old belief systems that no longer work or sustain the self, the world, and faith are put to rest, and new beliefs that are based on an integrated self are created. A working belief system is revitalized or created that allows the client to have a sustaining faith in something, whether that something be God, nature, the universe, or the power of having reclaimed themselves. New meaning is given to past events, and they are contextualized into the larger fabric of a whole life. One client spoke about her feeling that she had “reconstituted” herself, even though “it was not as simple as just adding water and stirring.” Trauma and Group Treatment Group treatment of trauma is a modality that went in and out of fashion during the twentieth century. Early work done in the arena of trauma recovery almost always included group interventions, such as rap groups for combat veterans and abuse survivors; critical incident debriefing groups for survivors of natural disasters; encounter groups of the 1970s and 1980s; and a plethora of self-help groups, many of which were modeled on the format of Alcoholics Anonymous. During the 1970s and 1980s, group treatment was ubiquitous and inclusive. Since the turn of the twenty- first century, however, many mental health professionals have backed away from providing group options for their clients, perhaps in the face of insurance restrictions or the lack of status or priority given to group treatment by agencies. Group treatment is still a highly recommended treatment modality for trauma survivors because it provides a peer group, a source of support, and an opportunity to share skills and resources. Providing good group treatment is a skill, however, in which many clinicians are not well trained. At this time, few professional graduate programs provide more than a cursory overview of group-work leadership, skills, dynamics, and development. In addition, facilitating a trauma group requires a set of skills and knowledge related to both trauma treatment and group work. Therefore, some clinicians do not feel prepared to provide trauma group services. If they do facilitate groups, they may not be doing so from a position of strength and knowledge. The lack of well-trained group leaders for trauma treatment has sometimes led to poor group facilitation, which has then resulted in clients dismissing or refusing to consider group treatment because of previous negative experiences in trauma groups. Both clients and clinicians have anecdotally reported this frustrating situation. Recent meta-analyses have shown that while group trauma treatment can be beneficial, it is less efficacious than individual trauma-focused treatment (Management for Posttraumatic Stress Disorder Work Group, 2017; Penk et al., 2019) Group treatment remains a treatment of choice for some trauma survivors and does show greater reduction of PTSD symptoms than no treatment or support groups (Penk et al., 2019). Group and community interventions can help clients regain a sense of safety and mastery. The key is to find and provide trauma group services that respect and adhere to the principles of phase-oriented trauma treatment. Too many clients have been referred to groups that were inappropriate for their stages of healing, causing them to be retraumatized by the experience and understandably reluctant to try another group format. Clients may say that they do not want to attend a group because they think that hearing other people’s stories will make them worse, not better. For this reason, it is recommended that strict group rules be put in place surrounding discussion of trauma experiences and that the type of group and stage within the healing process are well matched for clients (Penk et al., 2019). It is crucial to provide
The therapeutic relationship becomes less intense at this juncture, with little, if any, traumatic transference. There is more room for humor and less need for rigid boundary maintenance; careful and nonsexual touch, in the form of a hug or handclasp at the end of a session, may become tolerated or even anticipated. There is greater tolerance for inner conflict, and the window of affect tolerance is rarely breached. Although therapy is not completed, it can continue with the knowledge that there has been sufficient resolution so that the survivor can turn their attention from recovery to simply living life, with all of its vicissitudes. trauma group services from a phase-oriented perspective, just as it is for individual treatment. The types of groups to which clients are referred must correspond with their ability to tolerate affect and traumatic memories, both in themselves and in others, without being triggered. The following list identifies why group treatment is so useful for survivors of trauma. ● The shared historical and current experiences within a group lead to a universality of reactions and symptoms and to the potential for interpersonal learning. ● The group can become a therapeutic community. Establishing good emotional bonds is one of the key components to healing and recovery. ● A group can diffuse the transference and attenuate ego regression that can prolong or complicate individual treatment. ● Peer feedback in the group setting is often easier to assimilate than feedback from an authority figure. ● Exploration of group process and dynamics by members (in longer-term groups) allows for personal growth and insight into interpersonal dynamics in an “in-vivo” situation that is not possible in individual work. ● Groups facilitated from a mutual-aid model (Steinberg, 2013) allow group members to more easily address feelings of loneliness and isolation, shame, stigmatization, and self-blame than individual work can provide. ● Groups facilitated from the relational perspective (Schiller, 1995, 2008) are particularly attentive to countering isolation and creating meaningful and healthy connections through the highlighting of relational connections, mutuality, and an emphasis on staying empathically connected through times of conflict. ● Disturbances in self-perception and worldview can be challenged and addressed by peers who share common experiences. ● Group treatment is cost-effective from the perspective of both clients and agencies (Schiller, 2008). In groups for acute trauma survivors, members can provide a powerful short-term bond as they form a sense of community around shared experiences. Following a trauma or disaster, this commonality can reduce the stigma and shame of their reactions and provide a template for normalization and return to life. For example, many groups were offered to the community following the terrorist attacks of September 11, 2001, and members who shared certain demographics (such as children in groups that corresponded to various developmental stages) or connections to the trauma (such as firefighters or bereaved spouses) found these groups to be a vital resource in their return to functioning (Malekoff, 2007). Group treatment options should be provided for survivors of natural disasters, returning war veterans, and victims of violent crimes. As long as the premorbid functioning of the group members has been relatively stable and solid, they may be able to recover their pre-incident functioning with the support
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