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.
I think that it is best to check with the client to see if there is something wrong with the room. I am sharing this as a client. I had a good therapist who recognized the need for me to have more light coming through the windows and the blinds to be cleared out. Before our meeting started she had someone coming in and cleaned the blinds. That showed great responsibility from his part.
Yes, like that. For some reasons, I think that setting the room at the right temperature is mostly a challenge. There is a lack of in those that has plain red, blue, and green tone to make it more familiar and peasant to the eyes.
Utilize space in the room to make the client more comfortable, arrange the seating making sure there is a clear way to the door. warm colours in the room will also help. white is not good too stark.
I agree whith that is a fact. I ateended to a room that is dried out. It is the crude facts that thus therapists don’t want this to be a desolate place to spands hours in. So having a fish tankz, a founztain can be a complaisant mileu for the clients.
Needless to say that having many more women in the profession surely helps very much to create this sense of safety and comfort for the clients. It is set in their predisposition to be caring, and more approachable for most of the time. To the contrary, it has been shown what clients look for the most when coming to therapy is comfort, nurturance and caring therapists.
I have learned that being a client is the most unsafe place to be – since I have been in therapy myself for over twenty years due to a severe depressive episode after my father died. He was my rock and the loss was devastating. I had many compassionate therapists helping me unlearning and being aware of my codependency but it is time that helped me the most to get back to where I am the most and safest. Until today I still make it an anniversary to remind myself that he never left.
Often I take the client to the safe place where he or she is comfortable to be and where they feel ready and safe to share with me. It is a dance that the client has probably not learned yet and they step and fall and probably will feel disoriented. But it is for the therapist to leave the room to give that space for their clients ….
Thank you for sharing. Where can we find all the workshops that are in our local area? I am very interested in giving one myself, about Nutrition Health and Mental Health. Please advise.
Informative and helpful, thanks.
Remember that it’s not just therapists who work with victims after trauma. This kind of logistical information should be available to prosecutors, victim advocates, nurse practitioners, funeral home directors and others who work with families shortly after traumatization in order to help them avoid unwittingly causing distress. I include it when I do training workshops for these groups and hope others will find ways to share with those in their community. Thanks.
Thank you so much for all the help, I had never thought of the importance of a doorway to accommadate a trauma client. Will definetely incorporate this and giving them a choice to sit to regain control.
Most of these methods I have used and found them to be effective. There have been some who feel safer if the door can be, at least, partly, open but it would need to be where privacy would not be compromised. There were clients who could not come into the office. In a case like that it was meaningful to have the beginning session or sessions in their vehicle. This did two things. First, it gave the client the safety of a familiar surrounding. They felt some sense of control. Secondly, it let the client know that you cared enough to meet them at the point of their need at that time. Later, it would become comfortable enough to come to the office for therapy sessions.
John, it is honestly a devotion to find a way to accommodate and to show that you care for their well-being and professionalism to be well-prepared to attend to wherever they are. It gives a feel that your clients deserve your attention and facilitate the possibilities that they will open up more easily to you . I like that the next sessions have to be planned to be in the office.
Sorry. I will fix they to “your clients “ to be more accurate.
I agree. The “feel” of the counseling office is important. I have plants, a small fish tank, and original art by former clients.
Thank you will remember this good points.
Thank you for the excellent tools. I’ve not really thought much about the questioning technique relating to their coming for counselling actually requires an inner strength and how this helps them to realise they have the ability to change…. Great stuff with the office and seating plans by the therapists, and the initial seating choice given to the client.
I always have an electric teakettle and a variety of herbal teas on the table next to clients, for several reasons including that many are on meds that cause dry mouth, and I want them to have safe and healthy methods of soothing available.
(Many of my clients, that should say. Can I edit it?)
Has anyone have thought about allowing the client to have a kind of soft fabric, blanket like for them in their office? I have cushions and toys but often unused. Bright colorful things that are unbreakable and may be fresh flowers are some ideas
I will use to make it comforting. Thank you for all the comments.
Please do not use fresh flowers. Allergies can be an issue, as too particular smells can retraumatize.
I should have thought about it. . . thank you for reminding me.
Very helpful thanks.
Using a self esteem handout to prompt ideas
Hi, I let the client choose his chair and I noticed that people with past trauma, anxious people are always choosing the chair on which they see the door. Sometimes I get up to take a sheet and I wonder if he’s okay as he stands, if he wants to change something, maybe he does not have the courage to say that.
i have a lot of flowers in my practice, and nice happy colors.I have very soft music in the room.
When i start treatingvthe patient , i give them a very soft toy.They can choose between different toys.I stop with the treatment when they give a sign.
