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Lisa Ferentz LCSW-C, DAPA


The Need For Safety in Therapy, Part One

How to rebuild your client's senses of empowerment and control

 CCO Public Domain/Pixabah
Source: Photo: CCO Public Domain/Pixabah

Although it might seem obvious, it’s worth taking the time to highlight the idea that creating a context of emotional and physical safety during therapy sessions is paramount. It’s a key component in building a trusting therapeutic relationship and ensuring that the therapy process is reparative rather than re-traumatizing. One of the fundamental ways that we can help clients distinguish the past from the present is to give them the sustained and predictable experience of feeling safe. In the past often nothing felt safe, in the present they have a voice and, therefore, more control over the degree to which situations and their relationships are safe for them.

As we explore ways to create and heighten both internal and external safety, it's important for therapists and clients alike to be sensitive to the possibility that focusing on these aspects of treatment might feel counter-intuitive and even “unnecessary” to traumatized clients. This is typically because the concept of safety is so unfamiliar to trauma survivors that it isn't on their radar screen and doesn’t personally resonate for them. Clients often need to be convinced of the value of incorporating safety into treatment. It's common for trauma survivors to want to move ahead with more emotionally loaded material before safety has been established. This might be an unconscious re-enactment of a lack of safety in past relationships and it’s important for therapists to not inadvertently collude with this by not taking the time to work on it. Steamrolling through their trauma narratives as fast as possible to just “hurry up and get it over with” can also be reminiscent of their actual abuse experiences in the past.

When therapists can teach clients how to ask for what they need to increase a sense of safety in therapy this goes a long way towards rebuilding a sense of empowerment and control. Even encouraging clients to pause and notice the times when they might start to feel unsafe in session can help to increase their conscious awareness about the issue and reinforce the legitimacy of their radar when they do feel unsafe. So, despite the initial or ongoing pushback, it’s a critical part of therapy to address and firmly install. Particularly before moving forward with more potentially triggering trauma retrieval work.

When therapists attempt to pace the work, the metaphor of giving clients permission to start at the “shallow end of the emotional pool” rather than jumping into fifty feet of water without adequate preparation can be useful. It doesn't make sense to jump in if they don’t know the temperature of the water, whether or not there is a lifeguard on duty, whether or not they are wearing a life jacket and even assessing if they still know how to swim. Taking the time to set the stage and safely pace the work might be a new experience for clients, even those who have been in therapy before.

In the next installment we will explore some of the specific ways in which therapists can help clients to feel an enhanced sense of external safety as they courageously move forward in their healing work. Whatever paradigms a therapist might use, incorporating safety is the necessary foundation for all subsequent work.


About the Author

Lisa Ferentz, LCSW-C, DAPA, is a clinical social worker, psychotherapist, and the founder of the Institute for Advanced Psychotherapy Training and Education.