8 Keys to Safe Trauma Recovery:

Take-charge Strategies to Empower Your Healing

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Principles of Safe Trauma Therapy

1. First and foremost: Establish safety for the client within and outside the therapy.

2. Develop good contact between therapist and client as a prerequisite to addressing traumatic memories or applying any techniques even if that takes months or years.

3. Client and therapist must be confident in applying the "brake" before they use the "accelerator.”

4. Identify and build on the client's internal and external resources.

5. Regard defenses as resources.  Never "get rid of " coping strategies/defenses; instead, create more choices.

6. View the trauma system as a 'Pressure cooker."  Always work to reduce, never to increase the pressure.

7. Adapt the therapy to the client, rather than expecting the client to adapt to the therapy.  This requires that the therapist be familiar with several theory and treatment models.

8. Have a broad knowledge of theory both psychology and physiology of trauma and PTSD.  This reduces errors and allows the therapist to create techniques tailored to a particular client's needs.

9. Regard the client with his/her individual differences, and do not judge for noncompliance or for the failure of an intervention.   Never expect one intervention to have the same result with two clients.

10. The therapist must be prepared at times or even for a whole course of therapy to put aside any and all techniques and just talk with the client.




1. First and foremost: Establish safety for the client within and outside the therapy.

Judith Herman first taught us the importance of this principle in Trauma and Recovery (1992). Working with trauma involves helping the client loosen the defenses that have been used to cope with trauma. If the client is not living in a safe situation, or if the therapy situation does not feel safe, then a loosening of those defenses can lead to decompensation or even increase vulnerability to further harm.


2.Develop good contact between therapist and client as a prerequisite to addressing traumatic memories or applying any techniqueseven if that takes months or years.

Research consistently indicates that the therapeutic relationship is one of the most powerful factors affecting the outcome of psychotherapy. This also applies to trauma therapy.  Without a therapeutic alliance, the client will not feel safe to address the terror of her past.   Of course, there will be marked differences in how central a role the therapeutic relationship plays in individual therapy, but a solid alliance is always a necessary part.


3. Client and therapist must be confident in applying the "brake" before they use the "accelerator.

As with an automobile, safe therapy requires that you know how to stop a trauma process before you set it in motion or accelerate it.  Working with trauma can be uncertain and potentially volatile.   You never really know how a client will react to an intervention, or, for that matter, to a simple question, the color of your shirt, or the smell of your coffee.   One of the features of PTSD is that traumatic memory can be easily triggered.   When that happens, hyperarousal accelerates out of control, causing intense physical symptoms and/or flashbacks.   Until triggers are identified, they are unpredictable - literally anything can be a trigger.   In order for clients to feel safe in life and also in therapy, they need to be equipped with tools to help them contain reactions to therapy and triggers, and to halt the out ofcontrol acceleration of hyperarousal.   Being able to "put on the brakes" will aid clients in their daily life, as well as give them courage to address difficult issues.   Once clients know where the brake is, they are in control of rather than at the mercy of, their process.


4. Identify and build on the client's internal and external resources.

In general, resources mediate the negative effects of trauma.  Resources are like asset, the more you have, the better off you are.   Helping clients to identify the resources they already possess and develop the ones they lack is necessary to safe trauma therapy.   Functional resources such as adequate locks, physical resources such as strength or coordination, psychological resources such as a sense of humor and defense mechanisms, interpersonal resources such as friendships, family, and pets, and spiritual resources including belief systems and communing with nature will all help in mediating trauma.

5. Regard defenses as resources. Never "get rid of " coping strategies/defenses; instead, create more choices.

Defense mechanisms are strategies for dealing with adversity.   They are like old, dependable friends, helping us to deal with stress and getting us through hard times.   The problem with them is that they tend to be one sided, allowing only one choice for action.   However, getting rid of a client's defenses doesn't solve problems and can actually increase them.   Eliminating defenses robs clients of old friends and can leave them without coping     A better alternative is to create additional, more adaptive defenses new friends so there are more choices of response.   For example, instead of stopping a tendency to withdraw, pay attention to when it might be the best strategy, and simultaneously build skills for engaging with others.   That way the client can decide for himself when it is best to be in the company of others and when it is better to be alone.

6. View the trauma system as a ‘pressure cooker." Always work to reduce never to increase the pressure.

Provocation is never a useful therapeutic strategy for those with PTSD. These individuals are already at the edge of how much they can handle.   To further provoke a PTSD client's fragile system through confrontation or provocative interventions can further damage her; the possibility for retraumatization when using such interventions is great.  It is much better to reduce pressure while increasing resources.  That will enhance the possibility of opening up a fragile system without explosion (or decompensation).


7. Adapt the therapy to the client, rather than expecting the client to adapt to the therapy. This requires that the therapist be familiar with several theory and treatment models.

The trauma therapist who has only one  method to offer his clients puts them in jeopardy no matter how great the model is.   Many methods use techniques that are unappealing to some clients; others require ways of thinking that may be foreign.  With only one kind of therapy on hand, the clients who, for whatever reason, do not fit with that method are at risk of additional harm through feelings of helplessness and failure.

8. Have a broad knowledge of theory both psychology and physiology of trauma and PTSD. This reduces errors and allows the therapist to create techniques tailored to a particular client's needs.

Being versed in only one school of theory is like only being able to bake a cake from one kind of cake mix.   A more tasty alternative is to keep a wide range of recipes and ingredients on hand.   This makes it possible to create and choose the combination that is most appropriate at a particular time.
Knowledge is power.  While no therapist can help all clients, the therapist who is familiar with a variety of theories has many clinical possibilities open to her.    She then has the potential to create interventions uniquely suited to an individual client for a particular circumstance.


9. Regard the client with his/her individual differences, and do not judge for noncompliance or for the failure of an intervention. Never expect one intervention to have the same result with two clients.

When a medication fails to cure a patient it must be assumed that the correct one has not yet been found.  The same applies to interventions or methods that fail to work with clients.   The therapist must continue to look for or create an intervention or method that might succeed.  It is important to avoid blaming the client by habitually thinking in terms of "resistance" or "secondary gain."   Those terms imply that the client is impeding the success of the therapy consciously or unconsciously and that if he cooperated all would go well.
No two people are alike.  A single method can work for many individuals, but it is demeaning to clients to assume that that will always be the case.


10. The therapist must be prepared at times or even for a whole course of therapy to put aside any and all techniques and just talk with the client.

It is great to have a broad collection of tools to work with in helping clients.  However, there are occasions when the best thing we can offer clients is ourselves.  I look back with embarrassment on situations in my early professional years when a client came to therapy with a pressing upset.   Sometimes I was so quick to be clever with my tools that I would completely miss what was needed, often something as simple as listening.  We do our clients a great injustice if we can only relate to them through our methods.  For all clients sometimes and some clients all the time, the best therapy is just simple, unadulterated, human contact.


Rothschild, B.(2003)The Body Remembers Casebook: unifying methods and models in trauma therapy. New York: Norton.

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