Tag Archives: Trauma and Disaster

Trauma and Disaster

The mental health aftermath of Harvey, Irma

By Bethany Bray September 18, 2017

Residents of the Caribbean and the southern United States are still grappling with the aftereffects of two immensely powerful and destructive hurricanes — Harvey and Irma — both of which caused widespread damage and left millions of people displaced. Rebuilding what the hurricanes destroyed will be a long and painful process, but counselors who live and work in the hardest hit areas have seen people from within and without the damaged communities come together to help each other. This sense of community and resilience will help many of those affected to recover without signs of mental health problems, but counselors also caution that some residents of the storm-wrecked areas may experience greater trauma and require more time to recover.

Maureen C. Kenny, a professor of counselor education at Florida International University in Miami, has seen Hurricane Irma spur a significant amount of anxiety in her area, from worry over whether to evacuate to the stress of having children home from school for an unknown length of time.

“For many parents, they may need to return to work but the children are not [back] in school yet, so child care is an issue. Many families are without power and still dealing with hot weather, uncomfortable living situations and limited ability to cook or eat,” Kenny, an American Counseling Association member with a part-time counseling practice in Fort Lauderdale, said in the days following the storm.

At the same time, Kenny said she’s seen community members come together to help one another, such as neighbors helping neighbors install hurricane shutters and fix generators.

“Since people are often without power for extended periods of time, they spend time outside talking to their neighbors. People are out walking dogs, kids are riding bikes and neighbors are sharing storm stories,” Kenny said. “In a strange way, it brings people together. Without electricity, people are forced outside and have more contact with one another.”

NASA satellite image of Hurricane Irma passing Cuba on Sept. 8.

Harvey was a Category 4 hurricane as it made landfall near Corpus Christi, Texas, on Aug. 25. The storm then stalled over southeast Texas for days, bringing heavy rainfall and catastrophic flooding. Irma — one of the most powerful Atlantic storms ever recorded — was a Category 5 hurricane when it razed many of the islands in the northeastern Caribbean and “skirted” Puerto Rico, leaving 1 million residents without power. The storm had dropped to a Category 4 hurricane when it made landfall in the Florida Keys Sept. 10 and began its slow march up the Sunshine State.

Forecasters are also keeping an eye on two more hurricanes, Jose and Maria, which are currently churning in the Atlantic Ocean.

The barrage of catastrophic weather has brought weeks of news coverage and warnings to evacuate or stock up on emergency supplies.

“With technology’s advance notice of hurricanes, it allows people to get ready but also adds a lot of anticipatory anxiety,” Kenny said. “Schools and businesses were closed several days before

ACA Member Maureen C. Kenny took this photo of near-empty shelves in the bottled water aisle at a Winn-Dixie grocery store in Cooper City, Florida on Sept. 6, which was four days before Hurricane Irma made landfall.

the storm actually hit. This left people waiting for the storm to hit and unsure of what exactly would happen. … As days grew closer to the storm, there were long gas lines [at gas stations], the shelves at the stores were empty and people may have not been able to get supplies.”

ACA member Jeffrey Kottler also saw people pushed to their limits during the time he spent as a disaster mental health volunteer at Houston’s George R. Brown Convention Center in the days after Hurricane Harvey. At the peak of the crisis, the facility sheltered more than 9,000 people.

Kottler, a clinical professor of psychiatry at Baylor College of Medicine in Houston, worked with psychiatry colleagues from Baylor in a tent at the convention center, offering support and a sympathetic ear. They did everything from offer psychological first aid to help people contact family members, refill medications and get a new driver’s license because theirs was lost in the flooding and chaos that followed the storm.

When a distraught person would enter his team’s tent, Kottler said his approach was to pause, calm the person down and give the person time to tell his or her story, even if that meant walking around the conference center with the person or finding a quieter place to talk.

People were overwhelmed on many levels, Kottler said. Not only were they reeling from the loss of homes, vehicles and other personal property, but they were crammed in close quarters with complete strangers.

“[The convention center] was the most chaotic environment imaginable, and people’s brains were going off like fireworks,” Kottler said. “It’s hard to describe the chaos of what it was like to be there, seeing [thousands] of beds, with dogs barking and babies crying. People were just in shock.”

“Imagine having a car, a job and a home, and then in one day, it’s all gone and you’re living with 9,000 people. Those were most of the people that I was spending time with [as a disaster mental health volunteer].”

Kottler noted that the center featured a large police presence – alongside many, many volunteers and aid agencies – for safety and to ensure that weapons, alcohol and other banned items were not brought into the facility. For some, this added to the tension of an already anxious situation.

Kottler, a keynote speaker at ACA’s 2015 Conference & Expo in Orlando, Florida, recently moved to Texas to start a new position at Baylor College of Medicine and to serve in a volunteer role (consultant and staff trainer) at the Alliance for Multicultural Services, a refugee resettlement agency. Previously, he was a professor at California State University, Fullerton.

Kottler said he has been struck by the resilience of his new hometown – from grocery store cashiers asking if he’s OK to the local American Red Cross chapter having too many volunteers.

“I am new to Houston, and I’ve just been blown away by how the city and community have come together to help each other selflessly,” Kottler said. “What I found so personally disturbing is [the realization] that this could happen to any of us.”

