Mental Health

Disaster Counseling Primer for Mental Health Professionals

Although many of your usual ways of involving yourself with others’ struggles will apply during disasters, there are some special considerations in disaster crisis counseling as compared to traditional mental health practice. The contexts and approaches may be summarized as follows:

"Traditional" Mental Health Practice	Crisis Counseling
Is often office-based. Focuses on diagnosis and treatment of a mental illness. Attempts to impact the baseline of personality and functioning. Examines content. Encourages insight into past life experiences and their influence on current problems. Has a psycho-therapeutic focus.	Is primarily home- and community-based. Focuses on assessment of strengths, adaptation of existing coping skills, and development of new ones. Seeks to restore people to pre-disaster levels of functioning. Accepts content at face value. Validates the appropriateness of reactions to the event and its aftermath and normalizes the experience. Has a psycho-educational focus.

Here are some general principles and skills, many excerpted from a very thorough trauma treatment manual:

Understand and keep in mind the normal post-disaster stress response and how it can vary with developmental level. People experiencing disasters will demonstrate intense emotion and reactivity, numbness, intrusive memory, and “triggering.”

Organize your interventions around responding to the following basic needs. People having experienced disasters need to:

Feel relatively safe. We may begin by performing simple acts of kindness, by leaving people alone when they want to be left alone, by treating other people as if you cared about them.
Have their boundaries respected. Trauma, almost by definition, breaches people's normal boundaries. It is as if life drives a bulldozer over people's normal sense of protection, sense of safety, and sense of self. So people need to know that their wishes matter, that you will not force them to respond in anyway other than what they choose, and that you will not invade them. Physical touch is also such a boundary.
Feel accepted and not judged. Sometimes people experiencing disasters judge themselves very harshly for their response, and may even resent the fact that they are alive. They need those around to accept and affirm them as having value and not as having been "spoiled" or "ruined" by what they have been through, even if that is how they themselves feel.
To talk and be listened to. When people hurt, especially when they hurt more than you can stand to hear, or think about, or feel, it is hard just to listen to people. But it is the most important thing you can do.
To be believed. Trauma is, by definition, something outside of ordinary experience. We should not let our beliefs about what can and can't be true get in the way of believing the stories of survivors. Life can bring events into the lives of others that we can hardly stand to imagine. We could try to protect ourselves by denial and disbelief. But it is best to try to stay open, so that survivors of horrific trauma are not further injured by our disbelief.
To have their feelings attended to, not just the facts of their experience. When people hurt in ways they cannot stand, they freeze up their feelings. They just try to survive. That is nature's way of helping them to get through what they have to endure. But afterward they need to get their feelings back, so that they can function again, and so that they don't have to go through their lives closed down inside. If they are still numb, you should not push them. Nature knows when it is time to feel again.
Sometimes to be left alone.It is always important to respect people's healing process.

Bring, above all, your presence. Many think that to help in disaster that they should have highly specialized training, or they should know the right things to say in order to make others feel better. That is not true. What is most important to people experiencing disasters is that they know that you are there and that you care. It is often remarkably simple what people need. They need you to be able to be present, focusing your attention on them, and they need you to be open, listening to them with your heart and your feelings, feeling along with them.

Basic procedures and processes:

Begin simply. Introduce yourself. Tell the person you are with why you are there.
Let the other person lead. Perhaps the simplest and best rule in healing is to trust the other person's process. Nature heals, not you, and the person will bring things up in their own way and own time, as they are ready. Convey empathy through respect and patience.
Let people tell their story. Generally, people who are healing from horror need to tell their story. They don't need you to push them, but they need to know that you are there who cares and want to know and are willing to listen.
Remember ABC… Affect Before Content. How we feel is more important than the facts of what happened to us. Focus on feelings and reflect what you hear and see.
Do not push for catharsis. People having experienced disasters, especially in the near term, do not always benefit from strong expression of emotion.
Assess struggles, functioning, resources, and coping:

“Describe the problems/challenges you are facing right now.”

Selecting one problem is helpful. Identify it as the most immediate and focus on it first. The problem should be relatively solvable, as an immediate success is important in bringing back a sense of control and confidence.

“How have you coped with stressful life events in the past?”

“How are you doing now?”

Through observation, asking questions, and reviewing the magnitude of the survivor's problems and losses, the worker develops an impression of the survivor's capacity to address current challenges. Based on this assessment, you may make referrals, point out coping strengths, and facilitate the survivor's engagement with social supports. You may also seek consultation from medical, psychological, psychiatric, or disaster relief resources.

“Who might be able to help you with this problem?”

“What resources/options might help?”

Explore existing sources of assistance and support such as immediate and extended family, friends, church community, health care providers, etc. and how the survivor might obtain their help. Refer the survivor to the appropriate relief agencies and assess if the survivor is able to make the calls and complete the required applications. Assist with accessing resources when necessary.

“What steps will you take to address this problem?”

Encourage the survivor to say aloud what he or she plans to do and how. Offer to check-in with the survivor in a few days to see how it is going. If you offer or agree to perform a task for the survivor, it is very important to follow through. We should promise only what we can do, not what we would like to do.

Take care of yourself. Last but definitely not least, make sure you have support and that you do not overextend yourself. Secondary stress is a real phenomenon. Don't let your life be overwhelmed by others' traumas, and be sure to get plenty of support and help for the feelings that come up for you in working with other people’s traumas.