I am here today on behalf of the American Group Psychotherapy Association ( AGPA) to address the needs of veterans and their families. In the aftermath of 9/11, AGPA responded to the needs of a traumatized population with an extensive number of group programs including those for bereaved spouses, families, traumatized children, adolescents, schools, communities, survivors, service delivery workers and uniformed service personnel. Groups and trainings were conducted in-person, online and via the telephone.  In all, AGPA conducted over 600 groups in group programs providing services to over 5,000 people and trained over 1,500 clinicians in group interventions. What I propose is that many of these programs have particular relevance to the needs of veterans, their families and those who work with them. As will be discussed, group intervention has been shown to be therapeutically effective, cost-effective and most importantly attends to the restoration of trust and connection needed in the recovery from trauma ( Burlingame, Fuhriman,& Mosier (2003).

I. Rationale for Collaboration of the American Group Psychotherapy Association with The Veterans Administration In Meeting Mental Health Needs

With more than 3,000 soldiers killed and more than 25,000 wounded in Iraq and Afghanistan, the mental health needs of those who have served are considerable (Hoge, Castro, Messer, McGurk, Cotting, & Koffman,2004; Hoge, Auchterlonie, & Milliken, 2006). The numbers of servicemen and women who will eventually seek help for posttraumatic stress disorder and mental health symptoms, will far outstrip the Department of Veterans Affairs’ professional resources  and scope of services. The American Group Psychotherapy Association (AGPA) is particularly suited to support the DVA’s efforts in terms of expertise with trauma, group expertise and 9/11 lessons learned as reflected in programs described and formally published in Group Interventions for Treatment of Psychological Trauma ( Buchele & Spitz, 2004) and Public Mental Health Service Delivery Protocols: Group Interventions For Disaster Preparedness And Response ( Klein & Phillips,2008).Drawing upon such experience AGPA, a national organization for over 60 years with over 3,000 professional members, can serve as a resource for consultation, training and/or direct service to address the mental heath needs of veterans, their families and the clinicians and DVA personnel who work with them.

Rationale for the Use of Groups with Veterans

The relevance of a group based military initiative that could incorporate various theoretical models, time phases, sub-groups, and readjustment issues and needs can be supported from many perspectives.  Historically, each major military conflict has spurred the development and utilization of group methods to meet the sudden and greatly increased demand for psychiatric services coupled with the limited availability of qualified clinicians. The vast numbers of military casualties suffering from what were previously labeled "wartime neuroses" or "battle fatigue" syndromes were treated in groups following World War II, both in the US and in Britain. The "Northfield Experiment" (Northfield Hospital) in England involved the application of group methods in a hospital setting. These efforts in turn spurred the development of "therapeutic communities" in the US for providing treatment. Small groups were used for group therapy and large groups were used to create a therapeutic milieu and to examine the role and value of capitalizing on and using group dynamics in the treatment process.

With the Viet Nam conflict, we saw the development of "rap groups.”  The use of a variety of groups for dealing with trauma began to grow.  More recently, group therapy has been labeled the treatment of choice for combat trauma since World War II: “The favored use of group as a modality is not a matter of economy, but of effectiveness  ( Kingsley, 2007,p.65).”

Theoretically, several reasons underscore the effectiveness of groups in treating combat disorders. To begin with, traumatic events isolate and disconnect.  They assault a sense of self, safety and the systems of attachment and meaning to others. Herman (1997) notes that “ Traumatized people feel utterly abandoned, utterly alone, cast out of the human and divine systems of care and protection that sustain life” (Herman,1997, p.52).  Central to the recovery of any trauma victim, and particularly to the returning veteran, is the need to recover a sense of trust and connection with self and others. Adding to this, groups for the military can utilize the “band of brothers” mentality that is central to the cohesion and resilience of military personnel.  Underlying all group interventions is the development of trust and the communalization of trauma within a cohesive group.  Based upon his extensive work with Viet Nam vets, Jonathan Shay (2002) underscores the importance of group work as a necessary component to all treatment. According to Shay, people recover in community and although a vet may need individual treatment, group is seen as a crucial step in the “reconnection” needed for recovery. A group offers substantive validation from an audience that knows and can bear witness – an audience that can help with the destruction of social trust that often prevails when someone has survived the chaos of war.