I let them massage very lightely their underarms.
When they are starting to be afraid: i let them breath out very consciously together with me.
When they are in a panic: i do a kali/maori tecnique: i show them to pull out their tongue very far, lightely bite on the tongue and then looking left right and breathing out haaaa with pressure.
It does something in the brain ( i do not know what). Afterwards they are laughing or getting relaxed.
I went to a therapist once and had him mixed up with my creator. I suddenly took his place and thus his role. To keep the story short, I had full confidence in my that i am a better one than she can. What a learning!
Dear Dr. Ruth,
I felt validated when I heard this last set of suggestions because I already do all the three things that were suggested with all my clients. The comments helped me become more aware of what I am doing. Thank you!
Adela Gorodzinsky, RP,M.Ed,CBT
I have good results in therapy as a client. Mainly it was because I was educated and did a lot of research on the specialties that the therapist is specialized in. I think this mainly helps to create a strong connection and trust.
I couldn’t start the video. It just won’t run…could you please help
I make sure that there are no sharp corners in my office. I don’t have a desk and the one or two small tables I have for lamps have rounded corners so there is nothing threatening
Yes! Uncovering and working with a client’s strength and empowerment. That’s what its all about!
Thank you. Great info.
Peter Levine’s comment was a big memory-epiphany for me. With one therapist in particular, there was no clear line to the door, but worse than that, there was a demand that no one leave the room under any condition…in a group setting. I wanted to bolt! But I stayed against my better judgement.
Thank you. Very interesting.
Having changed therapists and worked lesser and lesser with a new recently, I have gone through the process of being more comfortable with myself, first. My therapist favorite work of choice is solution-focus and leading her to be pushy, as I felt like it. This has strangely incited me to come back for additional therapy and finding the answers to my problems, and to the abusive relationships, especially verbal ones, that I have unknowingly encountered for since our marriage. So when the silence is in the room, i just felt more compelled to keep on talking to myself, often, and come out of my mind to fill up the room, and safe.
Thank you for this clip. The fact that a person experiencing trauma makes it to the office to see a therapist is in itself a strength and a choice to survive and heal. It takes great fortitude and self love to make this step! The way an office is organized is also so important for someone to feel some sense of empowerment in terms of how they can organize themselves both in the session and in leaving the session without impediments. Our sensitivity to others as both therapists and human beings is the only way we can heal the planet. thank you Ronnie Rugys
This is an important issue since this involves future disclosure. I’ve found that pacing the session is crucial. One of my clients will start with her problems, she won’t know where her strengths are, nor does she about what she is for. So the pacing will create calmness in her when I ask her, for example “do you want to find work closer to home ?”, ‘would you rather not work night shift ?” or else like, “what would you do if your children are with their dads? ” those are supportive guidance but also that will leave a lot of options for where she choose to go.
Interestingly, I’ve set these conditions up in my office intuitively. Must be because I was subjected to early trauma and know what helps me feel safe.
I love beginning the first session with the strengths or positive aspects of the client not only because it orients is positively, but begins to rewire the brain.
I try to consider options for choice in every session; which place they will sit, offering to adjust lighting, etc. I also have “ritual” activities that are included in each session. I mostly work with families with children as my clients. I have attached Inside Out feeling characters with word lists on the back of my door and invite them to use chicken and unicorn slingshots to “shoot for their feelings”. This activity Helps develop capacity in identifying and sharing their feelings, and includes a physical movement component that can help with regulation as we begin our time together.
What a great idea!
In my personal life I am challenged by my relationship with my adult daughter who has a trauma history. My habit of fixing things makes things more complicated so I am working hard in learning to back off and persist in encouraging her to seek professional counselling. What is helping me is tuning in to my wise mind.
I also ask clients where they feel comfortable meeting, or wait until they choose where to sit before I do…
Hi Ruth – Really helpful. I work outside with clients which for most people gives them space not to feel trapped in a room and lots of space to move away if necessary..also we can walk and talk and not have to make eye contact if they wish – as Peter Levine wisely comments. When emotions escalate we can use the sounds or smells of tactile textures of nature to re earth the client and help them calm and recalibrate… I do however think that all the strategies in this clip were very helpful even if just reminding us of how best we can serve our clients to have the best chances of helping themselves with our support and starting the sessionswell . Thanks a lot for this . Jo Roberts uk
Using the outdoors for reintegration is in my opinion SO powerful. It is the active movement required and then the more ‘immediate’ experience of having traversed a territory actively (no matter how small sometimes). This builds an major sense of acheivement. Bessel vd Kolk talks about the importance of WHOLE body integration and maintains that whole body movement therapy is equally important (and we need to remember that it is mostly more easily accessible due to the financial constraints of getting psychotherapy). He is a great proponent of Yoga for this very reason, and for me, this makes sense when we consider Stephen Porges’s work on the Vagus nerve system, connecting the brain and the body.
