Compassionate Coexistence

This month I connected with Andrus- The Sanctuary Institute, a nonprofit based in Yonkers, New York, that provides mental health services and education through a trauma-informed framework called “The Sanctuary Model.”

The Sanctuary Model was first developed in the 1980s by Sandra Bloom and a team of clinicians at a small inpatient unit serving traumatized adults in Philadelphia. Bloom outlines the challenges and changes the model — and patient care — underwent over time in the excellent book Creating Sanctuary: Toward the Evolution of Sane Societies.

“Community life has broken down dramatically, and we are only beginning to recognize how important to our daily survival is the web of connection that a community provides. But there are relatively few voices talking about how we get from ‘here’ to ‘there.’ Part of the problem may be that we do not yet have any clear vision around where ‘there’ is. We do not spend a great deal of time envisioning a better future for ourselves and our children and even less time figuring out how to make that future a reality.”

—Sandra L. Bloom, Creating Sanctuary: Toward the Evolution of Sane Societies

The book notes how the model helped people experiencing serious fragmentation — including from borderline or multiple personality disorders — piece their worlds back together. Bloom noted, however, that the model could apply to us all.

“I believe that our work with some of the most injured and socially alienated of human beings provides us with some important information about what we need to do to reconnect with each other and to the natural world that sustains us,” she wrote in the 2013 edition.

Reading that held a revelation for this stunned writer – that we are all basically walking wounds, regardless of whether we “think” we have experienced (serious) trauma, and that healing our world must start with a recognition of this trauma.

As a baseline reference: The Sanctuary Institute defines trauma as “an experience in which a person’s internal resources are not adequate to cope with external stressors.”

I’m also (not surprisingly!) the only one who has realized this: The Sanctuary Model has since been implemented in schools, community-based organizations, domestic violence and homeless shelters, and residential treatment, juvenile justice,  and drug and alcohol treatment programs.

To help clients, the Sanctuary Model relies in part on The Sanctuary Commitments of Nonviolence, Emotional Intelligence, Social Learning, Open Communication, Democracy, Social Responsibility, and Growth and Change — values that can help lead people away from trauma-reactive behaviors.

Andrus’ Senior Director Maxine Reddy and Director of Business Operations Stephanie Dambreville caught up with me over Zoom about these commitments and their work with organizations seeking to implement The Sanctuary Model. Answers have been edited lightly for style and length.

To connect with Andrus or learn more about their work, you can check out their website here.

A Q&A with Andrus’ Maxine Reddy (MR) and Stephanie Dambreville (SD)

Tell us more (briefly) about The Sanctuary Model.

MR: The Sanctuary Model is really about organizational change, to help organizations get to that point of being trauma-informed so that they then can help those who come to them for services. Andrus, in particular, is really focusing on social determinants of health — looking at the immediate needs and helping to get clients onto a path of having those needs met first.

Andrus has adopted a One System of Care, so that people only have to tell their story once and then that information (with permission) is shared across the departments. A part of trauma-informed care is not re-traumatizing; so we ask people to tell their story once and then we start wrapping around those services for them.

Why is a trauma-informed framework so relevant in today’s world?

MR: The assumption that we need to make is that everyone has experienced some kind of adversity or trauma. The continuum, or the degree, to which that happened is going to be different for everyone, but approaching someone with that universal precaution — that you are interacting with somebody who has experienced adversity and/or trauma — is the starting point.

Humans can be “messy” — and so can their healing processes. What does healing look like via The Sanctuary Model?

MR: Sanctuary is a relational model. We use our seven commitments to create relationships, and then that’s how we participate in the relationships as well. It’s also understanding that there is no perfection, but we are always striving. For example: I don’t think there is ever going to be perfection around communication, but we are always working toward improving and getting it right or having it be more complete. And the same would go with all the commitments — for example, that commitment to nonviolence. Sometimes, we miss the mark. But we have an awareness about that, and we come together, talk about it, and figure out how we can do better.

SD: We talk about improving the care that’s delivered to the people that we serve (children who have experienced trauma, for example), but we also check in with ourselves using some of the model’s practices and tools. For example: What is our self-care plan? Self-care is very important. Even if you don’t have a high ACES (Editorial Note: Adverse Childhood Experiences) score, you can still learn about how to better support someone who might and how that impacts them. 

On the note of self-care, can you share more about how you’re seeing toxic stress or “burn out” impact caregivers and how The Sanctuary Model addresses that?

