The myths of ‘post-disaster counselling’

After almost any large scale disaster, you’ll hear reports that rescue workers, supplies and counsellors are being sent to the area – as if mental health professionals were as vital as food and shelter.

Time has an excellent interview with psychologist Scott Lilienfeld on how our ideas about ‘post-disaster counselling’ are rapidly moving away from the ‘everyone needs to talk’ cliché due to a better understanding of mental health and resilience in the face of tragedy.

Although everyone might be shaken up after a disaster, the vast majority – between about 70% and 80% – will not have mental health problems and will not need the help of psychologists or psychiatrists.

It was initially thought that legions of counsellors were needed to work with everyone affected by the devastation to give sessions of ‘critical incident stress debriefings’ – where people are asked to describe everything that happened to them and vent their emotions – supposedly to help prevent problems developing in the long term.

Instead, studies suggested that this was at best useless and instead probably made mental disorders more likely – probably because it raises or extends the level of stress in already very stressed people.

Perhaps unsurprisingly, most disaster victims are not that interested in exploring their emotions but want to get to a safe place, find out how there friends and family are, and solve immediate practical problems. This in itself tends to make people feel better.

Consequently, new strategies involve only working with people who specifically ask for help and – instead of getting people to ‘vent’ – the focus is on reducing emotional arousal, assuring physical safety and putting people in contact with loved ones.

This strategy is often known as psychological first aid and was specifically designed to avoid the debriefing approach.

Time interviewee Lilienfeld has been key in challenging the idea that ‘everyone needs counselling’ after tragic events and has been a leader in making our disaster response a lot more effective. Highly recommended.
 

Link to Time interview on post-disaster counselling.

16 Comments

  1. Posted March 15, 2011 at 1:33 am | Permalink

    It’s been interesting to watch this research develop–and to watch the way it filters out into common knowledge. My Intro Psych students vary wildly in whether they assume that most people are resilient, or whether they expect any sort of mental distress to cause long-term trauma.

  2. Emmy
    Posted March 15, 2011 at 1:40 am | Permalink

    Great points. I think this follows the research which shows that money does not buy happiness, **unless you’re poor. I mean really, who can talk their way out of needing clean water,food and shelter?

  3. Posted March 15, 2011 at 8:40 am | Permalink

    @emmy No, duh? ;-)

  4. Posted March 15, 2011 at 11:39 am | Permalink

    Well that’s a relief. It’s always slightly worried me that, if ever I survived a disaster, I’d be forced to sit down and start blabbing about it to a complete stranger, with refusal taken as evidence of being in denial!

  5. Posted March 15, 2011 at 12:43 pm | Permalink

    I’ve heard this now a couple of times – people DON’T need to talk about it, leave them alone! I’m wondering if this goes for teens, also, who are constantly hounded to share, share, share!

  6. Ben
    Posted March 15, 2011 at 1:01 pm | Permalink

    I lived in Edison, NJ, during the 1994 gas pipeline explosion behind my apartment complex. It was a difficult few days and when I visited the shelter to get news on what to do, I was approached by “mental health workers” who assured me that if I hadn’t already, I would start to experience symptoms like depression, worries, sleeplessness, etc., and that they were there to help. Well, I had been feeling just fine until then. But suddenly I was worried and stressed! I guess I hadn’t realized that I was traumatized until they told me I probably would be. Ugh.

  7. anthony
    Posted March 15, 2011 at 10:56 pm | Permalink

    the sad part about this is while people are talking about how they feel they are denied the cathartic and human release that come naturally when you exhaust yourself in the trying to clean up the devastation. Knowing you worked days on end after such a tragic event does wonders for guilt and leaves little time for deppression and anxiety.

  8. Sam
    Posted March 16, 2011 at 8:01 am | Permalink

    I have PTSD developed during a number of years of particularly vicious stalking /harassment.

    I didn’t get the ‘benefit’ of counselling. But what happened to entrench the horrors of the chronic psychological terrorism and physical threats was that I had to repeat the problems/offences/incidents over and over again – to all sorts of mainly dismissive and callous public service workers/police who just didn;t want to spend time and other resources on apprehending the perp in a difficult case.

    Your report here explains precisely why the PTSD I suffer is so much worse than it should have been.

    Sometimes it just isn’t good to talk; sometimes it’s really vital to ‘fake it to make it’ and return to normality asap.

    But of course one can only do that when the life and property threatening offending is truly ended- that is, what would have made all the difference is for less talk and more action in actually stopping the offending. ‘A stitch in time saves nine…’

    I have to say that, given my experience of the disgraceful counselling I’ve received over the last year, your article confirms my assessment that counsellors/therapists simply makework for themselves. No one benefits but them.

    • Posted March 24, 2011 at 5:27 am | Permalink

      instead of continuing to play the victim, why not seek out help by a professional that you can trust & that can help you? Not all mental health prof. are the same…. & this article wasn’t about your OR your trauma. So, yes, I think you should continue to seek help.

  9. matt
    Posted March 16, 2011 at 6:40 pm | Permalink

    Spot on, I say.

    “…probably because it raises or extends the level of stress in already very stressed people.”

    Seems like the fact that the counselors are raising the salience of of mental health concepts like PTSD, therapy, etc… would be a good explanation for this. People are prone to think themselves sick, especially when their minds/bodies are already worn down.

  10. Charlie
    Posted March 17, 2011 at 2:06 am | Permalink

    I think it’s also important to highlight that while the majority of people may not need such counseling, there is a not insignificant minority who do. So, broad generalizations about no one needing it (or appeals to a profit motive on the part of counselors) oversimplifies the matter.

    Of course, more research is needed to uncover why it is that some people find it necessary while others don’t.

  11. Mike
    Posted March 17, 2011 at 1:29 pm | Permalink

    The counsellors do have a job in keeping the teams together and landing emotions after confronting horrific scenes.

    No, first hand I’ve seen chocked aid-personnel and third-person people needing more help to break down what they’ve seen, and that help they received from the counsellors. Everyone else were too busy carrying body parts.

    /Mike

  12. Harbo
    Posted March 18, 2011 at 4:53 am | Permalink

    An old joke:
    Q What’s the definition of a Trauma counsellor?
    A someone who makes sure you’re traumatised.

  13. Michael
    Posted March 24, 2011 at 3:58 am | Permalink

    This seems parallel to the grief and bereavement industry. encouraging people to ruminate by calling it “processing”, or “working through”.
    Validation as a comodity.

    Foolish to mistake your divorce lawyer for your therapist, and foolish to mistake your therapist for a friend

  14. Posted March 24, 2011 at 5:25 am | Permalink

    Notice how this post reads “probably” a lot? Each person is different. Each person needs different treatment. PTSD is HIGHLY expected after any type of trauma or disaster & does need treated accordingly.

  15. Posted March 27, 2011 at 11:16 am | Permalink

    it’s so. Each of us is differente. But each uf us have stress in condition of war. It’s a non human condition. the war is a ilness of humanity,shameful of civili people. Youg people die, and fall ill. All to mantai the state of power politic and economic eager. The peace is without war, and ther is not freedom without the life of young people, of all .


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