Sunday, May 12, 2013

Is Trauma Counselling Actually Harmful?

 It seems standard these days that survivors of traumatic incidents of man-made or natural disaster are quickly whisked into trauma counselling.   It seems pretty intuitive - people are traumatized, people get counselling.

A report from The Observer claims new studies show counselling can actually worsen mental health outcomes for trauma victims.

One of the largest earthquakes ever recorded hit on Boxing Day 2004. The resulting tsunami devastated huge swaths of the Indian Ocean coastline and left an estimated quarter of a million people dead across Indonesia, Sri Lanka, India and Thailand. Aid agencies quickly arrived to help battered and traumatised survivors.

...the World Health Organisation promptly did something it has never done before or since. It specifically denounced a type of psychological therapy and recommended that it shouldn't be used. The therapy was a single session treatment called "psychological debriefing", which involved working with disaster victims to encourage people to supposedly "process" the intense emotions by talking through them in stages. It was intended to prevent later mental health problems by helping people resolve difficult emotions early on. The only trouble was that it made things worse. Studies had shown that people given post-disaster psychological debriefing were subsequently more likely to suffer mental health problems than people who had had no treatment at all.

Guidance from the world's most influential health authority had little effect, and the therapy was extensively used. The reluctance to do things differently was tied up with some of the least-appreciated facts about our reactions to disaster. In our trauma-focused society, it is often forgotten that the majority of people who experience the ravages of natural disaster, become the victims of violence or lose loved ones in tragedy will need no assistance from mental health professionals.

Most people will be shaken up, distressed and bereaved, but these are natural reactions, not in themselves disorders. Only a minority of people – rarely more than 30% in well-conducted studies and often considerably less – will develop psychological difficulties as a result of their experiences, and the single most common outcome is recovery without the need of professional help. But regardless of the eventual outcome, you are likely to be at your most stressed during the disaster and your stress levels will reduce afterwards even if they don't return to normal. Your body simply cannot maintain peak levels of anxiety.

It's a thought-provoking article.  It wouldn't be the first time that conventional wisdom made things worse while thinking it was making them better.   Remember blood-letting?

3 comments:

Purple library guy said...

The schtick ever since Freud has been if you have a problem you're supposed to talk and think about it a bunch, in an attempt to figure out why it's bugging you and "get past" it.

Well, maybe there's cases for that. But certainly for something like this, you know why it's bugging you--you endured bad shit and maybe nearly died. You don't need to be spending all your time thinking about that. Just keeps the trauma alive. If you want to do good for someone who's feeling crappy about bad things happening, don't pay for a shrink, pay for a concert or something.

The Mound of Sound said...

I agree, PLG. The Christmas after my mother died my father came to spend the holidays with us. It was a wonderful thing to be together in the wake of that loss.

One day Dad was reading the local paper and asked if we could go down to the Salvation Army for their "Blue Christmas" service. We didn't have much choice but to go.

It was wonderful and very moving. Imagine, a Christmas service for those who had recently lost a loved one. It was incredibly positive, a celebration of the life lost and a renewal of hope for the future. I'm not religious but it was an incredibly restorative experience.

It wasn't about victims or grief abatement but acceptance of what was, appreciation of what had been and embracing a future.

Damn I think the Sally Annes ought to have a franchise on grief.

Anonymous said...

Ridding the mind/body of negative feelings associated with traumatic memories is why a person can move on.

Without that "deletion" the negative feelings just sit there ready to rear their ugly heads, whenever ...

(Big business taking advantage of that tiny,little fact).

I use a technique called PSTEC. Easy enough to find online. And easy to implement in a self-help way.

Beats the keep-'em-coming-back-blame-therapy hands down, and in a fraction of the time.