Thanks Ruth, These are interesting ideas. I’m a person recovering from childhood trauma and I often find triggers difficult to avoid. Key things for me figured out by trial and error over many years have been 1. having some choice over the gender of my therapist and pursuing sources of support even if they aren’t local. 2. Training in Laurel Parnell’s “Tapping In” so that I can access positive resources whenever I need. 3. Pursuing Desmond Tutu’s 4 step strategy to Forgiveness so that I don’t get trapped in anger or fear 4. Focusing on the places where my needs are likely to be welcome and pursuing them. 5. Challenging myself to express my needs with people who I’m not entirely sure will refuse to support them. 5. Practicing pendulation, titration and body awareness whenever I can. Thanks for your support. Cheers, Garth
As a telephone advice nurse, when I get a call from an overwhelmed new Mom with a history of trauma, I need to remind myself to help her identify her strengths.
Thank you very helpful. I only have 2 chairs in my room but client’s chair faces the door and mine is at a 45degree angle. The client has a clear space towards the door. I always listen for strengths and what I hear I say affirming the client.
Does the client need to cross past you to get to the door? If so, that feeling of being trapped can be triggered. This was my experience in the prison system. Although the security recommendation is for the staff to put themselves closest to the door even though it creates a therapeutic disadvantage. I prefer to see the emotionally disregukated person have an escape route.
Very good info. As both a client and a mentor these help as well as,in my experience, clutter is distracting, the computer being on, bright lights, not having something personal from my councillor. ie. picture of self doing something with animals or friends. No family pics please.
The easy access to the door is a must for me as well and having my back against the wall is essential.
As a person working on boundaries and choice making, being asked where I want to sit ,at one time would have thrown me into a “where does he/ she want me to sit, is this a test, did I pick the right one” . I had no trust in what was EXPECTED from me. I’m much better now,LOL.
At first meeting , it can certainly be a challenge to know.
So grateful for all that I am able to learn and pass on.
Namaste
It is a special day. An app with your therapist. Anticipated and scarefully thought through. Allergic , claustrophobic anxious, fearful, uncollaborative, and wishing to have a fren to talk too. I don’t know anything better than a hearing your voice in a soothing and caring tone to introduce the session!
The best part of our profession is having that space for our client and ourselves to explore. But the surrounding cleared of clutters and freshly designed is a reflection of how safe it is for the client to see you dressed up for them and how special and welcoming the session is. I dislike having any clock in the room, any ideas to how to handle this issue ? Thank you
Thats exactly the pint of sitting having the door facing you rather than turning your back to it. Fir many clients that will give them a sense of knowing what can happen while they are conscious of their environment. I really find that makes the point perfectly clear. Thanjs for the great tsps.
I appreciate learning Peter ‘s recommendation to sit at 45 degree angles. I usually sit facing my client in order to let them know I am present, actively listening, that they are heard and that I care.
I can see how having the chairs at 45 degrees, they have the choice. It won’t be about talking to me. More about bringing up from within what they most need to say.
Thanks, great concise video!
I tank that sitting facing the client can make the client feel been in confrontation and in an uncomfortable pice to disclose. My point is having enough space in the zoom between them with no restrictive furniture in beetween have been most helpful to brith in my experience. Tanjs.
Very helpful points, thank you.
The clothes I wear also matter. I find that “smart casual” (like Peter Levine in the video) works well, with pleasant soft colours, avoiding any red. I also need to look professional and competent, so not TOO casual or they may feel I do not have the expertise to help.
Shame you don’t have them written. I’m hearing impaired and work with deaf blind people and when things are written instead of spoken they are so much easier to translate with apps instead of people
very helpful, thank you
Yes a clear view and door access is important. I also have the chairs facing the window to see outside. This gives them a feeling of not being in a little room.
I’d like to see out of the window but instead I put my back to it so they can see out.
More relaxing and soothing for my client
This is a great idea, i love your idea of the window seen to help. If paying closer to their non-verbal and facial expression, it gives you an idea of how secure and safe the client can be at that moment with you together in the room – this applies to those whose the perpetrator keptt in hostage or survivors who have been in abusive relationships. I would surely work this way from now on particularly with children. Great feedback and comments. Love to hear more from Pete’s Levine rich comments in working with his patients . This is my favorite video.