Automatic crisis counselling interventions do not work

I have always been sceptical about the usefulness of providing trained counsellors to help those impacted by incidents of major trauma. It is almost commonplace, nowadays, to hear in news reports that trained counsellors have been drafted in to help deal with the emotional carnage following a major incident. Such considerations for those affected may indeed be well intentioned but that is not the point. I have often wondered if such decisions to draft in a cadre of specialists might actually be counter-productive for the resilience of those affected by such events.

I was interested, therefore, to hear the recent statements from the President of the Royal College of Psychiatrists when he cautioned against the automatic provision of crisis counselling interventions for those affected by major public incidents including the recent terrorist attacks in Manchester and London.  Sir Simon Wessely, a specialist in the treatment of post-traumatic stress disorder (PTSD), believes that research has demonstrated that the routine screening of survivors as a way of seeking to find those most in need of psychological support has proven to be ineffective.  The research indicates that a policy of implementing routine counselling could potentially traumatise those who would otherwise have recovered from their experiences. There was a wider risk of “professionalising distress”, he cautions, in encouraging those going through sadness or grief to think there was something wrong with them,

This reminded me of the time when I worked at a national charity, offering a telephone sign-posting service for people affected by problem gambling. Managers would offer a debriefing telephone consultation (which alarmingly usually involved one’s line manager providing the debriefing) immediately following a shift in the misguided belief that debriefing was an appropriate tool of self-care to support helpline advisors to cope with potentially difficult material. They would almost pressurise people to take advantage of the debriefing service and there was little awareness of the risks associated with such early interventions or that such support, if it is to be effective, should be voluntary.

Most people who have been affected by major incidents will benefit from a normal healing process whereby they learn to cope by using their own support networks. The research would appear to show that affected individuals mostly get better by talking to and sharing experiences with friends, family and colleagues. Sir Simon suggests that only a minority will need specialist help and such need will only become evident after a period of what he terms “watchful waiting” (which could be a period of up to 12 weeks when the needs of individuals are properly assessed).

The provision of early counselling for those affected by major public events may, of course, be well intentioned. However, early counselling risked overwhelming survivors as well as possibly interfering with psychological defence mechanisms, which aim to protect against too much reality and horror. There is also a risk of pathologising distress and potentially undermining the resilience of individuals, if there is a rush to intervene too early. Further, with the power of suggestion, there is a risk that individuals might experience possible ill-effects merely from the thought that they might occur.

The people who need reassurance might be those who have unresolved and unprocessed trauma from the past which gets triggered by witnessing major public incidents of disorder. The risk for such individuals is that they will feel unsafe and might seek to engage in unhealthy safety seeking behaviours as a way of avoiding the heightened feeling of threat. In such instances it is vital that these people have the support to go about their business in a normal way and help in dealing with their hyper-vigilance. Therapy can help with dealing with historical trauma, acknowledging cognitive distortions as well as helping to reconnect with an internal safe place.  But crisis counselling should not be the first thing we think about for those who were unfortunate to witness the unpleasantness associated with major public incidents.

See also

Kings College study on returning soldiers