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Can Trauma Therapy After Terror Attacks Do More Harm Than Good? - 2002-09-11

In the aftermath of natural disasters or terrorist attacks, it has become standard practice in many countries for mental health professionals to rush to the scene and offer support to grieving survivors. But new research indicates the type of therapy they offer, while well-meaning, may do more harm than good.

More than 9,000 therapists, counselors and psychologists raced to New York City in the immediate aftermath of the September 11 disaster last year. They wanted to comfort those who escaped the catastrophe, as well as rescue workers suffering emotional strain from the desperate search for victims of the collapse of the World Trade Center.

The type of counseling most ofen used right after a disaster, according to psychologist Richard Gist of the University of Missouri, in Kansas City, is a one-time group therapy session known as "critical incident stress debriefing."

Mr. Gist says victims are asked to relive the traumatic events during such debriefings. He gives the example of how a counselor would help someone deal with the death of a loved one. "You come over the next morning. You remove all the furniture from the living room. You put all the dining room chairs in a circle," he says. "You sit down with a counselor and ask [the victims] to reconstruct in all vivid detail how the departed party clasped his chest, turned blue, frothed at the mouth and convulsed. Is that going to help? The briefings that rely on asking people to go back and reconstruct in vivid detail what they have just been through and the intense emotional reactions that it may bring forward may not necessary bring cathartic help, especially when they are poorly timed or rigidly conducted."

Instead, psychologist Richard Gist says such confrontational briefings may interfere with most peoples' natural resilience and ability to heal on their own.

Dutch researchers reviewing a number of studies found that critical stress debriefing did not have any positive effect on individuals exposed to trauma compared other methods of counseling, and did not improve their natural recovery from trauma related disorders. The results of the study are published in the medical journal The Lancet.

The critical stress debriefing approach might not be as effective as therapists believe, say Dutch researchers, because it may prevent trauma victims from seeking out the support of family and friends.

Mr. Gist says research has shown that such social ties are critically important after a tragedy. "You spend time. You help with errands. You take food over. You listen when they want to talk. You stand back when they don't. You give your presence and you give your concern. That turns out to be consistently helpful," he recommended.

In a related study, the U.S. National Institute of Mental Health released a report concluding that stress debriefings do nothing to prevent longer term psychiatric disorders, like post-traumatic stress disorder.

The report added such one-time debriefing sessions may do more harm than good by causing more distress in people who may be coping just fine. The national institute added most people who got counseling would have recovered on their own, saying the "sensible" policy was "to expect normal recovery."