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Native American Community Session 1: Care for the Self, Family, and Community

Overview
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Session 1: Care for the Self, Family, and


Community

Goals
• Describe the purpose, principles, and topics of the HOPE-NY groups
• Create safety within the group
• Discuss “Community Trauma,” stress reactions to traumatic events, “Historical
Trauma & Responses,” and “Care for the Self, Family and Community”
• Introduce and begin skills training related to care for the individual, family, and
community

Session Components Minutes


Introduction & Review of Group Guidelines 10

Introductory Activity with Check-In 15

Curriculum Module, Questions, & Discussion 75

Relaxation Exercise 5

Care Activity 10

Wrap-up/Brief Socialization/Conclusion of Session 5+


Total Group Time 120
Facilitator Peer Supervision 30

You will need


• Ball of yarn or twine
• Handouts (optional): “Building Community Strength through Caring” and “Care Plan
for Self, Family, and Community”
• Drinks & snacks (common to the culture of the participants)
• White poster paper, easel or tape & markers

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Native American Community Session 1: Care for Self, Family, and Community
Manual Instructions
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Session 1 Outline Minutes

Group Introduction & Review of Group Guidelines 10


• HOPE-NY and Agency Relationship
• Group Objectives
• Desired Outcomes
• Principles of “Integrative Psychoeducation”
• Session Topics
• Group Guidelines: Respect, Openness, Participation, Education, & Sensitivity
Introductory Activity with Check-In 15
• Check-in and Web Activity
▪ What is your name?
▪ What do you like to do when you want to relax?
Curriculum Module 75
• Building community strength through caring
• Community trauma and historical trauma
• Trauma signs and reactions
• Group survivorship and care
Questions & Discussion
• How do you define community?
• What traumas have your community experienced?
• How would you describe your reactions to historical trauma?
• How does stress and trauma affect your health, ability to work, family life,
religious belief, etc.?
• How do you, your family, and your community continue to survive?
• How do you care for one another?
• Have you found meaning within this community trauma?
Relaxation Exercise 5
• Progressive Relaxation
Care Activity 10
• Participants identify a personal care activity to practice before the next group
Wrap-up/Brief Socialization/Conclusion of Session 5+
Facilitator/Peer Supervision 30

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Native American Community Session 2: Grieving Toward Healing
Overview
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Session 2: Grieving Toward Healing

Goals
• Explore the idea that grieving is a necessary part of the healing process
• Understand normal and expected grief reactions following a trauma
• Identify and assess losses experienced in the wake of trauma
• Increase coping skills while living within a culture affected by trauma

Session Components Minutes


Welcome & Review of Group Guidelines 10

Check-In 15

Curriculum Module, Questions, & Discussion 75

Relaxation Exercise 5

Care Activity 10

Wrap-up/Brief socialization/Conclusion of session 5+


Total Group Time 120
Facilitator Peer Supervision 30

You will need


• Handouts (optional): “Care Plan for Self, Family, and Community” and “Care
Strategies”
• Drinks & snacks (common to culture of participants)
• White poster paper, easel or tape & markers

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Session 2: Grieving Toward Healing
Session Outline
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Session 2 Outline Minutes

Welcome & Review of Group Guidelines 10


• Session Topic: Grieving Toward Healing
• Group Guidelines: Respect, Openness, Participation, Education, & Sensitivity
Check-In 15
• Review progress with last week’s chosen care activity
• Discuss reactions to negative examples of relaxing (e.g., drinking)
Curriculum Module 75
• Grief: definition, characteristics, and expressions
• Types of loss: external, internal, and aspects of self affected by trauma
• Ambiguous loss
• Grieving as a part of healing and growing: active grieving, active coping,
constructing meaning, hope building, and positive outcomes of trauma
Questions & Discussion
• Have you been grieving? What does this look like or feel like?
• During your grief, have you experienced certain losses?
• What does healing look like for you?
• How could allowing yourself to grieve help in healing
• Is there something that might be helpful to you in the process of grieving and
coping during this time?
Relaxation Exercise 5
• Hand massages
Care Activity 10
• Select strategies that foster healing and growth to practice before next
meeting
Wrap-up/Brief Socialization/Conclusion of Session 5+
Facilitator/Peer Supervision 30

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Native American Community Session 2: Grieving Toward Healing
Session Outline
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Introduction and Group Guidelines 5 Minutes

I. Welcome and Introduction


• Set the tone as one that is safe, caring, relevant and helpful
• Briefly review the previous group
• Describe current group topic

