The SAFER Acronym . James Chu (2011) describes this work through the acronym SAFER: ● S: Self-care and symptom control The first step includes gaining control over self-destructive behaviors and reducing vulnerability to repeat victimization. Recognition of the need for self-care and learning self-soothing techniques and stress management skills will aid in this endeavor. Symptom control includes limiting intrusive thoughts and increasing the ability to remain grounded, centered, and safe. ● A : Acknowledgement At this early stage, naming and acknowledging the nature of the traumatic experiences and their effect on functioning, without delving into the details or the affect, are key. This area also begins to address the core of meaning-making that is derived from early or chronic experiences of abuse and neglect. ● F: Functioning The client is encouraged and supported in maintaining their current level of functioning in the world (at work, at school, in their family and social networks), and additional supports are encouraged and offered by the clinician, as needed, to optimize healthy functioning. Staying anchored in current daily life and reality is supported. ● E: Expression The client is encouraged to begin to find expression in words for the unspeakable realities of their traumatic experiences. Verbal reporting, as well as alternative and expressive therapies, which can allow the client to speak without words (such as art, movement, energy work, photographs), can be employed. The clinician also needs to monitor and pay attention to containment and prevent the spilling of too much information or affect. The client needs to learn to be able to tolerate the experience of feeling states without becoming dysregulated. ● R: Relationships A therapeutic alliance and other supportive relationships are formed that are mutual, supportive, collaborative, and empathic. The difference between healthy and unhealthy patterns of relating is addressed. Attention to and work on the establishment of trust is highlighted. Crisis Intervention . When the trauma is a recent acute crisis, the model of crisis intervention is fairly common. Crisis intervention focuses on a brief treatment model and a fairly rapid return to normal daily functioning. If the client has additional factors in their life that complicate the brief treatment approach, this approach may accomplish only the first stage of the recovery and more in-depth treatment may be called for in the future. Stabilization of symptoms is not the same as a full and integrated recovery (van der Kolk, 2014). Stage 2: Remembering and Mourning The remembering and mourning phase of treatment involves a reconstruction of the narrative of events that have occurred, connecting the appropriate affect with them, and then sufficiently resolving the affect (Herman, 1997). This stage involves the significant task of transforming traumatic memory into simple memory. The question “What does a person have when traumatic memory has been successfully processed?” is answered by the statement “Just a memory.” Taking the negative emotional charge off the events, through narrative and nonnarrative work methods, helps the client to transform the childhood or victimized perspective that originally accompanied the events to a more nuanced, resourced, adult, and rational point of view. The goal of reframing traumatic events is to help the client move from the stance of “I am helpless and powerless and everything is my fault” to “I am no longer helpless, these events are in the past, and I can clearly see who is responsible for what.” Placing appropriate blame on perpetrators and acknowledging the differences as well as the similarities between abuse and nonprotection are parts of this work. In addition, finding ways to atone for or make restitution, if the client actually
harmed others, is crucial for restoring a sense of moral balance. Examples of individuals who may have harmed others as part of the conditions of their own traumatic circumstances are the survivor of domestic violence who was unable to protect her children from similar abuse and the combat veteran who, while following the orders of a commanding officer, harmed civilians. The role of the clinician during this phase of treatment is to bear witness and provide a therapeutic alliance that allows the client to feel accompanied and cared for on this journey. The clinician also facilitates naming the events and the affect, helping the client to translate the unspeakable into words (Courtois & Ford, 2012). This moves the material from the nonverbal danger response system of the limbic system to the verbalizing cognitive brain of the cortex, with its abilities to reason, reflect, and differentiate. Reconstructing the story, and being able to develop a sense of the continuity of their own history, allows the client to restore a narrative flow to their life so that the past, present, and future flow in a single thread, rather than in multiple fragmented self parts (van der Kolk, 2014). Remembering is also “re-membering”—that is, putting the pieces of something back together again. This stage of the work allows the client to reclaim dissociated and split-off parts of self, affect, and memory, so that their fragmentation, which is so often a function of trauma, heals and they become whole again. The work here also includes learning to accept and integrate the self parts that have been hated and shut off, through nurturance, support, and caring by both the clinician and the client. The goal is to move the client from a victim stance to that of a survivor. This process involves a reconstruction of the events as well as a review and reworking of the meanings that have been made from the events (Courtois & Ford, 2012). These interpretations of past traumas can affect the client’s current view of themselves; the world; and their spiritual framework, beliefs, and values. The sharing of information allows the clinician to help the client explore a new interpretation of the events and validate the reality of things that have happened. The experience of not having reality validated and accepted is maddening, and something that survivors of chronic childhood trauma remember all too well. The denial of the facts of their daily existence by other family members or outsiders leads these men and women to deny to themselves what they know to be true. In recent years, there has been a movement for individuals to share their experiences in more public forums (i.e., the #MeToo movement on social media) as a means of facilitating political and societal shifts (Delker et al., 2020). This has allowed many to fight against long-held beliefs that dismiss a perpetrator as a “bad apple” and draw attention toward larger systems of inequality. The potential impacts of these public disclosures (both positive and negative) have not been well examined. Case Example Janice is a mother who insists that her husband is not an alcoholic or abusive toward the children, while making excuses for him regularly at work, telling her children to wear long sleeves so the bruises will not show, and saying that “Daddy is just a little tired” when he is passed out on the couch with a case of empty beer cans around him on the floor. Janice is denying the reality that she and her children know exists. Mourning Traumatic Loss. The other crucial part of this stage of the work is the mourning of traumatic losses (Herman, 1997). Trauma includes loss at its core. Although traumatic loss does not always include violence, violence always includes loss. Losses include concrete losses, such as a home, car, or loved one, but just as profoundly include the less tangible losses, such as loss of a sense of safety in the world, loss of personal power, loss of time, loss of a childhood, and loss of faith. Survivors often fear this stage of the work because it can carry a sense of timelessness. Many clients repeat some variation of “I’m afraid that if I start crying, I’ll never stop.” Simple reassurance that this has never actually happened to anyone can help to reduce this
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Book Code: PYFL4024
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