2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

Accessing the Untouchables: The Touch Points to Change

Effective treatment of Post-Traumatic Stress Disorder (PTSD) requires helping the trauma survivor find ways of acknowledging the role of past trauma in shaping his or her present experience and creating a vision for the future. Without a roadmap, this seemingly simple task may confound both therapist and client for years, prolonging symptoms and eluding wellbeing. The practice of the S.E.L.F. framework, a pillar of the Sanctuary Model®, as an organizing structure for therapeutic intervention creates a compass for therapists and clients to follow as well as paraprofessionals and family members supporting the client’s trauma recovery.

The Sanctuary Model is a blueprint for clinical and organizational change that focuses on building a trauma informed environment through establishment of values, language, theory and practice across an entire organization. A trauma informed environment can only be achieved when a community promotes, above all, the critical and recurrent tasks of safety and recovery (Herman, 1992; Janet, 1976). Sanctuary identifies trauma as a continuum of adversity on which occurrences may be discrete, on-going, and/or cumulative and that includes both tangible and intangible experiences of adversity, such as racism and poverty. Effectively supporting individuals with PTSD means helping them access past events and the emotions that accompany them that are often considered untouchable. It means offering a language that captures both the simplicity and complexity of traumatic experience and turns the untouchable to accessible.

S.E.L.F., an acronym that stands for Safety, Emotions, Loss and Future, is a vital tool for accessing those untouchable events and feelings. S.E.L.F. offers a language for describing challenges and planning interventions. Simply put, the S.E.L.F. framework levels the playing field by moving away from mental health jargon and toward the transformative power of change. Designed to foster clarity through a concise and flexible frame, S.E.L.F is non-linear in nature and focuses trauma survivors on a restorative perspective of hope and belief that a person can imagine a brighter, sustainable future. The idea is pure and organic: utilize an accessible language that eliminates the complex theoretical dogmas of trauma and recovery while empowering people to talk about their ability to heal and recover from their traumatic events. S.E.L.F. offers a sense of hope, which otherwise seems inaccessible, by promoting skill building and mastery in the framework’s four components: safety, emotions, loss and future. These natural touch points offer guideposts to explore and resolve grief in a safe, participatory and emotionally contained manner.

The S.E.L.F. framework is comprised of four key concepts, or touch points, that relate to the healing and recovery from trauma. They are:

Safety: How do you stay physically, psychologically, emotionally and morally safe?

Emotions: How do you manage the different emotions that you will feel? How do you support someone who is struggling with anger, sadness, the kinds of symptoms that emerge after exposure to trauma? How do you not let those take you over?

Loss: How do you deal with the loss of function, the loss of friends, and the inevitable loss that you feel when you choose one path over another? How do you manage the process of discomfort around on-going of self-discovery and evolution?

Future: How do you envision the future when victims of trauma are likely to have a foreshortened sense of future? How do you create a new definition of feeling safe? How do you imagine the ability to trust?

Promoting Recovery through S.E.L.F.

Treatment of trauma survivors is messy. Survivors often have difficulty recognizing and expressing their feelings, lose their positive and loving feelings toward other people or report feeling disconnected in their relationships and friendships. Additionally, individuals may not be interested in activities they once enjoyed; they may not readily remember parts of the traumatic event or even be able to talk about what has happened and how they feel. Shifting these barriers to memory and feeling is critical for recovery, and these shifts only happen through relationship. Unfortunately, the healing journey begins with an unwanted conflict: relationship is at the core of healing from traumatic experience while relational damage is likely at the core of the individual’s problems. (Bloom, Harrison, Yanosy, 2012). By attending to the need for safety, building skills for managing emotions, grieving the losses created by the trauma and creating a vision for a different future, those who are in a therapeutic, caring or supporting role to the survivor can partner with each other and the survivor to build the bonds of healing relationships.

Accessing the Touch Points of S.E.L.F.

Utilizing the S.E.L.F. framework establishes a collaborative structure for creating agreed upon expectations, boundaries and action plans that promote meaningful change.

Given the intricate nature and turbulent effects of trauma on the survivor, PTSD intervention and treatment must come from the conviction that people are not “sick” but instead, they are injured (Bloom, 1997). In making this paradigm shift, service providers, family and friends are able to create space to value and respect an individual’s experience, thus allowing him or her to be in control as he or she learns what it means to truly understand the impact of the trauma.

Because S.E.L.F. is a non-linear framework, using it effectively requires willingness to rearrange its order. Often, it makes sense to start with future (where we hope to be) and work backwards from there, considering concerns and possible interventions related to safety, emotions and loss. For instance, it may be hard for a survivor to invest in skill building around emotion management if he or she does not have a sense of future. Sometimes loss is the most reasonable starting point for trauma work. Unsafe behaviors are frightening, so eliminating those often becomes the paramount goal for those working with a survivor. These efforts may prove futile if unaddressed and unresolved grief is driving those unsafe behaviors. Equally important is the knowledge that S.E.L.F. recovery work does not happen in stages that are completed, but may require weaving in and out of the four touch points continually revisiting them in new ways over the course of healing.

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