Many in Houston have now begun the process of clearing out damaged homes and rebuilding lives after Harvey. In Florida, some residents are waiting for utility service to be restored, one week after Irma. Residents are still displaced and emergency shelters are still open in both Texas and Florida.

In Miami, Kenny said she had power in the days after Irma, but no phone or internet service. Classes resumed at Florida International University Sept. 18 after a nearly two-week closure. Some of the school’s facilities were being used as shelter for evacuated residents of the Florida Keys, Kenny said. Professors have been advised to be flexible with deadlines and assignments.

In her role as a counselor educator, Kenny said she has also witnessed anxiety among some counseling students who are concerned about the loss of internship hours because clinical sites were closed in the storm’s upheaval. In her private practice, Kenny had numerous clients cancel appointments prior to the hurricane because they were busy with preparations or didn’t want to travel for fear of using gasoline that might be needed later.

“Thankfully, cell phones [are currently working], so you are able to check in with clients and see who can return,” she said. “Many clients – those who were able – left town and still have not returned. Thus, practice remains slow. For some clients without power, coming to an air-conditioned office for an hour to cool off and vent is a welcome relief.”

Although hurricanes are part of the reality of living in South Florida, the upheaval that Irma brought has stirred up difficult memories for some longtime residents, Kenny noted. For others, watching Hurricane Harvey’s devastation from afar was equally troubling.

“For some in South Florida, [Irma] was also a reminder of Hurricane Andrew 25 years ago. For those [individuals], it definitely brings up posttrauma issues. These are people who lost their entire homes, businesses, etc., and were fearful of the same thing happening again,” Kenny said. “Others who are living here but have lived through storms in other parts of the country were also triggered by this storm. Some [of my] clients had family in Texas [who] had just survived Hurricane Harvey and were still dealing with them when this storm was approaching. For those clients, the back-to-back storms seemed overwhelming. I had a client who was able to arrange for evacuation of a family member in Texas through Facebook. The family member was elderly and in need of medical attention post-surgery but was in a completely flooded area. A stranger responded to the request and used their boat to get the relative to a hospital. This type of kindness demonstrates how a community can come together.”


The road ahead

For people who are directly impacted by a natural disaster, the aftermath can be marked by feelings of loss, fear, panic, grief or guilt, said Anka Vujanovic, an associate professor and director of the Trauma and Stress Studies Center at the University of Houston. Counselors may hear clients talk about strong feelings of irritability, anger or guilt, having difficulty sleeping or a sense of wanting to do more for their community because they made it through the storm relatively unscathed.

“There may be guilt in those who are not severely impacted – survivor’s guilt of ‘why them, why not me?’” said Vujanovic, a licensed clinical psychologist and co-director of the University of Houston’s Trauma and Anxiety Clinic.

Other clients may be in shock right now and focused on the immediate needs of putting their life back together in the storm’s aftermath, Vujanovic said. Mental health struggles can surface weeks, months or even years later when triggered by another natural disaster or traumatic event.

“Once they’re past the crisis, they may have symptoms. … Once things settle down, they have their house [renovated], they’re back to ‘normal’ and life has settled down. They may feel the aftershock even months later,” Vujanovic said. “People may or may not experience symptoms until the next rainstorm with high winds, or [next year’s] hurricane season. That may trigger people and activate some of their difficult memories.”

“It’s something to check in about for practitioners, especially if they work with people who were directly impacted. Keep in mind that there may be things that crop up. Clients may not be ‘over it’,” Vujanovic said.

Counselors may see clients develop panic attacks, intensifying anxiety or depression, loss of interest in things they normally enjoy, mood fluctuations or increased substance abuse. People often use alcohol or drugs to cope with feelings of stress, loss and grief after a natural disaster, Vujanovic said.

It’s vitally important for counselors to check in with clients in affected areas to see how they’re coping in the storm’s aftermath and to monitor their symptoms. Practitioners should encourage clients to maintain social connections with friends and family and “fight the urge to isolate,” Vujanovic said.

“Take time for self-care, which can be incredibly difficult if you’re living in a shelter. Take time for appropriate sleep, exercise, social activity – whatever is important to that person,” she said.

Vujanovic’s area of research is posttraumatic stress disorder (PTSD). Although 30 to 40 percent of people who are directly impacted by a natural disaster will develop PTSD, it is important to note that a majority of people who survive a natural disaster will not develop mental health symptoms, she said.

A number of factors – from whether individuals have pre-existing mental illnesses to how much social support and financial stability they have – contribute to whether they might struggle after a natural disaster. “All of those things will go into the complex equation of who develops a problem [after a natural disaster]. These factors up the risk, but it doesn’t mean they definitely will,” Vujanovic said.


Businesses in Miami Beach, Florida, board up windows on Sept. 7 in preparation for Hurricane Irma.




Related reading


Counseling Today’s August cover story, “Lending a helping hand in disaster’s wake


From Counseling Today columnist Cheryl Fisher, “Mental health cleanup following a natural disaster





Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org


Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.





Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.







