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Last week we explored the idea of creating and enhancing a sense of safety in therapy sessions to help traumatized clients work in ways that don't leave them flooded, overwhelmed, or re-traumatized. This week we will explore some specific strategies to heighten and install feelings of being safe in the therapeutic relationship while clients are working through their painful narratives. Focusing in this aspect of treatment is what I refer to as heightening “external” safety, which relates to interpersonal and environmental dynamics within the therapy room.
Consider that external safety can be dramatically enhanced when the therapist pays attention to things like the temperature of the room- and having a blanket for warmth or a hand-held fan for cooling to increase a client’s comfort level. The extent to which the session is distracted by inside or outside noises, the client’s physical proximity to the therapist, the arrangement of furniture in the office and the degree to which there are options for seating are factors as well. Even the use of natural or artificial lighting and whether the phone ringer is off or on during the session can make a difference. Sometimes, an office setting has visual distractions or triggers that can take clients out of their optimum window of arousal. Therapists should take the time to look at their offices through the “eyes” of their clients to see if there are objects or pictures that might create too much arousal or anxiety, or be triggering in some other way.
When therapists keep baskets nearby with objects that can be used for grounding such as koosh balls and stress balls, scented hand lotions, unlit but fragrant votive candles, colorful, smooth stones, small stuffed animals and soft pillows, clients have the opportunity to practice using those objects for anchoring and self-care. Those resources add to an overall feeling of being “safe and comfortable” in the office. They communicate a therapist’s interest in attending to their client’s well being which, in turn, deepens a sense of trust in the therapeutic relationship. Clients might initially need encouragement to use those resources but in time will naturally gravitate towards these objects using them to self-soothe as they process difficult material.
In addition, holding to the agreed upon timeframe for the session is critically important as it offers a consistent and predictable boundary. It’s the therapist’s job to make sure that sessions end on time and emotionally loaded material is not opened up and explored at the very end of the session. Clients and therapists need clarity about whether or not appropriate physical touch will be used to enhance safety and grounding. It also helps to install both verbal and non-verbal signals such as a hand gesture, so clients can communicate the need to “stop” at any time in the session. When those signals are honored and respected by the therapist a sense of safety is strengthened. All of these strategies model good boundaries and go a long way towards increasing external safety for clients. In the next installment we will focus on increasing “internal safety.”
Missed Part One of "The Need for Safety in Therapy?" Click here.
