What can families gain from learning about the Sanctuary Model

By Amy Long, MS, CTRS

It’s late at night. You get a call from the program your daughter is in … again. The staff called to report that she was restrained for attacking staff. She is calming down now. The staff members do not know what triggered her aggression this time. This is a pattern, and you, as her parent, feel helpless and distant. You have been through so much with your daughter, tried to support her, tried to get her the help she needs, but she has been through so much that it can be overwhelming and frustrating, for you and for her.

The stress on your family is tremendous: the time away from family activities to visit your daughter; the arguments about parenting and the “blame game” you have with your husband; the chaos in the house with the siblings and the distance your friends and neighbors have suddenly imposed. You go to bed worried about the future of your daughter and your family.

This is one of the scenarios of a family dealing with mental health issues related to trauma. Whether the family member is getting treatment at a residential treatment facility, therapeutic community program, outpatient program or through an individual therapist, the family is stressed in the process. The Sanctuary Model can assist families who have experienced trauma.

The Sanctuary Model is a trauma-informed model of care used to help individuals and organizations understand and treat symptoms of trauma. Many organizations such as residential treatment centers, hospitals, police departments and schools are using The Sanctuary Model to help guide them through issues related to trauma. Not only are the concepts beneficial for organizations who work with clients dealing with trauma, but for the families as well.

The Sanctuary Model is built using a common language to help all members involved understand trauma. Families can use the Sanctuary concepts and language to support the individual through their treatment and provide a supportive environment day to day. The S.E.L.F. (Safety, Emotions, Loss and Future) framework guides discussions and decisions, helping families consider the many facets of a problem and solution. Families can learn about S.E.L.F. through family psycho-educational groups provided by a mental health specialist, multi-family psycho-educational groups sponsored by a program, family support groups and resources online or provided by the program. The curriculum is a set of educational sessions that teach individuals about S.E.L.F., the Seven Commitments, how trauma affects the brain and tools the family can use to participate in the healing process.

So, what is the S.E.L.F. framework? S.E.L.F. represents the four fundamental domains of disruption that can occur in a person’s life: Safety, Emotions, Loss and Future. A family can use S.E.L.F. when presented with a problem. For example, your adolescent has become isolated and moody, unwilling to talk with you and easily frustrated. Together, you can explore S.E.L.F.: The Safety (is there some kind of physical bullying, is there some depression, has he been isolated socially and morally does he feel something was unfair?); The Emotional (is he identifying his emotions, communicating his needs and finding ways to manage his emotions?); The Loss (is there a loss that is affecting him?); The Future (is he stuck in his current problem, not able to see a way out?). You may discover something has changed such as the loss of a friend. Or maybe you have had less time to check in with your teen because of work, or he has been experiencing flashbacks due to something reminding him of the trauma. Maybe he has felt unmotivated and frustrated about the school year starting and worried about how peers will react to him. So, instead of looking just at the observable behavior (moody and isolated) and dealing with only the emotional aspect, you are able to explore all four aspects of S.E.L.F. and work toward a solution. “Victims of overwhelming life experiences have difficulty staying safe, find emotions difficult to manage, have suffered many losses, and have difficulty envisioning a future.” (Bloom & Yanosy, 2008)

The S.E.L.F Framework:
Safety – Physical Safety (with yourself and others); Psychological Safety (emotions); Social Safety (how you feel with others) and Moral Safety (doing the right thing). Individuals learn to assess each of the areas of safety, communicate what they need and plan for success.

Emotions – Individuals learn to identify their emotions. Once individuals identify what they feel, they learn to manage their emotions. Through practice, they begin to learn what techniques work to help manage the most difficult emotions.

Loss – It is important to recognize and address areas of loss in our lives. It is important to acknowledge loss, create awareness of how the loss has impacted the individual’s life and process through it. Even in significant cases of loss, there can be growth if we allow the grieving process to happen.

Future – What goals, aspirations or future does the individual envision? It is important to consider the future, because while the past cannot be changed, a hopeful future is a possibility using the tools in The Sanctuary Model.

The Seven Commitments:
These Seven Commitments are considered the framework for family values. What the family decides to reward, punish, say or not to say and the action the family takes communicates the family’s true values. The Sanctuary Model asks that each member agree to follow the seven values at all times by what they do and say. The commitments provide a “social immune system” for the family, giving everyone the ability to recognize and respond to threats of well-being, to defend and protect the family against the emergence of violence and to include everyone.

