The Globe as Group Room: Community Outreach in the 21st Century

This article first appeared in the Summer 2009 Issue of The Group Circle

AGPA Community Outreach Task Force Co-Chair Suzanne Phillips, PsyD, ABPP, CGP, FAGPA, discusses her pioneering efforts to combine group principles and technology in response to worldwide disasters—both natural and manmade. Her virtual globetrotting to China, India, and Hong Kong inspires a vision of leadership for AGPA in the evolving fields of trauma response and community outreach.
 

SP:    Being up close and personal with traumatic events calls into question one’s beliefs about self, safety, justice, even faith. As an event, 9/11 was of catastrophic proportions in its man-made intent to harm and the sudden and violent death of so many. The traumatic impact on our collective beliefs and our cultural assumptions about national power and invincibility still reverberate. We are now intimately linked to a global community that faces war, terrorism, natural disasters, and atrocities with uncertain outcomes. We can no longer deny we all share an existential darkness and collective trauma. As mental health professionals, we are faced with the possibility of being both victims and caregivers.
 

SP:    Inherent in trauma response is the dialectic of knowing and not knowing. As caregivers, there is the urge to know all to offset the feelings of helplessness and the fear of not knowing. Our best hope is to embrace this by continuing to learn whatever we can about trauma while accepting the necessary reality of sometimes not knowing. Humility and collaboration in trauma work reduces the sense of shame for those affected and is always enriching to the caregivers.
In a recent article, Robert Stolorow, PhD, suggests one ill-advised defense is to resurrect the illusion of grandiosity and invincibility and to invest in the retaliatory destruction of the enemy. He suggests instead we seek a relational home in which our collective existential pain can be grieved, understood, and integrated. This is the essence of group’s potential, whether the group is family, school, workplace, community, place of worship, military unit, or technologically facilitated outreach forums.
 
RS:   How has your professional outlook on trauma and group work changed as a result of recent world events?
SP:    After 9/11, an urgent call from AGPA went out: “Who works with trauma and groups?” I and many other members responded. As a result, I am more aware of the power of working with group process whether it’s in or out of the group treatment room. To see reservists and guardsmen informally stand around a kitchen and talk about war injuries, to organize large group meetings in corporate setting days after 9/11, to train and support caregivers in diverse agencies and settings, to witness a group of children in the earthquake disaster zone in China using materials translated from our 9/11 work, to plan for AGPA teleconference call-ins to reduce public anxiety about a potential flu pandemic—these kinds of experiences underscore my conviction that groups serve to mitigate devastation and build resilience. People heal in community—wherever it is!
 
RS:   Technology has emerged as a key feature of today’s outreach initiatives. Can you highlight some examples?
SP:    In the aftermath of 9/11, technology enabled AGPA to run seven on-line seminars for caregivers with at times more than 2,500 participating worldwide. An Israeli psychologist responding to a psychiatrist in Ireland or a group leader in Australia was a living example of the power of technology to reach across oceans.

Today technology fosters interagency coordination of direct services, consultations, and referrals around the world. The Internet enabled us to respond to the Asian Tsunami, Hurricanes Rita and Katrina, the California fires, and various school shootings by electronically sending published materials like Group Interventions for Treatment of Psychological Trauma (Buchele & Spitz, 2004) and Public Mental Health Service Delivery Protocols (Klein & Phillips, 2008) to AGPA Affiliate Societies and key responders. Our training materials have been distributed throughout the world as far as India, China, Hong Kong, Norway, Italy, and Canada. We have also responded to requests for child trauma group supervision in China, help with injured laborers in Hong Kong, guidance for families dealing with muscular dystrophy in Shanghai, and materials for couples facing trauma in Norway. This summer, we will offer an educational trauma program in Rome on AGPA Lessons Learned After 9/11 at the International Association of Group Psychotherapy and Group Processes, especially relevant for those colleagues dealing with the recent earthquake in Italy. In the face of suffering nationally or internationally, there is tremendous support and potential when responding as a global group of caregivers.

