News Experts Urge Against Trauma Counselling Immediately After Trauma (Pre-PTSD)

[NarcSis]

Okay, I'm sure I have already asked this question somewhere before, but if you take a person suffering critical incident stress, misdiagnose them as PTSD and then plunge them into immediate trauma counselling, will you not Create a sufferer who then adopts all behaviours associated with PTSD? I have long held this belief and I have always been a true believer in the fact that we best know our own reactions - especially those of us in healthcare.

I do not agree that debriefing should cease, there are those who will benefit from a debriefing and those who will not - individuals react as individuals. I do not think that 'debriefing' should be confused with actual psychological counselling. I am a trained CISM provider, I was the only one in my class who did not view myself as a counsellor; I am simply a skilled observer armed with the knowledge of the possibilities. No more. It is not my job to 'counsel', I am not qualified to do so. This is the reason our CISM team failed - people went out on their own and began 'counselling' coworkers - messing up a couple pretty bad!

CISM and debriefing need to follow a formal structure and this is where most companies error. Instead of investing the money in a Mental Health professional on staff to guide the process and oversee the debriefings, most companies simply jump headlong into a program without proper research or training. In this same vein, they do not pay enough for appropriate EAP providers or trauma resources - don't get me started on the EAP trauma counsellor I saw. All I can say from personal experience is that I knew I needed some CBT at the 2 month mark; my counsellor did not provide this...I struggled to deal with this on my own. I wasn't so lucky and here I am still struggling with this issue. Traumatized.

I wouldn't totally discount debriefing as a risk prevention strategy however it also needs to be backed up by internal supportive strategies to assist employees dealing with complex grief and trauma.

Just my two cents. (20?) :)

 

[anthony]

Whilst this is an old document, nothing has really changed in this area to date. Counselling / psychological intervention immediately after a traumatic event is not recommended, and instead should be left to the individual as to whether they feel they need additional support outside friends and family, or they just need a little time to process and see whether they settle on their own without intervention, which is proven to make mental health outcomes worse if interfered too early or as a caution.

 

[heidi]

To me trauma occurs when no one explains what it all means, gets ignored and suppressed for years and then explodes because your brain is trying to make sense out of all the unanswered questions.
I am not saying that everyone should be treated like they will automatically get PTSD. But I do believe that addressing possible side-effects of having been through a life endangering event would certainly be helpful. The panic that happens to people when they start having emotional responses to triggers and not know if it is normal could be somewhat alleviated if a person was warned ahead of time.

That's really brilliant. I wonder if trauma worsens as a result of the confusion experienced.

 

[Abstract]

nothing has really changed in this area to dat

Hi Anthony,
I am wondering what I should advise my friend who has approached me.

This is someone normally pretty unemotional and very together but who was left by herself trying to resuscitate her mother (who did not survive) from a heart attack yesterday. She is having graphic visual intrusions accompanied by intense emotional states all the time and unable to sleep and is behaving very out of character. It has nothing to do with the loss of her parent and all to do with the experience. She lost her father who she was much, much closer to a year ago and in a nasty way and was fine. As was she after a freak accident which killed her brother.

I know you have said natural death is not included in criterion A but she seems to be having similar symptoms even though it's early days.

I read the following document which was attached as a reference in your wiki.
The Medical Journal of Australia, 2007, Treating adults with acute stress disorder and post-traumatic stress disorder in general practice: a clinical update

Very uncharacteristically (she has always be sarcastic about therapy) she said she thinks she needs therapy and what should she do. I said to speak to her Dr but I am not at all confident they will give her the right advise.

I see that they say in the above that there should be no counselling for the first two weeks which agrees with your comments in the original post.

Please know I am not attempting to diagnose and a diagnoses really isn't relevant but I don't want her doing anything that could cause harm just in case and I don't trust the NHS.

 

[anthony]

Friends such as yourself are what typically get people through the immediate aftermath. As you said, this was just yesterday... so it is normal to now grieve, which means even grieving her father again from a year ago, as now losing her last parent she will experience vast symptoms, emotions and feel many different things. Going to a therapist can make things worse, or better... but grieving is a process which is best handled by friends and family who need to be empathetic, sympathetic, yet be tough enough to get them moving on with their life. We don't have to forget our loved ones, but becoming useless from their loss beyond a reasonable time period, isn't going to help anything.

