1.1 - Safety is the Most Important Priority Right Now!

Safety is the foundation for all therapeutic work. The long-term goals in Seeking Safety
are to:
1. Achieve abstinence from substances
2. Eliminate self-harm
3. Acquire trustworthy relationships
4. Gain control over overwhelming symptoms
5. Attain healthy self-care
6. Remove oneself from dangerous situations (domestic abuse, unsafe sex, etc.)
Goals of this Session:
1. Convery the central goal of this treatment: safe coping, no matter what happens
in life.
2. Discuss safety as the first stage of recovery.
3. Help patients explore what safety means to them.
“I would like to learn the difference between feeling safe and unsafe. I know the
difference in my head but not in my heart. I’m always scared.”
Check-In
Quotation – “Although the world is full of suffering, it is full also of the overcoming of it”
– Helen Keller (20th -century American writer)
Self-Exploration – Help patients explore ways in which they are currently safe and
unsafe. Guide them to prioritize safety as their major task right now. Reinforce current
safe coping (e.g., the “What Is Safety to You?” section of Handout 1).
Discussion:
1. “Do these stages make sense to you? Why or why not?”
2. “Why do you think safety has to happen first?”
3. “What does safety mean to you? For example, moving to a safer neighborhood?
Leaving a destructive relationship? Being able to sleep at night?”
4. “Why is safety the first step for both PTSD and Substance Abuse?”
5. “Are there any other ‘signs of recovery’ that you think are important?”
Check-Out
*Be sure patients understand the idea of safety. The treatment is designed to
convey one idea above all: Stay safe, no matter what happens. Help patients
understand this message.
*Stay flexible when discussing stages. As with all stage models, the stages aren’t
always separate. Patients may find themselves moving back and forth between
stages at times.
 1.2 - Safe Coping Skills
Goals of this Session:
1. Explore the list of Safe Coping Skills.
2. Encourage patients to return to the list of Safe Coping Skills throughout the
treatment.
Check-In
Self-Exploration – Ask patients to go through the list of Safe Coping Skills, checking off
(✓) the ones they already do and putting a star (★) next to the ones they want to learn.
Question-Answer format. This format can be useful because patients likely already
know many of the safe coping skills. After looking through the handout, you could ask
participants to turn it over and then ask them to describe, for each skill that you name,
either:
1. What it means;
2. How the skill could be useful to them; or
3. An example of when they used it recently.
Also, you could present hypothetical situations and ask how they might stay safe using
the coping skills: For example, “what if you have a flashback and feel like drinking? How
might you cope safely with that?”
Roleplay the scene: Ask patients to think of a time in the past week when they did not
cope successfully, focusing particularly on substance use or other high-risk behaviors.
Then have them “replay” it be describing how they could cope more safely next time,
using the Safe Coping Skills list as a guide. If you want, you can introduce the “replay”
as follows:
“Imagine that you are a movie director; and you can ‘replay’ the scene to have a better
ending – how could you cope safely this time?” Optional: You may want to use the Safe
Coping Sheet (Handout 4 in Chapter 2), which is designed specifically for this purpose.
Discussion:
1. “When you want to use a substance, what safe coping skills could you use?”
2. “Could you apply the skills to anything difficult coming up for you this week?”
3. “Are there any safe coping skills you like that are not on the list?”
4. “What would it feel like if you could cope safely every time life throws you a
‘curve ball’ (difficult event)?”
5. “Is there any situation that cannot be coped with safely?”
6. “Where can you keep the list so you can use it whenever you need it?”
Check-Out
*This handout conveys the essence of the entire treatment program: Stay safe,
no matter what. Nothing has to lead to substance use or any other self-destructive
behavior. No matter what events patients face in life, they can learn to cope safely
with them. Once again, be sure patients understand this core concept.
*It can be helpful to convey a sense of urgency. Now is the time for patients to
start coping safely; this is more important than anything else in their lives (because
without safety, they cannot recovery); and they need to practice it over and over until
it becomes habitual. You may also want to convey that safe coping is what some
people learn while growing up, and that there are good reasons why patients may
not have learned it (neglectful parents, overwhelming trauma, etc.)
*Ask patients to carry the list with them. When they feel overwhelmed, they can
pull out the list and see if anything might help.
*Many of the skills are taught in more detail in later sessions but are described
briefly in the list.
*Difficult Statements / Circumstances:
-“I don’t want to stay safe; I want to die.”
-“I am safe; that’s not a problem for me.”
-“I need to mourn my trauma now, not wait until later.”
-“Some of these safe coping skills contradict each other – one says to ‘Pretend you
like yourself,’ and another is ‘Honesty.’ Which is it – lying or honesty?”
-“These are fine, but when I get triggered, it’s so fast that I don’t even have time to
think about what I’m doing.”