Economically and expeditiously, groups can successfully address the needs of many simultaneously. Group modalities have been effectively used with veterans to address specific symptoms as well as the needs of specific sub-groups within the military populations. PTSD, anger management, stress management, combat nightmares, etc. have all been successfully treated using groups (Bolton, Lambert, Wolf, Raja, Varra and Fisher, 2004; Chemtob, Novaco, Hamada & Gross, 1997; Allen & Bloom, 1994; Brockway, 2005).  In addition, group interventions have been used effectively with sub-groups of African American vets with PTSD and veterans suffering from war and childhood trauma (Goodman & Weiss, 1998; Jones, Brazel Peskind Morelli & Raskind, 2000). Underscoring the viability of group intervention post –deployment, Makler, Sigal, Gelkopf, and Horeb (1990) reported in their work with Israeli soldiers that group therapy was particularly valuable in dealing with the rage, guilt, shame, dehumanization, abandonment and betrayal attendant to combat PTSD. Foy, Glynn, Schnurr, Jankowski, Wattenberg, Weiss, Marmar & Gusman ( 2004), who reviewed group treatments with a variety of trauma populations (sexual assault victims, male combat veterans, multiple trauma survivors, etc.) with multiple symptom clusters found positive outcomes in 13 out of 14 published studies.

This body of evidence has led many healthcare providers and professional organizations to endorse the value of group interventions for the treatment of PTSD, including the International Society for Traumatic Stress Studies (ISTSS) (Foa, Keane, & Friedman, 2004).  Similarly, the Iraq War Clinician Guide recommends group models as one of the viable interventions for addressing PTSD, grief and bereavement, anger management, and substance abuse, etc. (Schnurr & Cozza , 2004).

Given the number of military personnel and their families seeking health care, and the shortage and overload on military personnel (American Psychological Association Presidential Task Force on Military Deployment Services for Youth, Families and Service Members, 2007), the use of evidence-based group models addresses the economics of mental health response and the importance of early and timely intervention. This modality allows for the provision of care for a large number of individuals while decreasing the demands on clinicians’ time. The opportunity to reach and respond to more servicemen and women and their families in a timely way with group models that facilitate screening for higher levels of care, normalization of symptoms, transition and family re-adjustment as well as treatment for grief, depression, PTSD or delayed PTSD is likely to reduce the severity and overall duration of suffering for those returning from war.

Operation Enduring Freedom and Operation Iraqi Freedom have seen the deployment of more women into active service with combat exposure than any prior war. The unique needs of this group may be well served by a modality that offers a venue for dealing with issues of isolation, distrust, and sexual trauma as well as for affirming resilience and supporting transition to civilian life. Also at risk are reservists and guardsmen who, unlike career military, do not have the military infrastructure to support post-deployment and home-coming issues. Months or even years after a war or mission, PTSD symptoms may present or be masked as anger, isolation, family problems, or substance abuse (Kates, 2001; Meyers, 2003; Schnurr & Cozza, 2004; Shay, 2002).  While Readiness Programs have worked to serve these families, the delay in combat PTSD underscores the value of different types of group programs to address personal, marriage and workplace post-deployment needs.

One of the most compelling rationales for using group modalities in meeting the mental health needs of military is that group experience by normalization and communization of traumatic symptoms reduces the barriers to care. Even as symptoms appear, barriers persist to seeking help in the military. Stigma, fear of being judged, the view of the self as helpless and weak, and the risk to military careers, make attending to emotional needs difficult, if not impossible (Hoge, et al., 2004). The group modality capitalizes on reinstating the integrity of the “band of brothers.”  Servicemen and women are not alone in their reactions or their grief. Whereas there is a natural trauma bonding that occurs even for civilians who have shared a life- threatening event, this is even more pronounced with uniformed service personnel who expect to rely on each other as they face dangerous situations.

