Therapy’s Safety Axiom: Are We Setting Clients Up to Fail?
1 December, 2022
So much of our work as psychotherapists seems to be predicated on the axiom that most forms of deep emotional or trauma work can take place only after we support a client in establishing a sense of safety.
Resourcing in Somatic Experiencing, for example, relies on attuning to safety before any other facets of the modality are explored. And Polyvagal Theory places establishing a feeling of safety at the very core of the work. A sense of safety is essential to activating what Porges refers to as our ‘social engagement system,’ because only when we feel safe are our ‘neurological defense strategies inhibited.’
In this piece I wish to suggest that an insistence on establishing a sense of safety is not serving many of our clients well and, indeed, can be counterproductive. It can give our clients the sense that they are failing from the outset should they find safety an elusive feeling state to achieve.
Effective therapy is an inherently risky business
One problem with safety discourse is that feelings of safety are often associated with things that are familiar to us. But those things that are familiar, comfortable, and free of risk don’t necessarily serve us. Development, change, growth, all require a certain amount of discomfort to take place, ‘growing pains’ as it were. My friend Doug Braun-Harvey is fond of saying that some measure of ambivalence is ‘essential to the change process.’ That is, we do not move toward discomfort and uncertainty that necessarily accompany change and growth without some sense, as the queer theorist José Esteban Muñoz asserts, that the ‘here and now is a prison house,’ and that ‘we must dream and enact new and better pleasures, other ways of being in the world, and ultimately new worlds.’
To repurpose a Chandlerian construction, ‘risk is our business.’ Any robust informed consent process includes a discussion not only of the benefits of psychotherapy but its inherent risks.
The world is unsafe… and for some more than others
As those of us seeking to hold space for clients in the midst of the Covid-19 pandemic well know, nothing is 100 per cent safe. To suggest otherwise can be profoundly invalidating, for doing so would assert that healing relies on a state of being that we cannot attain in a world that is profoundly unsafe.
What’s more, this is truer for some of us than for others. Insidious trauma refers to the microaggressions and manifestations of structural oppression that members of marginalised communities routinely experience as a grinding, grating, low hum. Insidious trauma is often unacknowledged by members of dominant groups, but it accumulates in our bodies and is expressed in the many ways we tend to move in the world, always already anticipating violence and stigmatisation. And ultimately, insidious trauma is internalised and comes to structure our perceptions of ourselves, operationalising us as the tools of our own erasure.
For example, as a trans femme I experience insidious trauma almost constantly; I move in the world anticipating violence and discrimination, particularly at a time in the US and the UK where trans bodies have become heavily politicised and, indeed, the focal point of a moral panic.
Indeed, as Kai Cheng Thom has observed, safety is ‘an inherently classed, raced, and gendered experience,’ a state of being that is enjoyed – and, indeed, expected! – by only a select few, namely, white, cishet, high SES folks. Everyone else moves through a world that is, at least to some extent, unsafe and precarious.
An often impossible precondition for healing?
The point is this: to insist that a sense of safety is requisite for deep therapeutic work to take place can be counter-therapeutic for our clients because it can turn us and them away from the risk-taking that growth and change require. And seeing a sense of safety as a necessary precondition for healing is especially harmful when working with clients who are members of marginalised groups.
Doing so may set up an impossible expectation for our clients, namely, that they can – and should be able to – feel safe in a profoundly unsafe world. We might also focus so much on reaching an unachievable baseline that we never focus on what can be achieved.
In a future blog post I hope to expound on this last point and offer a constructive path forward, one steeped in holding and what I have come to call boundedness.
Lucie Fielding, PhD, MA, LMHCA, Resident in Counseling (she/they) is a queer, non-binary femme, and a therapist practising in Virginia and Washington. She holds an MA in Counseling Psychology from Pacifica Graduate Institute (2018) and a PhD in French from Northwestern University (2008), specialising in erotic literature. Their background in literature attunes them to the ways that cultural scripts inscribe themselves on our bodies and inform our embodied erotic lives. In addition to being a therapist, Lucie is a sex educator who has facilitated workshops for a range of organisations, universities, and agencies. They are the author of Trans Sex: Clinical Approaches to Trans Sexualities and Erotic Embodiments (2021), which was awarded an AASECT Book Award in 2022 (Sexuality Professionals Category) and named a finalist for a 2022 Lambda Literary Award (Lammy) in the Transgender-Nonfiction category. You can find out more about Lucie at www.luciefielding.com or follow them on Instagram (@sexbeyondbinaries).
Speaker Disclosures:
Financial: Lucie Fielding has employment relationships with Trans Care BC and Antioch University. She receives royalties as a published author. Lucie Fielding receives a speaking honorarium, recording, and book royalties from Psychotherapy Networker and PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Lucie Fielding is a member of the American Association of Sexuality Educators, Counselors and Therapists and the Transgender Health Alliance of Central Virginia.
