Safety

Safety is the antidote to trauma. How do we create safety for our clients?

The antidote to trauma is safety. When our trauma is joined with a feeling of complete safety, loving kindness, connection and support, we can heal. But safety must come first.

Safety has many dimensions: emotional safety, psychological safety, physical safety, spiritual safety and cultural safety. As practitioners, every element of our communication - both verbal and non-verbal, the physical setting of our work, and our every action must help to build trust and safety for the client.

For the human species, the capacity to accurately assess threat is critical for survival. Thus we have evolved sophisticated sensory and neural systems, and physiological responses, to protect us from risk and harm.

The Amygdala can respond within 75ms (about a 15th of a second) to a perceived threat, triggering a fight, flight, or freeze reaction. The initial threat assessment is subconscious, then we add cortical processing of the situation to make a more nuanced judgment. This system learns from past threats and primes us to react to triggers. Most of this processing is subconscious, because the Amygdala responds four times more quickly than conscious thinking comes on line.

Emotional safety arises when we sense, from the practitioner, loving kindness, empathy, non-judgment, understanding, validation, and grounded presence. The combination of these factors creates compassion. 

Our intuitive sensing involves our biological systems of social engagement, which are very sophisticated. Through our mirror neurones we can interpret the facial expressions, gestures, body language, spacial positioning, and quality of voice of the practitioner to assess their trustworthiness, warmth and intention. Most of us make an unconscious assessment of trust within a minute of meeting a practitioner.

Conversely, we feel less emotionally safe if the practitioner is distant, detached, intellectualises the process, or introduces processes that are triggering, such as having to tell the story of our trauma.

Psychological safety comes from having understanding, making sense of what’s going on, and feeling that we have power and control. The practitioner can enhance our psychological safety by helping us understand our biological stress responses, the nature of trauma, and explaining the nature and purpose of any therapy - offered in language appropriate to our age and education.

Psychological safety is also enhanced by an attitude of deep respect from the practitioner who explores our viewpoint and understanding, seeks our preferences, and asks for consent for every small detail of what is done. Our trust is also founded in the competence of the practitioner, their ethical behaviour, and their willingness to serve us.

Psychological safety is eroded if the practitioner intervenes without explanation or consent, uses language we can’t understand, imposes their own assumptions or beliefs, or intellectualises our suffering.

Physical safety is experienced when the practitioner is sensitive to our fears of being trapped, confined, having our personal space invaded without consent, or being touched inappropriately. The sensitive practitioner will read our body language, give us space, attune to our energy, facial expression and gestures, and seek permission to move closer, or to touch us.

Spiritual safety is enhanced when the practitioner is open to our spiritual beliefs, can help us make deeper meaning of our struggles, appropriately draws on our spiritual beliefs to provide support and comfort, and has faith in our capacity to heal.

Cultural safety starts with all of the above factors: we will start to relax if we feel emotionally and psychologically safe, deeply respected, and the practitioner is open and curious about our beliefs, rituals and preferences. If we belong to an indigenous culture that has been colonised, then the practitioner’s understanding of the trauma of colonisation and the intergenerational impact of our loss of identity, language, culture, lands and spiritual practices at least creates some understanding of the potential power dynamics between client and practitioner. 

Specific knowledge of the our language, appropriate greetings, cultural practices and taboos can enhance our sense of respect and consideration. But it may be impossible for a client from one culture to feel truly safe in the care of a practitioner from another culture.

So how do I create safety in my own practice? It starts long before I meet a client.

I ask all my clients to watch a twenty minute video before our first consultation, in which I introduce myself, my background, the nature of trauma, the science of the therapy I offer (Havening Techniques), and how we will work together. I am relaxed, smiling, informal, open about some my own story and trauma, authentic, kind and compassionate.

My therapy room is warm, inviting, and full of curious objects, toys, decorations, and books. The essence of trauma work is working with stories and my room is filled with items that have stories and significance. When I am working with children, I invited them to explore the room and play with any of the objects. The room is filled with natural light, looks onto a garden, and I attend to physical comfort with heaters, cushions, blankets and water to drink.

I prepare for each client in advance so that I can greet them with respect and interest, and give them my total attention. I never use a computer during a consultation and I write handwritten notes in a folder on my lap. I greet clients by name at the door and offer a warm smile. I sense their body language to see if they want to avoid touch, have a handshake, or be greeted with a hug.

I sit at a safe distance, on a level with my clients. I find out something about their life, their family, their education, their work and their interests before I begin to explore their reason for attending my clinic. I have a pre-consultation questionnaire completed by the client so I have some basic information before I begin.