Overall, group interventions have the potential to provide a structure, reduce shame and helplessness, foster symptom management, validate traumatic experience, permit ventilation and grief,  rebuild safety and trust, decrease isolation, render meaning and support the reconnection to self, family, belief systems and society.

Rationale for Use of Programs for Marriages and Families of Veterans

The collateral damage from war is too often the destruction of the marriages and families of veterans- 38% of the marriages of Vietnam veterans dissolved within 6 months of their return from Southeast Asia.  We are already aware of the difficult homecomings of our veterans from OIF and OEF. Homecoming is a complicated process. It is difficult to reverse battlemind mentality. The hypervigilance, mission focus, non-negotiation, targeted aggression, necessary numbing and use of a weapon necessary for survival in war does not translate into mutuality and intimacy in marriages. Similarly the split off grief for loss of buddies or shame and self-blame for being injured translates into anxiety, depression and PTSD.  Veterans serve bravely and then bring the war home in the physical wounds and posttraumatic symptoms they bear. Over 29,000 of our veterans have been wounded and 25% of those seen at the DVA have mental health diagnoses.  Their marriages and families are both at great risk and are the greatest resources they have – Research tells us that the lack of social support and subsequent life events are variables that put veterans at great risk for PTSD.  Conversely, the strength of close social ties like marriages and families are the most potent antidotes to the despair and isolation of Combat stress.

II. Programs And Expertise Of  The American Group Psychotherapy Association With Established Effectiveness And Suitability To The Needs Of Veterans, Families And Staff Servicing Them.

The American Group Psychotherapy Association has expertise in group based mental health responses.  AGPA provides evidence-based and supported interventions within pre-existing systems in order to deliver services efficiently, effectively and insure that the effort can be sustained into the future.  We strive to build expertise and strengthen infrastructure simultaneous with direct service delivery.

The Association also uses a “train the trainers” format whereby national experts teach others to carry out the work.  There are over 30 local and regional affiliates of AGPA positioned to work in their communities with assistance from a national network of experts.  We have been delivering these programs nationally and internationally in response to a variety of traumatic events including the events of 9/11, hurricanes and tsunami, and school violence.  Training and service programs have been delivered in-person, online and via the telephone.  An overview of our programs and the populations serviced follows; these can be tailored to the specific needs of each community, including military personnel and their families.

For Service Providers/Caregivers:  Helpers have an enormous need for consultation and support in the face of the demands of trauma work.  Military and veteran administration settings are frequently understaffed with large client populations.  The following are program elements that can be stand-alone or integrated based upon need.

• Didactic and experiential group intervention training in working with trauma, bereavement, the medically ill and more:  basic group dynamics, the elements of responses to trauma, whether for chronic issues or responding to catastrophic events, as well as in-depth training in evidence-based group programs. 

• Support groups and consultation for mental health professionals and clergy:  a key element is the provision of a forum in which to process their experiences and connect with colleagues.
• Groups for other personnel providing trauma-related services (management, administrators, etc.):  a more psycho-educational orientation for non-clinicians to support the cooperative goals of a setting requiring multiple areas to cooperate for overall patient care.
• Educational programs focusing on self-care:  Provides clinicians, clergy and other helpers with self-care tools to assist them in their work going forward, increasing their resiliency.

For Active Duty Members and their Families:  The following programs have been developed specifically for this community, and can be modified even further to attend to the differences between service branches which are specialized populations with unique cultures and needs for themselves and for their families. 

