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Book Review   |    
Trauma Recovery and Empowerment: A Clinician's Guide for Working With Women in Groups
Anne C. Bauer, M.D.
Psychiatric Services 1999; doi:
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by Maxine Harris, Ph.D., and the Community Connections Trauma Work Group; New York City, Free Press, 1998, 413 pages, $32.95

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I wish that when I was the new clinical director for an inpatient treatment program for women, I had a guide such as Maxine Harris' Trauma Recovery and Empowerment. This easy-to-use volume offers a practical, step-by-step psychoeducational approach to leading a group for traumatized women.

What makes this guide so user friendly is that it is the product of a collective effort by numerous clinicians and participants associated over five years with women's groups at Community Connections, a private, not-for-profit mental health clinic in downtown Washington, D.C. The impetus for developing a group intervention for traumatized women is stated by the authors: "Like so many others, we found that we could not effectively deliver the services we were mandated to provide without addressing the often overwhelming histories of physical and sexual abuse that our clients have suffered and survived."

Adding to the uniqueness of the group intervention described in this book is that it was designed by and for some of the most disenfranchised, disabled women treated in the public mental health system. Most of the epidemiological research and literature on treatment of trauma-related mental illness is not about recipients of public mental health services. Therefore, this approach, which is designed to be used with traumatized women who are in a variety of settings and who may be homeless, incarcerated, dually diagnosed, or psychotic, is valuable to any clinician who works with such women.

Although the authors indicate that Trauma Recovery and Empowerment was written for practicing clinicians, they consciously avoid the use of diagnostic and treatment-related language. They write that the trauma survivors in their groups usually did not view their abuse, past or present, as their primary problem. In addition, the authors imply that the women rarely thought of their problems as DSM-IV diagnoses, even though many of them were long-time users of public mental health services. They typically thought of themselves as "sad, bad, or mad."

The book is usefully organized into sections corresponding to a phase-oriented approach to trauma recovery work that has been well described in the literature on treatment of trauma-related psychiatric disorders. Part 1 focuses on topics of self-empowerment. Each topic is intended for a weekly 75-minute group. A rationale for each topic is provided, drawn from an understanding of the impact of trauma on self-development and theories of women's psychological development such as the self-in-relation model. Goals, agenda, exercises, and even leader's notes for each session are offered.

Topics for sessions in part 2 of the group work involve participants' taking a closer look at their personal history and the impact of abuse. Included is a session for exploring whether participants had experienced abuse in mental health treatment settings when secluded and restrained, overmedicated, treated like an object, or even sexually exploited. Parts 3 and 4 build strategies for safety and continued self-growth and end with closing rituals for the group work. Additional sections describe how the groups can be modified for male trauma survivors, incarcerated women, women with severe mental illness, and those who are abusive.

This guide to working with trauma survivors is filled with common sense and practical tools and is based on a solid theoretical framework. What is missing is any significant discussion of what is meant by recovery and any data on outcomes from the group intervention. Given the caliber of the Community Connections clinical group, one hopes that further work on the subject of Trauma Recovery and Empowerment is forthcoming.

Dr. Bauer is clinical director of the Maine Department of Mental Health, Mental Retardation, and Substance Abuse Services in Augusta.

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