The Counseling Connoisseur: Mental health cleanup following a natural disaster

By Cheryl Fisher September 14, 2017

“The sole meaning of life is to serve humanity.” ~ Leo Tolstoy


As I sit on my patio, warmed by the early autumn sun, I breathe in the alchemy of rosemary, thyme and oregano and a variety of mints — aromas from my herb garden. The squirrels chatter as they scamper across the trapezelike branches of the old maple and majestic oaks that provide me with shade and provide entertainment to a variety of creatures. Blue jays, robins and cardinals flit back and forth, foraging end-of-the-season strawberries. Finches hover overhead just long enough to steal a sunflower seed (or two) from the heads of the long stalks that have faded and now hang low. It is a beautiful September morning.

Yet, several hours away, nature has taken a different turn, spinning up water and winds of 185 mph, decimating lands and destroying lives. Hurricanes Harvey, Irma and Jose have created havoc on the Gulf and East Coasts, while fires have engulfed the West. An earthquake has devastated parts of Mexico. In each instance, homes have been lost and families separated. The same Mother Nature that offers me such solace during this early morning has wreaked havoc elsewhere.

As with any traumatic experience, I seek meaning, attempting to make some sense out of these tragedies. I try to identify who is to blame for such suffering and loss. Finding very little peace from my efforts, I turn to what I know best. I dive into my counseling toolbox for guidance and I DO something.


1) Volunteer

As mental health professionals, we offer skills that are much needed in cultivating calm and defusing crises. We can help by listening to the narratives of survivors, validating their experiences and providing tools for immediate coping. We can provide basic care and help them reconnect with loved ones. I have been a disaster mental health volunteer for the American Red Cross (redcross.org/take-a-class/disaster-training) for decades. (The American Counseling Association is an official American Red Cross disaster mental health partner organization.) It is a privilege to serve in local and national deployments. Additionally, we can assist local efforts through church or club affiliations. I am a member of the Maryland Responds Medical Corp, and I support the efforts of my faith affiliation.


2) Contribute to resource efforts

There have been many times when I have been unable to deploy. This is extremely frustrating because part of my healing is feeling that I have DONE something to help. I have found that numerous organizations accept both supplies and monetary contributions. Participating in these efforts allows me to feel that I have been actively involved in the effort toward recovery.


3) Gather with like-minded/like-hearted people

Being in the company of other compassionate advocates can lighten the load. Sharing the emotional burden may not only provide ease but may also promote collaboration and generation of innovative recovery strategies. For example, a group may want to craft a GoFundMe page, create a local fundraiser or organize an event in memory of those who were lost and in honor of the survivors.


4) Pray or hold intention

Regardless of one’s faith or belief system, lifting prayer and good intentions on behalf of another is an active service of compassion and kindness. It is (excuse the double negative) “not nothing.” In addition to a faith-based perspective, prayer and intention place the person or people in the forefront of our thoughts, reminding us of our connection with all humanity regardless of nation, culture, ethnicity, creed, age, gender, sexual identification or able-bodiedness.


5) Seek help

As advocates and first responders, we are not immune to the effects of tragedies. Viewing hours of social media in anticipation of the storm’s arrival, watching the desperate efforts of firefighters dousing the flaming forests of Washington and Oregon, or seeing the devastation in the Caribbean can take its toll on even the most resilient counselor. Seek professional help to aid in the development of strategies to provide nourishment and sustenance while buffering the abrasive nature of responding to traumatic events.



Nature provides us with endless sources of joy, wisdom and companionship. However, there are times — as with any living force — when disaster strikes. Counselors can contribute to the recovery plan in numerous ways that cultivate a sense of unity and community. It is a privilege to serve in times of need.


Satellite photo of Hurricane Katrina on August 28, 2005.




Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is affiliate faculty for Loyola and Fordham Universities. Her research interests include examining sexuality and spirituality in young women with advanced breast cancer, nature-informed therapy and geek therapy. Contact her at cyfisherphd@gmail.com.










Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

From the President: Resilience and growth after the storm

Gerard Lawson August 3, 2017

Gerard Lawson, ACA’s 66th president

Natural disasters don’t discriminate. Storms, floods or fires can impact any community. Human-caused disasters sometimes do discriminate, with certain individuals or communities being targeted (e.g., the shooting at Pulse nightclub) or neglected (e.g., the water crisis in Flint, Michigan). This complicates the work that needs to be done, but whether the disaster is natural or human caused, counselors are well-situated to bring about real, positive change and help people recover.

Disaster mental health (DMH) can seem like a misnomer. How can we be talking about mental health in the midst of a disaster? But counselors have demonstrated that being connected to the community and focusing on resilience, even in the midst of a crisis, can set the stage for remarkable growth.

We have seen an evolution in the field. We no longer refer to “victims” of disasters; rather, we talk about “survivors.” That may seem inconsequential, but language is important. Language helps us to frame and focus how we intend to respond. Being called a victim suggests that I am the passive recipient of something, whereas being called a survivor implies agency — I am active in my survival.

My friend Lennis Echterling and his colleagues took this idea one step further, suggesting that we don’t have to limit ourselves to being victims or even survivors of tragedy. Rather, there is an opportunity for us to thrive as a result of our experiences, even traumatic ones.