• On-site support services at service headquarters: provides an opportunity to receive care and support in a familiar and easily accessed setting, such as the military base, VA hospital or local agency.
• "Family Days" for armed service workers and their spouses and children:  A program model successfully initiated with the Fire Department of New York Counseling Services Unit (FDNY-CSU), which provides support and connections for families of those in the service and for families of deceased service personnel.
• Couples programs to provide relationship support:  The Couple Connection Program was initiated in partnership with The FDNY-CSU; this program is designed to provide support and increase familial resiliency by strengthening relationships. Couple Connection Program for Retirees addresses marriage and family issues in the aftermath of forced retirement due to injury.
• Telephone and online consultation with experts in working with trauma in groups:  For those situations and locales when an in-person visit is not practical or timely (such as for homebound veterans or those in remote locations).  An ongoing group with one’s peers can be an important support providing ongoing connections with peers and an experienced clinician.

For Children and Adolescents:  Children and adolescents are best helped with programs designed to recognize their differing needs according to their age and developmental stage, which can be impacted by the chronic stressors of having a parent(s) on active duty and/or the loss of a parent.

• School-based groups for affected children (with possible co-leadership with school staff):  Provides direct services to children and is designed to aid the healing and increase the resiliency of children using the school system (a familiar, naturally occurring setting with minimal disruption and stigmatization).
• School-based training and support for teachers and guidance counselors:  Providing adult caretakers with the tools to provide the services insures continuation of the program and increases the community’s resiliency.
• Groups for affected families (including parents):  An intervention model that provides the family structure with support and a forum in which to develop coping skills, augment personal resiliency and strengthen supportive resources.  This program works in cooperation with military institutions, faith based service groups, public service agencies and schools in order to utilize existing and familiar community structures. The Going On After Loss ( GOALS) program is an example of this and has potential to be adapted as Going On After War.
• Consultation and educational programs for caregivers (parents, teachers, daycare/after-school workers and others):  Another avenue of providing adult caretakers with skills and tools to attend to the needs of children.

Program Format Options:

• Single Session Public Education Groups - This often involves a speaker offering information about a selected topic (e.g. trauma and its impact, the effects of trauma on children and adolescents, etc.) followed by small group discussion; this format is highly effective in coping with the stigma attached to mental health issues as it normalizes responses and feelings.
• Time-Limited Groups – A specified number of group sessions, usually from 10 – 15, during which membership may be closed, or open when a "drop in" format is used.  The goals of these programs are usually to help work through a specific challenge, avoid relapse and/or bolster coping and resiliency skills.
• Extended Services Groups - Groups extending beyond 15 sessions for those who need more work to recover.  Members usually stay until they have accomplished their goals and are ready to move on.
• System Consultation - This usually involves a needs assessment followed by an intervention tailored to the particular needs of the organization in question, in conjunction with recommendations on infrastructure changes to continue to support the program and the staff/community needs.
• Online and Telephone-Based Groups:  Trainings and support groups for both caregivers and the general population are delivered online and via telephone.  These are effective options for the homebound and those in remote and/or rural locales with minimal or no access to services.

Printed Materials Available:

Training Curricula

• Group Interventions for Treatment of Psychological Trauma - Ten (10) training modules for mental health professionals who work with different populations and phases of trauma work.  The modules address:  group interventions for adults, children and adolescents; evidence-based programs for adults, children and adolescents; the later stage (coping with the aftermath of traumatic events); countertransference, unique aspects of group work, masked trauma reactions, and bereavement.  PowerPoint's that can be used for training accompany each module.

• Public Mental Health Service Delivery Protocols: Group Interventions For Disaster Preparedness And Response - A set of population-specific best practice interventions for use in delivering mental health services following disasters including Uniformed Service Personnel (also applicable to the Armed Services), children and families, school communities, adolescents, survivors, witnesses and family members, helpers and service delivery workers, organizations and systems, local community outreach programs, and the role of the philanthropic community. These protocols, which are group-based and focus on lessons learned from actual service delivery practices, have been collaboratively developed with organizations and professionals who have responded to past disasters, nationally and internationally. Summaries of the Public Mental Health Service Delivery Protocols are as follows:

Children and Families Dealing with a Traumatic Event - Maureen Underwood M.S.W., CGP

