The Functions of Safety in Psychotherapy: An Integrative Theoretical Perspective across Therapeutic Schools

The paper addresses the question of how safety functions in psychotherapy and human development across major therapeutic schools. Although safety is widely regarded as central to mental health and therapeutic effectiveness, conceptual fragmentation has obscured its meaning, mechanisms, and clinical implications. The authors aim to provide an integrative theoretical perspective on safety, clarifying what is meant by safety, why it matters for psychotherapy, how it functions, and through which mechanisms it affects clinical processes. Focusing on psychodynamic, cognitive-behavioral, and humanistic approaches, the paper situates safety as a foundational construct in both ontogenesis and psychotherapy and argues that development and change depend on experiencing enough, well-timed safety rather than maximal, continuous safety.

Psychodynamic approaches emphasize safety’s developmental and relational underpinnings, drawing on attachment theory (Ainsworth, Bowlby) and constructs such as holding, containment, secure base, and mentalization. Adequate early safety undergirds survival, trust, affect regulation, exploration, and the integration of self (e.g., mirroring, mentalization, mindsight), while therapy requires a safe, boundaried alliance that is safe but not too safe, balancing affect tolerance and optimal arousal (window of tolerance) to promote change. Cognitive-behavioral approaches conceptualize safety within evolutionary and neurobiological frameworks (e.g., polyvagal theory), differentiating danger versus safety signals, safety behaviors versus safeness behaviors, and employing psychoeducation, structured techniques (e.g., exposure), mindfulness, and security priming to cultivate inner safety, co-/self-regulation, exploration, and flexible coping. They warn against overreliance on safety signals/behaviors that maintain anxiety. Humanistic approaches frame safety as a core human need (Maslow) and ontological security (Giddens, Erikson, Laing), developed in relationships characterized by presence, unconditional acceptance, empathy, congruence, and invitational stance. Safety enables disclosure, exploration, creativity, self-actualization, and integration, and therapy strives for a dialectic of support (safety) and challenge (danger), akin to safe emergency or safe uncertainty. Across schools, safety is presented as necessary for survival/defense, restoration, exploration, risk-taking, and integration, with misdosage or misconstruction limiting growth and adaptation.

The authors conducted a panoramic, integrative theoretical overview rather than a comprehensive systematic review. They selected three major, paradigmatically distinct psychotherapeutic approaches (psychodynamic, cognitive-behavioral, humanistic) and surveyed key authors and constructs within each approach that address safety in development and clinical practice. Through comparative analysis and synthesis, they identified cross-school, school-independent functions of safety. The scope was intentionally limited to these approaches to ground an initial integrative account; no primary empirical data collection was performed. The work draws on the first author’s doctoral dissertation; funding and competing interests were reported as none.

- Safety is foundational across psychodynamic, cognitive-behavioral, and humanistic therapies for both ontogenesis and psychotherapy. - Five cross-school functions of safety were identified: (1) Securing survival and defense (e.g., attachment, boundaries, containment; reduction of defensive hyper-/hypoarousal), (2) Facilitating restoration (soothing, co-regulation, healing after distress), (3) Promoting exploration and play (secure base enabling curiosity and learning), (4) Sustaining risk-taking and coping with danger (dialectic balance of safety and challenge supporting resilience and affect tolerance), and (5) Enabling balance and integration (self-cohesion via mirroring, mentalization, mindsight, dreaming, narrative). - Safety operates dialectically with danger; effective development and therapy require enough, well-timed, and well-dosed safety rather than maximal or continuous safety. Excess, lack, mistiming, or misconstruction/misuse of safety (e.g., overprotection, overindulgence, neglect, exploitation, misattunement) can maintain pathology and hinder attachment, identity, autonomy, and regulation. - Clinical implications include creating a safe haven and secure base via therapeutic boundaries, empathy, attunement, mentalization, and presence; then progressively inviting exploration and tolerable risk within the window of affect tolerance. - Preliminary empirical support cited: early session safety predicts subsequent improvement with alliance mediating; client and therapist security relate to stronger alliance, rupture repair, in-session exploration and disclosure, and better outcomes; overreliance on safety behaviors maintains anxiety; security priming enhances calm and integration. No specific quantitative effect sizes are reported in the text excerpts provided.

The integrative synthesis addresses the research gap by articulating a cross-theoretical account of safety’s mechanisms and functions in psychotherapy, aligning developmental and clinical processes. Safety is posited as a sine qua non for effective therapy, not as an endpoint but as a platform enabling restoration, exploration, risk-taking, and integrative change. The dialectical interplay—safe but not too safe—reconciles differing emphases across schools: psychodynamic focus on attachment/mentalization, CBT focus on signals/behaviors and neurobiological regulation, and humanistic focus on presence and unconditional acceptance. Clinically, therapists should establish a safe haven and secure base (boundaries, confidentiality, empathic attunement, trust), modulate arousal within the window of tolerance, reduce defensive safety behaviors, and leverage security to foster exploration, tolerable frustration, and corrective emotional experiences. Misapplication of safety (overprotection, idealization, avoidance) risks stasis; calibrated, context-sensitive safety facilitates resilience, self-efficacy, and integration. This framework reframes common versus specific factors, suggesting many common factors instantiate the basic functions of safety while schools operationalize them differently.

Safety is central to both healthy development and effective psychotherapy. The paper proposes five school-independent functions—securing survival, facilitating restoration, promoting exploration, sustaining risk-taking, and enabling integration—and emphasizes that humans thrive with enough, well-timed, well-dosed safety rather than maximal safety. Integrating psychodynamic, CBT, and humanistic perspectives, the authors offer a common framework to guide clinical practice and theory. Future research should: (1) examine additional therapeutic approaches to test coherence with the proposed functions; (2) link safety functions to interpersonal neurobiology and affective neuroscience; (3) operationalize and measure safety with self-report and observational tools; (4) conduct process and process–outcome studies on safety dynamics (alliance, mentalization, interpersonal cycles, interventions) and their predictive value; and (5) test moderators (orientation, setting, diagnosis, attachment style) to refine tailoring and efficacy.

- Scope limited to three major therapeutic schools; other orientations were not reviewed. - The review is panoramic and integrative rather than comprehensive or systematic; potential selection bias and incomplete coverage may limit generalizability. - The account is primarily theoretical; limited direct empirical quantification is provided. - Publication provides preliminary, non-experimental support; causal inferences about safety functions in outcomes require dedicated empirical testing. - Variability in definitions and measures of “safety” across schools complicates standardization and comparison.