Group Treatment Plan; Sexual Trauma
Problem: Post-traumatic Stress Disorder (PTSD)
Secondary Problem: Panic Attacks
Adapted from The Complete Anxiety Treatment and Homework Planner
By Arthur E. Jongsma, Jr.
Counselor: Student Name
Population and Demographics of Group
The sexual trauma group consists of twelve female adults of heterogeneous backgrounds, ages 18- 35. The participants in the group are diagnosed with Post-Traumatic Stress Disorder (PTSD) after a sexual assault. They reported the symptoms of recurrent flashbacks of the trauma, constant fear, and low self-esteem. The women are emotionally distressed and find difficulty in trusting others. Seven out of these twelve women had been raped, and they had developed intense feelings of shame and guilt. They report the feelings of hopelessness, disturbed sleep, anger, intrusive thoughts, and nightmares. Furthermore, they increasingly fear for the safety of their children.
PTSD Symptoms
Posttraumatic stress disorder (PTSD) is a psychological disorder that usually develops after the experience of a traumatic event. A series of emotional distress and symptoms are linked with PTSD that causes clinically significant impairment in the person’s daily life. It also affects their social interactions, professional or occupational life, and other areas of functioning.
Certain factors contribute to developing PTSD. Among them are mental and physical health conditions, Gender (researches indicate the women are more vulnerable to develop PTSD as compared to men) and type of trauma. These women reported repeated upsetting thoughts, nightmares, physical responses like increased heartbeat and sweating. Almost all the women were experiencing anxiety and depression symptoms, such as lack of interest in daily routine activities. Those who were rape victims also suffered from panic attacks.
Panic attacks and Panic Disorder
Panic disorder is an anxiety disorder that is marked with recurring panic attacks. Panic attacks are sudden and intense—individuals suffering from panic attack reports of loss of control and fear. Physical symptoms may include sweating, numbness, shortness of breath, and shaking. The individual believes that something horrible is about to happen.
Comorbidity of Panic Attacks and Sexual Attacks
Traumatic life events can trigger post-traumatic stress disorder (PTSD), which might cause anxiety and panic attacks that can become common for a patient. The case of (PTSD) and panic attacks seems to be common among the rape survivors and the sexual assault victims because such cases are often not reported and are augmented. Researches show that 94% of sexual assault survivors are at high risk of developing PTSD than other trauma victims, specifically in the initial two weeks after the occurrence of the event (Krakow, 2001). Furthermore, it was also indicated that the child victims, who are not aware of the procedure to seek help, develop long-term PTSD, anxiety, and panic attacks.
The major emotional contributor to PTSD among the sexual assault victims is the sentiment of disgrace and guilt. Since it is often hard to reconcile the actual event and its reason, the victim starts blaming themselves. Many survivors often find it hard to travel past the event, so they develop PTSD symptoms. Other major factors that contribute to the development of PTSD and panic attack among the sexual assault survivor is negative support of peers, and history of psychological illness such as depression and anxiety.
An analysis of the US National Comorbidity Survey indicates that almost 35% of individuals suffering from PTSD experience panic attacks, which is linked to a higher number of disability and multiple disorders (Cougle, 2010).
Goals
The goals for the first four sessions of this group will focus on establishing a social support group. According to (Gros 2016), finding support from other members of the group plays a major role in overcoming the negative effects of a traumatic event and PTSD. Similarly, an effective support group provides the opportunity to develop trust and a healthy relationship with others. Further, they will be helped to develop an insight into their problems and reducing anxiety. They will be taught to develop a sense of control and accept their feelings and thoughts. Moreover, the focus will on enhancing their self-esteem and confidence (Paleg, 2015). The group counselor will work to reduce the sense of powerlessness, isolation, anger, and shame.
Pre-session
Before starting the first session, the emergency contact and personal information of the participants will be collected. Basic biodata and consent forms will be signed, and after complete confidentiality and the members’ consent, the first session will be initiated. At the start of the session, each group member will introduce herself.
| SHORT-TERM OBJECTIVES | THERAPEUTIC INTERVENTIONS |
| Session One: 1. Group counselor greets, and then each group member is asked to introduce herself. Then they state the symptoms that prompted them to join the group.