II. Group Guidelines

Description
• Respect: respect for each other’s opinions, differences, experience
• Openness: openness to new ideas and different experiences
• Participation: being “here,” listening, sharing, and/or participating in activities in ways
that feel safe to you
• Education: openness to, and participation in, learning
• Sensitivity/Confidentiality: respecting what is talked about in the group and not
repeating specific stories or identities but rather concepts learned in the group

Agreement to Adhere to Guidelines


• Ask for feedback and additional group guidelines
• Ask participants to agree to the group guidelines
• Remind group that each participant has signed the certificate of confidentiality

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Native American Community Session 2: Grieving Toward Healing
Check-In
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Check-In 15 Minutes

Facilitator Note:
• Make sure everyone who wants to participate has the opportunity to do so. Those
who do not want to participate do not have to
• Determine how the participants are doing emotionally and use this information to
adjust the group if necessary
• Help problem solve for those who are having difficulty practicing their care activities
Encourage the incorporation of the group skills into everyday life

Directions
• Each participant “checks-in”
▪ How he or she has been doing since the group last met
▪ How they have found their chosen care activity to be helpful or difficult
• Discuss reactions to negative examples of relaxing (e.g. drinking too much)

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Native American Community Session 2: Grieving Toward Healing
Curriculum Module
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Curriculum Module 75 Minutes

Facilitator Note:
• Use simple language and check regularly for participant understanding
• Avoid unnecessary or harmful uncovering and self-disclosing
• Be sensitive to the types of losses that people have experienced

I. Grief

• Do you feel you are or have been grieving, and what does that look or feel like for
you?
--Or for groups where members have had a direct loss—

• All of you have experienced the loss of a loved one. What was that experience like?

Define Grief (Stroebe, 2001)


Grief is a reaction (physical, emotional, mental and spiritual) to major loss. In grief we
• Cope with existing tasks and new demands (Schaefer & Moos, 2001)
• Feel the pain and sadness that comes with the separation or consequences of the
trauma
• Reconstruct meaning and rebuild previously held assumptions (Fleming & Robinson,
2001)

Characteristics of Grief (Lukens et al., 2004; O’leary, Alday, & Ickovics, 1998;
Stroebe et al., 2001)
A major loss changes us. In readjusting and redefining our lives, grief is a part of
healing in the context of a “new normal.”
• Normal and expected reactions to loss
• Many ways we can feel, think, and act
• Can move from one reaction to next and back again
• Can vary from person to person
• Can get “stuck” in grief, interfering with day-to-day life

Grief Expressions
• Shock • Overwhelming sadness
• Disorganization/confusion • Loss and loneliness
• Anger • Relief
• Up and down emotions • Rebuilding
• Guilt

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Native American Community Session 2: Grieving Toward Healing
Curriculum Module
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Over time, grief reactions can include more pleasant thoughts of the person or
circumstances that were lost.

II. Types of Loss

Facilitator Note:
• Use the manual to add to the discussion when necessary
• You may want to highlight “Aspects of Self Affected by Trauma”

• During your grief have you noticed that are experiencing certain losses?

Types of Loss Experienced in the Wake of Trauma (Stroebe, 2001)

External Losses
• A loved one • Economic security
• A life-style • A belief system
• A role • Loss of place (home, work)
• A job/work community

Internal Losses
• Self-esteem and mastery • Loss of freedom to travel
• Dreams for the future • Loss of love
• Loss of a belief system • Loss of feeling that you can protect
• Pleasure in the lost person’s life and others from harm
success

Aspects of Self Affected by Trauma (Saakvitne, 1996)

World Views
• Politics • Spirituality
• Identity • Meaning of life
• Family • Feelings/attitudes towards others
• Community

Ability to care Financially, Emotionally, and Physically


• For oneself
• For family, friends, community

Ability to Relate to Others

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Native American Community Session 2: Grieving Toward Healing
Curriculum Module
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

• Safety
• Trust
• Intimacy/Closeness
• Control
• Esteem

Feelings
• Inner strength
• Emotional stability
• Physical reactions

III. Ambiguous Loss (Boss, 1999; Boss et al., 2003; Lukens et al., 2004)

There can be uncertainty about loss with no resolution gained through grieving.
• A loved one could be missing (e.g. a soldier missing in action)
• A person can be physically present but psychologically absent (e.g. persons with
Alzheimer’s, a person who is substance dependent)

IV. Grieving as a Part of Healing and Growing

Facilitator Note: IMPORTANT


• Be sensitive to the group’s “readiness” to discuss “healing and growth”
• If not ready, postpone topic until session 3
• If ready, before discussing “healing and growth” you may consider holding a moment
of silence in honor of the members’ experiences
• Weave into the discussion the pathways to healing and growth

• What does healing look like in your current situation?


• How can allowing yourself to grieve help in healing?
• Is there something that you think might be helpful to you in the processes of grieving
and coping during this time?

