June 21, 2007 12:00am
TRAIN disasters, floods, and now the Melbourne shooting - ghastly traumas dominate our news. Behind the scenes a small army of counsellors is making a living from the emotional fall-out.
When Victorian police emerged from the grisly task of sorting through the mangled Kerang train wreck they were immediately whisked away for trauma debriefing, to prevent any lasting effects on their psychological health.
At least that's what the counselling was supposed to do.
But it doesn't work. This type of trauma debriefing – or critical incident stress debriefing – is now discredited.
The Australian Centre for Post-traumatic Mental Health (ACPMH) has just released new guidelines on post-traumatic mental health – which have been given the tick of approval by the National Health and Medical Research Council.
The first of these guidelines spells out that psychological debriefing should not be offered on a routine basis. That's a mighty blow for the large numbers of debriefers – or "trauma vultures" as they have been called, who for the past two decades have been peddling this type of group psychological counselling as the salve for post-traumatic ills.
Yet evidence has been mounting that venting inner turmoil immediately after a trauma is not only often unhelpful but can sometimes make things worse.
There's solid research – studying survivors of earthquakes, motor accidents, bushfires, victims of assault, burns, dog-bites, emergency workers as well combat experiences such as grave diggers and soldiers in the first Gulf war.
With studies showing debriefing sometimes increases the likelihood of post-traumatic stress disorder (PTSD), a review recommended compulsory debriefing should stop.
This doesn't mean leaving traumatised observers to battle with demons on their own.
What's needed is psychological first aid, say the guidelines, where survivors of potentially traumatic events are supported, their immediate needs met and monitored over time to see who runs into problems.
Most people who experience a traumatic event recover on their own with the help of family and friends.
Within a few weeks it is possible to tell who is likely to run into long-term problems – if they are having trouble sleeping, feeling highly anxious or distressed, using alcohol, drugs or gambling to help them cope or having difficulty expressing feelings or relating to other people.
That's when they need expert clinical help – which the guidelines say should involve five to 10 sessions of trauma-focused cognitive behaviour therapy, a treatment found to be highly effective in helping people regain psychological health (see http://www.acpmh.unimelb.edu.au).
But the large numbers of grief counsellors involved in the debriefing industry are battling hard to persuade their employers their skills are still needed.
Having attached themselves to a range of work forces – schools, banks, ambulance services, fire departments, and other emergency work forces – they now cling tenaciously to their hosts, fighting for survival.
Professor Grant Devilly from Swinbourne University's Brain Science Institute warns some are still doing debriefing under the guise of the recommended psychological first aid.
The landmark legal case – Howell v SRA – is used to convince employers that their services are required under law.
Yet this case – in which a railwayman received damages after he developed PTSD when the SRA offered only telephone counselling following a railway track suicide – makes the case for proper treatment as recommended by the guidelines, rather than debriefing.
So, beware the misguided trauma vultures and voice your protest if your child's school reacts to a tragedy by rounding up all the children for post-trauma counselling.
It's far better that children talk to their own teachers and their parents and those who don't want to talk be left alone.
Provide them with any information they may want to know and keep a careful eye for the rare few who may have lasting issues and only then seek professional help.
There's a role for the media here – challenging what has become the automatic postscript to every disaster story, the reassuring note that survivors will receive counselling.
This flat-Earth, cliched reporting is part of the problem – rather like advertising baby formula in third world countries. For all the efforts to present a good news spin, it won't improve their lot and may simply add to the disaster in their lives.
Then there were the far too many traumatic occasions with which I was personally involved with during WW2, Palestine 1947, the Korean war and other times during my service career, but I was among millions of others sharing these experiences.
I cannot recall during my service career anyone receiving counselling for witnessing any horrific Scenario, however, a few blokes cashed in on it, they were a small minority and heaps of Movies were made portraying these guys freaking out while sleeping, overreaction to the movie moguls created this present army of soothsayers whom I am glad to say have been given the chop.
I am not an insensitive person, I try to maintain a rational mind and think matters through, we were no tougher going back than the generations of today, most of us would have a good cry and get on with it.
life is not fair, get used to it.
Vest Daily Gaggle.
Thursday, 21 June 2007
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