Dr. Sandra Bloom is a psychiatrist largely responsible for the creation of the Sanctuary Model, which is both a framework for treating trauma, as well as an organizational change model that integrates evidence-based trauma interventions with the benefits of therapeutic communities.
The brilliance of this model is that it optimizes the safety and healing of all parties involved in social systems of care: patients and clinicians, prisoners and judges, victims and advocates, addicts and counselors. It is a model, in my opinion, that is applicable across all organizations no matter what their purpose, because it provides a roadmap for how humans should treat one another, no matter what position they may find themselves in.
Why do we need it?
Because most social/healthcare service organizations are in crisis. U.S. healthcare problems were detailed in a number of publications by the Institute of Medicine, with outcomes indicating that the U.S. has the most expensive healthcare system in the world, yet ranks far down the list in terms of overall quality. But it is not just our healthcare system that is in dire need of overhauling.
Our education, criminal justice, mental health, child welfare, and…yes, our addiction treatment system are all struggling to meet the needs of the populations they serve. The Sanctuary Model suggests that the problems are rooted in unhealthy systems, not individual people. If we understand the system, we then stand a chance of making changes within the system that ultimately translate into better outcomes for all involved.
Across the different social systems, the problems are similar: reduced funding, decreased training and education, more paperwork, more surveillance and micromanagement, greater staff turnover, and lots of stress across all levels of organizations.
These factors then translate into organizations that are chronically stressed, attempting to do more with less, always operating in a reactive/crisis mode, ultimately leading to folks being chronically hyperaroused.
In this state, it is like Brian Farraher, CEO of Andrus Children’s Center has said,
Managing like your hair is on fire
Stress leads to a loss of basic safety and trust, a breakdown of emotional intelligence, behaviors that result in more conflict, and staff who feel disempowered. As relationships become strained, more autocratic approaches to leadership emerge, and then folks just stop talking. In essence, organizations stop learning. The outcomes are costly for all involved.
The Sanctuary Model is the antidote
It acknowledges that stress, trauma…life problems, exist not only in the clients who show up for help (or are mandated for help), but also in the helpers.
Seven Commitments
The served and the servers are mirrors of each other, and both require focus and attention on seven commitments:
- Growth and Change
- Non Violence
- Emotional Intelligence
- Social Learning
- Open Communication
- Social Responsibility
- Democracy
The details of the commitments, and how best to implement them are documented on the Sanctuary Website and in Creating Sanctuary: Toward the Evolution of Sane Societies
Human history becomes more and more a race between education and catastrophe
HG Wells, Outline of History, 1920
Implementing the Sanctuary Model in organizations, and incorporating the commitments into all of our lives, means embracing our responsibility to the common good of all people, to our future, to our planet.
Yet again another reason that I’m grateful that you are out and about, share and spread that info around amigo!
We are all linked. Acknowledging this and paying attention to the helpers is a quite a snazzy concept I think. In order to provide quality care we must be able to take in the energy of our clients/wards/patients etc and be able to process it and reroute it into some other area. Taking the stress and energy of our clients, then in turn getting contaminated by it so we lash back at our clients, or our friends and family will ultimately be counterproductive!
In the vein of this post, be good to each other people!
me
IN reading this article, I did not find out comes,
also the assumption that all chemical dependency is trauma influenced, is not accurate
Richard, see website and her book for more information about outcomes. I do believe that most who struggle with addiction have some trauma history, but not all trauma meets diagnostic criteria for PTSD. That said, there are many factors that influence whether someone develops an addiction, trauma just being one of them. Thank for the feedback.
J
I am interested in this model and am considering it for a potential program model. I am interested to know if there has been any large organizations/services systems have implemented the model? Is it feasible for an organization with over 1,600 employees? Should it be implemented to direct service providers and their respective supervisors?
Christine, I am not sure to what extent the model has been applied to large organizations, although I see no reason why it would not work in large companies. I very much would encourage you to contact Dr. Bloom directly, as she is the best person to answer questions about the model.
Thanks for the comment.
J
Superb reference, many thanks for sharing! Take care.
When I left social services for graduate school a life time ago, we were just beginning to work on issues of vicarious traumatization in service providers. Now it seems that knowledge about vicarious traumatization is fairly common and yet agencies continue to work under “chronic stress”. For me, your discussion of agencies in a state of hyperarousal and reactive/crisis mode helped reframe some of the dysfunction I noticed in the agencies in which I worked, provided language to discuss how that dysfunction continually negatively impacted our clients, and let go of some of the hurt I carried recently over the continuation of these problems after we supposedly “did the work” to heal years ago. For me, any model that addresses these systemic issues is critical not only to services for addiction but any social service program, most of whom deal with people with addictions even when they are not addiction services.
