Some Guidelines for Using Groups in the Early Treatment of Trauma

The goals of group intervention in the early aftermath of trauma are safety, support, acceptance, connection, normalization of responses, development of coping skills, recognition of resiliency traits, and restoration of functioning. These are different from the goals of an on-going psychotherapy group. The idea in the aftermath of trauma is not to uncover or confront but to facilitate re-integration and recovery.

  • Try to restore, promote and ensure safety in the group ---this is essential for any group treating trauma. 

  • Establish initial safety by introduction of leaders, clarification of time, place and purpose of the group.

  • Go slowly; encourage members to join the group in their own ways and at their own pace; let members know they can listen and participate as they wish.

  • Remember that fears of stigma and cultural barriers may impede help-seeking and interfere with becoming a group member.

  • Utilize opportunities to normalize responses and provide information that legitimizes feelings, fears and physical symptoms in the aftermath of trauma.

  • Model support, acceptance and active, non-judgmental listening.

  • Try to remain experience-near, emotionally attuned and soothing.

  • Highlight similarities/commonalities/universalities to relieve aloneness and to pave the way for subsequent reconnecting.

  • Pay careful attention to basics---especially boundaries and boundary violations (task boundaries; time boundaries; role boundaries; confidentiality boundaries).

  • Recognize that the frame may be different in a trauma group. For example, outside social support and networking by members may be encouraged.

  • Give members the opportunity to find their voices; to share/discuss accurate information about unfolding events; share their experiences; and, in some instances to speak the unspeakable when the group is ready to hear it.

  • Remember that “emotional avoidance” may be an important and necessary defense for some in the early aftermath of trauma.

  • Contain/control the level of emotional stimulation and the anxiety level of the group; titrate stories of trauma so that group members can take in what is being said without becoming overwhelmed and re-traumatized.

  • Assess in an ongoing way and verbally check how speakers and listeners are doing with the material shared or feelings expressed.

  • Co-leadership facilitates on-going assessment and individual member support, if needed.

  • Attempt to re-establish trust; remember that this is a core issue and that members are likely to feel severely shaken, distrustful and suspicious.

  • Encourage members to help one another, especially in terms of sharing coping strategies and self-care activities.

  • Facilitate members’ use of existing family and social networks and well as fostering new networks of support.

  • Look for opportunities to identify and support resiliency traits, e.g., creativity, intelligence, spirituality, interpersonal strength, art, athletic ability, etc.

  • Avoid making interpretations; stick with conscious material; focus primarily on the current life situations, what lies ahead and the here-and-now of the group. 

  • Be alert to members who manifest persistent, intense or incapacitating symptoms of anxiety, depression, and PTSD.

  • Make provisions ahead of time for managing referrals and emergency interventions, e.g., for those in need of immediate individual assessment, medications, or hospitalization.

  • Work with a co-leader, if possible; co-leadership facilitates on-going assessment and individual member attention, if needed; it also affords support in terms of containment of traumatic material, physical and emotional fatigue, processing of countertransference issues, and reducing vicarious traumatization.

  • Establish an ongoing relationship with a supervisor/consultant.

  • If possible, participate in a support group for leaders where you can examine your own reactions.

  • Monitor your countertransference responses; be alert to signs of vicarious traumatization in yourself, especially the cumulative effects of prolonged exposure.

  • Be sure to take proper care of yourself.

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