Counselling can add to post-disaster trauma

New Scientist: Counselling can add to post-disaster trauma

The counselling routinely offered to people in the immediate aftermath of a disaster seldom protects them from developing post-traumatic stress – and it could even delay their recovery.

This is the conclusion of a comprehensive review of the “single-session debriefings” offered to victims straight after an incident. In single-session debriefings, a counsellor talks to a victim to help them learn about and prepare for any psychological problems they might encounter later.

Such briefings are still used by mental health professionals, although less so in Europe. But the review by a British team suggests it can exacerbate stress in some individuals who might otherwise have recovered normally, either by talking with friends and family or by blocking out any recall of the incident until they felt ready.

You know the routine. Something blows up, someone gets shot up, or someone gets mashed by something. All of the sudden, there are “grief counsellors” running all over the town, helping people get through something they were perfectly able to get through 50 years ago, but apparently aren’t able to handle today.
One-to-one debriefings might not always be appropriate, particularly for individuals who have undergone medical or surgical trauma, agrees George Everly, emeritus chairman of the International Critical Incident Stress Foundation based in Ellicott City, Maryland.

But he points out that group counselling, where a number of individuals who have been through a major trauma are counselled together in a structured environment, remains vitally important. The authors of the latest study accept that they have not yet been able to evaluate the validity of this alternative technique.

I happen to agree here. I think that part of the reason you do see more shellshock today than 50 years ago is because the personal support network is weakening. I come from a big extended family. Grief has never been a major issue for me. When someone dies, fifty or more people converge on the survivors. There isn’t a bunch of psychobabble about “the grieving process”. You have a bunch of people who take care of the everyday things — cooking, cleaning, washing — while the survivors do what they have to do for the funeral arrangements. Everyone sits around and talks about the dead, and you say what you need to say to put it behind you.

What I see as the problem with these one-on-one debriefings is that you segregate someone out, tell them, “Here is what is going to happen” and then you toss them right back into the everyday routine, and they don’t just do this for the immediate family — they do it for the entire support network. Where in my family someone would be preoccupied with keeping up the house for the survivors, they become one of the immediate survivors. When an uncle dies, I spend most of my time comforting the aunt, and then a little time on myself. Given the grief counseling approach, I would be spending most of my time on myself. Why should I worry about my aunt? I’m grieving too!

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