These counselors propose that once an individual resolves the distress of helplessness and hopelessness that often accompanies a trauma, they are ready to move into the Survivor stage. There, individuals begin to manage their emotions more effectively, make contact with people who have shared the experience, make meaning of their experiences and take action to set their lives back on track.

Some individuals are then able to move into the Thriver stage, feeling a sense of community, meaning, resolve and power in their lives again. Thrivers take their experiences and reengage in their lives as advocates, with a new sense of purpose that may have been lacking before. This is similar to the idea of posttraumatic growth, which can bring about a greater appreciation of life, closer relationships, new possibilities, increased personal strength and spiritual change. Although we are all well-versed in the concept of posttraumatic stress disorder, we talk less frequently about the potential for growth following a traumatic event. But most people possess the potential for resolve and resilience that makes becoming a Thriver, and experiencing growth, a real possibility even after a major trauma. 

Now, I’m no Pollyanna. I recognize that disasters take a toll that is real, and recovery takes time. Counselors need to support people through the grief, loss and shattered beliefs that accompany disaster. Our message can be, “This is going to be hard for a while, then it will be better, and then things will be different. As it gets closer, you get to choose what different looks like.” If we carry our own internal mindset of “what is right with my client is more powerful than what is wrong,” we can set the stage for growth, even in the darkest of times.

Just as in our day-to-day work as counselors, self-care is incredibly important in DMH. Staying connected to a community that can help us share the load, making meaning of our work and staying focused on the difference we can make (or have made), rather than the enormity of the crisis, are important considerations for counselors and survivors. We must also take time away to exercise, meditate or find renewal. There is important work to be done every day in our own communities, and counselors can make an incredible difference. 

Those interested in learning more about DMH may want to get involved with the ACA Traumatology Interest Network (see counseling.org/aca-community/aca-groups/interest-networks).



Lending a helping hand in disaster’s wake

By Laurie Meyers July 25, 2017

Sept. 11, Hurricane Katrina, Virginia Tech, Newtown, Superstorm Sandy, Pulse nightclub … It is only a partial list, but this roll call of places and events seared into public memory makes it obvious: The 21st century has provided counselors with many unfortunate opportunities to exercise disaster mental health counseling skills.

Post-9/11, the practice of disaster mental health has been shifting and evolving as practitioners have continued to gain a better understanding of how people recover from traumatic events. Disasters, whether natural or human-caused, can be life-altering and psychologically scarring, but counselors and other experts say that most survivors will recover without major psychological trauma. And it is now widely recognized that in most cases, brief targeted treatments work better with survivors of disasters than does extended therapy.

Historically, counselors would show up in the wake of a disaster and engage in talk therapy, says Gerard Lawson, president of the American Counseling Association. Today there is an understanding that the immediate aftermath of a disaster is not the time to engage people in traditional psychotherapy. Survivors need something much more immediate — psychological first aid, which Lawson describes as a kind of mental health version of medical first aid. Responders try to “stop the bleeding” in a sense by treating survivors’ immediate stress and assessing who might be a threat to themselves or others, he says.

“One of the foundations of psychological first aid is that we assume not everybody [who experiences a disaster] is going to develop severe mental health problems,” Lawson says. He notes that research has shown that a fairly low percentage of disaster survivors — approximately 10 percent — will go on to develop posttraumatic stress disorder. Although in a different context the psychological distress that many survivors experience might seem indicative of mental health problems, in the wake of a disaster, this emotional (and sometimes physical) dysregulation is normal, he explains.

“These are people having normal reactions to abnormal events,” says ACA member J. Barry Mascari, an associate professor in the Department of Counselor Education at Kean University, where he teaches, studies and writes about trauma and disasters. “Therefore you cannot look at their reactions through a traditional mental health lens. The reactions are often situation specific and transient.”

In fact, says Mascari, who is certified in New Jersey in disaster response crisis counseling, the practices used in the past — engaging in talk therapy and focusing on the details of the disaster — can cause survivors to “relive” the event, which can be retraumatizing.

Indeed, the help that survivors need most is often practical as much as psychological, notes Laura Shannonhouse, an ACA member and a licensed professional counselor who has worked with survivors of multiple disasters. She says that psychological first aid is designed to provide information, comfort and practical support, all tailored to the individual needs of each survivor in a structured manner.

This support consists of eight core actions: contact and engage, provide safety and comfort, stabilize, gather information, offer practical assistance, connect individuals to social supports, give coping information and provide links to needed services, says Shannonhouse, an assistant professor in the clinical mental health school and the counselor education and practice doctoral programs  at Georgia State University.

Disaster survivors are grappling with a substantial number of difficulties, notes ACA member Karin Jordan, who has worked directly with disaster survivors and is the coordinator of ACA’s Traumatology Interest Network. “Immediately after and in the wake of the disaster event, emotions tend to be very strong,” she says. “People are often put in a position in which they need to act in a heroic way to save their own or others’ lives and get themselves and others to safety. So safety of self and others is very important. This would include safety from the disaster and aftereffects.”

Safety concerns can involve anything from downed power lines to a disconnected gas line to earthquake aftershocks, notes Jordan, professor and director of the University of Akron School of Counseling. “Returning to damaged homes might be unsafe, which might mean that people will spend some time in a shelter or tent. Being displaced might also mean that some families are scattered across different camps.”