I was particularly drawn to the 6 issues they identify as being related to agencies under stress: (1) loss of safety, (2) breakdown of emotional intelligence, (3) conflict inducing behaviors, (4) disempowered staff, all of which lead to (5) autocratic leadership and (6) silences and barriers. For me, this list provides a fairly easy way of identifying whether an agency is functional or not on a systemic level. By making it a systems issue, it avoids the blaming and triangulating that often masks the problem by laying it at the door of one or two providers which is not only important to lasting change in an agency’s milieu but also in equitable service provision in which everyone provides equal service to clients and clients learn positive connections and ways to access service that don’t include staff engaging them in “whose better” games. It also helps explain certain kinds of leadership issues that arise in dysfunctional systems and provides language for addressing them in a non-shaming way.
I also liked that this model defined safety on multiple levels and in multiple realms. Though I did have a question about “psychological safety” which was defined as how we keep ourselves safe in the world, but fleshed out in terms of words modified by “self-“, ie that the onus fell on the individual rather than the environment. I worry about models that do not address systemic inequalities in their language as well as their philosophy, since language shapes and is shaped by world views. At the same time, the overall point of this model is systems and connections so that other aspects of the model address the issues I am raising.
Finally, I liked how the concept of a “trauma informed culture” better addressed the connections between trauma and addiction not only in diagnosis but also treatment models that avoided re-traumatization. My mother was an addiction counselor for pregnant and parenting women for many years and she often worked with in a more punitive “stripping down” model of addiction treatment that I always found extremely jarring an unproductive for people with abuse histories and I liked that the Sanctuary Model worked to decrease coercive techniques, victim-blaming, and judgmental behavior. I also appreciated that it works to heal providers, service provision systems, and clients together so that everyone is working on strengths, growth, and wholeness rather than parsed needs and limited resources. Lastly, I found the connection they made about Freud’s repetition compulsion and traumatic reenactment particularly useful for working with people with addictive behaviors so as to understand the disconnect between their intentions and some of their actions, the recreation of certain negative relationships that can trigger addiction even after “clearing out” older relationships, or even the kinds of transference that may occur between people struggling with addiction and positive people in their lives that make them feel trapped or forced into unfamiliar and unproductive roles or struggles with people caught up in addiction.
As a former teacher, I agree absolutely with this. There needs to be a change, the system as it is now is broken. I would see teachers who would just break students, and traumatize them – it didn’t just negatively impact their educational self-esteem but their personal self-esteem and sense of ability and self in every facet of their life. The movement towards “No Child Left Behind” has knee capped education as much as acute care models have knee capped addiction programs. It doesn’t seem that those who write the policies and the checks, are really interested in truly healing, educating, or helping the populations the programs were created for, it seems more like they just want everyone to hurry up and get through it following a standardized model and that after that they should be fixed. Obviously, that doesn’t work.
I wonder why when you have something that seems so functional and makes so much sense as the Sanctuary does, why is it that more people, policy makers, don’t move towards it? Perhaps, it is that organizations have stopped learning and they can’t see the forest for the trees.
This sounds like holistic treatment at its best- teaching “how humans should treat one another, no matter what position they may find themselves in.”
But I am always overwhelmed when I begin to read about system wide change. I do believe we have unhealthy systems, but I don’t always believe in problem solving these systems. Many times I believe its best to create what works for our lives and either recognize the flawed system while finding where we can fit, or by doing our best to engage in alternative choices. This is the reason I don’t vote Republican or Democrat. They are the same system, essentially. So this is where I differ in regards to social responsibility. Perhaps this stems from my own lack of community. This could be a product of life in a big city, where I feel not only unseen but also a bit useless, or unneeded. Obviously an area that needs self-exploration. This is probably not how I should approach treating humans.
What I love about this model is that it incorporates helpers as well- very similar to CRAFT. This type of work on a small scale is something that I can grasp.
I love the ideas behind this model. It sounds like a community oriented model that stresses safety and connectedness – something that is likely missing from the lives of many, if not all addicts. I feel as though this would be a great method for changing the way addiction treatment is put forth in the community. I get stuck when it comes to implementation. As stated in the blog entry, many organizations are forced to do more with fewer funds, staff, and resources than in the past. With any restructuring, there is going to in an incurred cost (not just monetary). It is unfortunate, but I feel as though the Sanctuary Model could fix a lot of these issues, but I’m left wondering how it is possible to implement something like this, considering the current state of many organizations – which is essentially what this model is trying to alleviate. Overall, I love the basic principles behind this model and hope that it can find its way into our broken social systems.
