Group Interventions For Complex Trauma: UKPTS March Dr Lisa Reynolds: Greater Glasgow and Clyde Trauma Service: The Trauma and Homelessness

Transcription

1 Group Interventions For Complex Trauma: UKPTS March 2013 Dr Lisa Reynolds: Greater Glasgow and Clyde Trauma Service: The Trauma and Homelessness

2 Outline of the workshop Developing a group intervention for Complex Trauma : Process, considerations and outcomes Organising group interventions in Complex Trauma: What is happening in Greater and Glasgow and Clyde Trauma Service? The experience of running a group intervention for complex trauma The Impact on the participant The impact on the therapist Complex Trauma Group processes to be aware of

3 Developing a group intervention for complex trauma Evidence Based Needs Led Safe

4 Developing a group intervention for Complex Trauma: Safe and Sound :Process Childhood Abuse has been linked with experiences of subsequent trauma in adulthood. Sexual re-victimisation has been shown to occur across diverse populations Research has provided evidence that childhood sexual abuse survivors are between two and eleven times more likely to be sexually assaulted as adults than non-survivors (Fergusson et al, 1997; Wyatt, Guthrie & Notgrass, 1992). Trauma and Homelessness Team audit of referrals illustrated clients disclose between 5-9 complex trauma experiences at time of referral average age No known evidence based intervention specifically designed for complex trauma clients to reduce re=victimisation

5 Developing Group Interventions: Process Until recently, predictors of revictimisation tended to be static, such as severity, duration and frequency of abuse, relationship to the perpetrator and responses of caregivers following disclosure (Classen et al, 2005). More recently studies have communicated the predictive value of dynamic factors in reducing the risk of revictimisation. Such factos include improving coping skills related to affect regulation (Classen et al, 2001), reducing PTSD symptoms (Gilbert et al, 2006) stabalising substance misuse (Gilbert et al, 2006). improving interpersonal relationships Improving communication skills (Finkelhor and Browne, 1985; Cloitre, 1998; Marx et al, 2001, Gilbert et al, 2006) increasing social support (McFarlane et al, 2006; Robinson & Tregidga, 2007, Sullivan & Bybee, 1999) Nevertheless, studies to date are limited by lack of or short-term follow up, and therefore if revictimisation occurs, it may not be identified. In addition, although participants are recognised as having experienced a traumatic event, complex trauma is not always identified and therefore the potential for the above interventions with participants who have experienced complex trauma remains unknown.

6 Dynamic Factors mediating relationship Depression Social Support / Advocacy PTSD Symptoms: Reexperiencing, hyperarousal and dissociation all shown to increase risk of revictimisation Alcohol and Substance Misuse Unsafe sexual Behaviours Sexual self esteem between childhood abuse and adult revictimisation Blame Shame Powerlessness Avoidant Coping Civil protection orders Assertiveness Disturbed interpersonal relationships Self Esteem Reduction in Identifying perceptual threat/ identifying danger

7 Group Interventions For Complex Trauma :Process Based on findings from systematic review, the Trauma and Homelessness Team applied for SurvivorScotland National Strategy Funding to develop, deliver and evaluate a treatment intervention to reduce distress and the risk of re-victimisation

8 Safe and Sound The intervention consisted of 10 group sessions and 9 individual sessions. Sessions were delivered by Clinical Psychologists. The group intervention focused on client s emotional, interpersonal and environmental safety and consisted of psycho education and cognitive behavioural strategies for improving areas of safety, managing trauma symptomatology and substance misuse. Individual sessions focused on improving interpersonal relationships using Schema Therapy. Outcome data collected pre, post, 3 month follow up, 6 month follow up and 12 month follow up.

9 Safe and Sound The present study aims to examine whether a phase 1 safety intervention for females with a history of complex trauma, revictimisation and homelessness, targeting certain dynamic factors, will improve psychological well-being and reduce the risk of revictimisation.

10 Safe and Sound Outcomes so far Age range: years Average age: 34.3 years Attendance at group sessions = 79% Attendance for individual sessions = 70% Drop-out rate = 38% (6 out of 16)

11 Safe and Sound Outcomes so far.

12 Safe and Sound: Outcomes so far

13 Safe and Sound Outcomes so far

14 Safe and Sound Outcomes so far

15 Safe and Sound Outcomes so far

16 Pre Group Reports of Childhood Trauma Number of Traumas average no. of traumas childhood 3.4 pre 4 post months months 0.2

17 Safe and Sound :Outcomes so far

18 Safe and Sound Outcomes so far. Scale significance Level Chi (p=<0.05) score CORE total TSI Intrusive Experiences TSI Dissociation SMI total SMI Detached Self Soother SMI Demanding Parent Safety - Emotional Safety - Environmental

19 What is happening within Greater Glasgow and Clyde Trauma Service Pre Phase1 Phase 1 Phase2 Phase3 Creative Group Safe and Sound Trem? ACT Mens Group Survive and Thrive Individual Treatments Vol Org connection AS & R Group Trem? Individual Treatments

20 The Experience of Running a Group

21 Large Group Developing Group Rules

22 Myths about Relationships I need to stay with him for the kid s sake I just need to put up with it It is better to be with someone than alone Relationships need drama and intensity to show that there is love and passion If I agree with everyone then I will be liked I am a magnet for bad guys

23 Group Task / Group Process Awareness of Group Process is a must even when running highly structured groups Red Flags within trauma all or nothing Boundaries = Rejection Ambivalence Abusive Behaviour Further Trauma Occurs Bullying / Scapegoating Passivity / Powerlessness

24 Group Interventions and Complex Trauma :Impact on Therapist