● 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). Groups may display different styles of group development. Prior to the 1990s, the prevailing model for the stages of group development was one that evolved along the lines of conflict first, followed by consolidation toward greater intimacy. In the field of psychology, Tuckman and Jensen’s (1977) classic model of group development followed the lines of “forming, storming, norming, conforming, and adjourning.” In the field of social work, a similar progression was articulated by Garland, Jones, and Kolodny (1973) as “pre-affiliation, power and control, intimacy, differentiation, and termination.” Both models contend that the natural tendency of groups is to move from the initial engagement phase into a period of conflict that must be resolved prior to moving into intimacy and settling down to do the work of the group. The problem with this format for trauma treatment groups is twofold. For one thing, not all groups develop in this style; furthermore, exploring conflict between group members immediately after the inception of the group is strongly contraindicated. Such a dynamic would violate the need for safety and connection as the initial phase of trauma work. The Relational Model The relational model of group development is different from traditional models. This model is founded on attention to the prerequisite of safety and connection preceding conflict, an idea that was developed by Schiller (1995, 2007, 2008). Originally basing his model on the self-in-relation theory employed in individual work (Jordan, 1991; Miller, 1976), Schiller adapted the stage theory of group development to be more appropriate for use with members of vulnerable populations, members dealing with oppression, and trauma survivors. This model of group development calls attention to the role of the facilitator in shaping group norms of stages of development rather than passively observing them. Additionally, the model holds the first and last stages constant (preaffiliation and Models of Group Development Traditional Models termination), while proposing three middle stages known as (a) establishing a relational base, (b) mutuality and interpersonal empathy, and (c) challenge and change. In short, the centrality of connection, so vital for survivors of trauma, is maintained first through connections and commonalities (establishing a Phase-Oriented Healing in Groups For a more chronic population, group formats correspond with the three phases of healing: Safety, remembrance and mourning, and reconnection (Courtois & Ford, 2012). The two early group types are homogeneous, providing treatment to members who have shared similar trauma histories. Early group treatment in the safety phase of the work must be psychoeducational in nature
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 of others who have also been through similar events. For chronically traumatized clients, groups offer an opportunity to re-experience safety and trust. Groups provide a safe place where clients can share their secrets in confidence and have a community of people, rather than just the clinician, to bear witness. relational base); then through acknowledgment of differences (mutuality and interpersonal empathy); and finally through observing or engaging in conflict with others, with facilitators, or within oneself (challenge and change; Schiller, 2008). Taking a relationally based approach also allows for differences in treatment course rather than expecting that all group members will follow a similar path to healing (Chouliara et al., 2020). Facilitators of trauma groups may find this model useful, as it mirrors the stage-oriented healing approach that is recommended for survivors of trauma. The experience of shame often accompanies a posttraumatic response. This sense of shame or survivor guilt can often serve to silence clients as they struggle with feelings of unworthiness and powerlessness. A group can often make a difference and create a shift from a sense of isolation and the feeling that “I’m the only one this ever happened to” or “It’s all my fault” to “I’m so relieved to know that others share my experiences and that my reactions are normal” and “By hearing others’ stories and knowing that they were not to blame, I can begin to see that I was not to blame, either.” What shifts acute or temporary negative self-assessments to chronicity and an overarching worldview is often the lack of a support system, a community, or even a single other person who will validate and share the experiences. It is not within the role of even the most supportive clinician in individual treatment to share specific details of their own trauma history; however, peer members of a group can do this. The support by peers can include sharing experiences, reframing or re-assessing culpability, and having the option of between-sessions contacts for self-regulation and touching base with a peer rather than a professional. A group can also provide support for shared grieving. Most religious and cultural traditions have a public time of connecting to mourn losses (e.g., a Catholic wake, sitting shiva in the Jewish tradition, the array of variations on funeral observances, commemorative walls or plaques that are visited in public arenas). A group can provide a forum for support of grief work that is not acknowledged or shared by others in clients’ lives, while becoming a surrogate community in which members grieve their losses related to the trauma and move through the stages of grief together. and very structured, and it must focus on self-care and learning the skill sets of self-soothing, grounding, and containment. DBT skills groups (Linehan, 2020) and STAIR (Cloitre et al., 2010) are structured approaches that have been shown to be effective in developing such skills prior to more specific trauma-focused treatment.
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