Report on a group therapy for supporters stationed in disaster-stricken areas*Reference: Japanese Association for Group Psychotherapy“Group Psychotherapy”,31(2): 221-227, 2015
Mitsuaki Katayanagi

Keywords
Great East Japan Earthquake, assistance to supporters stationed in disaster-stricken areas, grouppsychotherapy, mental health care activities, medium- and long-term support
Abstract
Despite it being more than four years since the Great East Japan Earthquake, there are still many residents who
have no choice but to live in temporary housing facilities. Supporters in various fields have been engaged in support
activities for these victims in disaster areas, but it is thought that there is still a long way to go for recovery, and assuch, support for care workers is essential. There are care workers in Minamisanriku Town in Miyagi Prefecture
who has been watching over and otherwise supporting residents moving into temporary housing. The author has
assisted these care workers by utilizing group meetings. This paper reports on the development of support activities
for a team of care workers. This support showed that the existence of venues where care workers can voice their
sentiments as care workers reduced their psychological burdens.
It also showed that the support provided in the mid- to long-term period after the earthquake had an equallyimportant to support provided immediately after the disaster.
I. Introduction
Four years after the Great East Japan Earthquake, disaster areas have seen considerable progress in theestablishment of public housing in many coastal municipalities, and recovery has finally begun in earnest.
However, there are still numerous residents who are forced to live in temporary housing. There is still a longroad to recovery, and the psychological burdens borne by residents are ongoing. Support for these types ofresidents has come in various forms. Care worker support must be maintained for these to continue.
Incidentally, one form of care worker support after the earthquake was the establishment of groups where care
workers speak among themselves about their experiences to help understand each other. Takabayashi (1997)
discussed “report meetings”, established by rescue workers in disaster areas after the Great Hanshin-Awaji
Earthquake as a form of group therapy. Discussions on group-based support by Fuji et al. (2010) stated that there
were three objectives for group-based support, including the sharing of mutual experiences as disaster care
workers, or having a place to discuss hardships. In these ways, group-based approaches have been used as a formof care worker support following a disaster, but initiatives until now have been established relatively shortly after
the disaster and there are no reports on those that were established during the mid- and long-term period following
a disaster.
With this in mind, this paper reports on the progress of group-based support for care workers that were engagedin activities during the mid- and long-term periods following a disaster and provides a discussion on these topics.
II. Prior to the start of “Group Meetings”
The author had worked at the Kesennuma regional center of the Miyagi Disaster Mental Health Care Center(henceforth, “Center”), which provided support for affected regional residents and its care workers in Kesennuma
City and Minamisanriku Town of Miyagi Prefecture and the group-based support reported in this paper was oneof the activities conducted by this center. These support activities have been referred to as “group meetings”, sothey will be referred to as such.
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Group meetings were designed for care workers who provide support for residents in temporary emergency
housing in Minamisanriku town. The daily work duties of these support staff were to visit individuals amongresidents in temporary housing who needed observation, confirm their physical status and lifestyle conditions
with regards to the body and mind and provide consultations regarding lifestyle difficulties. Furthermore, when
specialized support is needed, these care workers served as a bridge to municipal public health nurses andgovernment and so they held important roles by closely supporting the lifestyles of residents in various forms.
Next, the background of care workers is discussed. The primary duties of care workers were earlier mentioned
as visits to residents, but currently, the period that residents have remained in temporary housing has become
extended, and it is thought that the pain and struggle that residents have carried have increased and exacerbated.
Maintaining the mental health of the care workers themselves as they continued to provide support to residents
under these environments was essential, and it is for this reason that support was deemed necessary. Additionally,
support staff in Minamisanriku Town were residents, and many of them had suffered from the disaster themselves.
They are many who were employed in completely unrelated professions before the earthquake but are now
working as support staff due to the disaster. It is thought that even more support for these support staff is requiredconsidering their roles after having gone through such experiences. With this in mind, it was decided that groupmeetings would be started with the objective of discussing work- or lifestyle-related issues among care workers.
Tanabe (2012) mentioned that there is sufficient value in staff members who are engaged in disaster support or
specialists who have had some form of disaster experience in the past coming together to establish groups so thatthey can manage mental health. The region is undergoing the mid- to long-term phases of the Great East Japan
Earthquake, but a large amount of disaster area and resident support is ongoing in affected regions, so it is essential
to enact initiatives that utilize groups in the same affected areas for care workers.
There are support staff teams in each district of Minamisanriku Town, so analyses were conducted with each team.
Below, the activities that a given support staff team has conducted until now are presented. Virtually all of the support
staff on this team are women, with a wide age range between 30 and 60 years. There are usually around 10 individuals
in a single team of support staff.
II. Group meeting overview
Group meetings were conducted with the support staff at work that day and the center staff, including theauthor. The hosting date of the group meetings was pre-arranged so that as many support staff could attend as
possible, but there was some support staff that could or could not make most meetings based on work schedulearrangements.
A single group meeting was convened for one hour. The location was held at the support staff office, also
referred to as a satellite. The author acted as the facilitator for all meetings. The sessions were initially held oncea month but after a time, they were held once every two months. Group meetings were usually started with thecomment, “We often forget our feelings or thoughts during our busy lives, but please use this time to be awareof those sentiments and discuss anything that you would like to discuss”. The topic was allowed to be on anything,ranging from professional to personal aspects. The facilitator sought to advance the sessions in a supportive yet
accepting manner, focusing on topics raised by support staff. Center staff also reflected on the session before andafter the group meetings.
IV. Group meeting progress
1 Session 1 (Month Y, Year X)
Note that all session progress recorded henceforth is based on the activity records written at the time andthe memories of the author and staff.
There were eight support staff and three center staff present at the first meeting. It was the first time forthe author as well to meeting all support staff together in this manner. Once everybody introduced themselves,support staff spoke about all of their support activities conducted until that point, and afterward, the topic
switched to trends in lifestyle reconstruction of residents who are moving into temporary housing and how
support should be in the future. Topics not only included those on residents, but also lifestyle problems andfuture uncertainties held by the support staff themselves. There was a wide range of support staff
personalities: some spoke frequently, others spoke when spoken to, and still, others hesitated to speak even
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when spoken to.
At the end of the group meeting, support staff participants mentioned that “the staff usually talk among
themselves regarding the physical conditions or lifestyles of residents, but they’ve never talked about
themselves in this way, much less have time for that, so it was nice to listen to each other’s stories that they
otherwise don’t hear about”.
2