Active Grieving
• “Confronting and attempting to understand the loss of a loved one or another loss
[promotes growth]...” (Nerken, 1993)

Active Coping

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Native American Community Session 2: Grieving Toward Healing
Curriculum Module
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

• Social support, active problem-focused coping (Shaefer & Moos, 1992)


• A desire for help, motivation to change, establishment of personal goals (Miller and
C’deBaca, 1994)
• Optimism, extroversion, a sense of personal power (Tedeschi & Calhoun, 1995)
• Flexibility, determination, willingness to take risks (Aldwin, 1994)

Constructing Meaning
• Reorganizing one’s understanding with help (Hager, 1992)
• With the help of therapeutic relationships, personal motivation and insight, social
support, and self-esteem (Mahoney, 1982)
• Comparing one’s own situation to that of other people, and practicing faith and
spirituality (O’Leary & Ickovics, 1995)

V. Hope Building

Definition of Hope Building (Farran, 1995)


• Connectedness • Uplifting memories
• Goals/aims • Cognitive strategies
• Spiritual/philosophical beliefs/practice • Refocused time
• Affirmation of worth • Hope objects
• Personal attributes • Uplifting energy
• Lightheartedness

Facilitator Note:
• Highlight the responses that indicate participants are finding new meaning; are
actively engaged in grieving; are actively coping

Positive Things that Grow out of Trauma and/or Crisis


It is expected that as a person grows after a trauma there will be confusion, feeling of
being off-balance, coming to the end of old ways to cope (Hager, 1992; Mahoney,
1982; Tedeschi & Calhoun, 1995).
• New skills • Reordering of priorities
• Improved relationships • Accumulating wisdom
• Changed perspectives • Gaining a new appreciation for the
• Greater empathy helpfulness of others
• Increased self-understanding • Setting new life goals
• Finding more meaning or purpose in
life

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Native American Community Session 2: Grieving Toward Healing
Relaxation Exercise
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Relaxation Exercise 5 Minutes

Hand Massage Exercise

Facilitator Note:
• Use a calm, soothing tone of voice
• Encourage clients to be physically comfortable
• Allow clients to do what they need to feel safe
• Model the exercise while monitoring clients’ needs
• Let clients readjust to the group slowly

Directions for Easier Relaxation


• Acknowledge to participants that it can be difficult to clear our minds and pay
attention to one thing
• Assure participants that it is okay if their minds wander
• Encourage them to return to focusing on their hands when they notice they have
drifted away
• Encourage participants to get into a comfortable position
• Participants to close their eye if they feel comfortable doing so (if not, instruct
participants to let their eyes relax and focus on the floor)

1. Gently massage or touch your own hands


2. Focus on how your hands feel
3. Clear your mind of any other thoughts

• How do you feel after this exercise?


• When could you use this exercise outside the group in daily life?

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Native American Community Session 2: Grieving Toward Healing
Care Activity
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Care Activity 10 Minutes

Facilitator Note:
• You may choose whether to do this activity before or after the relaxation exercise
• You may also choose to do the relaxation exercise at the beginning of the session,
and wrap up the session with the care activity
• At any session, you may choose to distribute the following handouts:
“Care Strategies”
“Care Plan for the Self, Family, and Community”

Directions
• Separate participants into pairs or conduct the activity as a group
• Ask participants to choose and share one care activity that utilizes the healing
strategies
• Ask participants say when and where they plan on using the care activity
• Ask participants to practice the chosen care activity until the next session

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Native American Community Session 2: Grieving Toward Healing
Wrap-Up
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Wrap-Up 5 + Minutes

Directions
• Encourage participants to practice their chosen care activity until the next session
• Encourage participants to use the relaxation exercise throughout the week
• Remind participants of the next session’s topic, time, and date
• Introduce the brief socialization period for participants before they disperse

Facilitator Note:
• If possible, provide snacks and drinks
• Allow a person to participate at the level he or she feels comfortable
• If problems arose during the session, one of the facilitators can go outside of the
room with the involved participants to discuss
• If a participant needs to talk briefly with you after the session, do so if possible

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Native American Community Session 2: Grieving Toward Healing
References
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

References

Brave Heart, M. Y. H. (1998). The return to the sacred path: Healing the historical
Trauma and historical unresolved grief responses among the Lakota through a
Psychoeducational group intervention. Smith College Studies in Social Work,
68(3), 287-305.

Churchill, W. (1997). A little matter of genocide: Holocaust and denial in the Americas,
1492 to the present. San Francisco, CA: City of Lights Books.

