Trauma is referred to as an experience that is disturbing and distressing and is commonly caused by the day to day life occurrences such as illness, accidents that cause physical injuries, abuse, either physical, emotional or sexual, divorce and bereavement (Shapiro, 2014). The most effective treatment for trauma is therapy interventions. Most clinicians prefer to conduct group therapy where patients meet to share their experiences and assist each other to cope with traumatic symptoms.
There are two main models for group therapy: Trauma-Focus Group Therapy (TFGT) and Present-Centered Group Therapy (PCGT). Present-Centered Group Therapy (PCGT) refers to a supportive group therapy which is problem-oriented and provides social support to group members to improve their ability to cope with trauma while Trauma-Focused Group Therapy emphasizes on cognitive behavior method, cognitive restructuring, and systematic exposure to comprehend each group members experience (Shapiro, 2014). These models are mainly based on the strength of members narratives and the ability of the group to stand together to hear the experiences of the members without judging each other. Group members are encouraged to forget their traumatic experiences and move on with their lives without dwelling on the past. This paper evaluates the role of group leaders in trauma-focus group therapy.
Group Leadership Approaches for Trauma Therapy
Ardito and Rabellino (2012) argue that in Trauma-Focus Group Therapy, the group members and the leader guide the members and provide support to enable them to forget their traumatic experiences. The group therapy is aimed at gradually reducing ones emotional reactivity to painful memories. It also improves the members ability to manage their traumatic symptoms. The third aim is to improve the members ability to handle negative emotions. Group therapy also aims to reduce the negative emotions such as guilt and fear associated with traumatic experiences. These therapy groups usually require leaders. The leader supports and guides members contributions during the therapy sessions (Ardito & Rabellino, 2012). It is the role of group leaders to facilitate discussions, maintain therapy sessions in order to enable the group to cover the scheduled materials and preventing avoidance
In TFTG, most groups usually have a co-leader. This is vital in therapy sessions as one leader works with the member representing his traumatic event while the other member monitors the one who may experience a surge in symptoms or even suffer from panic attacks. The main role of the second leader is to support the patients and accompany patients in case they leave. In resolving countertransference issues, co-leaders play a vital role. The countertransference is usually first detected by the co-leader and both leaders must work as a team to develop a clinic resolution that will be utilized in determining the treatment plan (Al Sawai, 2013). In the therapy sessions, the teamwork between the group leaders is vital as it enables peer-to-peer supervision and constructive criticism that enable the patients to receive the best treatment. Since working with traumatic patients exposes a clinician to disturbing stories that depict human aggression and suffering, a clinician may develop traumatization due to this exposure. Having a colleague in these sessions reduces the chances of developing secondary traumatization.
In group therapy sessions, especially the first sessions, a group leader is supposed to be direct and precise when talking to the patients (Magyar-Moe et al., 2013). In a trauma-focused session, the leaders need to be supportive and should assist the patients in exposure to traumatic scenes. Patients are expected to have strong emotional reactions during therapy sessions. Leaders should access the level of emotional response in every patient throughout the sessions and ensure that these members remain in the affect and does not avoid the aversive feelings. They should also be confrontational especially when their clinical analysis shows that patients are avoiding memories and other effects that may accompany trauma.
Group leaders should be able to manage extreme affect in patients. They should be able to guide the patients on how to effectively utilize good coping skills to manage traumatic symptoms. Repeated emphasis on the use of these skills will be of utmost importance to the patients as it enables them to challenge negative affect associated with trauma. Relaxation skills and deep breathing techniques can be used on patients who demonstrate high levels of distress (Ardito & Rabellino, 2012). Group members should also be encouraged by the leader to develop a coping plan to ensure that they can cope with extreme distress levels during therapy sessions.
