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Communication | Creativity | Commonsense
In my work with intimate partner violence and abuse I have become more and more interested in trauma and traumatic experience, and its role in the transmission and perpetration of abusive behaviours. A fascinating article recently appeared that suggests evidence for the transmission of traumatic experience at a genetic level, and which is I think of real relevence to the intimate partner violence and abuse field.
In 2014 I began a conversation with a colleague and psychodramatist about working with a population where traumatic stress can literally be a very ‘live issue’: military veterans experiencing Post Traumatic Stress Disorder (PTSD). My colleague had a huge amount of experience in Australia working with the veteran population. Australia has been far ahead of the Uk for a number of years in this field, with a range of programmes.
Both of us knew the power and unique advantages of the three dimensional, kinaesthetic approach of psychodrama for working with trauma, linking to research on brain plasticity and processing of traumatic memory. Bessel Van der Kolk has been one of the leading researchers and practitioners in the field of work with trauma for decades, and in his latest book, The Body Keeps the Score, foregrounds experiential work. He is not a psychodramatist but writes very positively abut drama and theatre based work with trauma and veterans.
My colleague and I both felt that the UK Government and Department of Defence response to veterans had not been entirely sufficient, and we were keen to make a contribution to alleviating the distress experienced by this group as a result of their traumatic experience, whatever the political context surrounding their deployment. However, we also knew that suggesting a psychodrama-based programme addressing acute PTSD was too big a first step, and so we set out to develop a programme for veterans and partners experiencing relationship difficulties, but drawing where possible on our joint psychodramatic psychotherapy approach.
During 2014 we created a week long intensive residency we titled re:group. While it was in development we approached Help For Heroes, a leading UK veteran’s charity, to guage interest. Help for Heroes have worked wonders in the area of physical rehabilitation, and developed a suite of services; the development potential lay in enhancing their offer for psychological rehabilitation. The charity was extremely open to what we were offering, and agreed to run a pilot programme, eventually scheduled for early 2015.
Screening
We developed a screening process which built on Help for Heroes' existing documents, but also addressed areas of traumatic experience. This process of negotiation for the final form of the assessment was a struggle sometimes, but ultimately successful. One innovation was to try and take a more strength-based, positive psychology stance in the way areas of interest were assessed. We then conducted telephone interviews separately with each half of an interested couple, assessing phenomenologically (from their persepctive) what they saw as the issues, and what their goals of attending might be.
I was certainly grateful that guided by my colleague, we had negotiated the inclusion of exploring a number of areas of traumatic experience in the screening. Even though there was no requirement that participants discuss their experience, this enabled us to exclude a couple where the traumatic experience was simply too close and too raw safely to be addressed in the group.
The programme
Re:group was residential, and an intense experience. Client confidentiality means that I am limited in what I can describe, but there was a range within the group from individuals demonstrating quite a high degree of PTSD symptomology (nightmares, flashbacks, hyper-vigilance), to those with a good degree of recovery but still experiencing some symptoms, to those with no PTSD symptoms, but encountering relationship difficulties.
The programme took a primarily cognitive-behavioural and psycho-educational approach, with group inputs on depression, negotiation, and communication among other things. One of the most challnging elements for people was the presentation on PTSD by Help for Heroes staff; this was a very triggering experience for the majority of veterans in the group, even though, as said, most of the group had moved on from their original diagnosis.
One central issue was the concept of militarization. A theme in the group was the ‘grey area’ between military and civiian culture, and the group could furnish many examples of where the inculcated military ‘black and white’ thinking and efficiency of the veterans - which is absolutely functional in a military concept - could cause difficulties when applied within a civilian relationship context. To address this, we had a high degree of future-focussed work, creating a vision of changed positive relationships drawing on the work of John and Julie Gottman with couples, a rather transformative focus encouraging the joint vision that is necessary to a relationship.
One of the most interesting sections for me was when we moved beyond the psycho-educational and more towards the psychodramatic. One session looked at support desired and provided by partners. A female partner wished to explore her prevaricating responses. With me initially 'in role' as the female partner we created a 'live' scene where she was enabled to explore her behaviour and identify her needs.
The magic of psychodrama meant that we were able to help the female partner identify and model what support she would want from her partner (essentially a great big hug, of great emotional significance) and then physically bring in the male partner to replace me in his female partners' role, taking on the physical stance she had modelled. This enabled him to experience empathically her ‘role perspective ‘ – what her need and the fulfilment of it felt like in her shoes.
Through further psychodramatic magic we were then able to bring the original female partner back to her role as 'herself'. When asked who could take the role of her supporter she of course identified her male partner, and a beautiful brief scene followed where she was able to experience receiving, and he able to experience giving, the open physical contact and support identified as a change goal by both.
From my perspective, working with this specific client group was a stretch, and I feel like we had some major successes with a very challenging group. The group was small in number, which had an amplifying effect on the relative ‘weight’ of group members: in a small group one person who is very hard work is not diluted or potentially supported in the way that they are with a larger group, where a number of people may be in a similar position.
Outcomes
Even though we had put together a fairly extensive battery of psychometric evaluations for pre and post the residential group,and people very willingly took time to fill these in, the group was too small for any evaluation results to reach the level of statistical significance. The qualitative feedback however was very positive, with some participants commenting that the week had ‘saved their relationship’, equipping them with extremely useful, functional tools for communication and negotiation, and a clear vision of what they wanted to achieve in terms of individual and joint relationship goals.
This latter point has real parallels with Choosing to Change, the motivational input developed by Ignition for Relate, and which included a segueway where male and female partners' individual goals needed to ‘come together’ to create a joint plan, but with room for the infidvudal.
For the future
The pilot of re:group completed in early 2015, and a brief follow up for couples was delivered in August. Help for Heroes see real value and felt strongly that the programme has clarified the need for an input for couples addressing these relationship issues. Their intention is to integrate the focus of the re:group programme into the ‘in house’ suite of Help for Heroes interventions for psychological rehabilitation.
Certainly it solidified my sense of the potential of psychodrama as a trauma informed approach to therapy with veterans, which is not currently being done anywhere in the UK as far as I am aware, and I am pleased to have played a role in this development.
To come back to the focus of intimate partner violence and abuse, the process of researching and delivering the programme further solidified for me the importance of understanding and working supportively with, previous trauma.