Consistent with a strength-based or resilience paradigm, this protocol uses a family group intervention that acknowledges families’ pain, fear and loss and then identifies and emphasizes strengths and effective coping.  The protocol presented has applicability for use by faith-based agencies, school districts, disaster mental health agencies and communities. Drawing upon a pilot program utilized after 9/11 with families that have lost a father, it is a detailed guideline of a program that involves a series of community-based psycho-educational support groups.  It includes parallel parent-child interventions carefully planned in terms of timing, structure, content and group activities to address trauma and the grief process while restoring and expanding family stability, communication, coping skills and hope. It includes suggestions for initial and continuing outreach, criteria for screening, referrals for additional services, leadership qualifications and guidelines, and evaluation and research.

Caring for a Traumatized School Community - Toby Chuah Feinson, Ph.D., CGP

This module draws upon a school protocol that served as a response to the traumatized school communities seeking help in the aftermath of 9/11. It delineates a multi-level template that can be adapted to the needs of diverse school communities. The school protocol presented is two pronged in that it addresses both the direct and secondary traumatization in school caregivers as well as the direct traumatization in children. Described with detail, it involves training, supporting and supervising school personnel to lead children’s groups, and co-lead children’s groups with a trained facilitator. It is designed to equip school staff with the tools, skills, guidance, strategies and on-going support to strengthen their own inner resiliency while expanding their group leadership skills for taking positive action in the face of children’s needs. It offers guidelines for identification, parent appraisal and permission, screening for eligibility, selection and pre-group preparation, group contract and parameters, and developmentally appropriate tasks for strengthening resiliency, developing emotional insulation and using the peer group as an agent of change and healing.

Group Treatment with Traumatized Adolescents - Seth Aronson, Psy.D.,CGP, FAGPA

Group treatment is a particularly appropriate modality for addressing the impact of trauma on adolescents given that both research and empirical experience reveal the adolescent peer group to play a crucial role in development of identity, self-esteem, social-interpersonal maturation and separation from family of origin.  Drawing upon theory, and clinical material from adolescents groups, this protocol illuminates the impact of trauma on the developmental tasks of adolescence, delineating and discussing the steps and issues in setting up an adolescent trauma group. Issues addressed include proximity of the traumatic event to the group, match of needs to type of group, the screening interview, selection and balancing of group members, use of a group contract, roles and guidelines for leaders, and stages and phases of group development.

Responding to the Needs of Uniformed Service Personnel - Suzanne B. Phillips, Psy.D., ABPP, CGP and Nina Thomas, Ph.D., CGP

A comprehensive guide for working with uniformed personnel, it underscores the importance of understanding the culture, resilience, command structure, sense of mission, attitude toward injury, perception of mental health intervention etc. of firefighters, police, emergency medical services and military. This protocol highlights the pre-existing group mentality, the “Band of Brothers,” as a rationale for utilizing group response and intervention with uniformed personnel and emphasizes the goal of “added value” and restoring functioning without pathologizing. Drawing upon theory, research, consultation and experiences with members of each of the services after 9/11 and with respect to prior disasters and deployments, it offers responses, interventions, programs and resources to be utilized across the timeline of disaster and war.

Lessons Learned in Group Strategies for Survivors, Witnesses and Family Members - Richard Beck, M.S.W.,CGP, FAGPA, Estelle Rauch M.S.W.,CGP, Uri Bergmann, Ph.D., Alexander Broden,  M.D., CGP, Bonnie Buchele, Ph.D., ABPP, CGP, DFAGPA, and Yael Danieli, Ph.D.

Vignettes of actual 9/11 group interventions are combined with theoretical expertise in this protocol, which is intended to expand the skills of previously trained mental health workers.  The authors delineate high risk factors, the impact of trauma on neuro-chemistry and the impact of disaster when there has been previous trauma. The protocol both describes and exemplifies the characteristics of trauma groups for survivors, witnesses and family members as well as the types of trauma support groups that can be used across the spectrum of disaster recovery (short term grief groups, single session groups, corporate groups etc). Guidelines for groups as well as the role of the leader are offered.