3

4

5

Session 2（Month Y+1, Year X）
There were eight support staff and two center staff present. There was some overall awkwardness among
the participants, perhaps because the previous session was the first, so once everybody first spoke about
what has been on their minds in a circle, a free-form discussion was started. During this session, support
staff spoke at length on issues regarding lifestyles in temporary housing. Support staff mentioned that “theywere not sure what would happen to temporary housing following requests from landowners to return theirland. In those cases, what will the support staff do once they need to live even closer to neighbors that they
don’t get along with”. While they function as support staff by day, once their duties are done, these
individuals must live their own lives as victims and their struggles and difficulties in life were on full display
during this session.
Session 3 (Month Y+2, Year X)
There were eight support staff and two center staff present. This session had few comments overall, andthere were many quiet periods. The author also mentioned, “Maybe it’s because everybody is a bit tired, but
a today is a quiet group”. After this comment, the staff members mentioned that one individual among themwill be transferring to another satellite in the following month. This specific support staff member was notpresent at the session that day, but the other members mentioned, “I don’t know what to say to the staff
member”, “I’m glad that it’s not me who’s moving, but I still feel sad” and “I wonder what is going through[the moving support staff member]’s mind right now”. Finally, the support staff mentioned how flimsy
structure of the foundations and floors of the temporary housing facilities and the coldness of the coming
season.
After this session, meetings were held once every two months. A reason cited by the support staff was thatonce a month was too frequent, and they wanted a frequency where they would have enough to talk about at
each session.
Session 4 (Month Y+4, Year X) There were eight support staff and two center staff present. The staff support
leader was absent from this session due to other activity obligations. Additionally, one support staff memberthat was newly stationed at this satellite due to staff reassignment participated in this session for the firsttime. This staff member mentioned that it took all their energy to become accustomed to their new
surroundings, to which the other members mentioned that “after all, transfers happen out of the blue”.
However, the conversation moved on from the staff transfer and comments such as, “I’m worried about theincoming snow”, “there are few men among support staff”, “the sun sets early and it makes me uneasy”,
and “I’m usually alone for Sunday work, and it’s also at a different location. It’s difficult to switch mentally”.
Session 5 (Month Y+6, Year X) There were six support staff and two center staff present.
There were talks to be held next month to facilitate discussions regarding ongoing work for the next fiscal
year and the support staff leader mentioned that “they were curious to see what everyone felt about theinterview with the center supervisor for ongoing work in the following year”. In response, there were many
comments made on this issue, including, “I’m nervous”, “I still have documents I need to provide beforehand,
so I can’t even think about next year” and “I haven’t even heard about how many people will be hired fornext year”. Afterward, there were additional comments, such as, “the new years’ period is the first time I’ll
have five days off”, “vacation times are busier for me. Even if it’s temporary housing, I still need to do water
offerings and prepare mochi”, “I couldn’t do anything since temporary housing was too small, but now thatit’s been rebuilt, I’ve been able to do more” and “the amount of work for those where clients visit and thoseare dispatched is completely different”. Then, a staff member mentioned, “During the new year, many
children in the area often received new year’s gifts from adults in the neighborhood, but these were all
washed away by the earthquake and tsunami. Many adults went back home to get their valuables and were
washed away as a result”, after which everybody fell silent. As the session time was nearing its end, the
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group meeting was concluded at this point.
Session 6 (Month Y+8, Year X)
There were eight support staff members and two center staff present.
When support staff was asked about how the interviews which were mentioned during the previous groupmeeting session went, they responded, “Thankfully, everybody was able to continue”. When asked if “theyfeel relieved”, they responded that “next is staff reassignment”, and the staff members with previous
reassignment experience mentioned, “the last assignment was sudden. I had three days to prepare”, and that
it was difficult for the new residents to learn who the support staff was. Afterward, one of the support staff
who was usually silent mentioned, “Sometimes I just want to quit. I can’t stand listening to the residents
anymore and I feel so discouraged. I don’t want to interact with other people. I feel like support staff always
has to be the perfect person”. In response, other support staffs were completely in agreement, with somestating the same sentiments, and others mentioning, “It’s good to let it out”, and “I worked in the service
industry, so I don’t feel that way”. Afterward, the topic changed to the self-care activities of each memberof the support staff.