Counselors should keep all of this in mind when engaging with survivors, says Lawson, whose areas of expertise include disaster mental health and response and resilience. He explains that after introducing themselves to and establishing a basic rapport with survivors, counselors should assess for safety and comfort. For instance, if the person is having a panic attack or hyperventilating, the goal is to try to stabilize them, he says. Counselors should then gather information about survivors’ needs and concerns, such as whether they know the location of their loved ones, have a place to stay and have or know where to get items such as clothing and other supplies. Helping survivors identify resources to meet their needs can help them feel more in charge, Lawson notes.

Counselors also play a very important role in normalizing what survivors are feeling and how they are reacting to tragedy, Lawson points out. “We want to help them feel competence so they are not waiting for someone to come in and rescue them. We want to move them toward being in charge of what comes next,” says Lawson, who previously chaired an ACA Task Force on Crisis Response Planning.

“We hope for them [survivors] to be able to return to something like pre-trauma functioning,” Lawson says. “It won’t be the same, but similar. We talk about a ‘new normal.’ Your life isn’t going to be exactly the same as before, but you can get to a new normal.”

Healing connections

It is also crucial to get survivors reconnected with social supports such as family members, friends, their spiritual communities and the community in general, Lawson says. These natural support networks are particularly important to the long-term well-being of those who experience disasters, he adds. “As helpful as it is to have counselors there, they are ultimately going to go away,” Lawson points out.

ACA member Laura Captari, who has a background in community mental health and has counseled survivors of disasters in the United States and internationally, agrees. “Disasters often uproot social networks just like they do trees,” she says. “Isolation is a strong predictor of negative mental health outcomes. … Responders should listen for signs of isolation, loss of relationships and/or disconnection from community resources, and be looking for ways to facilitate reconnection with neighbors, family members and faith communities.”

“For survivors, acting on and celebrating interdependence on others can ease feelings of loneliness and isolation,” continues Captari, who is earning her doctorate in counseling psychology at the University of North Texas, where she works in the Family Attachment Lab studying the role that spirituality and attachment play in facilitating posttraumatic growth and resilience.

When survivors of disasters come together to support one another, in many cases they gain not only practical assistance and the comfort of being with people who understand what they have endured, but also a variety of emotional benefits, Captari says. She notes that research has associated altruism with increased gratitude and well-being among those who practice it.

Although most survivors will not need long-term treatment, counselors should be alert to certain signs and symptoms. “Disaster can lead to feeling hopeless and desperate,” Captari says. “Responders should listen for any indication of harm to self or others, as well as impulsive or risky behaviors. It is important to recognize when a survivor may need additional follow-up services from another professional, agency or organization, and [then to] provide this referral.”

Lawson adds that signs such as hypervigilance and difficulty sleeping can indicate trouble if they are present for weeks or months at a time.

Calling on a higher power

The Humanitarian Disaster Institute at Wheaton College in Illinois is a research center that studies the role that faith plays in helping people cope with disasters. Shannonhouse is a fellow at the institute, where she is part of a team that is developing a program of spiritual first aid.

“Survivors [of disasters] often turn to their faith to make sense of suffering, and there is more than 40 years of scholarship on religious and spiritual variables in coping and making sense of suffering,” Shannonhouse says. “Unfortunately, most of this knowledge is left out of disaster mental health programming.”

Captari is also working with Shannonhouse and others at the Humanitarian Disaster Institute to develop general spiritual first aid practices. “In working with professionals of diverse cultural backgrounds, I have learned so much about resilience in the wake of systemic trauma … and have seen, time and again, that for many individuals, their personal faith and spiritual community buffer against negative psychological outcomes,” Captari says.

Captari points out that multiple studies have indicated that the majority of Americans (an estimated 89 percent, according to the Pew Research Center) express a belief in God or some other higher power. In part for this reason, Captari contends that counselors have an obligation to understand and integrate survivors’ cultural, religious and spiritual values into treatment.

Shannonhouse, who also works at Georgia State University’s Center for the Study of Stress, Trauma and Resilience, notes that although spiritual beliefs can be a source of strength for survivors, disasters can also cause feelings of spiritual distress, such as feeling abandoned or punished by God. These feelings can lead to a loss of hope. Spiritual first aid is intended to help promote positive spiritual coping, Shannonhouse says.

“SFA [spiritual first aid] is an evidence-informed, early disaster, spiritual- and emotional-care intervention that promotes fortitude and resilience through spiritually oriented support, resources and interventions,” she explains. “[It] is designed to help triage survivors immediately following a disaster by reducing spiritual distress, fostering spiritual support [and] improving access to spiritual resources.”

Some of the aspects of spiritual first aid are based on general coping behaviors, such as practicing self-care and understanding common stress reactions. In addition, spiritual first aid involves working with survivors to help them identify what rituals or beliefs connected to their religious or spiritual traditions might bring them comfort. Disaster mental health workers then encourage survivors to turn to these practices as a way of coping, Shannonhouse explains.

Says Captari, “This could include attending religious services, vigils [or] support groups; meeting with spiritual leaders; yoga, meditation and mindfulness practices; reading sacred texts; listening to religious or spiritual music; prayer; journaling — the possibilities are endless, but they should be guided by the client.”

