Seeking Safety Therapy as Trauma Informed Care for Individuals with Co-Occurring Disorders: A Case Conceptualization Utilizing Seeking Safety and STAIR Narrative Therapy Interventions

By Lynetta Hale

This ebook is an excellent tool for practitioners and lay-mental health providers seeking to better understand the practical efficacy (via a case conceptualization) of Seeking Safety and STAIR Narrative Therapy interventions for individuals with co-occurring mental health conditions and substance use disorders. Though both treatment modalities specifically focus on the diagnosis of PTSD, many persons struggling with co-occurring disorders have also experienced complex trauma. Through my 30 years of work in the mental health treatment field, I have not yet worked with an individual who has not experienced trauma from childhood, their co-morbid conditions and resulting life consequences, and/or their crisis - treatment experiences as they frequently recycle through various mental health and substance abuse treatment systems of care. As a licensed psychiatric nurse, a certified addictions treatment counselor, a marriage and family therapist, and a person with lived experience, I have found that working with these treatment modalities/interventions is effective in helping to develop therapeutic rapport and a viable, safe community for some of our most vulnerable populations of people.

• Language: English
• Publisher: Lulu.com
• Release date: Aug 4, 2022
• ISBN: 9781387722235

Book preview

Lynetta L. Hale

Seeking Safety Therapy as Trauma Informed Care for Individuals with

Co-Occurring Disorders

Masters in Marriage and Family Therapy (Trauma Concentration)

2021

Table of Contents

A. Introduction ………………………………………………………………………………... 3

B. Clinical Application of Seeking Safety Model …………………………………………….. 4

I. Treatment Goals …………………………………………………………………….. 5

II. Role of the Therapist ……………………………………………………………….. 8

III. Assessment and Interventions ……………………………………………………. 10

IV. Expected Changes and Outcomes ………………………………………………… 13

V. Cultural Understanding ……………………………………………………………. 15

C. Client Conceptualization – Seeking Safety – Prentice (A Pseudonym) ………………… 20

I. Client Info and Demographics

II. Presenting Problems

III. A Seeking Safety (Trauma Informed) Perspective of the Presenting Problems

IV. Interventions Using Seeking Safety

V. Interventions Using an Alternate Theory – STAIR Narrative Therapy

VI. Goals

VI. Ecological Risk Factors and Protective Factors

VII. Cultural and Cross-Cultural Considerations

D. Person as the Therapist …………………………………………………………………… 31

I. My Journey

II. Strength & Growth

III. My Culture, Spirit and Practice

Appendix

References

Introduction

The dual diagnosis of Post-Traumatic Stress Disorder (PTSD) and substance abuse is surprisingly common (12%-34%); for women (30%-59%) (Najavits, 2002, p. 1). Men experience lifetime trauma rates at 60.7% and comorbid substance use disorder with lifetime rates of alcohol use disorder (51%) and drug use disorder (35%) (Kessler et al., 1995)" (Najavits, Schmitz, Gotthardt, & Weiss, 2005, p. 425).  Counterintuitively, abstinence from substances appears to have a potentially negative impact on some PTSD symptoms (Najavits, 2002).  The work of Lisa Najavits, creator of the Seeking Safety (2002) clinical treatment model, was the result of decades-long work in exploring the common phenomenon of individuals struggling with the symptoms and consequences of living with these dual disorders. 

Research into this dual diagnosis began in the early 1990’s as a desire to understand the burgeoning interrelationship between mental illness, in general, and substance abuse.  The topic was framed within the Which came first, the chicken or the egg? mindset in which clinicians argued that mental health disorders were separate from substance use disorders.  Clinicians suggested that mental illness led to self-medicating symptoms, that severe substance abuse led to development of mental health issues, or that mental illness and substance use disorders were both distinct, primary interactive disorders that required conjoint treatment (Ortman, 1997). 

Ultimately, clinicians took the unitary position that the disorders were linked to one another.  The cognitive-behavioral camp viewed substance use as self-medicating arguing, They don’t necessarily realize this.  They just know that when they are high, they don’t seem to recognize having so many problems (Ortman, 1997, p. 46).  The psychodynamic camp saw the disorders as inextricably linked, describing An addiction process that begins with the utilization of the substance to blunt the impact of painful experience and progresses to become a disease (Ortman, 1997, p. 46).  The debate then focused on how these disorders should be treated. Trends included requiring sobriety before beginning mental health treatment and/or mental health stabilization prior to addiction treatment, leaving those with co-morbidity suffering because of fundamental clinical disagreement and lack of systems coordination (Ortman, 1997). Seeking