If the client chooses to share their story, I listen with complete attention and offer empathy, compassion and emotional validation. I intuitively mirror their energy level, expressions, gestures, voice and language so that we are attuned. I normalise their reactions, such as crying, and don’t rush to offer tissues. I make plain that I am comfortable with emotional displays and tears, and sometime shed a tear with a client.

I help the client make sense of their story, their experiences and reactions, and assure them that their traumatic responses are understandable and not their fault. I explain that trauma is ‘hard wired in the operating system of their brain’ and that they cannot ‘think their way out of the trauma’. However, I also assure them that their traumatic responses can be rapidly healed.

If we decide on a technique, I fully explain what we are going to be doing, what the client might experience, and I normalise all the outcomes. I assure them that they cannot do the process right or wrong, that the healing will occur spontaneously, and invite them to be curious about what happens. I want the client to give fully informed consent for the process, with no surprises - except for their disbelief and delight that a horrible trauma has been suddenly erased!

Havening Techniques depends of specific forms of soothing touch applied to the client’s face, upper arms and palms of the hands. It breaks the taboo that therapists should never touch a client and I am mindful that I need to make the touch safe for the client.

I give a detailed scientific explanation of the reason for the touch and the physiology of the healing response. I make the client aware that these forms of touch are in fact intuitive and commonly used by people to sooth themselves or others, such as rubbing the hands together, or offering an empathetic touch to the shoulder and upper arm of someone who is distressed.

I offer the option of the client to apply the Havening touch to themselves (as I do on a Zoom video consultation) and I perform the same touch to myself during the process so that they are not self-conscious. Or else, I offer to sit close to the client and apply the touch to them, seeking their permission, step by step.

The therapy is usually done in chairs and I explain that I never sit in front of a client, which would be intimidating and might create a feeling of being trapped, or confined. I position my chair to the right side of the client and ask permission to gradually come closer, to demonstrate the touch to the hands, then the arms, then the face. 

I seek consent for each individual touch, and check that the client is comfortable with what I have demonstrated. I also make the process humorous by sharing stories of the time I accidentally ran over the bare toes of a client, or was told off by a very sassy young girl!

Havening touch is one of the ways we create deep safety because it rapidly elicits a biological response that creates a feeling of connection, safety and love (see my blog on the healing power of touch for more details).

I counsel clients that they do not need to tell me anything about the nature of their traumatic events and that I can work ‘content-free’ without knowing what the story is. The client simply has to briefly recall the event, in silence, then as soon as we begin therapy I engage the client in mental activities to take their mind away from the trauma. The work is often conducted in a playful and humorous way, requiring no effort from the client.

At other times we use processes to help the client release a burden on painful feelings and self-beliefs and I bring a presence that is grounded, compassionate, and deeply validating. I have faith that the client can find their own resolution, and spontaneously come back to a safe and calm place, feeling much lighter and less burdened. We may then take the opportunity to strengthen self-beliefs.

When I am working with children (as young as five) I always work with the parent first. I invite the children to witness the process, to see how much fun it is, to contribute to the mental activities - such as ‘shopping by the alphabet’ - and to join in the Havening touch. Often the trauma is shared between mother and child, thus helping the mother heal her trauma directly eases the burden for the child. Most children are excitedly wanting to ‘have a turn’ when I have finished the process with the mother.

Sadly, in our modern world, many counsellors, psychologists, psychotherapists and psychiatrists are taught a professional ethics that emphasises neutrality, clinical detachment, and processes that abstract or intellectualise the client’s difficulties. They are taught never to touch a client or patient, and never to show their own feelings, or share any of their own story or personality. It’s a kind of ‘blank slate’ model of therapy.

Of course there are many practitioners who bring humanity to their work, who bend the professional ethics, who offer deep understanding and compassion, and offer hugs to their clients. One of my friends is dual-qualified as a psychologist and psychiatrist and she also has her own experience of psychotic illness. She and I are agreed that the best healing practice comes from a practitioner who brings all of themselves to practice: their own stories, experiences, vulnerabilities, feelings, and experience of healing.

Yes, there are dangers of over-identification, transference, counter-transference, co-dependent relationship, and accidental triggering of trauma. But the wise practitioner who has navigated life’s challenges, who has done the self-work, who can remain mindfully aware, grounded and compassionate, who can remain humble, and who has profound faith in the capacity of others to heal - that is the practitioner who creates safety and healing, not the detached clinician.

While the traditional approach, as used by many mainstream mental health professionals might be labelled ‘clinical’, I wonder what is the right word to convey a more humanistic, compassionate, whole-person way of working? Any suggestions? I might start a chat on this question.