People grieve differently... and family and friends have to adapt to that, let them have their space and some time, and hope they get on with things themselves without intervention from family and friends. A therapist isn't going to solve anything for someone who just lost a parent yesterday. Friends and family can do more help than a stranger.

 

[Abstract]

Thanks Anthony. It really isn't the grieving aspects it seems and she specifically said that to me and that it is rather about seeing death in that way. I think in a lot of ways she is relieved her mother died.

But I am understanding that early therapy is not recommended and I am going to put her off for a while. I have no doubt she will come through this regardless.

 

[anthony]

Grieving her father a year ago because her mother died yesterday, is still normal. It will raise everything for her, like her father died yesterday. All the things she ignored, maybe didn't say or deal with, now come back to the surface. As you know... negative emotion doesn't just go away, it sits in waiting to jump you at the next event in your life.

Intrusive thoughts, dreams and such are not exclusive to PTSD... they are normal symptoms of any trauma. It could be a relationship breakdown, death of a loved one, a fight with your spouse, to rape, torture and more.

Don't put your blinkers on when someone mentions symptoms to you, thinking it is a serious issue. Daily life can produce intrusive thoughts, nightmares and such, without any real trauma. You only need some stressors to achieve that, you don't need a mental health condition to do it.

 

[Abstract]

You are right and I need to make sure I don't see things through the lens of PTSD. Thanks.

 

[zaniara]

This makes a lot of sense to me. After the last crime I wouldn't have been helped by de-briefing or talking it through with anyone else than my friends. I couldn't even talk to them, and my brain didn't function even near to normal for a couple of weeks(of course it doesn't now either.. :D ..but it was really bad at the time; so bad I was very "out of it" to the extent of almost not being able to cope at all). I think it took exactly 3-4 weeks to get out of the shock, sort of. I actually remember the day I fell out of it. It was just that sudden: I sort of woke up one day and understood what had happened(again). But then it took a while longer before the PTSD got really bad(but I know now that I have PTSD from childhood, so it only got worse after this; but I was never well before this either). And yes, trauma focused cognitive behaviour therapy has worked really well for me; alongside with EMDR(my therapist uses both and some other tools too).

I do think the support of friends and family can help a lot though. I had very little support. Just a few friends, but they wasn't feeling too well themselves at the time. My partner got jealous(of a rape-attempt??) and wanted to kill the person, couldn't listen to anything at all or handle me not being well/feeling well, and doubted me and ditched me when the police finally started the investigation.

 

[Abstract]

If you read this then thank you for previously being patient with me Anthony.

I think I was over empathising or in truth mostly projecting. I need t stop.

***
I am on my way to visit my friend and hope I can keep my stuff and hers separate. It is hard to see someone I have known for almost 40 years so out of character.

Stay away from the wine Abstract!

 

[Abstract]

This may not be the right place for this. It seems it may not have been so much about my projections after all. I thought this was done with but it isn't and has not improved for my friend. This isn't about a diagnoses as that isn't relevant here and the impairment is limited. It's merely about considering what the correct help would look like. I have never thought of this in terms of PTSD but it does seem to be some form of minor traumatic response.

This is also very obviously not about grief. I know the issues with grief are usually: "difficulty accepting the loss, confusion about one’s role in life, avoidance of reminders of the loved one, inability to trust others, bitterness or anger surrounding the loss, difficulty moving on, numbness and shock, and a sense that life is meaningless." She has none of these. Much less than average when it comes to grief related responses would be my evaluation. In fact she is happy for her mother and father that they are gone.

The only things she is experiencing are graphic unexpected intrusions (visual and emotional) of her attempts at resuscitation and death with intense emotional responses attached, avoidance of things related as a result of fear of triggering these intrusions; related nightmares. Nothing else. Just not sure a normal grief counsellor is the correct choice. As I said there was a previous very unusual and gruesome accidental death of a sibling and watching her father being starved/dehydrated to death in hospital, which took a week, not long before. I don't know if grief counsellors know how to deal with this aspect of things:

graphic unexpected intrusions (visual and emotional) of the actual attempts at resuscitation and death with intense emotional responses attached