A Vital Choices reader well-versed in the subject had cogent comments on our article about trauma counseling
Last week, we published an article about the effects of counseling on victims of traumas, including car accidents and the like.
The article, titled “Post-Trauma Counseling? Thanks, but No Thanks,” focused on the generally negative scientific reviews of trauma-counseling efforts.
And it featured the results of a Web-based survey of Americans who claimed to have been negatively impacted by the terrorist attacks of September 11, 2001.
Our overall impression was that much of what passes for post-trauma counseling provides no benefit and can often be counterproductive.
We received a thoughful letter in response from experienced Marriage and Family Therapist Sheryll Thomson, and wanted to share it with our readers.
I have appreciated so much your information on nutrition and illness from your emails and on your website and have forwarded many to others.
I scanned your article on trauma therapy and find it is lacking in some respects. I was a therapist trained in trauma therapy for many years (therapist for 25 years; trauma training and practice for over ten years).
This study is useful as far as it goes, but it doesn't give anyone, especially therapists, an idea of what to do instead.
This study shows no differentiation between “counselors” who have been trained in trauma therapy and those who have not. This is an important difference.
There is an assumption, in the article, that “venting” or reliving a trauma or expressing emotions about it is helpful in itself. We now know it is not, and may re-traumatize a person. Yet, there are many counselors who think that it is, and 'go for' emotions (and I think the study shows that), when it would be far better to go for containment and education and just sitting with a person (such as at the site of a disaster).
I was trained in trauma therapy, disaster mental health and CISD, but do not use them in the ways suggested in this article. The counselors or therapists who used “venting” or going for the emotions, at disaster sites need training in other approaches:
Regarding disaster mental health, sitting with a person, helping them with physical needs, making calls for them, advocating for their needs, giving them accurate information about their plight and their surroundings and what to expect, is the most helpful.
Red Cross Disaster Mental Health training advocates these things. I once knew a therapist who installed himself behind a counter (“the therapist is IN” approach) waiting for people in a disaster relief center to come to him. This was unhelpful. He must go out to people, tell them he is a professional and ask what they need; sit with them if that is all there is to do. Listen. Do not advocate for remembering the moment of disaster… do not wait behind a counter, either.
Regarding CISD (Critical Incident Stress Debriefing), I was trained in this approach and used it in a dozen of a variety of situations.
But I found myself only using the aspects which are educational, such as informing each person of what to look for in the way of symptoms in the coming weeks, handing out a list of symptoms, for instance, and telling them the most important thing in any trauma, that PTSD is a normal reaction to an abnormal situation, so that they can go to a trauma therapist if they need to without considering themselves “mentally ill” if symptoms get worse or persist.
I have heard the Army talk about PTSD as 'mental illness', which does nothing to encourage individuals who need help badly to get it.
I saw that, especially in the case of groups who normally work together, that actively presuming to use this one-time situation as a therapy group would be inappropriate and possibly everlastingly embarrassing. So I didn't use it as an opening-up situation, rather as an informative one, and if they wanted to talk about the incident, fine.
Regarding Trauma Psychotherapy, there are some very good approaches and one, the one I used for ten years, before my retirement, is Eye Movement Desensitization and Reprocessing (EMDR; see www.EMDR.com).
[Editor's note: EMDR enjoys substantial, albeit mixed, evidence of efficacy. Although eye movements are its most distinctive element, EMDR is a complex therapy containing numerous components.]
PTSD need not last forever. Therapy need not take years.
Going for emotions is not the way. Building the person's constructs, strengths, internal structures must be done first before “allowing” (not demanding or forcing or eliciting) emotions, which may simply overwhelm.
I hope this helps. The study may be right in terms of what the (uninformed) counselors on 9/11 and other scenes did and the outcomes that ensued, but it leaves out what professionally-trained trauma therapy can do.
See the International Society for Traumatic Stress Studies (www.istss.org) for more information on these important, international and cross-disciplined approaches.
Therapists and counselors can and should be trained specifically in trauma therapy approaches if they are going to work with trauma in their clients. And, at disasters, therapists should have taken Red Cross (or other) disaster training so they will know what to do and not to do in such a situation.
It is very much too bad that many graduate psychology institutions (and psychiatry also) do not teach trauma approaches.
I don't know when they are going to catch up; there are many therapists who went to school before trauma training was available (about 1991 or ‘92) and still use what doesn't work.
Very sincerely yours,
Sheryll Thomson, MFT
(Marriage and Family Therapist)