SP:    Talk about not knowing! Buoyed by Priscilla Kauff, PhD, CGP, DFAGPA, and Cecil Rice, PhD, CGP, FAGPA, (who had been using Skype in China and Northern Ireland respectively) my colleagues Robert Klein, PhD, ABPP, CGP, DFAGPA, Jeffrey Kleinberg, PhD, CGP, FAGPA, and I entered new territory together. Having a point person in the culture one enters who speaks English is key. We were fortunate to work with a terrific Chinese psychologist named Jiang Qizhuang, who organized a training group and provided an interpreter (see letter below). In India, the key to our trauma training was our own member Siddharth Shah, MD, MPH. I have thought often about the emotional connection with our colleagues in China and India. Skype, with both auditory and visual capacity, helped foster a depth of emotional connection that was unexpected. I believe that, in some way, our willingness to reach, to connect and to share as 9/11 victims/caregivers across miles reduced the helplessness, isolation and sense of loss experienced by both victims and caregivers in the aftermath of trauma.
 

SP:    Two crucial areas were assessment and follow-up. Jiang and his colleagues made a request for a basic group training course and ongoing supervision. We learned that this desire for more leadership skills and understanding of group process and dynamics is an expectable outcome following trauma training. We are also experimenting with pre- and post-assessment in the Adaptation of the Basic Group Training to measure self-esteem and cognitive mastery. We learned that credibility in the trauma field is very much tied to assessment findings. We have already made valuable strides with the contributions of Gary Burlingame, PhD, and those who have worked on the development of the CORE-R Battery. As an organization, we need to work on integrating assessment into our interventions.
 

SP:    The challenge for leadership is a mix of persistence, flexibility, collaboration, and humility. We must keep adjusting the plan and working in concert with others. We need to accept that refusal, rejection, and resistance by those in need or those providing help is an inevitable part of trauma response. It is also important to recognize that that there are many different needs that can be met by different groups, at every point in the disaster continuum. It’s not always about rushing in at the acute stage. Often the opportunity will arise when the smoke clears and the media goes home. It is at that time that much of AGPA’s most effective outreach has taken place. Underscoring any effort is financial sustainability. Outreach is a new and different mission for AGPA. While we may feel compelled to respond, we must find funding supporters who believe in our mission and want to work with us to achieve it.
 

SP:      The AGPA Community Outreach Task Force, co-chaired by Elizabeth Hammer, MS, PhD, and myself, oversees community outreach programs to provide professional assistance to diverse group populations in the aftermath of traumatic events. These have included national and international efforts and a commitment to our military. I am continually impressed by the knowledge and depth of experience of our AGPA members. Many have been working with trauma and diverse populations for many years. Trauma work necessitates a trusted person or group in the community or culture impacted. Our Affiliate Societies and our individual members can serve a crucial role in trauma response by being uniquely positioned to respond directly or by serving as a bridge for a wider AGPA initiative. As we expand our reach, we need to expand our ways to access our membership with relevant expertise and a desire to participate.

SP:    Ultimately I would say, in the company of those who believe in each other, anything is possible! No one recovers from trauma alone, and no one can really do trauma work alone. I feel fortunate to be surrounded at AGPA by uniquely gifted people with a similar passion for healing in community. What we have learned together from those we have helped has been a tremendous leap forward in our understanding of how to be effective and we want more members to share this journey with us. In the face of global uncertainty, AGPA serves as a relational home for its members and is well situated to provide leadership and support in the evolution of community outreach in the 21st century. It is a privilege to be a part of this effort and I invite others to join us.

Letter

Dear all of my friends and teachers: 

Just as Dr. Suzanne Phillips said, we just finished the eighth training. All of us students are excited and sad for this separation and termination. Thanks, Bob, Jeff, Suzanne, Dr. Dianne Kane, Dr. Dave Hescheles, Dr. Orit Shwartz and all the colleagues and friends of AGPA.

You cannot imagine how much we appreciated all that you have done for us. We learned a lot from this training. And we are growing with this training. We learned a lot of theory and technique from this training, however, the most important things is about the attitude and belief. That we learned how to respect ourselves and clients, and we realized that we want to try their best to listen to and understand ourselves and clients. This is so wonderful change. We learned all of these not only from the course but from the activity and attitude of all the teachers. I know and can imagine how much all of the teachers have done for this training. I cannot find words to express my feeling and my appreciation.

Looking back, from the first training about “use the group to intervene,” we really realized we have done so much and have gone so further. In these three months, we have eight training sessions, two study sessions by ourselves as a whole, and some more sessions as a part, and we decided to set up a regular seminar just discussing the case and sharing the experience. I cannot promise that every one can become a good therapist, however, I do believe that AGPA plant a wonderful seed, which will bloom in future. Some of them are becoming and will become good group therapists with the help of AGPA.

Just as Jeff said, we have had a good cooperation, we will do more, and we have a wonderful future. Thanks, thank all of you very much.

China