Table Of ContentRESTORING SANCTUARY
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Restoring Sanctuary
A New Operating System for
Trauma-Informed Systems of Care
Sandra L. Bloom , M.D.
Brian Farragher , M.S.W., M.B.A.
1
3
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Library of Congress Cataloging-in-Publication Data
Bloom, Sandra L., 1948-
Restoring sanctuary : a new operating system for trauma-informed systems of care /
Sandra L. Bloom, Brian Farragher.
p. ; cm.
Includes bibliographical references.
ISBN 978–0–19–979636–6 (hardback : alk. paper) — ISBN 978–0–19–979649–6 (updf) —
ISBN 978–0–19–997667–6 (epub)
I. Farragher, Brian J. II. Title.
[DNLM: 1. Mental Health Services—organization & administration. 2. Delivery of Health
Care—organization & administration. 3. Models, Organizational. 4. Organizational
Innovation. 5. Stress Disorders, Post-Traumatic—therapy. WM 30.1]
LC Classifi cation not assigned
362.2068′5—dc23 2012029880
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
My heart is moved by all I cannot save:
so much has been destroyed
I have to cast my lot with those
who age aft er age, perversely,
with no extraordinary power,
reconstitute the world.
Adrienne Rich, 1977
From “Natural Resources” [1]
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Contents
List of Figures and Tables x v
Prologue x vii
1. It Starts with a Dream 1
Creating Sanctuary 3
Trauma-Organized Individuals 3
A Humbling Experience 4
Trauma Th eory 5
Attachment and the Loss of Integrated Experience 6
Neither Sick Nor Bad, But Injured 7
A Stress Continuum 9
Healing = Integration 1 0
Broad Defi nition of Safety 1 1
Grappling with Complexity and Democracy 12
Destroying Sanctuary 1 3
Living Systems 1 3
Systems Under Siege 1 4
Workplace Stress, Bad Habits, and Parallel Process 1 4
Organizational Hyperarousal 1 5
Loss of Emotional Management 1 6
Organizational Learning Disabilities and Organizational Amnesia 17
Miscommunication, Confl ict, and Organizational Alexithymia 1 7
Th e Uses and Abuses of Power 17
Punishment, Revenge, and Organizational Injustice 1 8
Unresolved Grief, Reenactment, and Decline 1 8
Trauma-Organized Systems 19
Sanctuary Trauma 2 0
Restoring Sanctuary: Focusing on Organizational Culture 22
Can Computers Be a Useful Metaphor? 2 2
Hardware, Soft ware, and Operating Systems 23
Th e Human Operating System: Healthy Attachment 2 4
Th e Bad News: Trauma Is the “Virus” Th at Disrupts Attachment 24
vii
viii Contents
Organizational Culture: Th e Organizational Operating System 25
Changing Operating Systems: Developmentally Grounded and
Trauma-Informed 26
Th e Impossibility of Engineering Human Service Delivery Change 2 6
Why Sanctuary? Why Now?: A Public Health Approach 2 7
Nobody’s Coming 2 7
Shift ing to Developmentally Grounded, Trauma-Informed Systems 2 8
Th e Good News: Most Human Dysfunction Is Preventable 2 8
Th e Sanctuary Model: A Parallel Process of Recovery 2 9
Chapter Summaries 3 1
2. Turning Imagination into Reality: A Vision of Health 33
“Healthy” and “Normal” 3 3
Th e Inevitability of Change 34
Healthy People Adapt to Changing Conditions 3 4
Healthy Organizations Have a Purpose and Can Adapt 3 5
Commitment to Growth and Change (Chapter 3) 3 6
Managing Power 36
Healthy People Value Diversity and Participation 3 6
Healthy Organizations Are Democratic 3 7
Commitment to Democracy (Chapter 4) 3 8
Envisioning Safety 3 8
Healthy People Are Safe and Secure 3 8
Healthy Organizations Are Safe 3 9
Commitment to Nonviolence (Chapter 5) 3 9
Emotional Intelligence 4 1
Healthy People Can Manage Th eir Emotions 41
Healthy Organizations Are Emotionally Well Regulated 4 1
Commitment to Emotional Intelligence (Chapter 6) 42
Learning All the Time 4 2
Healthy People Love Learning and Are Able to Adapt to
Changing Conditions 4 2
Healthy Organizations Are Real-World Classrooms 4 3
Commitment to Social Learning (Chapter 7) 4 3
Th e Constancy of Communication 4 4
Healthy Human Beings Communicate Constantly, Verbally
and Nonverbally 4 4
Healthy Organizations Encourage Conversation and Feedback 4 4
Commitment to Open Communication (Chapter 8) 4 5
Justice and the Common Good 4 5
Healthy People Are Socially Responsible and Care about
Social Justice 4 5
Healthy Organizations Encourage Individual and
Social Responsibility 4 6
Commitment to Social Responsibility (Chapter 9) 4 6
Contents ix
Th e Sanctuary Model: Transforming Vision into Reality 4 7
Trauma Th eory 4 8
Th e Sanctuary Commitments 4 8
Leadership Commitment 5 1
S.E.L.F.: A Compass for the Recovery Process 5 3
Sanctuary Education and Training 5 5
Sanctuary Implementation 5 6
Th e Sanctuary Toolkit 5 7
Sanctuary Certifi cation 5 7
Sanctuary Network 58
Results of the Sanctuary Process 5 8
3. Growth and Change: Isn’t Th is the Whole Point? 6 3
A Vision of Growth and Change 6 3
What Do We Mean by Growth and Change? 64
A Boy Named Peter 6 4
Starting with the Future 66
Hope and Saying Goodbye to the Past 6 7
It All Starts with Being a Baby: Attachment and Development 69
Before We Have Words 6 9
Habits 7 0
Change, Attachment, and Loss 7 2
Sending Out Signals 7 3
Th e Commitment to Growth and Change and Trauma-Informed
Practice 7 4
Traumatic Reenactment 74
Disrupted Attachment 7 5
Fear Conditioning 7 6
State-Dependent Learning 7 6
Th e Addictive Potential of Arousal 7 6
Loss of Language—Speechless Terror 7 7
Failed Enactment 7 7
Self-Fulfi lling Prophecies 7 8
Foreshortened Sense of Future 78
Putting It All Together in Peter’s Story 7 8
Organizational Commitment to Growth and Change 81
Recognizing Reenactment 8 3
Rescripting Reenactment 84
Implications for Growth and Change Leadership 8 6
Be the Change You Want to See 87
Leadership and the Emerging Future in Complex
Organizations 8 8
Adaptive Versus Technical Problems 89
Sanctuary Toolkit for Growth and Change 91
Th e Reenactment Triangle 9 1
Red Flag and Green Flag Reviews 9 2