“SFA is not a step-by-step manualized intervention,” she continues, “but rather provides a simple, flexible model to help facilitate therapeutic interactions with survivors in a variety of short-term contexts through empathic listening and support.” She explains that when talking with survivors, counselors and community responders can hold in mind the acronym S.O.U.L.S. to assess how the individual or family has been affected and what the survivor’s greatest needs are:

S: Stress

O: Other support

U: Ultimate concerns

L: Loss of resources

S: Self-harm and harm to others


Another acronym, C.H.A.T, describes the helping process taught in spiritual first aid:

C: Connect through presence

H: Help with humility

A: Assess by observing and questioning

T: Triage with spiritually oriented interventions


S.O.U.L.S. and C.H.A.T. will be featured in a spiritual first aid manual currently being written by Shannonhouse, Jamie Aten (founder and director of the Humanitarian Disaster Institute) and Don Davis, an assistant professor at Georgia State.

Both Shannonhouse and Captari caution that no one-size-fits-all approach exists for spiritual first aid. Like any counseling method, it must be practiced with cultural humility.

“Be curious and seek to understand the survivor’s unique experience and needs,” Captari says. “Some survivors may be reticent to talk about spiritual issues due to fear of judgment or criticism. Counselors can use SFA to ask about, encourage and validate the importance of existential questions and struggles that may be present rather than shying away [from them].”

Captari also emphasizes the importance of counselors maintaining an open, interested and accepting attitude toward the beliefs and faith tradition of survivors. “For example, if the survivor identifies as religious or spiritual, explore how the disaster has impacted their relationship with the sacred or their connection with their faith community,” she advises. “Spirituality for many people is a profoundly physical and emotional experience, and people who have lived through disaster are likely experiencing acute stress reactions. It is often difficult to connect with the divine when one is in a state of hyperarousal. Normalize feelings of anger or confusion toward their higher power. Do not minimize, trivialize or pass over the very real negative impact of the disaster, and do not try and correct, challenge or ‘fix’ survivors’ theology, assumptions or beliefs.”

Counselors can help disaster survivors who identify as religious or spiritual in a number of ways, Captari says. These include:

  • Helping them to draw on their sacred texts to normalize their feelings
  • Exploring themes of mercy and protection with them
  • Facilitating gratitude
  • Encouraging the practice of daily spiritual routines such as prayer, yoga or meditation
  • Encouraging them to identify and reflect on hope-filled mantras, positive imagery and stories of overcoming adversity

Says Shannonhouse, “Counselors don’t need to identify as religious or spiritual themselves in order to utilize the assessment [S.O.U.L.S.] and intervention [C.H.A.T.] strategies included in SFA. Nor do they need to be well-versed in the survivor’s faith tradition or spiritual beliefs. An attitude of humility, curiosity, empathy and acceptance is what is important, rather than coming in as the mental health expert who has all the answers.

“Joining with survivors and entering into their experience is the key to the therapeutic presence offered by SFA. This model provides a framework for talking about and exploring how the disaster has impacted a survivor’s sense of well-being and helps providers critically consider ways to connect survivors with spiritual resources that are in line with their faith tradition to help facilitate grief, adjustment and restoration of stability.”

Spiritual first aid isn’t just for counselors or other mental health professionals. Clergy and other professionals and volunteers such as emergency management professionals, humanitarian aid workers, first responders, and health and public health professionals may also find it helpful, Shannonhouse notes.

Resilience and growth

Helping people with the immediate negative aftermath of a disaster is important, but it is also crucial to note survivors’ capacity for resilience and growth, say Lawson and Mascari.

“Human resilience is amazing,” says Mascari, who studies disaster response and co-edited the third edition of the ACA book Terrorism, Trauma and Tragedies: A Counselor’s Guide to Preparing and Responding with Jane Webber. “People come out of disasters feeling stronger.”

Adds Lawson, “We focus an awful lot on posttraumatic stress, but there is also the potential for posttraumatic growth.”

Survivors of disasters often emerge with a new appreciation for life, value their relationships in a new way, feel a new sense of community or are strengthened spiritually, Lawson explains. In some instances, survivors even experience a renewed sense of power and purpose that they devote to a cause related to the disaster.

Lawson notes that the organization Mothers Against Drunk Driving emerged out of traumatic experiences. “They could have stayed in the victim stage, feeling helpless and distressed,” Lawson says, “but those people connected with others who had been through the same thing and resolved to do something about it.”

Shannonhouse points to the concept of spiritual fortitude. “Spiritual fortitude is … a process of facing adversity in which one intentionally engages redemptive narratives and the sacred in order to metabolize the difficulty of suffering and loss. Spiritual fortitude does not imply conquering adversity or returning to a state of previous functioning, nor is it simply enduring suffering. Rather, spiritual fortitude is about leaning into the suffering and undertaking virtuous action.”

Counselors can help encourage posttraumatic growth by assisting clients with the meaning-making process, say Shannonhouse and Captari.

“Invite them to view their present adversity from a transcendent perspective,” Captari suggests. “Ask them to think about how their life is part of something bigger.” Counselors can also help survivors create a “spiritual life map” or history to rediscover insights, strengths and resources that they have gained from their beliefs over the life span.

