Utility of group treatment for trauma‐affected refugees in specialised outpatient clinics in Denmark: A mixed methods study of practitioners’ experiences

Abstract

Objective Group treatment (GT) is proposed as a relevant and cost‐effective intervention for trauma‐affected refugees. Due to heterogeneity in symptoms and culture, GT with trauma‐affected refugees is also assumed to pose certain challenges. The aim of this study was to explore practice‐based experiences and gather recommendations from practitioners working with GT of trauma‐affected refugees. Methods This sequential, explorative, mixed methods study included 32 practitioners with GT experience, representing all outpatient clinics in Denmark providing specialised treatment for trauma‐affected refugees. The study was conducted in two strands. Strand 1 comprised two questionnaires assessing characteristics of and experiences with various group programmes. Strand 2 comprised five semi‐structured interviews, which elaborated on findings from Strand 1. Descriptive statistics were applied on quantitative data. Qualitative data were analysed using thematic analysis. Results Group treatment is widely utilised and most practitioners reported favourable treatment experiences. Groups were applied for varied purposes, most often psychoeducation, and organised in various ways. Practitioners experienced treatment guided by patient‐centred clinical objectives, such as interpersonal learning, as more meaningful and effective than treatment primarily aimed at accommodating administrative aims such as cost‐effectiveness. Interpersonal dynamics were identified as a significant challenge and potential advantage in GT of trauma‐affected refugees. Careful inclusion and establishment of safety were among factors identified by practitioners as beneficial for treatment delivery. Conclusions The findings support the potential of GT for trauma‐affected refugees. Results can be used to inform group programmes and inspire further empirical research in this area.

Moving Forward: New frontiers in treatments for psychological trauma

“…In particular, this sequential mixed methods design by Brochmann et al. () based in Denmark raises some valuable questions about working with groups of refugees, many of whom have experienced multiple traumas. This study does not aim to identify which kinds of therapeutic interventions may be more or less effective in working with refugees, due to the heterogeneity of experiences and cultural perspectives of different groups.…”

“…One of the key issues that Brochmann et al. () highlight is the essentialness in groups of creating a sense of safety as a basic starting point. Creating a felt sense of safety for traumatised clients is often considered to be a pre‐requisite to engaging in the specific “trauma processing” elements of a therapeutic intervention and has been one of the foundational premises for working both individually and in groups with clients.…”

“…The key components identified by Brochmann et al. () for creating a safe environment were to ensure a degree of predictability , such as by providing suitable information and establishing agreed group rules, being transparent about the boundaries of confidentiality , and structuring clear expectations that specific trauma narratives would not be addressed. Typically, a phased approach to working with complex PTSD is recommended (Cloitre et al., ), which initially focuses on supporting affect regulation, management of dissociation through grounding and stabilisation, and enhancing a sense of safety (Bisson, Cosgrove, Lewis, & Roberts, ).…”

“…Notably, in the group work discussed by Brochmann et al. (), the specific work of trauma processing was considered to be best addressed in conjunctive individual therapy. One of the things that perhaps marks out CRM from this traditional “phased” approach is that developing safety, stabilisation and resourcing are considered integral to the model itself, with these being intertwined throughout therapy (Schwarz, Corrigan, Hull, & Raju, ).…”