Seeking Safety
Seeking Safety is a cognitive-behavioral psychotherapy developed by Lisa Najavits in 2002. Its core mechanism: teaching safe coping skills across cognitive, behavioral, and interpersonal domains simultaneously addresses trauma and substance use. This catalogue links it to PTSD, complex trauma and substance use, typically in individual or group format, short-medium (25).
Related condition topics
These links support exploration. They do not establish that Seeking Safety is effective or recommended for each condition.
How Seeking Safety works
Teaching safe coping skills across cognitive, behavioral, and interpersonal domains simultaneously addresses trauma and substance use
Ontology
Trauma and substance use are functionally linked; substances manage trauma symptoms; both need simultaneous stabilization
Therapeutic Voice
"When the craving hits and you want to use, what's one safe coping skill you can reach for instead?"
View of the Person
A being whose trauma and substance use are functionally linked and who needs safety before exploration
Epistemology
Evidence
3 source checks available
An overall effectiveness assessment has not been completed. This describes the state of our review, not whether the approach works.
Guidelines and official sources (3)
3 clinical guideline checks
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder
Insufficient evidence for or against
VA/DoD finds the evidence insufficient for a recommendation for or against this treatment.
Scope: Seeking Safety for adult PTSD treatment.
- Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults
Discussed in the source
APA reports no difference in effect on PTSD symptoms or substance use and makes no recommendation for or against these comparisons.
Scope: Adults with PTSD and co-occurring SUD; Seeking Safety, with or without usual care, compared with usual SUD care.
- Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults
Insufficient evidence for or against
APA finds insufficient evidence to prefer either side of these active-treatment comparisons.
Scope: Adults with PTSD and co-occurring SUD; Seeking Safety compared with COPE or Creating Change in the reviewed care arrangements.
Recorded material under review
The existing notes below are retained separately from assessment records. These recorded claims await source checking, including study design, recommendations and numerical estimates.
10+ RCTs
Multiple reviews
Strong evidence for co-occurring PTSD/SUD. Does not require trauma narration.
Training and certification
Manualized for broad dissemination. Manual is self-contained
No formal certification
Self-study; optional 2-day training
$500-1K
Equity & Cultural Adaptations
Clinical cautions and blind spots
Assessment and precautions
Active psychosis, severe cognitive impairment preventing skills acquisition, clients who are fully stabilized and need trauma processing rather than stabilization, clients unwilling to address the connection between trauma and substance use
Blind spots
Present-focused stabilization means trauma is never directly processed; may leave core trauma unaddressed
Philosophical roots
Herman (trauma recovery stages: safety first); harm reduction philosophy; dual-diagnosis integration; pragmatism (stabilization before processing)
Compared with other approaches
Seeking Safety in 1 Comparative Clinical Vignette
Each vignette presents the same client through multiple theoretical lenses side by side — showing how Seeking Safety formulates presenting problems, sets treatment focus, and sounds in the consulting room compared with other approaches. This comparative pedagogy is unique to Epoché Clinical; no other clinical reference systematically formulates the same case across traditions.
Test Yourself
Why 'present-focused' for trauma?
Show answer
Builds safety and coping first without processing trauma memories: a Phase 1 approach.