Trauma affects brain development. When the family members begin to understand how the brain is affected, they are able to provide a more supportive and healing environment. The link between observable behavior and brain functioning is important to understand, as we will see in the following examples.

A parent might say, “My kid just can’t sit still” and everyone sees a hyperactive, constantly moving and fidgeting child. By understanding what might be going on in the brain, we learn that trauma causes hypervigilance, thus traumatized people are always on the lookout for danger. This is a survival skill. Staying on the move helps the individual stay safe. But, it is a good survival skill gone wrong and looks more like hyperactivity than vigilance. terror_wall_group.jpgOr, you might say, “My child isn’t very bright – he’s such a concrete thinker.” People see a kid with black-and-white thinking, an all-or-nothing attitude and the inability to appreciate complexity. What’s actually going on in the brain is a trauma reaction that causes dichotomous thinking. With limited choices, he is more likely to make the right one. Again, it’s an example of a good survival skill that’s gone wrong.

A parent may say, “My daughter is a pathological liar.” A teacher or friend may see a kid whose stories don’t make sense or is a bad liar who gets caught a lot. The brain may be causing gaps in memory called dissociation. For survival, we need things to make sense. We need to learn from our mistakes. When we are missing pieces, we tend to fill them in, and this can be perceived as lying or storytelling.

You might complain, “I can’t turn my back for a moment or he will be into trouble.” We see an impulsive adolescent with limited self-control. But, in the brain, actions, not thoughts, are most likely to get us out of danger, so the adolescent is acting before thinking as a survival skill.

Some parents lament, “My daughter just can’t make any friends. Nobody likes her.” We see a child with poor social skills and difficulty in relationships. We understand that trauma causes disrupted attachments. If loving and trusting relationships lead to pain, don’t do it! This is yet another good survival skill gone wrong.

A parent may say, “It doesn’t take anything to set that boy off.” We see a hair-trigger temper. Trauma can result in flashbacks. Our trauma can get stored in different parts of our brain, and survivors can even exhibit body memories without really understanding them.

These are all examples of what we think about the behaviors of our children who have experienced trauma, but it may be that their brains are trying to protect them. Increased stress and trauma on the brain and body can cause the areas of the brain that control fight or flight responses to become overly sensitive, triggering the survival responses even when the threats are minor.

The Sanctuary Model teaches tools to help educate all members of the treatment team about trauma, ways we can create a therapeutic community, how to best deal with overwhelming emotions, how to provide healing and structure to our days and how to make sure we are working as a team to provide the best treatment for the family. Sanctuary teaches us to do this in many ways:

• Safety plans: creating a card with five things you can do when you are feeling overwhelmed;
• Community meetings: identifying your feelings, sharing your daily goal and reaching out for someone to help;
• Red Flag meetings: holding a solution-focused meeting to solve a problem; and
• Self-care plans: preventive ways you can reduce your stress and maintain overall wellness.

You can learn more about The Sanctuary Model and trauma by joining The Sanctuary group on Facebook. There is also a great audio episode on Radio National on Facebook related to trauma. Check out “Life Matters: Dr. Bruce D. Perry- Neuroscience approach to trauma” on the Sanctuary Facebook page. You can also find The Sanctuary Model online at www.thesanctuaryinstitute.org and http://sanctuaryweb.com. Information about upcoming events, training, articles and model information are available on these sites. Sanctuary is also available on Twitter @sanctuarymodel and LinkedIn by joining the Sanctuary Institute group. These resources provide ongoing discussions and topics of interest related to trauma.

Consider the difference Sanctuary can make for your family:
It’s late at night. You get a phone call. It is from your daughter. She is calling to check in. She is spending the night at a friend’s house. She asks you for a community meeting. You share your feelings, your goal for the night and who can help you with that goal. She is feeling “ecstatic” to be at a friend’s house having a great time. You are feeling “relieved” and “blessed” that your family is able to support her and provide her what she needs to feel safe. Your family still has a lot of work to do, continuing to follow the Seven Commitments and working through challenging times, but together you see a bright FUTURE!

Bloom, Sandra L. & Yanosy, S. (2008) “The Sanctuary Model of Trauma-Informed Organizational Change” “Reclaiming Children and Youth” 17 (3), 48-53.
The Sanctuary Leadership Development Institute Five Day Training Manual, The Sanctuary Institute of the Andrus Center for Learning and Innovation, Aug. 1-5, 2011.