely to overwhelm someone and leave them feeling that they have “failed” at the first hurdle. I also like the idea of a strengths’ inventory and helping a client to identify and admit to their own resources.
Thank you for sharing, it is a great presentation. To add to this, I personally think that for a person to feel safe inside can only come from personal growth … For me, for a person to feel safe inside … As I have been in a relationship for years, I thought it could evolve from the self-affirmation and confirmation of one’s own conviction. I see at my client’s place that being present and holding it close to you gives them strength and a base to stand on when they are ready to move forward. And they do it. One step after another. Whenever they feel safer and stronger. Some would be open to showing some vulnerabilities if it had been useful in the past. My many relationships have failed and taken me apart. My thfreefailed marriages in some ways were all my fault in a sense I gave myself the permission to fail. I dropped out from high school, ran away, and got pregnant at sixteen. There was no growth behind it. It just felt safe for me this way. My determination was to get away from it. After many years of seeing my therapist, I have matured and give the love to myself as I deserve it and not judging the part of me as either good or bad, but as being human. Today, I live alone wth my two dogs in my beautiful flat. Now it feels safer for me to talk about it.
Thank you for your reaction, Denis . I feel the same way. Deep listening and a lot of reassurance create not only a basic therapeutic alliance but also is nourishing for the heart and the mind.
As a combat veteran I can attest to having space issues and wanting a clear line of sight to the exit. Creating a safe space is for me being able to open my heart and truly feel that I can speak my own voice. In my practice I have worked with veterans professionally for the last 12 years, I have found that deep listening, creating a friendly smile and greeting the person with respect and dignity, and putting their needs above my own, or what gives them reassurance and yes choices, and that’s part of my job is to help them see their choices. How the room is arranged, how the veteran feels, how anyone feels after a traumatic experience(s), all these things matter. Sometimes I just ask how do you feel and then let them know that I am here for them.
Denis Hoin Darby
Chaplain, Behavioral Recovery coach
Navy Combat Veteran