Bright Spot: Seeking Safety for Adults

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This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.


Detailed Description

Seeking Safety for Adults is a present-focused, coping skills therapy to help people attain safety from trauma and/or substance abuse. This treatment is designed for flexible use in group or individual format; females and males; and in various settings (e.g., outpatient, inpatient, residential, home care, schools).

Key Principles

  1. Safety as the overarching goal (helping clients attain safety in their relationships, thinking, behavior, and emotions);
  2. Integrated treatment (working on both PTSD and substance abuse at the same time);
  3. Focus on ideals to counteract the loss of ideals in both PTSD and substance abuse;
  4. Four content areas: cognitive, behavioral, interpersonal, and case management; and
  5. Attention to clinician processes (helping clinicians work on counter transference, self-care, and other issues).

Expected Outcomes

The primary goals of the program are to increase safe coping; and reduce trauma and/or substance abuse symptoms.

Cost Details

As of June 2014, the cost of this intervention is as follows:

  • $46 for manuals (required)
  • $16 for poster of safe coping skills (not required)
  • $16 for card deck of safe coping skills (not required)
  • $250 per set of training videos (not required)
  • $1600 per day plus travel expenses for on site training (not required)
  • $115 per hour for telephone consultation (not required)

Key Steps for Implementation

  • Client selection - describe the treatment and then give clients a choice in whether to join
  • Be as inclusive as possible - invite anyone who has an interest and only remove someone who presents a danger to others or is likewise unable to participate
  • Encourage clients to apply coping skills broadly
  • Use the case management component of Seeking Safety to engage clients in additional treatments
  • Tell clients to ignore the term "PTSD" or "substance abuse" in the handouts if these do not apply
  • Allow clients to try the treatment before committing to it
  • Clients can be at any stage of recovery
  • Clients do not need to be stabilized first

Clinician selection:

  • Any clinician can conduct Seeking Safety Several clinician characteristics are helpful
  • All clinicians need to recognize their limits
  • Consider a try-out using the manual Seeking Safety sessions are structured to emphasize good use of time, appropriate containment, and setting goals and sticking to them. Sessions are conducted with the following four parts:
    • Check-in: brief questions to find out how clients are doing
    • Quotation: A quotation is read aloud to emotionally engage clients in the session
    • Handouts: handouts are used to explore a new coping skill
    • Check-out: brief questions to reinforce clients' progress and close the session on a positive note There is a training coordinator who can discuss agency needs and develop a training plan that includes fidelity and supervisory training.

Special Infrastructure

There are no space/room/AV requirements. The only things needed are copies of the program materials, which can be photocopied from the book by the clinician for use with his/her clients. The program is typically conducted in community agencies, hospitals, outpatient clinics, residential care facilities, or schools.

  • Clinician guide
  • Client handouts


Onsite training is common; and there is no limit on the number of attendees. Some programs set up a training and invite others from the region to attend. Training associates are available throughout the country. Training videos are another option. Phone consultation is possible. While training is not required to conduct Seeking Safety, it can be helpful to introduce staff to the model. A typical training day can be 1, 1.5, or 2 days, but any length is possible Training Contact: Treatment Innovations [email protected], phone: (617) 299-1610

Types of Staff

Seeking Safety has been successfully conducted by a wide range of clinicians including substance abuse and mental health counselors, social workers, psychologists, psychiatrists, bachelor's level counselors, case managers, nurses, clinical trainees, domestic violence advocates, school counselors, pastoral counselors, and paraprofessionals.

Outcome Measures

  • Client completion of treatment
  • Decrease in substance use
  • Improvement in trauma-related symptoms
  • Improvements in psychopathology
  • Treatment retention

Process Measures

  • Number of clients who attend the sessions
  • Completion of the Seeking Safety structure (following the 4 component session)
  • Use of Seeking Safety content
  • Use of strong, general clinical skills (e.g., empathy, warmth, etc.)


Website of Seeking Safety
Seeking Safety
Resource - Website/webpage
Brought to you by Treatment Innovations

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