V. Discussion
Although the number of sessions was limited to only six, some discussions on these regularly conductedgroup meetings will be presented here.
① Having a place where support staff can “speak” as support staff
These group meetings were designed so that support staff “speak”, and other support staff “listen” tothese words as support staff, but statements that left a strong impression were the following: “they’ve nevertalked about themselves in this way, much less have time for that, so it was nice to listen to each other’s
stories”, and “I can’t stand listening to the residents anymore. I feel like support staff always has to be theperfect person”. It is thought that these remarks highlighted the imbalance between the “speaking” and“listening” inherent in their roles as support staff.
One of the activities of support staff is visiting residents in temporary housing, but here, support staff
inevitably take up the “listening” role. Every single day, support staff take in all of the residents’ lifestyleconcerns, anxieties, irritation, lack of clarity for the future, etc. In Minamisanriku Town, many support staff
themselves were affected by the disaster and their living in temporary housing is the same as the residents
they visit, but because they are support staff, they are required to “listen”, not “speak”.
There are tea sessions known as “Ochakko Salons” hosted for residents in various disaster areas, but there
have been no instances of similar support provided for support staff. In other words, they do not have a place
to “speak”.
This is not a simple case of having no opportunities to speak. Due to their role, the reality of support staff
is that they are not allowed to say what they want to and even if they have a variety of thoughts or feelings,
they must tuck it away and continue to act as support staff. Under such circumstances, these individuals needsome form of “container” that accepts their unique background of acting as both a victim and supporters.
For these reasons, it was believed that regularly providing support for support staff, where residents whoare support staff can “speak”, and residents who are support staff “listen” to these “spoken” words.
② Meaning of groups for support staff during the mid- to long-term periods following a disaster – takeaways
from the present initiatives Next, the meaning of the groups for support staff conducted during the mid- to long-term periods
following a disaster will be discussed from the perspective of the present initiatives
During these group meetings, support staff talked about and incorporated:・ the chronic stresses that come as a result of being both a victim and support staff,
・accepting the recovery of a town and reconstructing their own lives and・ accepting changes in their roles and work content as support staff.
Generally speaking, it seems that support staff often spoke about events that frequently change and occur－ 170 －

