Tag Archives: Trauma and Disaster

Trauma and Disaster

Relieving the heavy burden of survivor guilt

By Lindsey Phillips June 27, 2019

Patience Carter took a bullet in the leg during the 2016 mass shooting at Pulse nightclub in Orlando, Florida — the second deadliest mass shooting in the United States — and survived. In a poem she wrote while recovering, Carter captured the devastating effects of survivor guilt: “The guilt of feeling lucky to be alive is heavy. It’s like the weight of the ocean’s walls crushing, uncontrolled by levees.”

Some people are able to grasp and admit that they are suffering from survivor guilt. Others, however, don’t necessarily realize they are wrestling with it, or they struggle to acknowledge carrying a sense of guilt. Luna Medina-Wolf, president of Professionals United 4 Parkland, was part of the mental health response team after the 2018 shooting at Marjory Stoneman Douglas High School in Parkland, Florida. She says many of the teachers sought help for their trauma after the shooting and, through therapy, also found they were dealing with survivor guilt for not being able to protect all of their students or for living when a child died.

Thus, Medina-Wolf, a licensed mental health counselor and the owner of Helping Moon Counseling, advises other clinicians to pay close attention to subtle comments clients make that may indicate they are struggling with survivor guilt. Rather than directly stating “I shouldn’t have survived,” a client may say, “How is it that my friend died?” This question infers the thought “And I didn’t die,” explains Medina-Wolf, a member of the American Counseling Association. Counselors must sharpen their listening skills and not be afraid to ask questions and dig deeper, she adds.

“Even when people are admitting [their guilt], when the words are coming out, they’re not realizing what it is that they’re admitting,” says Melissa Glaser, an ACA member in private practice in Connecticut. “They don’t know as they’re saying it that this is survivor’s guilt and that they’re stuck in a place that they can’t navigate out of.”

Glaser, a community response and recovery leader, served as director of the Newtown Recovery and Resiliency Team following the mass shooting at Sandy Hook Elementary School in 2012. She says counselors can listen for telltale comments that clients are struggling with survivor guilt. For example:

  • “I can’t accept the help because someone else needs it more than me.”
  • “I keep thinking if only I had …”
  • “Other people were so much more courageous while I was just hiding under the desk.”
  • “I became frozen and immobilized, and I still feel like I’m in that place. I’m so angry at myself that I couldn’t move or do something more.”
  • “Why did my child come home while another [parent’s] didn’t?”

Glaser is a consultant, a public speaker on trauma and relevant clinical applications, and a licensed professional counselor (LPC) who specializes in trauma and posttraumatic stress disorder (PTSD). She says survivor guilt typically manifests when someone feels a sense of responsibility for a loss or traumatic experience or when someone is grappling with questions of why and how (e.g., Why did this happen? Why did I react that way? How can I enjoy life when others can’t?). This is especially true if they think they could have done something differently to prevent or change the outcome.

“It’s really important for clinicians to help individuals get to a place where they are able to understand that they’ll never have the answers [and] that they can’t stay rooted on the why. … You have to find a way to project those whys into or onto something else,” Glaser says. “Otherwise, it can consume you, and it can become such a part of your identity.”

Glaser often suggests that clients picture themselves throwing their why questions into the air and they don’t come back down. If clients value spirituality, they can imagine that God is going to deal with the questions for a while, she adds.

“Survivor guilt is complicated. … [A] lot of the time, people will not even seek counseling because … they feel they don’t deserve to feel better or they’re not worthy of getting relief,” Medina-Wolf says.

She had a client who was diagnosed with cancer at the same time a friend was diagnosed. When the client survived and the friend didn’t, the client said, “My friend was such a good person. I’m not a good person like her. She volunteered and was kind to everybody. I’m not kind to people. Why did she die?”

