Consultation and Training

TREM Questions and Answers

Q: I was trained in a psychodynamic model, and am now trying to adjust my leadership style in TREM's more psycho-educational group approach. Are there some pointers you can give me that, in general, are common shifts in thinking psychodynamically-trained clinicians need to make in using TREM?

A: You are absolutely right — there are some techniques you are likely to use, that are not used in the more psycho-educational structured TREM group.
Therapeutic Silences — are not so "therapeutic" in TREM groups. Leaders do not want members to feel anxious or pressured to participate. Leaders can help facilitate conversation so that members can join in when and if they like.
Telling one’s story — how do I balance a woman’s desire to tell her story in detail with the need to get through the content agenda for the session? The group should be flexible enough to allow a woman to tell her story, but the telling should be brief and ideally related to a particular point that the group is discussing. A lengthy recounting may be too uncomfortable for other members. If a woman needs to tell her story in greater detail, she can be referred for individual therapy or a co-leader could offer her some time after the group. In any case, the interruption of a story should be done gently and leaders should acknowledge the importance of the story and the courage it takes to begin to let it out.
Processing group dynamics — In general, leaders should not address group dynamics. This is an agenda-driven intervention and leaders should be attending to the goals of the session. When group dynamics or external factors interfere with members’ ability to attend to the task, some attention to group dynamics is appropriate. Leaders should use a trauma framework for understanding the issue and guide the group back to the agenda.
Re-enacting troubling dynamics — If you notice intimidation or flirting that is disruptive to the group, you need to intervene and stop the dynamic. Your goal is not to help members in question gain insight about their behavior, but rather to make sure that the group stays safe for the overall membership. If you can de-personalize the dynamic and relate it to some general behavior of women who have been traumatized, feel free to do so. Remember that survivors are very prone to feeling ashamed of their behavior. By calling attention to a dynamic, you do not want to shame the members in question. You also do not want to risk beginning an intervention that appears as if you are doing individual or couples counseling in the midst of the group.
Leader Disclosure — While leaders should not disclose their personal histories with group members, they should be prepared to participate in group exercises which may be somewhat revealing. Leaders can choose to give answers that are somewhat impersonal if this is more comfortable. If asked about personal experience, leaders should be prepared to give answers that are appropriate without disclosing more than feels comfortable, and which does not make members feel ashamed for asking.
Encouraging members to express feelings in response to others comments — In general you should avoid putting members on the spot and asking them to evaluate one another’s remarks. You may want to ask a particular member to comment about her own experience if you feel that it is related to what has just been said.
Asking follow-up questions to promote elaboration — You can ask for more information if a comment is unclear, or better still, you can make an additional comment that elaborates the material or ties it specifically to trauma themes. You want to avoid anything that seems like you are doing therapy with an individual in the group. If you do ask a follow-up question, make sure that it relates to the question being discussed and does not go off on an interesting tangent.
Importance of remembering one’s full trauma story? — The TREM model assumes that women can recover from the effect of trauma without experiencing total recall of the traumatic events.