Trauma

There has been a greater focus on trauma this week at Samaritan Inns. Having reread the article on groups with clients with a traumatic history, there are a number of correlaries and outstanding issues I have.

The most relevant issue raised by the article was the stages of trauma groups. At first, the focus of the group should be on readjusting the client's perceptions and thoughts in the present. I understand this need, but it wasn't clear in the article if this type of treatment should occur directly after treatment or upon admission to treatment, even years later. In my field placement, all clients have undergone major trauma. However, for most of them, the trauma was years ago. Since then, they have tried to maintain equilibrium through substance abuse, which in turn retraumatized them many times over. Should I be dealing with the acute concerns in the here and now or delve deeper?

Devling deeper would involve catharsis, which the clients seem to crave within the groups, and abreaction. Because I am unsure of the directions in the article, I don't know if this level is appropriate for my group members. This is a substance abuse group, but issues around trauma have become paramount in this stage of group development. Ultimately, the client will dictate their openness to exploring those feelings. The comfort, understanding, and self-efficacy they will build as a result of exploring these feelings either in the "here and now" or "there and then" is the most important aspect of these groups.

Roles

In the Intensive Recovery Program, the group structure and expectations are unique. The group is expected to hold each member accountable for their behavior, at times with confrontational "pull-ups." An older client, D, expressed her ambivalence about the confrontational style. Her behavior during the group, in which she addressed another member's behavior pattern of nitpicking other clients, was passively confrontational and designed to hurt. During her "pull up," she addressed the client's psychiatric diagnosis, a detail that should not have been shared, and tried to enlist other group members in her cause. This behavior did not match with her supposed opposition to confrontation.

Another counselor and I were leading the group in order to openly address these interpersonal problems, which came to our attention during lunch. When confronted, D not only maintained her opposition to confrontation, but criticized the group norm of holding each member accountable. She stated that she was only responsible for her behavior and the behavior of others. The other counselor agreed, stating that she is merely accountable for others' behavior. D expressed confusion about the difference between accountability and responsibility in spite of the patient efforts of the other counselor.

In order to elucidate the concept and give her perspective on her interactions with the group, I asked her what her role was in the group. She gave a circuitous response that directed the question back to her opposition to confrontation. Undeterred, I pressed her for behaviors she exhibits in the group and a metaphor for them, such as caretaker or scapegoat. She still could not think of any, so I offered a suggestion of my own, the caretaker, as she is the eldest of the group and tries to nurture others. I then connected her role with the reciprocal determinism of group interaction, in that the group impacts the individual as the individual impacts the group. This is why you are accountable for others' actions and why the counselors insist upon the maintenance of those group norms.

Children of Alcoholics

This week's reading on children of alcoholic parents was especially relevant to the population I work with.  The majority of the addicts in the Intensive Recovery Program have children, and most were raised in a family with substance abuse problems.  For many of our clients, the interventions spoken about in the reading would have helped them greatly.  The one that spoke most to the need presented by the clients were the education and implementation of effective coping skills.  I believe addiction is a maladaptive coping skill (not a disease).  I witness the poor coping strategies of clients mentioned in the article, such as perfectionism or internalized defeat.  From this article, I have gained information on how to treat alcoholism by teaching clients emotion and problem based coping strategies.

The interaction between substance abuse and family was further highlighted while I was completing my program assessment for another class.  I was speaking with the coordinator of the Intensive Recovery Program and she expressed her frustration that families could not play a significant role in our treatment model.  During the first 28 days of treatment, the clients are not allowed to contact anyone, let alone their family.  If the client is accepted into the transitions program, he or she is strictly limited in the time spent with their children.  Even in the Singe Room Occupancy program, for which the clients interview after 6 months in transitions, family visits occur rarely and count towards the total number of visitor hours one is allowed.