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Therapeutic Groups with Adult Trauma Survivors Anita S. Treloar, Ph.D. April 29, 2011 4/29/2011 1 Therapeutic Groups With Adult Trauma Survivors - Anita Treloar (copyright)
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Therapeutic Groups With Adult Trauma Survivors - Anita Treloar (copyright)
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Therapeutic Groups with Adult Trauma Survivors
Anita S. Treloar, Ph.D.April 29, 2011
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Therapeutic Groups With Adult Trauma Survivors - Anita Treloar (copyright)
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Presentation ObjectivesParticipants will understand the basic
theoretical basis for Seeking Safety and Acceptance and Commitment Therapy (ACT) groups for adult trauma survivors.
Participants will learn the basic structure of Seeking Safety Groups.
Participants will learn the structure and content of one example of an ACT group which can be provided for trauma survivors.
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CreditsInformation on Seeking Safety Treatment and
Acceptance and Commitment Therapy is derived from resources noted in Resource List.
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Post-traumatic Stress Disorder (PTSD)Person exposed to traumatic event that
Involved actual or threat of death or injuryInvolved experience of intense fear,
helplessness, or horrorTraumatic event is persistently reexperiencedPersistent avoidance and numbingPersistent symptoms of increased arousal
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Co-occurrence of PTSD and Substance AbuseHigh co-occurrence of PTSD and Substance
AbusePTSD can elicit substance abuse (e.g., for
coping), which can make client more vulnerable to further trauma
Recovery from substance use can trigger PTSD or memories the substance had been blunting
Therapy re. PTSD can trigger substance abuse to cope with memories
Therefore best to treat them together (e.g., Seeking Safety approach)
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Stages of Healing from PTSD and Substance Abuse*1. Safety: Goals –
Free self from substance abuseStay aliveBuild healthy relationshipsGain control over own feelingsLearn to cope with day-to-day problemsProtect self from destructive people and situationsNot hurt self or otherIncrease functioningAttain stability*From Seeking Safety p. 101, derived in part from
Herman, 1992.4/29/2011
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Stages of Healing from PTSD and Substance Abuse (continued)*2. Mourning the past: losses and pain
experienced.
3. Reconnection with the world in joyful ways: thriving, enjoying life, able to work and relate well to others.
*From Seeking Safety p. 101, derived in part from Herman, 1992.
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Theoretical Considerations: Learning CurveIndividuals learn best at moderate levels of
challenge.
Too low challenge: boredom, inattentionToo high challenge: overload, shut downModerate challenge: optimal learning
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Theoretical Considerations: Therapeutic PacingPace therapeutic challenge for clients’
moderate range.“Building emotional muscle.”Building ego strength, client’s “observing
ego.”
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Theoretical Considerations: Session Cognitive-Affective CurveGenerally: start with cognitive, move to
affective work, end with cognitive.
Don’t go deeper than the client can contain.
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Advantages of Group Treatment of Trauma SurvivorsReduces stigma and feeling of isolation; they
know they are not aloneClients can learn from each other’s
experiencesMutual support is empowering
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Challenges to Group Treatment of Trauma SurvivorsContagion of trauma stories/pain can trigger
memories or “flooding”One client’s trauma can “hijack” a group
sessionBoundary problems can create rescuer,
victim, persecutor roles, etc.
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Seeking Safety Treatment ApproachConsidered an evidence based best practiceCan be used individually or in groupsFocus on Safety Stage of HealingMourning work may take place in parallel
individual sessions.During mourning work, participants may
often need to return to safety stage.
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Seeking Safety ContentFour content areas: cognitive, behavioral,
interpersonal, and case managementStructured format of each sessionPresent- and problem-oriented to reduce
symptomsPsycho-educationalAffective components are contained in a
cognitive structure.
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Seeking Safety TopicsExamples:
SafetyPTSD: Taking Back Your PowerDetaching from Emotional Pain (Grounding)When Substances Control YouTaking Good Care of YourselfIntegrating the Split SelfRecovery ThinkingHealthy Relationships
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Seeking Safety Group DescriptionWomen’s Seeking Safety Group
First Nations Community HealthSource What is the Women’s Seeking Safety Group Approach? The Women’s Seeking Safety Group is for women who have experienced trauma and related issues such as substance abuse and
domestic violence, and are seeking a safer, healthier life. Sessions will include both information and the opportunity to share. Participants are usually also involved in individual counseling.