Duran, E., Duran, B., Brave Heart, M. Y. H. (1995). The trauma of history. In R.
Thornton (Ed.) Studying Native America: Problems and prospects. Madison, WI:
University of Wisconsin Press.

Farran, C. J. (1995). Hope and hopelessness: Critical clinical constructs. Thousand


Oaks, CA: Sage Publications.

O'Leary, V. E., Alday, C.S., & Ickovics, J.R. (1998). Models of life change and
posttraumatic growth. In R. Tedeschi, Park, C.L., & Calhoun, L.G. (Eds.),
Posttraumatic growth (pp. 179-215). Mahwah, New Jersey: Lawrence Erlbaum.

Saakvitne, K. W. (1996). Transforming the pain: A workbook on vicarious


traumatization. New York: W.W. Norton & Company.

Stroebe, M. S., Hansson, R.O., Stroebe, W., Schut, H (Ed.). (2001). Handbook of
bereavement research: Consequences, coping and care (1st ed.). Washington,
DC: American Psychological Association.

Yellow Bird, M. (1998). A model for the effects of colonialism. A summary report
submitted to the Office for the Study of Indigenous Social and Cultural Justice.

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Native American Community Session 3: Giving and Receiving Care
Overview
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Session 3: Giving and Receiving Care

Goals
• To explore the concepts of giving and receiving care
• To explore the healing aspects of giving and receiving care
• To explore the difficult aspects of giving and receiving care
• To help participants access social support

Session Components Minutes


Welcome & Review of Group Guidelines 10

Check-In 15

Curriculum Module, Questions, & Discussion 75

Relaxation Exercise 5

Care Activity 10

Wrap-up/Brief socialization/Conclusion of session 5+


Total Group Time 120
Facilitator Peer Supervision 30

You will need


• Tissue boxes (2)
• Handout (optional): “Care Plan for Self, Family, and Community” and “Care
Strategies”
• Drinks & snacks (common to the culture of the participants)
• White poster paper, easel or tape & markers

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Session 3: Giving and Receiving Care
Manual Instructions
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Session 3 Outline Minutes

Welcome & Review of Group Guidelines 10


• Session Topic: Giving and Receiving Care
• Group Guidelines: Respect, Openness, Participation, Education, & Sensitivity
Check-In 15
• Review of progress with last week’s chosen care activity
• Discuss reactions to negative examples of relaxing (i.e. drinking)
Curriculum Module 75
• Care
• Receiving care
• Giving care
• Current care/social support needs
• Tangible aid
• Relational support
• When care/support is needed: everyday vs. crisis support needs
Questions & Discussion
• What is care? Are there unique practices of care within your
culture/community/family?
• What does giving care look like? What interferes with giving care?
• What care in the form of social support do you feel you and your family need?
• What type of “crisis support” do you feel you and your family need?
Relaxation Exercise 5
• Stretching
Care Activity 10
• Select strategies that foster healing and growth to practice before next
meeting
Wrap-up/Brief Socialization/Conclusion of Session 5+
Facilitator/Peer Supervision 30

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Native American Community Session 4: Future Planning and Strength Building
Overview
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

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Native American Community Session 4: Future Planning and Strength Building
Session Outline
Integrative Psychoeducation Principles
Resilience in the context of community trauma
Collaborative community of care across systems
Information dissemination—knowledge as power
Culturally relevant processes, content, and context

Session 4 Outline Minutes

Welcome & Review of Group Guidelines 10


• Session Topic: Future Planning and Strength Building
• Group Guidelines: Respect, Openness, Participation, Education, & Sensitivity
Check-In 15
• Review of progress with last week’s chosen care activity
• Discuss reactions to negative examples of relaxing (i.e. drinking)
Curriculum Module 60
• Introduce future planning and strength building: definitions, potential needs,
future planning steps, benefits of future planning
• The Seventh Generation Native American future planning
Questions & Discussion
• In what situations do you think you need help? What has and has not helped
in the past? How did you get help?
• Based on your experience in this group, what have you learned that might help
you manage your crises in the future?
• What are the positive and negative practices of your culture that impact the
future generations? How do these affect the Seventh Generation?
• Whose support can be enlisted in planning for the Seventh Generation?
• How can we overcome difficulties in planning for the Seventh Generation?
• How can we use ideas discussed in this group to help us with the planning for
the Seventh Generation?
Relaxation Exercise 5
• Listening to ambient sounds
Care Activity 10
• Discuss realistic care skills participants can use in upcoming/potential crises?
• Discuss how participants will communicate with persons about stressors/crises?
Termination 20
• Participants discuss their experience in the group and include any parting
words
Wrap-Up/Brief Socialization/Conclusion of Session 5+
• Set up transition session appointments
Facilitator/Peer Supervision 30

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