Rick Berman: Treating trauma and addiction

Rick Berman, LPC, CGAC I, faculty instructor and coordinator of Problem Gambling Services at Lewis & Clark’s Graduate School of Education and Counseling, has been employing the treatment method, Seeking Safety, for over 15 years in his practice. We asked him to reflect on the treatment of co-occurring disorders, how this has changed since the creation of Seeking Safety, and why knowledge of the treatment is beneficial to all practitioners.

In today’s field, how often are co-occurring disorders encountered in patients?

Many studies confirm what therapists know from our own clinical experience: there are high rates of addictions among treatment-seeking individuals who are diagnosed with Post Traumatic Stress Disorder (PTSD), and high rates of PTSD and other trauma-based symptoms in addictions treatment populations. Co-occurring trauma-based symptoms and addictions are the norm, rather than the exception. However, even with the known prevalence with which these symptoms co-occur, there was little to no information available on how to treat them.

What sort of treatment options were available prior to Seeking Safety?

I began working with addicted trauma survivors back in the early 1990’s and at that time there was almost no research and certainly no treatment manuals or protocols, which resulted difficult and challenging work.

In 1995, Mike Sullivan and Katie Evans published the first treatment protocol for therapists who work with addicted trauma survivors. I utilized this protocol while practicing at the Evans & Sullivan Clinic in Beaverton—one of the first clinics in the U.S. to specialize in what at the time was called dual diagnosis: individuals who had a psychiatric disorder and an addictive disorder. I found it to be effective, but it also had a number of limitations and wasn’t widely adopted.  For example, it wasn’t formatted as a step-by-step manual. It didn’t include handouts for clients. It was based on a modified 12-step approach that was not a good fit for many clients.  And it wasn’t easy to learn. For one thing, it required specialized training in clinical hypnosis. 

When Seeking Safety was first published in 2002, it was a revelation. Today it’s difficult to over-estimate the impact that its author, Dr. Najavits, and her collaborators have had on the field.

“It belongs in almost every therapist’s toolbox…”

Seeking Safety revolutionized treatment. It is a blended treatment designed for trauma survivors who struggle with addiction. When I began using Seeking Safety nearly 15 years ago, my biggest surprise was how much the clients liked it and gained from it. They liked the democratic spirit of the treatment, and the combination of structure and process.

Based primarily on Cognitive-Behavioral Therapy, Seeking Safety is relatively easy for most therapists to deliver well and can be used in individual or group therapy. It provides solid advice for therapists about how to co-create effective therapeutic relationships and includes practical and powerful learning material for clients. Plus there is a substantial body of research that backs its effectiveness.

Seeking Safety is now the most widely used treatment for individuals who are early in the recovery process from trauma-based symptoms and addictive behavior.

Many therapists don’t like to use manualized treatments. I’ve certainly had bad experiences with some that were too rigid or put me in more of a teacher role than a therapist role.  Seeking Safety is anything but that. Done properly it’s a flexible, creative therapy that allows deep processing. It belongs in every therapist’s toolbox.

Learn more and register for the Seeking Safety workshop on Friday, April 12