Is this group right for me?This group may be right for you if: You are experiencing consequences of unhealthy choices in your life. You have experienced a traumatic event or events. You have difficulty maintaining positive, safe relationships. Memories or feelings about the traumatic event make it hard to stay clean and sober, or to make healthy choices.
Focus on safetyThe #1 goal of these sessions is to help you be safe. “Safety” includes the ability to: Manage trauma symptoms (such as flashbacks, nightmares and negative feelings) Cope with life without using substances Take good care of yourself Find safe people who can be supportive of you Free yourself from domestic violence or other abusive relationships Prevent self-destructive acts (such as cutting, suicidal thoughts, unsafe sex) Find ways to feel good about yourself and enjoy life. How can I join this group? Individuals interested in joining this group may contact Anita Treloar at 262-6586 or the Behavioral Health receptionist at 262-
6520. Membership is open to clients involved in individual therapy through FNCH Behavioral Health services. Sessions will be Wednesdays from 4:00-5:30 p.m. New members may join by coming at 3:30 p.m. on their first Wednesday to meet with Anita for group orientation.
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Seeking Safety Treatment AgreementIncludes safety, honesty, confidentialityGroup treatment agreement includes
Not discussing details of trauma or substance use
Contact with members outside sessions is discouraged
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Seeking Safety Group StructureCheck-in:
How are you feeling?What good coping have you done?Any substance use or other unsafe behavior?Did you complete your commitment?Community resource update?
The quotation (with discussion)Session topic: readings and discussion related to participants’
livesCheck-out
One thing got out of today’s sessionNew commitmentWhat community resource will you call?
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Seeking Safety ApproachQuestions; Discussion
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Acceptance and Commitment Therapy (ACT)*: Core ConceptsMindfulness: being in the presentAcceptance (not the same as agreement)Commitment to valued action
*Steven Hayes; see Resource List
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Goals of ACTPsychological flexibility (see pre- post-
assessment tool)Requires facing pain that individual may have
been avoiding: this confronts the avoidance strategy of PTSD
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Clients Most Appropriate for ACT Group*Preferably clients have demonstrated ability
to keep themselves safe. Some may have completed Seeking Safety Group.
Ability and willingness to use a complex cognitive approach.
Especially helpful with clients who have felt stuck in their progress and want to move forward in their lives.
*Note: Group is developed from resources noted in Resource List
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ACT GroupAcceptance and Commitment Therapy
(ACT)Helps individuals to:
Accept Your Reactions and Be PresentChoose a Valued Direction
Take ActionThis approach is helpful for those experiencing:
Depression, anxiety, substance abuse, post-traumatic stress, chronic pain, medical issues, and stress.
New twelve week cohort for men and women will start December 3, 2010 at 2:00 p.m. at FNCH Behavioral Health Services, and will meet Fridays from 2:00-3:30. The group is open to FNCH BH clients with assigned individual therapists. Come join us!For information, contact Anita Treloar at 262-6520.
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ACT Group Topics*1. Introduction: ground rules, introduction, pre-test2. Avoidance and Control; Pain and Suffering3. Pain and Suffering (continued)4. Acceptance and Willingness5. Passengers on the Bus6. Defusion: Handling the Passengers7. Defusion (continued)8. Who Am I?9. Values #110. Values (continued)11. Committed Action12. Graduation*Developed from materials in Resource List by Anita Treloar.
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ACT Group Format: 12 week cohort modelCheck in (thoughts and feelings since last
session; application of last sessions material)InformationApplication through discussion and/or written
materialCheck out (what learned, reactions,
application to the week ahead)Mindfulness exercise (ground in present)
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ACT GroupCommentsDiscussion
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Resource ListFollette, V.M. & Pistorello, J. (2007). Finding life beyond
trauma: Using Acceptance and Commitment Therapy to heal from Post-traumatic Stress and trauma-related problems. Oakland, CA: New Harbinger.
Hayes, S.C. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press.
Hayes, S.C. (2005). Get out of your mind and into your life. Oakland, CA: New Harbinger.
Herman, J.L. (1992). Trauma and Recovery. New York: Basic Books.
Najavits, L.M. (2002). Seeking Safety: A treatment manual for PTSD and substance abuse. New York: Guilford Press.
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Resource List (continued)First Nations Community HealthSource,
Behavioral Health Services, 5608 Zuni Rd. SE, Albuquerque, NM 87108, 505-262-6520.
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