Passing Therapeutic Safety Tests

by Linda Chapman, MA, ATR-BC

The first therapy session is often the most important when treating children and adolescents. The therapist must address concerns such as confidentiality, reporting laws, information conveyed to parents or caregivers and the rules of the studio or office, if any. There is one more critical issue at the beginning of therapy—addressing safety. Physical and psychological safety must be established for the therapy to begin. This is different than rapport building or creating trust
I recommend clearly stated rules posted in the art studio. Each child who begins therapy is read the rules and is given examples as to his or her expected behaviors.

My studio rules include:

• Listen and Follow Directions (Example: When others are speaking, be respectful to listen and follow directions)
• Use Materials Appropriately (Example: Avoid wasting or destroying materials. All materials are non-toxic and tools are kept in a different room for safety but may be requested as needed)
• No Provoking (Example: No teasing, bullying, name calling or making fun of a person or their artwork)
• No Electronics (Example: No electronics. Staff must take calls outside the studio)
  In a recent session, after reading the list to a new group of teens, one male teen said, “Oh, you keep us emotionally safe.” Use the word safety as often as possible in the initial phase of therapy. This is especially important as children and teens try mostly mild, unsafe things during the beginning sessions.

Early in the therapy, when children with trauma histories set up scenarios in play or drawings with a character being killed or annihilated, the therapist might respond with, “What can we do to help keep the person safe?” If the child cannot come up with a safety plan, create one to either facilitate or help facilitate a rescue. It is not long before the child will typically set up the exact scenario again. It is only after “passing the safety test” that the therapist should ask if what they are showing happened to them and then they typically reveal a traumatic fear or experience. The mental representation is to not let the child be annihilated or killed. This has occurred with very young children and teens.

Older teens might test safety with a tool, or a remark. Ignore nothing and frame all comments pertaining to safety. It is remarkable what occurs. Pay particular attention to seemingly insignificant or overt, unsafe scenarios presented by children and teens early in therapy. The response to these “safety tests” dramatically affects the course of therapy.

Even the most resistant teens will participate in therapy when they feel physically and psychologically safe.

© Copyright 2009-2011 Linda Chapman.