When people experience posttraumatic growth, it can allow them to say, “I’m not a victim. I didn’t just survive, I thrived,” Lawson concludes.




Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

ACA Disaster Mental Health webpage (counseling.org/knowledge-center/trauma-disaster)

Includes information on the U.S. Substance Abuse and Mental Health Services Administration’s Disaster Distress Helpline and 15 fact sheets compiled by the ACA Traumatology Interest Network covering topics such as one-to-one crisis counseling, disaster and trauma responses of children and parents, helping survivors with stress management skills, grief reactions over the life span and intrusive memories.

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • Terrorism, Trauma and Tragedies: A Counselor’s Guide to Preparing and Responding, third edition, edited by Jane Webber & J. Barry Mascari

ACA Interest Networks




Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counselors play part in Orlando crisis response

By Bethany Bray July 8, 2016

On June 12, America woke up to the terrible news that dozens of people had been killed and injured in a spree of violence perpetrated by a single shooter at a popular nightclub in Orlando, Florida.

Within 24 hours, local counselors began circulating a spreadsheet, asking practitioners to sign up for shifts to offer therapy and support to victims, their families and community members at several locations around Orlando. The spreadsheet had more than 650 practitioner names on it within a few days, says Kristin Page, a licensed mental health counselor (LMHC) who offered crisis counseling in the days and weeks that have followed the tragedy.

“It was truly a community effort. People were willing to pitch in as needed,” says Page, a faculty member in the Department of Professional Counseling at Webster University in Orlando.

“I wish I could share the beauty of the counseling community in Orlando,” agreed Shainna Ali, president of the Florida Association of Multicultural Counseling and Development, and one of the many who provided crisis counseling in Orlando after the shooting. “Instantly following the [shooting] there was a surge of willing and able counselors ready to meet the needs of the Rainbow heartcommunity. I was able to see our counseling values in action, live in front of my eyes. As hundreds signed up for volunteer shifts, my heart was warmed as I noticed familiar names, peers, colleagues and past students. The counseling community has certainly banded together and is presently championing social justice in Orlando. I never have been more proud to be a counselor in the City Beautiful.”

The June 12 incident at Pulse nightclub in Orlando is being called the deadliest mass shooting in modern U.S. history. Forty-nine people were killed and 53 were wounded.

The first 911 calls came from the packed nightclub just after 2 a.m. After an initial barrage of gunfire, the shooter, 29 year-old Omar Mateen, barricaded himself in a bathroom with other clubgoers. The standoff came to an end just after 5 a.m., when law enforcement breeched the premises and killed Mateen in an exchange of gunfire.

“The community as a whole is grieving. [The shooting] has taken a mental health toll on people here in Orlando in various ways,” says Page. “This really hit home for so many community members – even people who didn’t know anyone who was at Pulse are finding themselves struggling, crying all the time.”

Following the shooting, many who came to counseling “just wanted to sit with someone and talk – be safe, and be heard,” says Page.

“In the initial days and weeks after the attack, we were doing a lot more listening [than structured therapy]. Just letting people express how they’re feeling is important, getting those feelings out there,” says Page.

The ad-hoc group of volunteer practitioners met with people at churches and other community locations, talking with victims, friends and family of victims and community members. They also saw first responders, such as emergency dispatchers, police officers and others who were involved as the shooting unfolded.

Many people expressed feelings of grief, sadness, denial, anger or survivor guilt, says Page, as well as general unease and feeling unsafe.

Through crisis counseling, Page says she focused on the message that feelings of grief and sadness are natural in the wake of trauma, she says.

“So they’re not thinking ‘this is just me’,” she explains. “The intensity of the feelings is very real to them. We [counselors] are letting them know that this is a process, and normal in the wake of something traumatic or the occurrence of a grief event.”

“Overall, the way the community has come together already shows me that we’re going to survive this. We’re going to be OK,” says Page. “The wonderful efforts on local therapists part have just stunned me. I have seen so many people come together. But this has taken a mental health toll on so many in Orlando. We will continue to need services. This is something we’re going to have to build together.”

Grief over the Pulse shooting was felt acutely by both the LGBT community, as Pulse is a popular gay nightclub, and the Latino community, as the violence occurred during a Latin-themed night at the venue.

Counselors should understand that “a safe place for the LGBT community was attacked” on June 12, says Ami Hooper, a LMHC in Tampa and leader in the Florida branch of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC). “Our LGBTQ clients need to know they are still safe and [should] be allowed an opportunity to process these events from various perspectives as the realizations come to them. I want counselors to know that like in all times of grief, you don’t have to have the answers. Often, there are no answers. Only that the best approach is to offer a safe space for clients to come as they are, when they desire. Not all of those impacted will seek counseling immediately, but [will] rather wait some time to seek help.”

The Pulse shooting took place during a week when several other traumatic events shook the Orlando community, including an alligator attack that killed a toddler on the Walt Disney World property and a murder-suicide at a rock concert.

Candace Crawford, president and CEO of the Mental Health Association of Central Florida (MHACF), says her organization’s mental health referral service has seen calls increase by roughly 20 to 25 percent since the Pulse shooting.

