By Rachel Rollins, Assistant Clinical Director
Recently, two members of our Juniper Canyon team were able to present at a local NATSAP (National Association of Therapeutic Schools and Programs) conference. This blog is a re-cap of our presentation, tittled: How safe is too safe: Redefining the parameters of treatment.
In this blog, I will be sharing some of the main thoughts and points made from this presentation. We focused mostly on the following:
1. How to define safety (for ourselves and others).
2. The difference between safe and comfortable.
3. What the impacts on treatment are when clients are not challenged.
4. Research, focusing specifically on exposure therapy and CBT.
5. Safe interventions to use with our clients, and how and when to use these.
To start, we used the below quote as our guiding principle. I find it useful for many of my sessions with clients in the world of trauma informed care with compassionate challenging:
“1. The trauma I went through was not my fault AND I have a personal responsibility to heal
2. I’ve learned unhealthy coping mechanisms AND through intentional practice I can unlearn them
3. My habits reflect my past AND I work to shift them through keeping promises to myself.
4. How I behaved in survival mode does not reflect who I am AND it’s only me who can make new choices
5. My ego seeks someone to save or fix me AND I am the only person who holds that power”
In this field of work, we are constantly working with and challenging people’s perceived window of tolerance for distress versus their actual tolerance. Our clients at Juniper Canyon rarely believe in their full potential as individuals, and have very limiting beliefs that they alone are not capable of doing hard things. This presentation was all about how we as mental health professionals can help our clients believe in themselves and recognize that they can do hard things, even if we have to challenge their beliefs to do so! As a clinician I can be empathetic towards a client’s trauma and recovery- see them as a whole person and advocate for them- while also challenging them to believe they are not a victim in their lives and they can handle hard things.
One of the challenges with treatment is that we have to define emotional safety for ourselves and, at times, for our clients when they are experiencing limiting beliefs about their own capacity for discomfort. People will get triggered in treatment, people will not be free from discomfort, and they will not be ‘happy’ all the time. However, I believe that mental health workers have the ability to keep people safe, even though we may not be keeping them comfortable their entire time here.
A great example of this is our adventures at Juniper Canyon such as canyoneering. When we canyoneer- there is great perceived risk- it feels scary, it IS scary. Every survival instinct in our bodies says that going over a side of a cliff is a BAD idea. Not safe. And without a rope it isn’t safe. We will never push our clients over the literal or metaphorical edge without first giving them a rope and making sure they are safe. However, once we have made sure that the actual risk is low we are going to push- both on adventures in the canyons and in clinical work. We are going to ask clients to push past their perceived risk, because we as professionals can accurately assess the actual risk.
The perceived risk for someone who has never canyoneered before is extremely high! The thing is, once you are in a canyon, the only way out is through. You have to keep going. Giving into the fear of the perceived risk leaves you stuck in a canyon. Similarly, giving into the fear of the perceived risk of treatment or recovery leaves you stuck all the same. With both canyoneering and recovery, the actual risk can be very low. In canyoneering we build systems, do safety checks, and never go alone. Recovery is not so different. We build systems, do safety checks, and never go alone.
The Fear-Avoidance Model: This model tells us that avoidant behaviors, (drinking or drug use, unhealthy relationships, depressive episodes, eating disorders, etc.), most often occur in anticipation of pain rather than as a response to pain. We also know these behaviors have a tendency to persist, resulting in decreasing opportunities to correct them.
A lot of the information we presented detailed how we challenge clients around their avoidant behaviors, however, there are many clients or times where, as mental health professionals, we should not be challenging their window of tolerance, instead allowing them to exist within safety to re-regulate their systems to re-engage with their world. Some examples of this include clients who do not trust in the program, people who have no tools or abilities to utilize coping skills because they haven’t been taught how to, active dissociation, suicidality, active psychosis, or any major mental health diagnosis and/or symptoms.
This presentation was also about Exposure Therapy. Exposure Therapy is a modality in which we slowly allow triggering stimuli back into a client’s life so they can become more neutralized to the stimuli. Much of the research around Exposure Therapy is about war veterans, from the National Center for PTSD. This research suggests that when providing Exposure Therapy to war veterans they found no increase of suicidal ideation, and they were able to deactivate trauma triggers which lead to quicker results than modalities such as DBT or EMDR. Maura and I were so grateful for the opportunity to present on these important topics to our professionals colleagues and peers. We look forward to the opportunity to do so again, and share what wonderful, (albeit, challenging!), work we do with our clients here at Juniper Canyon.