When Counseling is Dangerous
Psychological debriefing after disasters may do more harm than good.
Posted January 19, 2010
Now that another huge humanitarian disaster is upon us, teachers, psychologists, counselors and social workers should be reminded that talking--and encouraging those who have suffered losses-- to talk and talk more--about their painful experiences is not the route to recovery. In fact, asking people to rehash terrifying events can be dangerous. Strong research evidence shows that psychological debriefing not only is ineffective, it can exacerbate trauma.
"People who received psychological debriefing exhibited more severe symptoms of post-traumatic stress disorder than controls; the intervention increased the risk of the stress disorder, and critical incident stress debriefing, in particular, was potentially harmful,"write Magdalena Szumilas, Yifeng Wei, and Stan Kutcher in an analysis of the research on psychological debriefing just published in the Canadian Medical Association Journal.
It seems counterintuitive to those who have been trained to believe that airing negative experiences and emotions is the route to healing. And people should be lauded for wanting to assist. But what we are learning is that human emotion does not function on the hydraulic system, building up pressure that must be released or else explode. Different people have different approaches to recovery. And some must simply be given a safe haven, a calm, reassuring environment, and the time to recoup.
If they really want to help, grief counselors should dig into their pockets to donate-and stay far away from the hundreds of children and orphans arriving in established communities in the Haitian diaspora, from Miami to my home in Montreal. These communities are in shock, grieving their losses and trying to locate survivors. The last thing they need is ineffective, and possibly harmful attempts to prompt people-and especially children and orphans--- to relive their horrific experiences. The science tells us that evincing traumatic experiences can be harmful in adults. And the debriefing approach--despite its popularity in schools--has never been tested in children. Using untested methods to treat a fragile population is risky at best, and despite good intentions, unethical at worst.
In a recent Op-Ed column, New York Times columnist David Brooks blames the pervasive poverty and lack of basic infrastructure in Haiti that has hampered emergency efforts on a number of social forces, including " the influence of the voodoo religion, which spreads the message that life is capricious and planning futile." When educated professionals persist in using unproven therapeutic approaches, they too, seem to believe in the healing power of voodoo. "It's becoming a social phenomenon," said Dr. Ogrodniczuk, a psychiatry professor at the University of British Columbia, who is one of a growing phalanx of critics of conventional grief counseling. "They're showing the public that they care, that they're here to help--even if what they're offering is not really useful."
What should be done instead? Proven crisis interventions include sticking to the following priorities: promoting a sense of safety, calmness, a sense of self and community efficacy (resilience), and a sense of connectedness and hope.
When the twin towers fell in 2001, an army of 9000 psychologists, social workers, and counselors descended on New York, hoping to help the survivors. But evidence has since emerged that their fallback approach-prompting people to rehash their traumatic experiences through counseling and debriefing-did more harm than good. Instead of preventing post-traumatic stress disorder, grief counseling provoked it. Now that we're facing another crisis it behooves us to learn from our mistakes.