| 1. The group counselor asks each participant in the group to introduce herself and share what motivates her to join the group. 2. The other members of the group are encouraged to extend support and empathize with the one sharing her thoughts and feelings. 3. The counselor further facilitates and provide a comfortable environment where the participants can face and confront their denials and rationalization or in some case, overgeneralization. |
| 2. The next step will be establishing group rules. The participants will provide verbal acknowledgment and abide by the rules. | 1. Each group member will be required to follow the group’s established rules and maintain the confidentiality of the other women, their position, and status. 2. The group members will be asked to read and sign the handout, including group rules. They will ensure the group member’s confidentiality. |
| 3. She is verbalizing the painful event. Each woman will narrate her personal experience of the traumatic event. | 1. Each group member relates to each other, and a support bond is strengthened. 2. Each member of the group will be asked to describe the intensity and frequency of their stressful emotions. 3. A baseline chart with clear identification of stressful emotions for each individual will be prepared.
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| Session Two 1. The members will be encouraged to share their concerns regarding their safety. | 1. Provide them the comfort and surety of being at a secure place. Local emergency centers and helpline will be made accessible. 2. Each group member will extend support to each other by maintaining their confidentiality and standing by each other. A healthy social support network is a key factor in building trust and confidence of in-group members. (Corey, 2013) |
| 2. Deep Breathing and Relaxation exercise | 1. Educate the group members and teach them about the Deep Breathing exercise. This is the first and most important technique to learn the control of our bodies. 2. Conduct relaxation exercises in a group and develop a sense of control over their sensations and feelings. 3. Learn to differentiate between stressed and relaxed muscles. |
| 3. Educate the members about healthy and unhealthy thoughts and create a list to identify unhealthy thoughts.
| 1. Help the members to develop an insight into how their thoughts influence their feelings. 2. Establish a sense of confidence in self-control and changing their unhealthy thoughts and feelings into positive ones. 3. Help them realize they have control of their lives.
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| Session 3 1. Develop insight into their emotional condition and identify the signs that trigger emotional distress such as panic, fear, and loss of control. | 1. Identify and explore the cues with the help of group members that trigger feelings of fear, anger, or guilt. 2. Carry out a group conversation with the participants about their feelings as well as thoughts that trigger stressful emotions. 3. Guide the members to be aware of their emotions and watch their thoughts that lead to distress.
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| 2. I am narrating the stressful or re-experiencing the event related to trauma while maintaining a relaxed posture. | 1. Encourage the participants to discuss their fears and aggression. They will learn to describe their experiences with controlled emotions. 2. Enable them to evaluate their thoughts and feelings objectively. 3. Provide them a convenient environment to share and discuss with the other members the coping mechanisms.
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| 3. Discuss the positive and negative effects of support groups and relaxation exercises. | 1. Group members will be asked to evaluate the progress and the effects of group therapy. 2. The coping mechanisms which are effective in each individual’s case will be discussed. 3. Encourage them to develop a healthy habit such as music or reading a book. 4. Monitor the change they observe, such as intensity and severity of their distress as per the baseline. |
| 4. Identification of healthy and unhealthy emotions as well as healthy and unhealthy thoughts | 1. Provide further detailed insight into healthy and unhealthy emotions. 2. Group members can discuss and come out with better coping skills. |
| Session Four 1. Reinforce the mutual support among group members
| 1. Review the impact of previous sessions and progress charts. Reconnect the group members by sharing their contacts. 2. Ensure to sign the consent form not to share the contacts outside of the group. |
| 2. Build the confidence to reduce the sense of low esteem and guilt | 1. To lessen the guilt and anxiety, confidence-building measures will be taught. 2. Participants will be made aware of their verbal as well as non-verbal communication. 3. State positive thoughts and positive statements. |
| 3. The participants will be encouraged to accept the new and confident version of themselves. They will be considering themselves equally productive parts of society. | 1. Accepting themselves and knowing their potential is very important to move forward. 2. The women participants will be encouraged to support the fellow members and be a support for them. 3. Empowering them and enable them to have a feel of an independent and constructive member of society. |
Bibliography
Corey, M. S. (2013). Groups: Process and practice. Cengage Learning.
Cougle, J. R. (2010). Comorbid panic attacks among individuals with posttraumatic stress disorder: Associations with traumatic event exposure history, symptoms, and impairment. Journal of Anxiety Disorders.
Gros, D. F. (2016). Relations among social support, PTSD symptoms, and substance use in veterans. Psychology of Addictive Behaviors.
Krakow, B. H. (2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with post-traumatic stress disorder is a randomized controlled trial. Jama.
Paleg, K. &. (2015). The Group Therapy Treatment Planner, with DSM-5 Updates. Wiley.