Book Review: Seeking Safety: A Treatment Manual for PTSD and Substance Abuse

prioritises the role of substances, exploring how substances only "solve" PTSD problems in the short-term. The treatment does not explore past trauma, the hypothesis being that certain memories may overwhelm and thereby worsen substance abuse.

Chapter Two provides a step-by-step guide as to how this form of dual treatment is conducted. The manual consists of twenty five topics which are each independent. Because of this, the topics can be covered in any order and can be selected by patients so that they feel in control of their treatment. The treatment can be longer or shorter than 25 sessions and is designed to be integrated with other treatments. It can be conducted in a variety of formats, such as groups, and is applicable to a wide range of patients, even those who do not meet full formal criteria for current PTSD and substance abuse. As it is highly structured, it helps patients to know what to expect and emphasises careful planning, organisation and focus, which are needed for recovery from these two disorders.

Although each treatment topic can be discussed in one or more sessions, depending on the length of treatment, each session follows a sequence of four steps:

Check-In: this occurs in the first five minutes of each session, and allows the patients to inform the therapist of their progress, identifying issues that can be discussed in the session. Any unsafe incident since the last session must be prioritised in the current session. During check-in patients are also asked to identify a good coping strategy that they have used since the last session, as it encourages them to respect their strength and reinforces positive behaviour.

The Quotation: each treatment topic provides a quotation that can be used after check-in to emotionally engage and inspire patients. They are asked to read it aloud and then to identify its main points. Patients can also bring in their own quotations.

Relate the Topic to Patient's Lives: patients are asked to look through the handouts provided and to select the ones they wish to cover. Patients are also provided with handouts which can be read before sessions. During the session, the topic should be related to current and specific problems in the patient's lives, as the focus is to help patients achieve safety in the present. This can be done by discussing what patients find relevant in each topic and identifying problems to work on. PTSD and substance abuse should be mentioned in every session.

The Safe Coping Sheet: this is used to help patients process events that went wrong in their week, as well as conveying that while everyone has difficulties, personal coping strategies are what is important, and that safe coping leads to positive consequences.

Check-Out: this is the final part of the session, therefore no new issues are introduced at this point. Patients are asked to identify one thing they got from the session, and to name a new commitment (homework). They are also asked about which community resource they will call upon to help with their recovery. They are also given a questionnaire to complete so that they can convey positive and negative reactions to the session.

The remaining twenty five chapters each discuss a treatment topic, providing a quotation, any issues that may arise from the topic, and handouts for each topic. They also provide examples of how to relate the material to patient's lives.

The book is a very comprehensive treatment manual, providing a step-by-step guide to conducting the treatment. The layout of the chapters makes it easy to find certain reference points, and all the materials required to conduct the treatment are available in the various chapters. The additional examples of how to make topics more individual are particularly helpful, especially for those practitioners who are not specialised in the fields of substance abuse or PTSD. The language used in the book is simple and therefore easy to understand, and all specific terminology is thoroughly explained.

As this specific treatment can be integrated with other treatments, the book is useful to any practitioner working with individuals who suffer the dual disorder of PTSD and substance abuse. This may include individuals working within the substance misuse field, or generally within the community, as well as psychologists who treat a variety of patients. Due to the treatment's focus on the present, however, it is not recommended for therapists who explore past trauma, as this is not indicated in Seeking Safety.

In terms of its use to the existential practitioner, PTSD may be seen as an existential issue, as trauma can precipitate loss of trust and meaning, with patients often failing to identify any reason for being alive (Frankl, 2004). Substance abuse also creates existential ramifications, through a loss of ideals, an inability to cope with life, and sometimes a loss of the sense of self, thereby pushing away reality. Both PTSD and substance abuse, especially where they occur in combination may destroy the "ideal world" we create to give us a sense of meaning (van Deurzen-Smith, 1984).

Najavits is clear that this treatment aims to relieve symptoms of both PTSD and substance use, so as to keep the patient safe. Although existential therapy does not focus on the illness-health dimension to such an extent (van Deurzen, 2002), integrating this treatment into an existential framework has the potential to enhance the patient's progress through treatment.

References

Deurzen, E. van (1997). (2002). Existential therapy. In Dryden, W. (ed) Handbook of Individual Therapy (4^th Ed.). London: Sage.

Deurzen-Smith, E. van (1984). Existential therapy. In Dryden, W. (ed.) Individual Therapy in Britain. London: Harper & Row.

Frankl, V. (2004). Man's Search for Meaning. London: Rider.

Catherine Atnas