Trauma-Informed Drop-In Groups: A guide to finding the path to healing and connection

Trauma – What is it?

Derived from the Greek word for ‘wound’, (psychological) trauma was not (despite the WW1 term ‘shell shock’ and the WW2 term ‘battle fatigue’) formally recognised as a disorder (PTSD) until 1980, after a decade of studies with Vietnam veterans. The definition of ‘trauma’ today has widened significantly within the therapy world and is focussed more on the personal experience, rather than the event itself. In broad, nondiagnostic terms, then, we can say that trauma is the, lasting, consequential, emotional experience of one or more distressing, safety-threatening events, resulting in an adverse effect on our daily functioning and our mental, physical, social, emotional, and/or spiritual well-being. In other words,if our experience of a safety-threatening event from our past continues to interfere with our daily life or mental well-being, then we are living with trauma.

Trauma within this definition incorporates a wide range of distressing events (e.g., warfare, sexual and physical abuse, exploitation) and has seen its most recent form in the collective experience of Covid Trauma.

The Consequences of Trauma

All humans experience in unique ways, but common emotions associated with trauma include feeling overwhelmed, powerless, betrayed, angry, shocked, confused, detached (numb), and/or guilty. Trauma survivors often feel a combination of these emotions.

Resultant behaviours include risky, reckless and destructive behaviour, as well as aggressive outbursts. Trauma survivors also often demonstrate avoidance, irritability, hypervigilance and frequently suffer with relational problems.

For adults who have survived childhood trauma the data shows the significant impact of ACE (adverse child experiences) on various maladaptive behaviours (such as substance abuse and self-harm).

Multiple or prolonged exposure to childhood trauma (Complex Trauma) can lead to dissociative behaviour in which the trauma survivor splits off parts of self as a mechanism to stay emotionally distant from the trauma and keep safe.

On a cognitive level a trauma survivor can experience negative automatic thoughts (NATS) and flashbacks which cause sufferers to relive their trauma and experience the emotional and sometimes physical distress they experienced at the time. These recurrent, unwanted and uncontrollable memories can be as terrifying as the original event itself.

With such a wide range of possible consequences it is perhaps not surprising then that the latest psychiatric diagnostic manual (DSM-5), PTSD allows for 600,000 different permutations of symptoms.

Culture Awareness and Trauma

Disadvantaged people and communities facing problems as wide as poverty, disability, stigma, religious persecution are particularly vulnerable to the stressors of trauma and consequential PTSD. This situation can be exacerbated by the fact that those very same problems can themselves hinder access to interventions. Cultural competence and collaborationare cornerstones to ensuring that the client’s experience and reactions are understood within the client’s framework, belief system and values.

Treating Trauma

An initial GP appointment is always advised, in order to consider physical factors and bio-medical options following an initial assessment, and whether a referral to a psychiatrist for a formal diagnosis is appropriate.

For the first month after a traumatic event the approach is usually ‘watchful waiting’ for people showing diagnostically ‘sub threshold symptoms’; careful monitoring of the situation will establish whether clinically important symptoms of PTSD develop after the initial one month threshold and (aside from delayed PTSD) this will distinguish between post traumatic stress (PTS) and PTSD.

At this point (for adults) a trauma focussed CBT intervention will usually be offered and this typically involves 8-12 weeks of one to one sessions by a specialist practitioner, with the aim of restructuring trauma-related meanings as well as processing trauma-related memories and emotions.

NICE (the National Institute for Health and Care Excellence) guidelines (adhered to by the NHS) do not recommend that drug treatments are offered for adults to prevent PTSD in the first instance, unless a preference for medication is expressed. For those exhibiting psychotic episodes specific medication will be considered.

EMDR (Eye Movement Desensitisation and Reprocessing) is also a recommended [1-3 months after event presenting] is widely recognised an an effective evidence-based treatment for PTSD. This intervention involves treating unprocessed traumatic memories which the brain is constantly revisiting for answers, by stimulating bilateral brain activity (most commonly using side to side eye movement), focussing the brain on the memory itself and restructuring how it is stored.

Though EMDR deals directly with the emotion and can therefore be distressing, the skilled and qualified practitioner will use a guided and structured approach to minimise any uncomfortable emotions.

Trauma-informed therapy versus trauma therapy.

Whereas the above specialist interventions seek to address trauma-related difficulties specifically, trauma-informed therapy takes a more holistic approach by considering how a wide range of of mental healthissues have experienced differently due the client’s trauma. The key here is to avoid any re-traumatising of the client and t is worth remembering the 6 key principles of trauma-informed therapy: safety, trustworthiness, choice, collaboration, empowerment and cultural consideration.

Peer Support Trauma Groups – What to Expect

Peer support trauma groups can offer a distinctly different and complementary dimension of help for trauma survivors; with an opportunity for participants to connect and share with others. Often this sharing, the awareness of similar (but different) experiences is the first point in ‘normalising’ the experience of trauma and combatting the stigma and guilt that many survivors experience every day. Peer support helps tackle the feeling of isolation reported by many, fostering understanding and belonging.

In peer support groups, clear boundaries and group ‘contracts’ are established collaboratively. Working together can foster a support network with many group participants choosing to set up their own WhatsApp groups. Peer support groups will promote active listening in a judgement-free zone, with freely available resources and referrals, as needed.

Peer support groups also offer a less structured and open-ended approach, where participants are under no pressure; they can, if they wish, simply observe, as participation is redefined to mean simply turning up for group. These factors all align with one of the key factors common to all trauma work: promoting the client’s agency and redressing the power imbalance at the heart of so much trauma.

No matter where the trauma survivor is on their unique path to healing, peer support can provide an invaluable space to be inspired and continue, or even start, the healing process.

Nic Auerbach is a Shrewsbury-based, BACP registered, integrative counsellor and psychotherapist who runs the weekly male trauma group at BCMH: Mantalk!