Shame is also often intertwined with survivor guilt, adds Courtney Armstrong, an ACA member with a private practice, Real World Therapy, in Tennessee. “When there’s an element of survivor’s guilt on top of [grief], they feel ashamed or guilty for having any joy … because that’s disrespectful to this other person,” she explains. For example, when a child dies, parents may not want to change the child’s room because they feel guilty about moving forward and seemingly “dismissing” their child.

Other clients have told Armstrong, “I can’t be happy if [my loved one] isn’t here. … I feel bad for enjoying my life when they’re not here.”

The ripples and waves of guilt

Survivor guilt can set in immediately, or it can make its presence known months or even years later. This past March, roughly one year after the Stoneman Douglas High School shooting in Parkland, two survivors — Sydney Aiello and Calvin Desir — took their own lives. Aiello’s family reported that she suffered from survivor guilt. A few days later, Jeremy Richman, who lost his daughter in the 2012 Sandy Hook shooting and who later served as one of the keynote speakers at an ACA Conference, also died by suicide.

Richman, along with his wife, had created a foundation to prevent violence and build compassion through brain health research. Up until his death, Richman was actively working with Parkland families. Glaser says Richman was the last person most people would have expected to take his own life, but she stresses the importance of being aware that everybody is in a different place. Counselors “have to be well-versed in [the] signs and symptoms [of PTSD and survivor guilt] and never hesitate to reach out, never hesitate to ask questions,” she adds.

John Super, coordinator of the Community Counseling and Research Center and a lecturer of counselor education at the University of Central Florida, has observed that a person’s proximity to the traumatic event may affect how quickly he or she feels survivor guilt. After the Pulse nightclub shooting, Super, along with two other colleagues, helped organize a grassroots collaborative plan to offer supportive counseling services to those affected.

Super compares trauma and the potential for experiencing resulting survivor guilt with throwing a pebble into a lake: “It ripples out. Those [who] are the closest feel it the quickest and the strongest, but that doesn’t mean that people on the outside don’t feel it.”

Working closely with media reporters after the Pulse shooting, Super witnessed how they also experienced a sense of guilt. “Generally, reporters tend to see themselves as hardened — ‘We’ve seen and heard the worst of life so, obviously, we can’t have any guilt or emotional response to this,’” Super says. “And they would be the ones who buried it the deepest.” Some reporters felt guilt almost instantly because they knew they were prying into people’s lives or pushing people to comment who weren’t ready. Super noticed the guilt appeared later for other reporters, such as when they were writing their stories, editing a video or doing a follow-up special.

According to Jeffrey A. Lieberman, who chairs Columbia University’s psychiatry department, adolescents are particularly susceptible to the after-effects of trauma, including survivor guilt, because they are already dealing with massive changes as they move toward adulthood.

One way that counselors can help survivors is to normalize the guilt they may be feeling after a loss or traumatic event. Glaser, author of Healing a Community: Lessons for Recovery After a Large-Scale Trauma and co-author of the chapter “Disaster Recovery in Newtown: The Intermediate Phase” in the fourth edition of ACA’s Disaster Mental Health Counseling: A Guide to Preparing and Responding, points out that part of the recovery process is simply understanding what is involved. After the Sandy Hook shooting, she noticed a sense of relief when she told clients about common physical and emotional responses to trauma. The clients would look at her and say, “Oh my God! That’s why I feel the way I do. That’s why I can’t do that [activity] anymore.”

During the first session, or when clients are otherwise ready to absorb information, Medina-Wolf will show them a “window of tolerance” infographic created by the National Institute for the Clinical Application of Behavioral Medicine (see nicabm.com/tag/window-of-tolerance/). The infographic helps clients understand that what they are experiencing is a normal reaction to a traumatic event.

