Group EMDR in Ōtautahi Christchurch

How Does Eye Movement Desenstitisation and Reprocessing (EMDR) Work in a Group Context?

Before training in the group traumatic episode protocol (G-TEP), we had wondered how it was possible to work through traumatic memories in a group setting. The G-TEP was developed by Elan Shapiro to work with groups impacted by negative life-changing events with ongoing consequences (Lehnung et al., 2017). There is growing evidence that it is effective in reducing posttraumatic stress disorder (PTSD) and other mental health problems. For example, studies have indicated that engaging in the G-TEP significantly reduced rates of PTSD and depression in samples of refugees (Lehnung et al., 2017; Yurtsever et al., 2018). Other research found this approach was effective in reducing distress related to vicarious trauma and negative affect with mental health professionals (Tsouvelas et al., 2019). Closer to home, new research conducted by the Aotearoa Whakaora Recovery Group has shown improvements in depression and PTSD scores for survivors of sexual abuse and Cyclone Gabrielle (Neuenfeldt et al., in press).

What is the G-TEP?

The G-TEP is highly structured, and people in the group do not share their trauma memories with each other at any time. Participants are screened to ensure they are able to self-regulate their stress levels to a minimum degree. They receive an A3-sized worksheet that they work on throughout the group. Participants are led through stabilisation and containment exercises, including developing a safe/calm place or state exercise, and connecting with a positive past resource or a time that they felt good about themselves. They identify a desired future statement about how they would like to think back about the trauma event or episode (e.g. ‘I survived’, ‘I am safe (enough) now’), which they review at the end of the memory processing work. Participants subsequently draw or write down a part of the trauma memory to work on. They then engage in EMDR reprocessing using bilateral stimulation involving following their fingers moving between two marks on their page signifying the date today and the written or drawn symbol of the memory they are working on. The group is guided through this process multiple times by the facilitators and rate their subjective units of distress (SUDs) as they proceed. The session concludes by running through stabilisation and containment exercises.

Our Experiences With the G-TEP

In Ōtautahi, we were lucky to have Astrid Katzur train clinicians in the G-TEP after the 2019 mosque attacks. She then ran several G-TEP sessions for members of the Muslim community. Octavia volunteered to assist for one of these groups and saw how the G-TEP worked in reality. Subsequently, Octavia set up a G-TEP group for birth trauma in Christchurch, which ran multiple times throughout 2020 and 2021. Participants reported positive feedback and distress scores were reduced for the majority of participants. Annabel helped with this group and became inspired to use the G-TEP in more settings. Barriers we noticed included finding clinicians to volunteer their time to assist with running groups, and funding issues (it was free for participants to attend). The difficulties of this pro-bono model meant that it has been shelved for now.

Since 2020, Annabel and Octavia have offered the G-TEP approach to therapists to assist in treating vicarious trauma. These groups have not only been helpful for us (when we attended as participants), but have also been positively received by other attending therapists. In 2023, Annabel focused on developing a G-TEP group called Restore EMDR Group Therapy. So far, it has been running for Accident Compensation Corporation (ACC) Sensitive Claims clients, who are survivors of sexual trauma. We gained confidence to proceed based on positive results in both the Kāpiti EMDR Group and Whakaora Recovery Group, who run G-TEP groups in this context. Group members are met for a pre-group screening ahead of time to establish if the group will be a good fit. Then, the group is run by two clinicians over 2 hours once a week for 5 weeks. Clients continue to work with their ACC therapist alongside the group. To date, Annabel, Octavia, and clinical psychologist Brigette Gorman have run three groups with between six and 10 clients per group. More groups are planned to commence in 2024.

Results

For the most part, group participants’ ratings of distress reduced over time. Feedback from clients emphasised that at times they found the processing work intense, but helpful at reducing overall distress about their traumatic memories. In addition, some described finding it powerful to be in a group context with people who had experienced similar events. One client planned a trip overseas once the group had finished to meet a new grandchild, which their symptoms of PTSD had previously prevented them from considering. We are also contributing data for research with the Whakaora Recovery Group. This research is gathering qualitative and quantitative data assessing pre- and post-treatment effects of engaging in G-TEP groups in New Zealand, including for PTSD and depression symptoms (Neuenfeldt et al., in press). With supervision, Annabel has added elements of Tikanga Māori^[1], including starting and ending with karakia^[2], and increasing time spent on whakawhanaungatanga^[3], with positive feedback around this from kiritaki^[4] (please note, these terms are everyday words used in New Zealand, but we have added explanatory footnotes if needed).

Challenges and Looking to the Future

In our opinion, some challenges of doing G-TEP work include a lack of awareness among clinicians about the safety and clinical utility behind G-TEP. Practical issues include finding appropriate locations that are relatively quiet and can seat a group of clients at a table to accommodate their worksheets and have a second breakout room with space to see clients one-on-one during the group if they need extra support. Working out the funding model for seeing clients in a group format and managing possible dropouts from the group are other practical issues. However, the possibilities for currently under-served client groups who could be reached by G-TEP are numerous and we are excited and optimistic about these possibilities.

Implications for Practice

In our current context where demand for psychological services is high and clients struggle to find a therapist, let alone one trained in EMDR, the use of the G-TEP offers huge benefits. It has the ability to reach a wider number of people and reduce their distress in a shorter amount of time. It can be used as an adjunctive treatment for clients who are working longer-term with a counsellor trained in another modality, as done in Restore EMDR Group Therapy. It is evidence-based and has shown effectiveness across multiple client groups, with high levels of trauma. We would encourage therapists to seriously consider training in the G-TEP.