The survivor needs to be able to take on this task for their own satisfaction, not because their healing depends on a specific result. The offender rarely responds in an ideal way, which would entail a full admission of guilt; a request for forgiveness; and an offer of restitution for the emotional, physical, and financial suffering caused by their actions. Instead, at best, the response may be a partial acknowledgment of past transgressions; typically, the denial continues unabated. The client must be prepared for the full range of possible responses and be strong in the knowledge that their own healing process is not dependent on the offender’s response. Premature confrontation can lead to disappointment or setbacks in recovery. Case Example 1 Pam disclosed during her initial interview that she had confronted her uncle a few years ago on her own. She said that although he did not deny the abuse, he did not acknowledge it either. He stated that it “ran in the family.” This new information was appalling to Pam because she had not considered whether it may have happened to anyone else or that it might be multigenerational. This new possibility “shook her world” and she then had to regain her equilibrium from her own trauma as well as from the possibility that it had happened to others in her family. Case Example 2 John spent the better part of a year in therapy discussing the details of how, when, with whom, and where he would confront his emotionally and physically abusive mother with the effects that her upbringing had on him. By the time he sat down to speak with her, he had considered a broad range of her possible responses and how he would respond to each scenario. Clients should be prepared for the reality that many times confrontation is not a one-time event. It is usually a process with multiple aspects that occurs over time. Preparations for the actual confrontation as well as the aftermath of the encounter 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
may involve several meetings. At this time in the healing process, the client may also decide to break their silence and secrecy and inform others about the abuse, including family members, friends, and lovers, or in a public forum, as has been the case in recent times with the multitude of disclosures of sexual abuse by clergy. This stage of healing involves facing and planning for the future, rather than being bound up in the past. Old trauma- based relationships must be transformed, and new ones that are not formed through the trauma lens need to be created. Herman (1997) confirms that empowerment and connection need to replace isolation and helplessness. In this stage, 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.” 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. 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 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.
Page 96
Book Code: PYFL4024
EliteLearning.com/Psychology
Powered by FlippingBook