From practical experience, (as discussed in a previous blog entry: Staff Voices: Integrating Deployment Experiences - The Process Group as a Critical Resource ), I am a staunch advocate for use of the process group format as an exceedingly useful resource and/or addition to the individual psychotherapy/psychopharmological treatment protocol for Service members who have deployed. As noted previously, the group provides an ideal “space” in which Service members who have deployed are able to engage in the critical process of integrating their deployment experiences into the self (versus avoidance and/or suppression). Today I’d like to continue to expand upon my support of this treatment avenue. More specifically, I would like to report an observation as well as present a challenge to the community of mental health providers who serve the needs of military men and women who have deployed.
Towards the end of 2011, throughout 2012, and throughout 2013, I had consistently averaged 10+ individuals in attendance for my “Men’s Post-Deployment Group.” The number of referrals to the group, the number of individuals reporting interest in attending, as well as a low attrition rate, made it necessary to establish a second such group in August 2013. The second group quickly filled to capacity (10-15) and both groups have consistently averaged 12 to 14 participants weekly. Interest in attending the group has remained high and referrals from service providers continue to trickle in with reports from Service members of their “satisfaction” with the group. Consequently, a third weekly Men’s Post-Deployment Group will be started in January 2014 and, given the interest shown to date, will undoubtedly fill to capacity in short order.
My “observation,” as mention earlier, is that…”something is working” that gives participants a sense of satisfaction with this particular group process. Service members are attending and returning to group. Providers from a number of Carelines (aside from Outpatient Behavior Health) within the Military Treatment Facility (TBI, Social Work, Inpatient, etc.) are referring their individual treatment patients to the group regularly. The group is not compulsory and as I state to participants, “You can spend 5 minutes or 5 months in the group; if it doesn’t work for you, feel free to quietly leave and no one will think much of it.” They rarely do.
There are many questions. What is it that works? Why do Service members attend this post-deployment group when other such attempted groups go defunct or never really establish a consistent following? Is it the group leader? Is it the group format and protocol for processing pre-deployment, deployment-related, and post-deployment adjustment experiences? How about the time of day that the group is held? Is it because a significant number of participants are in the Warrior Transition Battalion and feel that they must find something to do with their time? Is there a treatment effect?
I conducted a literature review in an effort to understand what has been done related to the topic and perhaps the most significant of the limited materials available was an article titled “Efficacy of Group Treatment for Posttraumatic Stress Disorder Symptoms: A Meta-Analysis” conducted by Sloan, Denise M.; Feinstein, Brian A.; Gallagher, Matthew W.; Beck, J. Gayle; Keane, Terence M. [Psychological Trauma: Theory, Research, Practice, and Policy, Vol 5(2), Mar 2013, 176-183]. This article described “a meta-analysis of published randomized clinical group trials for adult survivors of trauma.” The authors’ finding that group treatment is better than no treatment is relevant and to that end, leads me to my second point which is: for the sake of providing effective and appropriate treatment protocols for our valiant men and women who have placed their lives on the line for our freedom (and lived to tell the tale), it is our responsibility as clinicians to ensure they are being dutifully care for when they access the services we provide. The fact that “something” is being facilitated, which seems to compel participants to present for and actively engage in the group process, should not go unnoticed. “It” is working and “it” should be examined and explored. As indicated above, many questions regarding the impact of the post-deployment group as structured and facilitated by this provider go unanswered. However, one question has been answered: Will Service members attend if they “perceive benefit” from the experience? The answer is a clear and resounding “Yes.”
The process group experience seems to be as appropriate a clinical outlet to “treat” deployment related symptomology as any other clinical approach. Is it? I would go so far as to argue that it is a necessary element allowing for a pseudo “natural” processing of experiences with like-minded individuals (a process known to be beneficial in establishing and maintaining good psychological health). The challenge then, given the success that I have experienced with Service members’ interest in participation, is to ramp-up our efforts to establish the Group Process as an efficacious and understood element of the treatment protocol for addressing the symptomology of Service members who have deployed.
Given that this is a blog based on my own observations, it would be interesting to hear the thoughts and experiences of other clinicians related to this topic. Please, feel free to comment below.
Dr. Anthony McCormick is a Deployment Behavioral Health Psychologist at Dwight D. Eisenhower Army Medical Center at Fort Gordon, Georgia. In this capacity, he provides behavioral health treatments interventions aimed at resolving the clinical issues and mental health concerns of Service Members. Additionally, he serves as a faculty member, instructor, and long-term supervisor of the Medical Center’s Clinical Psychology Internship Program.