Elements of Refuge

Unresolved trauma acts like an internal abrasive, leaving a survivor’s nervous system feeling raw. After trauma ruptures both emotional and physical boundaries, we feel exposed and endangered. Each change in the environment has to be evaluated as a possible threat.

Healing practitioners can provide a calm refuge for overwhelmed survivors by offering a stable container around logistics, emotions, and the relationship.

Sturdy frame
A practitioner creates a sturdy frame around sessions with careful attention to consistent details. Sessions that start and end on time are reassuringly predictable and trustworthy. Some clients like having the same time slot every week, while others appreciate flexibility that gives them access to care when their own schedules are not predictable.

A physical space that stays the same becomes familiar and comforting. All the elements of a stable frame help clients orient to the present and separate it from the past. “I recognize this room. I feel safe here. That traumatic event is not happening now.”

When a practitioner does not provide a stable frame, traumatized clients will struggle to make progress, while more resilient clients will be able to take instability in stride. This makes it easy for the practitioner to blame traumatized clients as “resistant” rather than addressing the problem in their own practice.

Gradual transitions
Transitions are hard for everyone. They are especially hard for traumatized people who already feel off balance in an unreliable world. Transitions into and out of a session need to be similar each time and give the client time to adjust. External stability and consistency make it safer to explore internal change.

Hold space
A sturdy emotional container is equally important. The practitioner gives the client plenty of room to experience big emotions, while staying right there to offer accompaniment, help with regulation, and tools to manage emotions.

Non-judgmental kindness, warmth, and acceptance create safe space to acknowledge internal truths and explore painful wounds. A gentle, respectful approach allows the client’s defenses to soften and Inner Guardians to go off duty.

The practitioner holds space for the client by staying present with them, while silently acknowledging and setting aside their own emotions and reactions. At the same time, it can be healing for a client to hear, “Wow, I feel angry when I hear how you were treated.” It is important to respond to the client’s story in a caring way while keeping the focus on them.

Strong boundaries
The client/practitioner relationship also needs steadiness and protection. Of course, the practitioner maintains confidentiality for everything that happens in the session, and respects the client’s boundaries. The practitioner also honors their own boundaries around fees, appointment times, and being treated with respect. This brings their presence more solidly into the room and models good boundaries for the client.

Dual relationships
The practitioner stays mindful of their healing role, and avoids dual relationships (additional roles) with the client. A dual relationship might be an additional business relationship (for example buying something from a client), friendship, or sexual relationship. Sexual relationships with clients are ethically forbidden. Other additional roles need to be carefully considered, always with the well-being of the client in mind.

Dual relationships make the therapeutic container more fragile. Discord in an additional role (for example the item purchased from a client is faulty) carries over into the therapeutic relationship. The roles of practitioner and client are inherently uneven, which conflicts with a more equal friendship. The client might feel pressured to take care of the practitioner in sessions, or the practitioner might feel pressured to continue to be “on duty” in the friendship.

Dual relationships also threaten the confidentiality of sessions. Information or events inside a session might “leak” into conversations outside the session.

Clear roles
Dual relationships work best when they are temporary, include a lot of open communication about the risks, and meet a need for the client. For example, a survivor might not feel comfortable receiving bodywork from a stranger, so they prefer to go to a friend. In small communities and rural areas, it might not be possible for a practitioner to maintain a strict separation from clients.

Both practitioners and clients can make dual relationships work better by carefully separating the different roles. During a session, the focus is fully on the client, and personal matters are set aside. At other times, sessions are not discussed and the practitioner is not expected to hold space.

Survivors of childhood abuse experienced damaging lack of clarity in relationships where their parents were also abusers, and perhaps also required the child to take on parental roles, all veiled in secrecy. It can be both unfamiliar and relieving to have clear roles when receiving help.

Internal container
Survivors can create a vivid image of an internal container to use when external containment is not available. When traumatic memories and emotions become overwhelming, visualize placing the traumatic material inside the container to be held securely for a few hours or days until there is time to process it, either alone or with help. While the material cannot be put aside indefinitely, it is useful to have more choice about when to process it.

Relief and ease
Survivors long for a protected space for healing, and practitioners long to help them. When practitioners pay careful attention to the elements that create a refuge, it removes distractions from the healing process and brings relief and ease. Gradually, survivors regain (or gain for the first time) a sense of safety and reliability in the world.

Learn more

• Nina McIntosh’s book The Educated Heart gives a lot of great advice for bodywork practitioners, with concrete examples.
• Nan Narboe’s article Finding the line is a clear introduction to why and how practitioners should create a secure frame.
• Heather Plett’s article Hold Space talks about various ways to hold space for people.
• Tamara Pearl’s paper From Fragmentation to Wholeness: Containers for Healing in Journal of the Canadian Association for Curriculum Studies, Vol 16, No 1 (2018) delves into containers for healing.