Clinicians also need to make decisions on the patients to be included in therapy sessions by assessing whether new group members will boost or undermine the functionality of the group (Spei et al., 2014). Decisions such as gender of participants need to be made by the group leaders. However, it is important to avoid putting members of the same family in one group as family conflicts may threaten a groups harmony. The members should also agree to participate in the group and to interact with other members. The exclusion criterion is also developed by the group leader to determine individuals who cannot be admitted into the group (Shapiro, 2014). In many groups, people suffering from acute psychosis and people having suicidal tendencies are usually not permitted to participate in these therapy groups. Factors such as cultural factors and proficiency in languages to be used in therapy sessions should also be considered. The members should also be committed to attending the group sessions and commitment to perform all assignments necessary for the therapy.
According to Lothstein (2014), it is the role of the group leader to set up rules that all participants must abide by to ensure that the group remains focused. This enables easy management for difficult individuals during the group sessions. In these groups, there is a high chance of admitting difficult members. The rules should ensure that patients attend sessions when sober, guarantee attendance and show the utmost respect for other members. If members fail to abide by these rules, they should be immediately expelled from the group to avoid creating disharmony and lack of trust in the group. Group leaders should also consider premature terminations that may occur in the group (Lothstein, 2014). Significant events such as bereavement or sudden illness may happen to a group member, forcing him or her to terminate the sessions with the group. It is vital that for group leaders to review the effect of departure on the remaining members. This is important as it avoids disruptions that a departure might cause.
Legal and Ethical Issues
Informed Consent among the participants is very important. Many individuals may only participate due to pressure from families and clinicians. It is important for the group leader to explain vividly about the benefits accrued from ones participation in group therapy sessions and provide basic information about the group to the person (Spei et al., 2014). At the first session, it is important that the group leader informs the members on procedures for leaving the group. It is the responsibility of the leader to ensure that members participation in a group is voluntary and that the members are not pressured to remain in the group.
Where there is the probability of psychological abuse arising from participation in group therapy sessions, it is the mandate of the group leader to protect members against this abuse by making sure that members are not pressured to divulge confidential and personal information (Welfel, 2015). Group members should not be confronted in a threating manner (Shapiro, 2014). Confidentiality is a vital aspect in harmony of a group. Members should be taught on what entails confidentiality and the consequences of breaching it. The group members should be encouraged to maintain confidentiality and not to discuss the details of the therapy sessions with non-members.
The main role of a therapy group is to empower marginalized people in the society. It is important for the groups to provide a platform for the group members to address issues of power, oppression, and discrimination (Welfel, 2015). The group leader should ensure that the members are not discriminated based on their social status, race or sexual orientation. Equality is paramount in group therapy. This should be considered irrespective of the diversity of the cultural orientations of the members. Trauma does not choose whom to affect. Therefore, all members ought to be treated with fairness.
Group leaders play a vital role in trauma therapy sessions. The success of these sessions can be attributed to the way a group is run. The group leader supports members and facilitates discussion in the group. Managing the schedule of a group, setting up rules to be followed by the members, and admitting individuals into a therapy group are some of the roles played by the leader. To effectively run the affairs of the group most managers enlist a co-leader to assist them in assessing the participants. It is important for group leaders to avail suitable environment for therapy sessions for members from diverse backgrounds. The members have to participate voluntarily and confidentiality of the therapy sessions should be guaranteed. People experiencing trauma are very delicate and it is therefore important for leaders to ensure that these sessions are carried out with adequate emotional care.
Al-Sawai, A. (2013). Leadership of healthcare professionals: where do we stand?. Oman Medical Journal, 28(4), 285-287.
Ardito, R. & Rabellino, D. (2012). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Frontiers in Psychology, 2(4), 131-142.
Lothstein, L. (2013). Group therapy for Intimate Partner Violence (IPV). International Journal of Group Psychotherapy, 63(3), 449-452.
Magyar-Moe, J., Owens, R. & Conoley, C. (2015). Positive psychological interventions in counseling. The Counseling Psychologist, 43(4), 508-557.
Shapiro, F. (2014). The role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experience. The Permanente Journal, 24(5), 71-77.
Spei, E., Muenzenmaier, K., Conan, M. & Battaglia, J. (2014). Trauma-informed cognitive remediation group therapy. International Journal of Group Psychotherapy, 64(3), 381-389.
Welfel, E. R. (2015). Ethics in counseling & psychotherapy. Cengage Learning.
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