Re-experiencing Military Trauma in Groups: A Veteran's Case Study Revivre les traumatismes militaires en groupe : Étude de cas d'un ancien combattant

Although different theoretical orientations for trauma-focused psychotherapy exist, foundational to all of them is re-experiencing the trauma to explore trauma-related thoughts and emotions (Foa, Huppert, & Cahill, 2006; Paivio & Pascual-Leo ne, 2010). The underlying assumption across these orientations is that avoidance of the trauma-related thoughts and emotions leads to psychological distress. Further, by re-experiencing the trauma, new and more adaptive information is integrated into clients' emotional and belief structures.Various theoretical orientations use different interventions to facilitate reexperiencing trauma. For example, prolonged exposure-a cognitive-behavioural orientation-utilizes imaginai exposure (Foa, Hembree, & Rothbaum, 2007). During imaginai exposure, clients recount the trauma in the present tense, recalling as many specifics as possible, and the therapist facilitates specificity by asking the client to recall omitted details. This narrative is repeated until the client experiences reduced distress due to habituation to the memory. In cognitive processing therapy-another cognitive-behavioural approach-clients write their trauma narrative and, with the therapist, utilize the written account to identify and alter maladaptive beliefs related to the event (Resick, Monson, & Chard, 2007).In psychodynamic orientations, therapists often use the therapeutic relationship to explore the experience and meaning of traumatic events (Kudler, Krupnick, Blank, Herman, & Horowitz, 2009). For example, a psychodynamic psychotherapist may use transference to bring traumatic reactions into the present for interpretation, processing, or other purposes. In emotion-focused therapy, therapists use imaginai confrontation (IC)-the client speaks to the offender in the trauma as if the offender were sitting across from the client (Paivio & PascualLeone, 2010). IC facilitates eliciting the client's thoughts and emotions toward that person and the event to explore and resolve the negative emotions related to the self, offender, and trauma.The vividness of re-experiencing has been found to mediate psychotherapeutic outcome. Across therapeutic orientations, higher levels of feeling emotions in one's body during psychotherapy predict better outcomes (Bohart, 1993; Hendricks, 2002). In a related line of research, the degree to which therapists focus on hotspots-the most distressing moments of the trauma memory-predicts clients' posttraumatic stress disorder (PTSD) symptom reduction (Nijdam, Baas, Olff, & Gersons, 2013). Taken together, this literature indicates the importance of creating and evaluating interventions for re-experiencing trauma memories.THERAPEUTIC ENACTMENT: A GROUP-BASED INTERVENTIONTherapeutic enactment (TE) is a group-based intervention used to vividly reexperience traumatic events (Westwood & Wilensky, 2005). Prior to the group, one or both group therapists meet with each group member to identify the most distressing trauma (i.e., the index trauma) and the surrounding events. Together, the client and therapists plan and construct the scenario to be enacted so the therapists are aware of what the enactment will be and thus able to actively direct the trauma scene. This further facilitates clients' vivid experiencing during the enactment; because the group therapists instruct, organize, and plan the sequencing of events throughout the TE, clients can focus on their present experiences. In the group session, six to eight group members take turns enacting their index traumas (we have conducted TEs in several-day-long retreat-style groups and in more traditional once-a-week group sessions over several weeks). While description and evaluation of programs that utilize TE as one of several interventions have been presented elsewhere (see Cox et al., 2014), the present article focuses solely on TE.With the assistance of the group members, therapists recreate the index traumatic event of one group member (hereafter referred to as the lead) at a time. …

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