Comprehensive Understanding of Individual Treatment in the Group Process: PTSD in Focus Lorenzo E. Aranda CNSL/561 University of Phoenix Lorenzo Aranda CNSL/561 In understanding an individual’s treatment plan, as it pertains to a group counseling atmosphere, you must first realize that it is a multifaceted process. This process ensures the appropriateness and effectiveness of group counseling in the client’s treatment. And, as the individual’s progress may shift, the applicability of a group counseling plan may shift as well.
In order to illustrate the process a hypothetical client, Joe, will be used. He is a soldier with the U. S. Army and was recently deployed to Afghanistan for 12 months. During his deployment he and his unit were exposed to direct and indirect fire by enemy forces. On one such occasion a fellow soldier, and close friend, was killed by an improvised explosive device 20ft from his location during a routine patrol. Upon his return to the states three months later Joe underwent a debriefing and post-deployment program.
This program included a standardized psychological screening. This screening has been modified in recent years in an effort to mitigate the overwhelming increase in cases of PTSD and soldier suicides (Shalev, Rogel, Ursano). After a brief series of questions it was determined that he showed some indications of Post Traumatic Stress Disorder. Joe was then referred to a Behavioral Health Specialist for an official evaluation and verification of the initial assessment. Diagnosing PTSD in an office visit can be challenging.
The diagnosis is frequently missed because patients do not typically volunteer information about the traumatic event or the stereotypic PTSD symptoms. Careful attention must be paid to subtle cues in words used in responses and body language in order to probe for symptoms. Through self-report it was revealed that he had been exposed to a traumatic event in which he experienced and witnessed events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
His response to these events involved intense fear, helplessness or horror. The traumatic event is persistently re-experienced in the form of recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions. There are periods where he feels as if the traumatic events were recurring in the form of dissociative flashback episodes. He shows significant efforts to avoid thoughts, feelings or conversations associated with the trauma. He shows a diminished interest or participation in significant activities.
He feels detached estranged from others, including his family. He experiences persistent symptoms of increased arousal as indicated by his difficulty falling and staying asleep. He reports that he feels irritable more easily and has difficulty concentrating. It was verified that the duration of these issues was for more than one month and that they caused clinically significant distress and impairment in both his social and occupational functioning (American Psychological Association: Diagnostic and Statistical Manual of Mental Disorders, Fouth Edition, 2000).
Based on the fore mentioned points, cross-referenced in the Diagnostic and Statistical Manual of mental Disorders, the initial assessment was verified and an appropriate diagnosis was made. Joe was then referred to the health clinic at his assigned instillation for follow-up treatment with a psychiatrist. It was determined that pharmacologic intervention was necessary to deal with Joe’s most impairing difficulties and he was prescribed Zoloft. In addition, he was prescribed Ambien to address his reported difficulty with sleeping.
From there Joe was referred to an on-post counselor who specialized in the treatment of PTSD for ongoing psychotherapy. After the initial intake interview and a review of Joe’s records, it was determined that he was a good candidate for group counseling. One approach a facilitator may employ in running a group for PTSD clients is Cognitive-behavioral therapy (CBT). This approach has proven to be a highly promising treatment for PTSD as it deals with a person’s awareness and reasoning in order to change their emotions, thoughts, and behaviors.
This approach can easily be incorporated in the group counseling atmosphere. Topics addressed over the course of these group counseling sessions would include education about the disease, learning skills for coping with anxiety, dealing with negative thoughts, managing anger, addressing urges to use alcohol or drugs when trauma symptoms occur, and communicating and relating effectively with people. This would all build up to tackling the core issue, the trauma triggering event. In some cases, traumatic memories can be confronted all at once.
This is known as “flooding. ” Exposure therapy is one example of this. It involves having the client repeatedly relive the frightening experience under controlled conditions to help him or her work through the trauma. In a group setting the members of the group may play the roles of individuals involved in the traumatic event while the client reenacts it. The danger in using this method is it could possibly reverse any progress already made with the client by taking them back to day one, depending on how unstable they are.
For most clients, it is preferable to gradually work up to the most severe trauma by using relaxation techniques or by taking the trauma one piece at a time. This is known as “desensitization. ” In a group environment this can be accomplished through forms of meditation such as guided imagery. The group may sit in a circle in a relaxed position whit the lights dimmed or turned off completely. The facilitator would then read a script or play a prerecorded CD. As mentioned earlier, one key aspect of PTSD is the client’s resistance to thinking, feeling, and especially talking about the traumatic event.
Using relaxation techniques sets the foundation for the recover that follows. With the anxiety level of the group reduced, the client would examine and resolve their strong feelings. Common feelings among survivors of trauma may be anger, shame, or guilt. Following that the client would be taught to cope with the post-traumatic memories and feelings without becoming overwhelmed or emotionally numb. All this is done through the cumulative efforts of the group members through sharing and feedback while the facilitator monitors progress and mediates the flow.
Group therapy, as a treatment for PTSD, is very effective because the controlled environment provides a sense of safety for sharing feelings. Additionally, being placed with other soldiers with similar experiences creates a sense of cohesion that further facilitates the sharing process. The support and empathy provided by this scenario cannot be equivocated by the support of a lone counselor in an individual counseling scenario. As the sharing progresses the level of trust between the group members will likewise increase and growth will inevitable occur. Sources Blank, Y. Jr.
Clinical detection, diagnosis, and differential diagnosis of post-traumatic stress disorder. Psychiatry Clinic North America (1994). 17, 351-83. Shalev, Peri T, Rogel-Fuchs Y, Ursano RJ, Marlowe D. Historical group debriefing after combat exposure. Mil Med (1998). 163, 494-8. Ponton, R. a. (2009). The ACA Code of Ethics: Articulating Counseling’s Professional Covenant. Journal of Counseling & Development, Vol. 87 , 117-121. American Psychological Association: Diagnostic and Statistical Manual of Mental Disorders, Fouth Edition. (2000). Washington D. C. : American Psychological Association.