Numerous therapeutic activities have been identified as a means of healing the clients with traumatic experiences. For majority of the therapeutic activities, one-on-one activities have been advocated for as a basis of improving the health of the patient. However, group therapy has been embraced more as it is applicable for family patients and unfamiliar patients. The most common group therapy practice is through narrative where the individual participants engage in telling their stories as an integral process of healing. The following paper focuses on Narrative Group Therapy as it has been incorporated in healing patients of trauma. This may include military personnel of war, children of sexual abuse, war victims and orphaned children among others. The paper will identify the process of change that take place in a client, its effectiveness and limitations that could help further developments of the narrative group therapy.
Context
Butera-Prinzi, Charles and Story (2014) identify the high rate of brain injury in a family in Australia where three out of four people are under the age of 65 whereby 2 out of 3 are below 25 years. This could be identified as a critical issue in the events of a family that could lead to the experience of trauma among family members. The brain injury in the patient could lead to effective physical, emotional or cognitive disability. As a result, family members have to sacrifice their time to take care of the individual. This significantly changes the relationships that are common in a family. For instance, a family member may contract a disease that is believed to be life threatening. The family member, possibly a parent, who is the victim of the disease could be the source of traumatic experiences for the children and spouse. The family members are filled with confusion and distress as they are challenged in adjusting to the new roles within the family set up. It also a major challenge for the family to accept the new reality and move on with life.
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Kangaslampi, Garoff and Peltonen (2015) conduct a study on the use of narrative exposure therapy among children who have been traumatized as a result of war. The study identifies hundreds of millions of children who encountered war in 2014. As many as 47% of the children exposed to war torn areas could experience Post Traumatic and Stress Disorder while 43% could experience depression. However, the numbers are lower among immigrants into high income countries as it could be 10%-30%. Though the effects of trauma may die down with time, it is evident that numerous patients could present symptoms of PTSD even at adulthood age. As a result, it is important that effective therapy is applied to assist the child to improve quality of life and reduce suffering.
Processes of Change
As the family or relatives come in for therapy, it is evident that the process of change has begun. Clients move from a traumatic life experience to a better understanding of these previous events. The first session will usually identify the transforming life experience. In this case, it may be loss of a parent, war experience or unexpected life-threatening diseases affecting a family member. Identifying the source of the trauma is an effective means of acknowledging is occurrence and significance in the life of the participants in narrative group therapy. This means that members present their experiences through telling a story and the therapist creating a safe place where they can share. This will enable externalizing the trauma event so that they can move on with life. Through diagnosis, complex and confusing behavior is understood to the individual members of the family or therapy group.
The clients are then asked to describe their responses to the traumatic event. Prior to seeking therapy as a measure for increasing quality of life, members of the family are acknowledged for working together to come up with an effective means to deal with the problem. Many families that encounter traumatic events together will usually discuss ways of reducing stress that come with the events. This is seen as a sense of hope for the family members. This will also be connected to the family practices that members of the family enjoyed prior to the traumatic experiences. Through narrative group therapy members of the family can identify a common valued activity that could serve as a means of moving on with life. These activities serve to transform diminished identities of family members.
It is noted that in a family group therapy, it is more effective to conduct a separate session between siblings and couples. This is especially in cases where some of the siblings are noted to be young and may be scared of speaking out their mind in front of the parents. This helps bring out the nature of relations between the siblings and the effect of the trauma events. It is after this that the family is reunited and may be linked with others who have had a similar experience. This has the effect of realizing that they are not alone in such events. The larger group is then used to come up with narratives of their experiences and acquired wisdom that comes about.
Effectiveness
The narratives that are used in the process of therapy have been identified as reflecting the cultural meaning while also presenting the personal details respective to the speaker. The stories that members of a group therapy present are used as tools by the therapist to teach, comprehend, influence and self-understanding of the clients within the unique social environment. Recent studies indicated increasing evidence of the efficacy narrative approaches have achieved with children. The narratives are effectively used to peek into the lives of children and how they understand the complex events in their lives. The narratives will help parents understand how the children are responding to these traumatic events and how they are affected. Scaletti and Hocking (2010) have identified the need to create stories as a means of understanding grief or loss no matter how insignificant it may seem to the caregiver. The child may do this in a sand tray.
The process of bring children within the same peer group is seen as a space for interacting. This may be in the form of siblings or a completely different family. Scaletti and Hocking (2010) have indicated the significant impact that bereavement groups have had on children with clinical depression. The children will be seen to share their stories on their traumatic events and their behavioral responses. When children come together, narratives help in interpreting their responses to the events that have taken place. The appropriateness of the individual’s actions will be identified as a means of modifying them into a new behavior. The groups have served as a safe environment for building confidence and changing feelings and behavior. The parents or caregivers who then join back the therapy session will work towards understanding the story told by their children in previous session. Artwork may be used as means of eliciting family interaction.
Limitations and Further Developments
Kangaslampi et al. (2015) identifies the effect of narrative exposure therapy as one that could lead to increased stress and discomfort. However, it is important to note that this occurrence is usually temporary and should not only be on a short-term basis. In cases where narrative group therapy is carried out on children who are immigrants, it is noted that interpreters are required. This is where the language barriers are present. The interpreters are asked to be as literal as possible to ensure effective understanding within the group. It is seen that for effective application of the intervention, interpreters should understand trauma and therapeutic methods that may be present. However, previous results have shown no effect between using interpreters or not. Recent studies show that the use of interpreters could affect the emphasis of narration and verbal story telling.
The use of case studies in the research conducted by Butere-Prinzi, Charles and Story (2014) and Scaletti and Hocking (2010) have been an effective means of providing information in therapy activities of helping children with PTSD. The use of narrative group therapy activities has been an effective means towards an end of therapy. The researchers identify the stories as cultural mediums that can be used to harness therapeutic ends. It is seen as a limitation that the responses of grief and occupational approach within the narrative theory as it is drawn from literatures from overseas (Scaletti & Hocking, 2010). Therapists through the application of this therapeutic process should find a contextual basis of the ideas depicted.
The prevalence of traumatic experiences is identified to be global as it affects both adults and children. It is seen that the effect on the children may usually be downplayed particularly when they depict unwanted or inappropriate behavior. However, the narrative group therapy has been identified as an effective means of providing a deeper understanding of the events and thinking process of the children. The use of this technique has been identified to have positive effects on the children and the family as a whole. The therapeutic approach should be used more often to help modify experiences of families that may encounter grief and loss as well as other traumatic events.
References
Butera-Prinzi, F., Charles, N., & Story, K. (2014). “Narrative Family Therapy and Group Work for Families Living with Acquired Brain Injury.” Australian & New Zealand Journal Of Family Therapy , 35(1), 81-99.
Kangaslampi, S., Garoff, F., & Peltonen, K. (2015). “Narrative exposure therapy for immigrant children traumatized by war: study protocol for a randomized controlled trial of effectiveness and mechanisms of change.” BMC Psychiatry , 15:127-142.
Scaletti, R., & Hocking, C. (2010). “Healing through story telling: an integrated approach for children experiencing grief and loss.” New Zealand Journal Of Occupational Therapy , 57(2), 66-71