Support for Disaster Response Helpers and Service Delivery Workers - Michael Andronico, Ph.D., CGP, FAGPA, Trish Cleary, M.S. CCMHC, LCPC-MFT, CGP, FAGPA, Felicia Einhorn, LCSW, CGP, Madelyn Miller, LCSW, ACSW, CGP, Emanuel Shapiro, Ph.D., CGP, FAGPA, Henry Spitz, M.D., CGP, DFAGPA and Kathleen Ulman, Ph.D., CGP, FAGPA

This protocol underscores the attention and informed care deserved by service providers who are affected directly and indirectly and through shared experience with survivors. Group is recommended as an intervention that affords a context for sharing challenges, understanding experiences, sustaining identity, addressing self-care and supporting a sense of hope often compromised by all that providers must contain in the face of disaster. The protocol is a comprehensive guideline for providing group interventions for mental health service providers and other support workers. Reflecting theoretical understanding and clinical experience it addresses everything from suggested time frames to the specifics of group content. It also includes an extensive set of appendices addressing vicarious traumatization measures, evaluation tools and group climate measures.

Crisis Intervention at the Organizational Level - Priscilla Kauff, Ph.D., CGP, DFAGPA and Jeffrey Kleinberg, Ph.D., CGP, FAGPA

This protocol provides a group-centered response to trauma with an organization as the client. It aims at returning an organization to its original pre-trauma structure and level of productivity.  Recommending the use of “clinician consultants,” highly skilled group therapists with appropriate theoretical understanding of individuals, groups and systems, it stresses the needs of the organization as well as the individual must be addressed if the intervention is to be effective. Using experience and theoretical perspective, this protocol offers guidelines for the process of engagement with an organization, needs assessment, developing a working alliance, establishing a contract with management that accounts for issues of staff participation, and clarification of the advantages of a group format. The actual components of an intervention are detailed (e.g. design, composition, use of outreach leaders, content of material, decisions re mixing employees and supervisors) and address services to management, evaluation, long term relationship with the organization and helping the helpers.

Local Community Outreach Programs in Response to Disaster - Diane Feirman, CAE and Randi Cohen, M.S.W., M.A., CGP

This protocol delineates a community outreach model as an effective means of identifying, establishing and delivering group mental health interventions in the aftermath of disaster. The protocol is divided into two sections. The first section offers practical strategies for implementing an outreach model, i.e. identifying a Community Based Organization (CBO) as central to the effort, clarifying the role of the CBO, pairing with other agencies, identifying community needs and resources etc. The second section describes the actual clinical aspects of the model. It includes descriptions of the role of a clinical liaison in initiating and developing outreach possibilities, the consideration of community outreach across the time frame of disaster and the possible group interventions used in an outreach model.

The Role of the Philanthropic Community in Disaster Response - Robert Klein, Ph.D., ABPP, CGP, DLFAGPA and Harold Bernard, Ph.D., ABPP, CGP, DFAGPA

This is an integrated set of recommendations for members of the philanthropic community, with recommendations drawn from the experience of major contributors to the relief and recovery work following 9/11. Resonating with the sentiments of Gotbaum, former CEO of the 9/11 fund that “the greatest challenge in helping the victims of 9/11 was not getting the resources-it was working together,” this protocol fills a valuable need by recommending specific pre- and post-disaster steps for philanthropic response, e.g. pre-disaster plans between government and philanthropic entities.  It includes issues for philanthropies’ consideration, such as understanding donors’ intent, tailoring efforts to remain consistent to their mission, accessing communication networks between and among philanthropies and government agencies and  providing clarity regarding the purpose and criteria for extending financial aid in the aftermath of disaster and transparency with regard to follow-up and evaluation.

Public Education Information:

• Group Works:  What Everyone Should Know About Trauma - a short brochure geared to the general population which describes what groups are and how they work, and which contains an insert with information about responses to traumatic events.  Electronic and hard copy are available, in both English and Spanish.