MHACF, an advocacy and mental health support nonprofit in Orlando, is working on creating a comprehensive plan to offer post-crisis counseling services for at least another 12 months, says Crawford.

“The crisis intervention is great for right now, but there will be many people for whom that is not sufficient,” says Crawford. “What we’re looking at is the delayed onset of trauma. There’s so much to be done for families who are attending to the immediate needs, moment by moment, day by day. There will be a time when they will be impacted, [and] they will all the sudden be unable to get out of bed … We want to be there to provide that safety net for those who have made it through for a time, but are impacted.”

After the Pulse shooting, Orlando city leadership organized a 24-hour response center at the Camping World Stadium, the downtown venue where the Citrus Bowl is played. More than 50 agencies collaborated to provide support services – everything from help with funeral arrangements to finding out-of-town relatives a place to stay.

Crawford said the community-wide response following the shooting has been “remarkable.”

In the week after the shooting, Crawford said she received a group email sent from Orlando’s LGBT community center, asking for help finding an apartment for one of the shooting victims as they were being released from the hospital.

“Within two minutes [someone replied and] they had an apartment for this person. Two minutes. That just shows you the kind of response we’ve been getting from this community,” says Crawford.





The Florida Counseling Association, the American Counseling Association’s branch in the Sunshine State, kicked into high gear on June 12. In the days and weeks that have followed the Pulse shooting, the association has sent out regular communications and social media posts connecting members with resources and information as well as calls for volunteers to join the Orlando-area crisis counseling efforts.

“We are incredibly thankful for our local counselors who quickly came to assist and help those in need, and we are continuing to remain in constant communication with our contacts in Orlando, FCA President Michelle Bradham-Cousar wrote in an email to Counseling Today. “We have sent out various communications to our counselors in order to secure an abundance of counselors for constant rotation and to provide for the needs of the Orlando community.”


In their own words

We asked several counselors from FCA who have been involved in Orlando’s trauma response to share some thoughts on the situation in Orlando.


“Counselors outside of Florida should be mindful about how clients feelings, thoughts and behaviors may be directly or indirectly related to the [Pulse] shooting, although they do not live in Florida. Providing them with the support they need and letting everyone know you stand with Orlando, even in a small way, can make a huge difference to help the nation heal. Counselors can prevent this from happening again by providing education, advocacy and clinical services to and on behalf of marginalized groups to reduce the effects of mental health issues and inequality from contributing to future incidents.

… When people worldwide go back to their regular lives and the media moves on to other stories, people all over will still be suffering from the shooting massacre just like the victims, families and community members of similar [past] tragedies are still suffering or were re-traumatized by this event. [They] will still be grieving, and trauma symptoms will emerge or continue for victims, their families and first responders, including professional counselors.”

— Letitia Browne-James, a LMHC who provided crisis counseling in Orlando


“As counselors, it is essential that we remember to be kind to others and most importantly, to be kind to ourselves. Tragedy can occur at any point in time and our ability to heal and process difficult emotions arising from a difficult event is easier to endure with supportive individuals at our side. Enhancing safety for the LGBT community and educating the public regarding awareness on mental illness — more specifically anxiety and depression, among others — will be the first step in helping our communities prepare for future tragedies … Although individuals around the globe have not directly experienced the calamitous event in Orlando, they are still impacted and are in need of comfort and support from caring individuals. Counselors worldwide are subject to compassion fatigue and may also be indirectly impacted by this senseless tragedy.”

— Courtney Martensen of Jacksonville, president-elect of the Florida Association for Child and Adolescent Counseling


“At the present time, there is heightened energy and willingness to assist. However, individuals are still in shock and absorbing the news. It is important to remember that when considering traumatic events, self-awareness to mental health needs often occurs much later than the actual event. Thus, it is important to consider that realization and subsequent need for counseling may likely occur in waves following the Pulse tragedy.

… The traumatic influence of this tragedy influences individuals within and beyond Orlando. Counselors should be well aware of the pervasive impact of this event. Beyond clients, individuals who may be affected yet not enrolled in counseling services may seek solace in a counselor who may be a family member, friend or acquaintance. Counselors should be prepared to provide these individuals with the gift of presence and be prepared to provide clinical resources and referrals.

To do your part in standing against such acts of violence, counselors should take a moment to consider what their counseling identity means to them. Beyond specialty and training, counselors should consider what advocacy means to them and how this looks for them. Counselors should be propelled to action to stand upon their values and tenets of counselor identity.”

— Shainna Ali, president of the Florida Association of Multicultural Counseling Development, who provided crisis counseling in Orlando





Find more information and resources by visiting:


The Florida Counseling Association at flacounseling.org

The Mental Health Association of Central Florida at mhacf.org

ACA’s page on disaster mental health: counseling.org/knowledge-center/trauma-disaster

The American School Counselor Association page on helping kids during a crisis: bit.ly/29A8Nr0

The Substance Abuse and Mental Health Services Administration (SAMHSA) page on mass violence: bit.ly/1M4yJBi


From Counseling Today:

Counselor addresses self-care, guilt in the wake of Orlando shooting

After Orlando: Helping others, helping ourselves

When tragedy hits close to home





Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org


Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.