Sometimes, Trauma…

The Case for Group Work as a Complement to Individual Therapy 

Sometimes it is “Brain/Body” not “Mind” that matters most in the therapy room.

Sometimes, being “Trauma-Informed” is to put Regulation before Relationship.

Sometimes, having the depth of one-to-one therapy combined with the somatic strength of a practical group is the most impactful and direct pathway for clients recovering from trauma.

I have been pondering what being truly “Trauma-Informed” means in the sacred space of supporting clients. Therapy for me has always been a relational space and will remain so. However, when I trained 20+ years ago, truly understanding the neuroscience of trauma and how it manifests with shame-laden, multi-faceted physicality (brain/body, not mind) was not at the forefront of teaching. I learned to be mindful of relationship and attachment always – and I am glad of it. I was not however taught to be mindful of brain and regulation. In my supervision work with both student and new therapists, I recognize there may still be a clash existing between relational therapy and trauma-informed therapy.

Starting with the clients for a moment: they themselves are often not at all informed about theories of trauma, types of therapy available to treat its symptoms, or are indeed able to hold any clear sense of what might help them to “recover”. 

Sometimes even believing in recovery for clients feels impossible. 

Clients might not perceive what has happened to them as worthy of a “Trauma” label – so they aren’t going to be the best drivers of seeking a Trauma-Informed therapy that attends to the brain/body as much as thought, feeling and attachment. 

After 15 years working as a supervisor, I worry that clients and therapists alike can miss essential pieces of information regarding regulation, the nervous system and why/how their trauma is carried in the body. 

For me, being truly trauma-informed is to be prepared to sometimes put aside a working model (transferential, person-centred, psychodynamic or other) in order to recognize back-brain aspects in the here-and-now therapy room such as Re-experiencing or Dissociation. 

In this recognition, the therapist needs the confidence to step in and get a client to regulate using the corresponding “here and now” tools of breathing, mindfulness, movement and/or tapping. At these triggered points, the safest therapeutic intervention can be to work with the somatic, rather than stay in the world of words. 

Sometimes, the therapist needs to take control, not giving the reins to the client, whose brain may be re-experiencing or “offline”.

My wise supervisor said something which struck me deeply: 

“Remembering is not Recovering” 

Clients and therapists alike get confused about this. In my own training, I remember a debate about re-experiencing as a deliberate tool for therapy. I shudder thinking about it. We can now see in an MRI scanner what happens in the brain during a flashback: either the total shut down of “flop/freeze” or someone’s “flight/fight” reaction lighting their brain up like a Christmas tree. Neither of these activations are useful for the client in trauma therapy. We all need to be in our Window of Tolerance (Dan Sigel) to process. It seems clear to me therefore that teaching a client the skills of Regulation to calm both brain and body is critical to therapeutic recovery and that this is a hands on (not hands off) process.

What might be helpful therefore to move the client forwards in a quicker and safe way? 

For ten years I ran groups for people recovering from various compulsivity and addiction, mostly linked to alcohol and drugs. Without fail, the client group held pervading underlying traumas: interpersonal disturbances and affect dysregulation that matched common CPTSD symptom clusters. 

Offering a psychoeducation groupwork alongside regular therapy worked beautifully. 

Onto this dual approach of group and one-to-one, adding body-based therapies (Massage, Reiki, Meditation/Relaxation) to the treatment pathway had a dramatic impact on people’s ability to become safe longer term. The deeper level relational aspects and history exploration were held within the therapy. Empathy, self-acceptance and compassion were modelled within the reactions of group members to each other. Understanding triggers, looking at coping strategies and learning about how to soothe the nervous system arrived best from the psychoeducation and the modelling peer to peer.

Confidence to do the Weird and the Wonderful

The conscious therapist often does wonderful and effective relational work. The “drip, splash, drip” of progress will have a profound impact over time, especially with relational trauma. But for many therapists, listening with core conditions is easier than having the confidence mid-session to ask a client: “Stand up and shake all your body like a dog who just stopped barking at the post man!” (this is how I teach Pat Ogen’s “Shake, Stretch, Rock”). Likewise, knowing when to stop a client – to put on the brakes on narrative and ask what the body feels or to enter a teaching arena confidently: these skills don’t come automatically and are often missed in initial trainings. 

With many clients therefore, I think a Trauma Group which teaches how the body holds Trauma and creates a practical map to safety is a beautiful complement to one-to-one therapy. I see the following benefits:

• Clients can be taught and practice tools for self-soothing without the need to disclose their trauma in a way that might feel unsafe or exposing.
• Experiencing commonality with other clients helps clients realise their reactions are normal responses to abnormal events.
• Witnessing what works for others can directly help mobilise and motivate even very stuck clients.
• It keeps the 50-minute therapy space clearer for working on other essential components of recovery: looking at what happened specifically to them and how the meaning-making can be changed to create a greater sense of survival and freedom.
• Because a group-work model can be unashamedly practical and educational, it can fit to offer things that otherwise may be missed when the relational aspects are the main element being offered.
• It broadens the feet, the standing ground of the therapeutic journey for the client – giving them two safe spaces, not one during each week.

In September 2023 “Sometimes, Trauma..” was created with a view to offering practical support to clients and therapists dealing with CPTSD/PTSD. As well as a range of online regulation videos and poetry, group work is now central to what I offer those who approach me for trauma-therapy. This runs perfectly as a complement to one-to-one, or as a space for clients to learn sufficient regulation to feel safer in their lives.  A recent client (who has received years of excellent individual therapy) said of group:

“Understanding why I have been this way in relation to my trauma is really helping. It is the missing piece of jigsaw puzzle I needed to find under my chair. The toolbox the Group is giving me is so great: there are quality gadgets here. I just need to learn to use them appropriately and practice them. The group is helpful next to my one-to-one therapy in this, because we can talk about the tools in a different way in our sessions. I feel so lucky to have access to both therapies” (Client J, 62)

If you would like more information about the Sometimes, Trauma Therapy Group, or want to comment on anything in this article, please feel free to contact me on hannah@sometimestrauma.com or via social media. There are also free regulation resources available on YouTube channel @sometimestrauma.