Having recently been laid off due to budget cuts from a local nonprofit, I can really resonate with some of the comments above. Working as a vocational counselor, it was an ironic experience to be laid off and end up in the same position as many of my own clients. This is of course after being incredibly overworked by an agency that itself was managing itself as if its hair was on fire! It was an incredible reminder that we are all part of this system, and I am really happy to hear that there are individuals who are seeing things this way! With the rampant nature of addiction (in its many forms) in this country, it is great to see somebody align themselves with the systemic struggle that addiction is for all of us.
I feel that that is one of the things I have really appreciated learning recently is that addiction is a chronic disease, a monster with many faces; it is as pervasive as it is diverse in its manifestations. And this incredibly humanizes what was once an “other” for me. I can now see addictive patterns in about all of the people I know in my life! It’s quite humbling to see yourself as part of the movement towards healing this HUGE hurt (both the individual and the collective). Symptoms always manifest in order to demonstrate something. In order to communicate. Addiction as a symptom manifesting in our systems is a huge message.
I think that this sounds like a good model. Having a “roadmap for how humans should treat one another, no matter what position they may find themselves in” seems like it could be very helpful. It is ridiculous to me the amount of money we spend on our health care and that we are still not at the top of the quality list. You mentioned American’s becoming “hyperaroused” which I think is probably a big factor in this. More than anything about this model, however, I liked the seven commitments: democracy, growth and change, nonviolence, emotional intelligence, social learning, open communication, and social responsibility. These are all characterists that exhibit positive behaviors and could potentially help us out of the crisis that we are currently in.
Wow! I had never heard of this model before. Great information. I agree with the information presented, especially with the fact that stress, trauma, and life problems not only affect the clients that need help but also those that provide help. I strongly believe that in order to heal, educate, or make a difference in people’s lives, one needs to implement the seven commitments.
The Implementation of the Sanctuary Model is executed through a combination of trainings and consultations provided by the Sanctuary Institute Faculty members which move an organization through a series of steps to align the practices, attitudes and philosophies of an organization toward a trauma-informed perspective. There are four manuals that will be made available to staff to assist in the implementation:
– The Sanctuary Implementation Guide
– The Sanctuary Staff Training Manuals
– The Sanctuary Psycho-education Manual
– The Sanctuary Standards
The Sanctuary Model® is a “trauma-informed” method for creating, sustaining or changing an organizational culture – any organizational culture. Why does every culture need to be “trauma-informed”? We now have a large body of epidemiological information demonstrating that exposure to trauma, adversity, and chronic stress are universal experiences that affect individuals, families, organizations, and entire systems in a wide variety of ways – some that are creative and that insure growth, others that produce dangers to our physical, psychological and social well-being.
The Sanctuary Model is grounded in and informed by the growing and interlocking fields of scientific endeavor that study disrupted attachment, acute stress, chronic trauma-based problems, and adversity. The Sanctuary Model tenets have application in working with children and adults across a wide spectrum of problems. Originally developed in a short-term, acute inpatient psychiatric setting for adults who were traumatized as children, the Sanctuary Model is an evidence-supported template for system change based on the active creation and maintenance of a nonviolent, democratic community in which staff and clients are empowered as key decision-makers to build a socially responsive, emotionally intelligent and just community that is able to transform internal and external conflict, and that fosters growth and change.
The basic components of the Sanctuary Model are embodied in Seven Sanctuary Commitments that must guide the thinking, planning, and action of all community members: Commitment to Nonviolence, Commitment to Emotional Intelligence, Commitment to Social Learning, Commitment to Open Communication, Commitment to Democracy, Commitment to Social Responsibility, Commitment to Growth and Change. The Seven Sanctuary Commitments represent a whole interdependent system of values, beliefs, and practices.
The nonlinear operational tool that helps to guide thought, reasoning, and action through time is called S.E.L.F., representing the four interactional domains fundamental to all healing: Safety, Emotional Management, Loss, and Future. In order to reason well, make good decisions that inform future action and allow for appropriate risks, human beings require physical, psychological, social and moral Safety. Our safety is always at risk when we are unable to manage our emotional states, particularly distressing Emotions. In order to be safe enough to use our minds effectively, we must be able to manage our emotions, including the fear of what we will have to give up – the inevitable Loss that accompanies change – if we are to make any movement forward. And no one would be foolish enough to endure Loss unless they had something to gain. Unfortunately, in any effort to make change, we usually experience distressing emotions and loss before we gain. Therefore, positive change requires the use of imagination to envision a different Future. The journey of change always involves taking risks and we can reduce risk only by creating sufficient safety, developing skills to manage the disorientation of emotional distress, being willing to tolerate loss, and remaining steadfastly guided by the vision of where we are trying to go.