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Book Reviews |
Key Words: Books Reviewed
Intense interest in psychological trauma has been central to the field of psychotherapy since its inception. Encounters with the sequelae of trauma are virtually universal in any psychotherapist's experience. There is, however, often a broad gap between the ability to identify the impact and phenomenology of severe psychological trauma and the ability to provide knowledgeable, effective treatment. The information provided in this text represents an attempt to close the gap.
While the term trauma has found its way into the everyday parlance of mental health practitioners, it is used loosely and often does not mean the same thing to all people. One key contribution of this book is that it takes the time to clearly define what does and does not constitute psychological trauma and its specific psychological manifestations. The book is divided into two sections: "Concepts, Theories, and Strategies" and "Special Populations and Trauma Groups."
In the first chapter, Klein and Schermer set the stage by providing a thorough overview of the relevant trauma literature, an analysis of the impact of trauma from an object relations point of view, and a rationale for the advantages of specialized psychotherapy groups. Their scholarly yet very reader-friendly style condenses a great deal of theoretical material into language that is clear and clinically relevant.
Goodman and Weiss begin the book's journey from theory to practice in a chapter that explicates the "nuts and bolts" of the trauma group model. They highlight issues of screening and evaluation of prospective group members, the advantages of homogeneous group composition, stages of group development, and the key issue of how to control the pace of self-disclosure by group members in discussing their prior traumatic experiences. Hageman and Wohl amplify the themes from the first two chapters and provide a more in-depth study of dissociative states and of defenses employed by traumatized individuals. Their broad view of the many faces of dissociative defenses includes behavior, affect, sensation, and knowledge as potential avenues for dissociation in trauma victims.
Chapter 4, by Ganzarain, is well written but narrow in scope. He takes a specific theoretical position, the "group-as-a-whole" model, and applies it to work with trauma patients. There is not much new information in this chapter, but it still serves as a good review of the work of Bion, Hopper, and others who advocate this orientation to group dynamics. The chapter by Ziegler and McEvoy that follows is particularly noteworthy. It is a thoughtful, sensitive, and clinically wise presentation of the critical dimension of countertransference reactions in trauma groups. The use of their personal "field journals" describing their ongoing reactions as leaders of trauma groups is impressive for both its honesty and the ease with which clinicians will be able to recognize their own blind spots and personal vulnerabilities evoked by members of psychotherapy groups for trauma.
The countertransference chapter at the end of Section I serves as a natural bridge to the second half of the text, which describes group therapies for various subsets within the trauma spectrum. Entities including posttraumatic stress disorder, sexual and physical abuse, medical illness, the impact of trauma and loss on children, community reactions to disaster, political torture and ethnic persecution, dissociative disorders, and severely psychiatrically impaired and/or substance-abusing patients are the focal points for this part of the book. Although all of these chapters are very strong, Chapter 7, by Buchele, deserves special mention for the model it offers of a leadership style that is highly empathic but clear on boundary issues, and for the emphasis she places on the need for traumatized individuals to move beyond a one-dimensional identity as "survivor" and to improve the overall quality of their lives.
By devoting eight chapters to the creative ways in which groups are being used to address the broad range of issues emanating from traumatic experiences, Klein and Schermer make the essential point that practitioners need to move beyond a global view that all trauma and its consequences are the same. Thinking only about similarities can present the temptation to adopt formulaic and nonspecific treatment plans, thereby risking unsuccessful outcome and avoiding countertransference sensitivities. Each chapter clearly explicates the unique aspects of how groups are tailored to meet the needs of their membership. This second section of the book will be invaluable to new and seasoned group therapists interested in conducting groups for individuals who have undergone a severe psychological trauma.
This is not merely just another good book. It is an invaluable contribution to a rapidly emerging field and is likely to be the cornerstone text in the field of group psychotherapy and psychological trauma for some time to come.
FOOTNOTES
Dr. Spitz is Clinical Professor of Psychiatry and Director of Group Therapy Training, Columbia University College of Physicians and Surgeons, New York, NY.
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