Story telling of traumatic memories has no place in groups for survivors who are in early recovery and is the error that frequently contributes to retraumatization or a refusal by clients to attend group treatment in the future. Storytelling is, however, appropriate for and indeed a central component of second-stage groups (Mendelsohn et al., 2011). The notion that “knowledge and structure bind anxiety” should be considered in planning a treatment group for clients who are in early recovery. A group for clients in early recovery should be time-limited in nature, ideally no more than approximately 10 to 12 sessions, and should be based on some type of curriculum-style format that leaves room for practicing the skill sets that are taught, but not for in-depth discussions of traumatic material. The mutual- aid bond comes from the knowledge of others having had similar experiences and being able to share containment and recovery strategies to help the members return to a secure level of functioning (Steinberg, 2013). Second-stage groups are the type of groups that are most often referred to as trauma groups. These groups are also homogeneous, generally time-limited, and quite structured; however, this structure may include time for members to share the details of their traumatic experiences with a goal of mutual aid, empathic connections, and resource sharing as part of the narrative component. From a mutual-aid perspective, the energies of the members are brought together to support each other and the group members feel the bond of being “in the same boat” as a part of their healing process (Yalom & Leszcz, 2005). The structure of many groups is based on Herman and Schatzow’s (1987) classic model for rape trauma survivors (Schiller & Zimmer, 2005). These structured and phase-oriented groups are appropriate for clients who have achieved some degree of stability, who are not currently at risk for self-harm or in danger of being harmed by others, and who are able to tolerate both speaking about and listening to others’ experiences. Members of these groups are able to experience the powerful interpersonal learning that comes from being part of a shared experience. These groups are structured to progress in a phase-oriented process over the life span of the group itself and are well-suited for second-stage survivors. The early group sessions begin with attention to safety issues and then move on to identify personal and collective goals for each member. The middle phase of the group is made up of the narratives of each member and includes time for processing and feedback. The final stage (which corresponds with the reconnection phase) will often pick up on the themes that have emerged in the Conclusion Phase-oriented healing from trauma is the recommended standard for trauma treatment. Each individual session should follow this formulation, as should the treatment over time. Following a traumatic event, acute trauma can often be well addressed by short-term homogeneous support groups. Herman’s (1992) classic stages of healing are a useful prototype and outline to follow for survivors of chronic trauma. The stages are (a) establishing safety (from others and from self), (b) remembrance and mourning (of traumatic memories and losses), and (c) reconnection (with self, others, intimacy, and a
group and help members to incorporate the growth they have achieved in the group setting into their daily lives. These groups are usually time-limited in nature, ranging from 12 to 20 weeks in duration. Not all trauma groups necessarily include the sharing of trauma narratives. For example, Cognitive Processing Therapy (CPT; Resick et al., 2017) can be completed in a group format without the necessary completion of a trauma account or sharing one’s trauma account with the group. The final type of group corresponds with the third stage of healing. At this point, survivor clients may not need a group that focuses exclusively on issues of recovery from trauma. At this time of reconnecting with self, outside life, and the world at large, a general psychotherapy group that focuses on relationships, consolidation of life themes and goals, and moving ahead in life may be appropriate. These groups may be open- ended in nature, long- or short-term, and are generally much less structured, as members have now generated enough internal structure and ego strength to be able to tolerate a more flexible and open-ended format. These groups may still focus on issues of trauma and occasional “blips” of new traumatic material that can arrive at any stage of recovery; however, the main focus is on broader challenges in relationships, new discoveries of self and self-capacities, and longer-term goals. In addition, this may be a time and place for consolidating or renewing spiritual life approaches, meaning-making, and turning the traumatic events and the hard work of recovery from trauma into strengths and growth and insight, creating a place from which to help or support others (Yalom & Leszcz, 2005). Finding commonality with other people at this stage of healing means recognizing the Buddhist principle that everyone is born with “ten thousand drops of joy and ten thousand drops of sorrow” in their lives and that all people are part of a shared humanity that contains the full emotional range. The secret to being able to contain all the drops is in the size of the container—a person’s capacity to hold the vicissitudes of life without losing functioning or being distracted by defensive responses, and having the space to access the joy in life as easily as the sorrow. The Buddhist story goes on with the following exercise: If you place a spoonful of salt in a glass of water and drink it, what is the taste you will find? (Answer: salty) If, however, you take the same spoonful of salt and place it in a freshwater lake and taste it, what is the taste you will now find? (Answer: clear and fresh) belief system). Both individual and group treatment approaches are recommended as part of a comprehensive treatment plan. Trauma-specific groups should be available to meet the needs of clients in all three stages of the healing process, and great care should be taken to ensure that the group referral matches the client’s stage of healing to avoid the risk of retraumatization. It is recommended that clinicians receive specialized training to familiarize themselves with individual and group trauma treatments.
INTEGRATIVE AND HOLISTIC TREATMENT APPROACHES: AN IN-DEPTH LOOK AT THE HEALING PROCESS
This chapter examines the need for an integrative and holistic approach to the treatment of trauma survivors. When individuals experience traumatic events or a series of traumatic events in their lives, they are affected at all levels of being—at the conscious level, at the unconscious level, at the body level, and at the soul level (van der Kolk, 2014). The experience is internalized as the sensations accompanying the traumatic event are felt: The trembling ground during an earthquake, the searing heat in a fire, the smell of alcohol on someone’s breath during an assault, the sound of footsteps in the hall, or the taste of
bile from an irritated stomach. The traumatic events are seen, heard, felt, smelled, tasted, and experienced at multiple levels of knowing and being that do not have easy labels but that can be held in the category of an energetic or whole-body sensing. Traumatic events and their aftermath are held and contained in the mind, heart, body, and spirit of the survivor. Treatment approaches that do not address the totality of a person’s being in response to the trauma fall short of being truly complete. It is not unusual for a client to re-engage in treatment after several courses of therapy by other clinicians.
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