Clinician Research Tools

• CORE Battery-Revised - An assessment toolkit for promoting optimal group selection, process and outcome.

III. Prior Collaboration between AGPA and Service Providers

When you have the privilege of doing trauma work, when someone trusts you with their pain, by necessity you enter hazardous terrain. Aware of the impact on caregivers after 9/11, AGPA provided group training and curriculum guides to agencies and organizations to prevent and reduce secondary PTSD and Vicarious Traumatization in clinicians, spiritual caregivers, First Responders and other service providers. AGPA has continued to collaborate with agencies and institutions to provide Care to the Caregivers in initiatives set up in  response to Hurricanes Katrina & Rita, and with First Responder Groups ( police, fire and EMT) in the aftermath of critical incidents and disasters. For example, a program is planned in April 2008 for Military, First Responders and clinicians in the aftermath of the California Fires.

IV. Present Collaboration between AGPA and the Department of Veterans Affairs

Program initiatives for clinicians and staff working with veterans are presently in process with Houston and San Antonio DVA Departments:

In Houston, Texas, plans are in place for a Basic Group Therapy Training Course for psychiatric nurses. This will be a four-month, 24-hour course specifically designed to build the group therapy skills of DVA nursing staff assigned to programs in Mental Health Services at Michael E. DeBakey VA Medical Center, Houston, Texas.  Special emphasis is placed on the unique issues that DVA group therapists face in serving Veterans and their families in this healthcare facility. The San Antonio DVA Department is working with a plan to do a needs assessment of Mental Health Personnel for workshops provided by AGPA. There is particular interest in trauma group training for ancillary staff (e.g. dental hygienists and occupational and physical therapists) with a recognition that in a system all aspects of support for veterans serve as resources to enhance their recovery. When staff are trained and understand PTSD, their risk of secondary PTSD is lowered and their potential to offer “ added value” to veterans and families is enhanced.

V.Personal Feedback from Recipients of Programs of the American Group Psychotherapy Association

Staff Support Group Member:

The facilitators have done an excellent job in providing counseling to many if not all of the staff members in our division.  Personally, I must admit that at first I was not too crazy about going to the Wellness Group.  I was skeptical and didn’t feel comfortable talking about my issues and frustrations at the work place.  But S. and G. (the therapists) won me over, since I have been attending the meetings I have felt much more relaxed and I look forward to attending every Thursday meeting.  These meetings have helped me both professionally and personally and I see the difference everyday.

Family Group Member: 

My daughter, 7, and I often had the most meaningful conversations after group. They clearly stemmed from group topics. I know she is internalizing your messages, when I hear the following kind of response.  I recently told her about 2 boys, ages 8 and 10, whose father died unexpectedly at the age of 37.  I asked her what advice she would give them since she had been through the same situation.  She very naturally replied that she would say, “Sometimes life is unfair, but you are strong and you can get through it.  Some days will be bad but you can still have fun and be happy.

 First Responders:

 This weekend was wonderful.  My husband & I have erected walls around us & this was a giant step towards knocking them down.  It won’t be easy but thank you for giving us tools that we can use.

 Thank you for this opportunity!  My husband and I definitely grew from our experiences here.  Couples counseling is extremely important when dealing with the recent trauma we’ve experienced.  We all need to support our family unit!

VI. Summary

The last and most difficult stage in the recovery from PTSD is reconnection to self and others.   I ask you to consider that the group programs and lessons learned by the American Group Psychotherapy Association in the aftermath of 9/11 hold potential as significant options for expanding the services to veterans and their families. By directly including spouses and children in programs, we not only reduce the impact of  PTSD on them, we enhance the recovery of our servicemen and women. As their families and marriages are their greatest assets, we make possible the emotional connections that finally bring them home.

References

American Psychological Association  Presidential Task Force on Military Deployment Services for Youth, Families and Service Members (2007)  The Psychological Needs of U.S. Military Service Members and Their Families: A Preliminary Report.