close to them as the huge tide that is recovery flows through the region. These voices reflected the shocking
realities and sights that have no doubt would have been discussed in speaking sessions among support staff
immediately after the earthquake, their feelings of powerlessness and emptiness against those realities, theseemingly gentle recovery which comes in contrast to those realities, and the reality of living in a world
where they cannot resist these monumental changes. Their dual nature of being both a victim and support
staff influenced their perspectives as well. It was felt through the various remarks made by individuals thatthey expressed how they ended up where they are today by facing the earthquake against which they werepowerless, and moving forward one step at a time, but Yalom et al. (1989, 1991) believe that this process ofsteadily accepting what is happening by “existential factors”, which were raised as treatment factors, can beinterpreted as group support. Fuji et al. (2010) has mentioned that the possibility of neighboring regions,schools, and workplaces in a community coming together to discuss and understand mutual experiences andfeelings in the aftermath of a disaster is a characteristic of group psychotherapy, but disaster area conditions
become individualized and complex as they enter the mid- and long-term periods after a disaster and thefatigue of support staff subsequently increase as well. Support staff support using groups are thought to bejust as important during the mid- to long-term periods as they are immediately after the earthquake.
VI. Summary and challenges
A minor discussion was presented following a reflection on support staff support using group discussion.
These initiatives were shown to have value not only during disasters or following a disaster, but after these
periods as well.
However, challenges remained. One example was during the initial group meeting, when one of the support
staff mentioned, “I was able to listen to stories from other support staff that I had never heard before”. This
could have been interpreted as a positive statement, but there was a significant fear at the time that the initiative
may have disrupted the balance between support staff that has been heretofore maintained. This is thought toreflect how these initiatives had inadvertently created two groups, despite being the same support staff team,
where one group that was involved in these initiatives, and another group was within those who are engaged indaily activities, and that these groups had already begun to mutually influence each other. Research on theeffects of group-based support will need to pay attention to the development of these influences.
Another point regarding the effect of group-based support was determining to what extent did holding
meetings at a frequency of once every two months decrease the psychological burdens of support staff. Initially,
the group meetings were conducted at a frequency of once every month, but the frequency was changed to once
every two months upon request by the support staff. From the author’s perspective, it would have been ideal tohave increased the frequency, but even today, support staff are overwhelmed with work, and increasing thefrequency under conditions where support staff is constantly engaged in activities and workshops was thought
to potentially even increase the psychological burdens borne by support staff. With this in mind, it is also
important to find ways to provide small but steady support in the mid- to long-term periods of recovery. In
either case, the fact that only six sessions were conducted severely limits the extent of conclusions that can be
made. We would like to continue group-based support, and further the discussion on reducing psychologicalburdens in support staff in the mid- to long-term periods of recovery, and afterward as well.
＜ References ＞
１） Fuji, N., Takamori, K., Tahara, A. （2010） Disaster and mental health: considering the role of the
conductor.Group Psychotherapy, 26（2）, 125-128.
２） Takamori, K. （1997）Hazards and group psychotherapy for rescue workers during a large-scale earthquake.
Group Psychotherapy（1）, 15-20.

３） Tanabe, H. （ 2012 ） Mental health and PTSD during the Great East Japan Earthquake. Group
Psychotherapy 28（1）, 24-31.
４） Vinogradov,S. and Yalom,I.D.（1989）Concise Guide to Group Psychotherapy. New York: American
Psychiatric Press. Kawamuro, Y. (translator).（1991）Group Psychotherapy. Tokyo: Kongo Shuppan.

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ABSTRACT
Report on a group therapy for supporters stationed in disaster-stricken areas
Mitsuaki Katayanagi*
Key words: the Great East Japan Earth quake, assistance to supporters stationed in disaster-stricken arias,
group psychotherapy, mental health care activities, medium and long term support
In spite of the fact that it has now been more than four years since the Great East Japan Earthquake struck,
there are still many people who have no choice but to live in temporary housing facilities. Supporters in various
fields have engaged in support activities for those sufferers in the disaster stricken areas, where recovery is
expected to still have a long way to go, and therefore any assistance to the supporters for the disaster victims
is indispensable. Some of the supporters have been watching over and protecting the victims living in
temporary housing facilities in Minamisanriku-cho, Miyagi. The author has provided assistance to those
supporters through utilizing a group meeting. This paper reports on how the assistance activities for a term of
supporters have developed. This approach proved that it was important to ensure a setting of reducing supporters’
psychological burden where they could share their thoughts and feelings. It also showed that the support
activities implemented this time over four years after the disaster was no less important than those done rightafter the disaster.
J. Jpn .Assoc. Group Psychother.31:222-227,2015* Miyagi Disaster Mental Health Care Center Note) Original text

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