This post discusses Principle 1: Safety of SAMHSA's six key principles of a trauma-informed approach.
Safety is one of SAMHSA's six guiding principles of trauma-informed care (SAMHSA, 2023). Helping clients recover from trauma begins with creating safety in the home, community, and helping relationships (Herman, 2015). We can begin by asking clients what would help them feel safe at home and in the community. When clients with histories of trauma and substance use disorder do not feel safe in helping relationships, they often drop out of counseling and continue substance use. Below are several steps we can take to create safety in the helping relationship.
Creating a welcoming environment can include a warm voice when the client calls to schedule the initial assessment, a warm greeting when the client arrives for the initial session, an inviting waiting room and a short wait, pictures on the wall and magazines in the waiting room that reflect the client’s culture, positive service energy when greeted by the helping professional, and a tour of the facility.
A non-confrontational counseling style can help create safety in the helping relationship. It is also important for clients to oversee all disclosures regarding their traumatic experience and missing details are ok, as they share their story (Herman, 2015). Discussing trauma can be emotionally dysregulating. It is often helpful to check with the client during the session to see if they need support and utilize grounding exercises to help them become emotionally regulated (deep breathing, mindfulness etc.).
Traumatic memories can be a relapse trigger for many clients as these memories can produce flashbacks, intense fear, and intrusive memories, which some clients medicate with drugs. It is often helpful to check in towards the end of sessions to find out how the client is doing and what support they might need from you before the end of the session. Traumatic memories are often connected to past traumas, and a number of strategies can be used to help ground the client into the present moment, including discussing a current event of interest to the client, meditation, relaxation, and breathing exercises.
Finally, it’s also helpful to review the client’s safety plan at home and in the community. This can include brainstorming self-care and grounding strategies if the client experiences trauma triggers prior to the next session.
Substance Abuse and Mental Health Services Administration: Practical Guide for Implementing a Trauma-Informed Approach. SAMHSA Publication No. PEP23-06-05-005. Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2023.
Herman, J. Trauma and Recovery. (2015). Generic Publications. Sidney, AU.
Mark Sanders, LCSW, CADC, is an international speaker in behavioral health whose presentations have reached thousands throughout the United States, England, Canada, Spain, Lithuania, West Indies, and Guam. He is the recipient of five behavioral health lifetime achievement awards, including the prestigious NAADAC Enlightenment Award. He is the founder of The Museum of African American Addictions, Treatment and Recovery, which was honored as the 2023 winner of the Faces and Voices of Recovery Innovations In Recovery Award. He is the author of 5 books on recovery and has enjoyed a 30-year career as a university educator.
Isa Vélez Echevarria, PsyD, is a Puerto Rican clinical psychologist. She is the Ohio State Project Manager for the Great Lakes Addiction, Mental Health, and Prevention Technology Transfer Centers managed by the Center for Health Enhancement Systems Studies at the University of Wisconsin-Madison. During her pre-doctoral internship at Children’s Institute in Los Angeles, CA, she was certified as an Interpersonal Psychotherapy Clinician. She was trained in Trauma-Focused Cognitive Behavioral Therapy and Family Therapy. In addition, she provides telehealth services to communities of color in Massachusetts and Puerto Rico. Her clinical work has focused on culturally tailored and trauma-informed services for Latinx communities.
