Monday, January 19, 2004

The Pros and Cons of Grief Counselling An article in today's The New Yorker by Jerome Groopman discusses some of the approaches to grief and crisis counselling in the US. There is considerable controversy in the fleld about the method of intervention used. The author discusses case vignettes from post September 11th and other types of trauma to describe the process. One technique, that has been widely used called critical-incident stress debriefing uses a structured seven-step debriefing regimen that could be applied to groups of paramedics, firefighters, and other professionals who regularly witnessed traumatic events, has fallen out of favor recently. In fact, according to Groopman, the American College of Neuropsychopharmacology Task Force on Terrorism will release a paper this week recommending that debriefing be abandoned as a mainstream prevention method. Studies describe that after a catastrophic event, most people are resilient and will recover spontaneously over time. A very small percentage will require extended psychological care. This was seen post September 11th when a great number of counsellors in Manhattan were mobilized but most New Yorkers received no therapy following the attacks. Scientists like Rachel Yehuda are trying to determine what causes some people to fall victim to PTSD after a traumatic event by looking at brain mechanisms and Edna Foa has used a cognitive behavioral approach with some success. Finally, the author of the article approached Steven Hyman, a neuropsychiatrist, provost of Harvard University and former head of the National Institutes of Mental Health. He believes, when necessary, in a cognitive behavioral approach which has scientific evidence to prove its efficacy. He described the debriefing approach as a reflection of the prevailing cultural bias which is analogous to saying that a single outpouring of emotion or "one good cry" can heal a scarred psyche.  Dr Hyman commented that perhaps the solution, is to drop the idea that "counselling" is necessary and the way we respond to an individual or mass trauma should be guided by how we behave after the loss of a loved one. The traumatized person should share what he wants with people he knows well: close friends, relatives, familiar clergy. We should take advantage of the power of our social networks - these are "what help people create a sense of meaning and safety in their lives." The New Yorker Issue of 2004-01-26 Trauma Information Pages 10:52:37 PM    comment []

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