What Makes a Trauma Group Go Well? Lessons from the Field
Karen Carnabucci, LCSW, TEP

Years ago, we had certain ideas about trauma. That trauma only happened to men during wartime. That certain kinds of sexual abuse were quite rare. That trauma is only experienced by those directly involved in the traumatic event. That trauma damages people forever, and people will never recover. That trauma is only healed in one-to-one psychotherapy.

Thankfully, these old myths are slowly fading as we become informed about the true nature of trauma, how it injures our nervous systems, impacts our ability to regulate our emotions, and interferes in the quality of our relationships and the functioning of our society. We are realizing that trauma is more common than not, that somatically oriented therapies are superior to talk therapy alone, and that groups can play a huge role in healing and growth.

Even so, young psychotherapists often feel rattled about working in trauma groups. “If I’m struggling with one person with trauma,” one professional asked, “how can I effectively work with a whole group of people with trauma?”

Here are my suggestions.

Get training that focuses specifically on the nature of trauma and how it impacts people and people in relationships. This kind of learning is now popularly called trauma-informed training and begins by focusing on the six principles of care. These principles include creating physical and emotional safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment and choice and cultural, historical, and gender awareness.

Groups are about relationships, so your skills in facilitating a group will be important. This recommendation is not only for psychotherapy groups that address trauma but also for other kinds of groups where trauma is often a strong component, such as addiction treatment groups and eating disorder groups. There are also trauma-related groups that are not “official” psychotherapy but are designed as therapeutically oriented, such as support groups, yoga groups, book discussion groups, art-making groups and the like.

Many people speak of the form-warm-storm cycle of groups, but I have found it most helpful to understand that groups need carefully considered warmups to allow people to connect authentically and learn how to trust each other. Survivors of trauma have been wounded in relationships and are best healed in relationships, with each group member ideally becoming a healing agent for each other. The warmup, action and sharing process of the Hollander Curve of psychodrama, the action method co-developed by Jacob L. Moreno and Zerka Moreno, offers a helpful structure for both new and seasoned group leaders.

Your main task is to create a space of safety for the people in your group which is the primary and essential healing — that group members get the opportunity to experience safety, to be seen and understood. Remember that safety IS the treatment. Safety is built by having clear group guidelines – not too many but enough – and by slow pacing that recognizes that traumatized people benefit from having time to recalibrate their nervous systems.

Do not occupy yourself with the bells and the whistles of high drama, like you might have seen in the movies. Although big floods of tears certainly may show up, the healing comes through your ability to be emotionally and energetically present as a group leader with individuals and with the group energy. Keep facilitating with safe activities that little by little allow people to connect, find commonalities and offer support to each other.

The more you learn, the less you do. Be careful about overpreparing for your group and filling the time during the group with a zillion activities, lectures, work sheets, homework and more. Instead, focus on the key element of the theme of the group for the hour or two that you have together and stay aware that the group’s needs may take a detour from what you have planned. If that happens, let your spontaneity and creativity adjust your plan.

Resist your urge to heal the group members yesterday – which is typically parallel to the group members’ spoken or unspoken urgency as well – and gently acknowledge and steer them from their own rush to heal yesterday. Urgency, in fact, is a trauma response.

Encourage self-care and model self-care. This kind of modeling not only informs your group about the importance of self-care but also supports you in holding space for the pain that your group brings to the group. Do all that you can do to stay grounded and resourced for yourself so that you can stay present. The activities of psychologist Peter Levine’s Somatic Experiencing provide excellent resources that are simple to practice yet hugely grounding, and you will benefit by having your own communities to refresh, rest and learn.

Karen Carnabucci, LCSW, TEP, is  the founder and director of the Lancaster School of Psychodrama and Experiential Psychotherapies in Lancaster, Pa., and is the author of “Show and Tell Psychodrama”, “Healing Eating Disorders with Psychodrama” and more.

Original artwork by Susan Aaron.