Sanctuary Model

Background

Originally developed from 1985 to 1991 in an acute care, community hospital-based, psychiatric unit for adults, from 1991 to its closure in 2001, the sanctuary was an inpatient program designed to treat the complex problems of adults who had been maltreated as children. Although many people have been associated with the creation and development of the Sanctuary Model, Sandra L. Bloom is generally recognized as the founder of the program. The first published description of the program came out in 1994, in which she quoted a colleague remarking on the now often-repeated phrase “It's not what's wrong with you, it's what happened to you.” The name itself derived from the first chapter describing the inpatient treatment of trauma survivors—a program for Vietnam veterans who were expecting a welcoming and healing environment and found instead, more trauma, which the author described as “sanctuary trauma.”

The first 10 years of development of the sanctuary were captured in the 1997 publication Creating Sanctuary: Toward the Evolution of Sane Societies, in which the notion of “hurt people, hurt people” was explored. The wider public health implications of trauma and its effects were similarly developed in Bearing Witness: Violence and Collective Responsibility. Most recently, two of the current developers of the Sanctuary Model have coauthored a volume describing the impact of organizational stress and the trauma-organized systems that result in Destroying Sanctuary: The Crisis in Human Service Delivery Systems. The next volume of the series (forthcoming, January 2013) will describe in more detail the process of implementing the Sanctuary Model in Restoring Sanctuary: A New Operating System for Organizations.

Philosophy

The Sanctuary Model has a well-developed philosophical approach that is grounded in the complex biopsychosocial and existential adaptations that individuals and groups make to cope with overwhelming and repetitive stress. As an organizational approach, the Sanctuary Model views systems as alive and therefore subject to conscious and unconscious dynamics similar to those of the individuals who work in and are served by those systems.

The Sanctuary Model is structured around a philosophy of belief and practice informed by the scientific study of attachment and child development and the impact of adversity, toxic stress, and trauma. [Page 580]Attachment between parent and child results in the human operating system, whereas toxic stress disrupts that operating system. Human beings and human organizations are living systems that adapt to changing conditions in complex ways. New mental models for how we view human problems are beginning to emerge from these scientific findings. The notion of parallel processes helps explain how trauma-organized systems develop and provides a framework for helping systems recover and, in doing so, become trauma-informed.

“Creating sanctuary” refers to the shared experience of creating and maintaining safety within any social environment. In the Sanctuary Model, the notion of safety encompasses physical, psychological, social, and moral safety. The philosophical tenets of the Sanctuary Model are embodied in the Sanctuary Commitments. The seven Sanctuary Commitments are tied directly to trauma-informed treatment goals. The process of creating sanctuary begins with getting everyone on the same page—surfacing, sharing, arguing about, and finally agreeing on the basic values, beliefs, guiding principles, and philosophical principles that are to guide decisions, decision-making processes, conflict resolution skills, and behavior.

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