Burlingame,G.M.,Fuhriman,A.F.& Mosier,J.(2003).The differentiated effectiveness of group psychotherapy: A meta-analytic review. Group Dynamics: Theory, Research and Practice,7(1),3-12.

Bolton, E., Lambert, J., Wolf, E, Raja, S., Varra, A., & Fisher, L. (2004)  Evaluation of a cognitive-behavioral group treatment program for veterans with posttraumatic stress disorder. Psychological Services, Vol.,No.2, 140-146.

Brockway, S. (2005)  Group treatment of combat nightmares in post-traumatic stress disorder. Journal of Contemporary Psychotherapy, Vol 17, No. 4, December 1987. 270-284.

Buchele,B. & H.Spitz (Eds.) (2004), Group Interventions for Treatment of Psychological Trauma. New York:

      American Group Psychotherapy Association

Chemtob, C.M., Novaco, R.w., Hamada, R.S. & Gross, D.M. (1997) Cognitive Behavioral treatment for severe

     anger in posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 65, 184-189.

Foy, D. W., Glynn, S. Schnurr, P.,Jankowski, M.,Wattenberg, M., Weiss, D., Marmar, C., & Gusman, F. (2000) Group Therapy in E.B. Foa, T.M. Keane, & M.J. Friedman (eds.), Effective treatments for PTSD (pp. 155-175). New York: Guilford Press.

Goodman,M. & Weiss, D. (1998). Double trauma: A group therapy approach for Vietnam veterans suffering from war and childhood trauma. International Journal of Group Psychotherapy, 48, (1),39-53.

Galovski,T. & Lyond,J. (2004). Psychological sequelae of combat violence: A review of the impact of PTSD on the veterans’ family and possible interventions. Aggression and Violant Behavior, 9, 477-501.

Herman J. ( 1997) Trauma and recovery. New York: Basic Books.

Hoge,C. MD, Auchterlonie,J., Milliken C.,Mental Health Problems, Use of Mental Health Services and Attrition from Military Service after returning from deployment to Iraq and Afghanistan, JAMA. 2006;295:1023-1032.

Hoge,C., Auchterlonie,J., Milliken,C. (2006) Mental health problems,use of mental health services and attrition from military service after returning from deployment to Iraq and Afghanistan, JAMA. 2006;295:1023-1032.

Hoge, C., Castro, C., Messer, S., McGurk, D., Cotting, D., & Koffman, R. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. The New England Journal of Medicine, 351, 13-22.

Jones, L., Brazel, D., Perkind, E., Morelli, T.,& Raskind,M., (2000). Group therapy program for African-American veterans with posttraumatic stress disorder. Psychiatric Services, 51(9),1177-1179.

Kates, A. R. (2001). Copshock: Surviving posttraumatic stress disorder (PTSD). Tuscan: Hillbrook Street Press.

Kingsley, G. (2007)  Contemporary Group Treatment of Combat-Related Posttraumatic Stress disorder. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 35(1) 51-69.

Klein, R.and S.B. Phillips (Eds.), (2008) Public Mental Health Service Delivery Protocols: Group Interventions for Disaster Preparedness and Response.New York: American Group Psychotherapy Association

Makler, S., Sigal, M., Gelkopf, M.,Kochba, B., & Horeb, E., (1990). Combat-related, chronic posttraumatic stress disorder: Implications for group-therapy intervention. American Journal of Psychotherapy, Vol. XLIV (3),381-395.

Meyers, S.L., (2003, June 21). Battlefield aid for soldiers battered psyches. The New York Times, pp. A1, A8.

Schnurr, P., & Cozza, S. (Eds.). (2004). Iraq war clinician guide. (Second Edition). Washington, D.C.: Department of Veterans Affairs, National Center for PTSD.

Shay, J. (2002). Odysseus in America: Combat trauma and the trials of homecoming. New York, New York: Scribner.