MR: In nonprofit human services, I’ve just really become more and more aware that there is so much work for one individual; most people are doing the job of at least 1.5 if not two people. If I had a wish that could come true, it would be to have more people so the work could be spread out more, and people would have less burnout and vicarious trauma and more opportunity to bring their whole selves and be really dedicated to their work. As it is, you sometimes kind of run around putting out the fires, but you never really get to the real stuff that, in fact, would make the difference if you had the time to attend to it. 

In The Sanctuary Model, we teach about vicarious trauma and burnout, and then we use that self-care tool, which is the antidote, in a sense. This is not a blanket statement for everyone, but you work to resolve your own issues (potentially through counseling and therapy), ensure that you have social or spiritual connections, and community involvement and engagement. It’s really finding and giving opportunity: What can you do outside of the work you are doing that will fortify and fulfill you so that you have the energy and the stamina to come here and do what you do really well?

Can you give an example of how toxic stress may manifest — signaling to caregivers that they need to take a break to take care of themselves?

MR: One of the components of trauma theory in the Sanctuary Model is this idea of collective disturbance. It’s this understanding that things happen that we have to push aside, but those emotions and feelings are going to come out somewhere. The example we use often is that you’re at work, and your supervisor is unhappy with a report you did, and now you are upset because you have to stay late and rewrite it, but you cannot take that out on the supervisor. But who ultimately do you take it out on? You go home most likely to somebody, whether it’s a human or an animal, and we see it come out there: You’re short-tempered or you pick fights or you’re yelling at your pet and they don’t understand why. We teach about this collective disturbance and how we identify when we are in one — when our emotions are coming out elsewhere — and then what can we do to identify these types of things earlier.

 It’s really about asking, “Are we starting to see things that are a little bit different than they normally are?” Are you not passing along phone messages, are people parking in places they aren’t supposed to park, or is someone demonstrating an unconscious “I just don’t care” shift — such as overlooking or not doing the things they normally would have done?

If you follow this idea through to the next time it gets really busy, and somebody needs help, are you stepping up to help? Or are you not, because where is it going to get me anyway, what’s the point? That’s when you know that you are at a point of burnout and not in a healthy environment.

One of Andrus’ on-site healing campuses features farmed animals and gardens as well as licensed professionals — can you tell me more about how those elements contribute to clients’ healing?

MR: It’s really about having licensed professionals in each of all of those programs, whether it’s horticulture or art, who use those modalities as ways (in addition to talk therapy) to give people experiences that enrich and help move them toward the values of Future and Hope and Growth and Change. It’s about giving experiences that some of the students and young people who come into residential centers may not have ever had. It’s about giving them hope that they can do and be like others they have seen. And I will say, in terms of horticulture, that giving young people the opportunity to create a garden, to plant a seed, to tend to it, to harvest, and then to serve a meal to someone else in need is such a reparative and restorative experience.

The ‘Growth and Change’ commitment stood out to me — what lessons can that value have for people from all walks of life?

MR: From my perspective, ‘Growth and Change’ is really about hope. It’s about creating future. People who have experienced trauma and adversity often don’t think about the future and don’t really have any hope; it’s all about surviving in the moment, to whatever degree. So this commitment is really about showing people that by developing even the smallest of goals and achieving them, you start to believe that there is future, and that in turn creates hope. That’s what growth and change is about: It’s about hope, it’s about future, and it’s about getting there in the tiniest of incremental goals.

The community meeting, one of the Sanctuary Model’s tools, can be used to give people space to create goals for the long-run, the moment, or the day. The final tool of that community meeting is the question: “Who will you ask for help?” That is really important to help repair broken relationships that have occurred along the way with trauma, abuse, and adversity; it helps people start to realize that there are safe connections and to step back into  those relationships and believe that somebody is there for you.

Are there other Commitments you’d like to touch on?

MR: For Open Communication, it’s not just about having the strength and the fortitude to say your piece, but to say it in a way that is not harmful to others. The other piece is the responsibility of others to also communicate: It’s not only about Me, it’s about Us. 

FOOD FOR THOUGHT: What Choice Will You Make?

“A sense of safety, wholeness, life, caring, and home is something each of us actively creates — or destroys — every moment of our lives.” ­— Sandra L. Bloom, Creating Sanctuary

“Not everything that is faced can be changed, but nothing can be changed until it is faced.”— James Baldwin

REFERENCES

Bloom, Sandra L. (2013) Creating Sanctuary: Toward the Evolution of Sane Societies. Routledge-Taylor & Francis Group.

Bloom, Sandra, Yanosy, Sarah M., and Harrison, Landa C. (2015). Sanctuary Model Community Implementation Guide. https://sandrabloom.com/wp-content/uploads/2015-yanosy-harrison-bloom-sanctuarycommunity-implementation-guide.pdf