A person’s window of tolerance is the ideal place for coping with stressors and triggers, Medina-Wolf explains. Hyperarousal (e.g., hypervigilance, anxiety, panic, fear, racing thoughts) sits at one end of the window of tolerance, whereas hypoarousal (e.g., feelings of numbness, emptiness) sits on the other. The infographic illustrates how a traumatic experience can narrow a person’s window of tolerance, causing the person to feel dysregulated. Although most people commonly associate trauma symptoms with hyperarousal, many of the symptoms of survivor guilt — such as feeling helpless, unmotivated, immobilized, numb or disconnected — are components of hypoarousal, Medina-Wolf adds.

Medina-Wolf says she has had clients cry upon viewing the window of tolerance infographic because they realize they are not going crazy. “A lot of what people need in the beginning is just that reassurance that what they’re going through is symptoms of trauma,” she says. 

In addition, recovery from survivor guilt and trauma isn’t a linear process. The guilt and grief of the loss comes in waves, not stages, says Armstrong, author of Rethinking Trauma Treatment: Attachment, Memory Reconsolidation and Resilience and Transforming Traumatic Grief. The reality is that people who are grieving typically move back and forth between loss-orientated waves, in which they feel emotionally and physically drained, and restorative waves, in which they become more task-oriented and don’t dwell on the pain, she explains. Counselors should reassure clients that experiencing grief and guilt in waves is a normal part of the recovery process, Armstrong says. Otherwise, clients who have been feeling better may wonder what is happening when they suddenly find themselves back in a loss-oriented wave.

Of course, as both Armstrong and Medina-Wolf point out, when clients start feeling better and moving through their grief, this can actually cause their survivor guilt to flare more intensely because they don’t think they should be “over it” this quickly or because they feel guilty about being happy again.

Medina-Wolf, who is certified in eye movement desensitization and reprocessing (EMDR), uses recent traumatic episode protocol (R-TEP) for early EMDR intervention with clients. If clients don’t have any underlying issues, this protocol often helps them feel better in as little as three to five sessions lasting 90 minutes apiece. This sometimes prompts them to ask, “How can I feel so good so quickly?” she says.

Of course, some clients may feel that they have their survivor guilt and grief under control, only to turn on the news and be faced with the reality of another traumatic event transpiring. This can throw survivors back into a sense of guilt, distrust and questioning why, Glaser says.

“It isn’t that [trauma] is going to be erased,” she says. “It isn’t that they are going to recover and never be triggered again or never have a day or moment where they’re feeling that extreme sadness, or they’re feeling dysregulated again, or they’re feeling things are foggy. They will experience times like that for the rest of their lives. Hopefully, it’s fewer and further between as they work through this.”

When you can’t talk away the guilt

Glaser is trained in cognitive behavior therapy (CBT), but when it comes to collective community trauma, she has found that CBT may not be the most effective approach — or not effective at all — until the client is grounded.

Medina-Wolf agrees: “Communal trauma requires specific brain-based therapeutic techniques to really be able to break some of the negative schemas that were created due to the trauma. Just doing talk therapy would really take a long time until you would be able to heal. … [A] lot of times, it doesn’t take care of it all. You just learn to cope with it, but the damage is done. And if you don’t make sure to really work on the underlying schemas, then [they] may stay with [you] for the rest of your life.”

With survivor guilt, clients experience a disconnect between what they feel and what they know, Medina-Wolf explains. They may realize on a cognitive level there was nothing they could have done to prevent someone’s death, but they still feel differently.

Medina-Wolf uses a metaphor to explain to clients how trauma shapes the way they see the world and themselves in it. If they were to put on red-tinted sunglasses, she tells them, then everything would seem reddish; once they removed the sunglasses, they would realize it was just the glasses making things appear red. Similarly, being in a state of hyperarousal or hypoarousal makes it difficult to think rationally and process one’s thoughts and emotions, which may alter a person’s perceptions, Medina-Wolf says. Thus, bottom-up approaches such as EMDR, neurofeedback and brainspotting, which allow emotions to be processed at an unconscious level, work better to treat survivor guilt and other trauma-related symptoms than does a top-down approach such as CBT, which assumes that changing thoughts will change behavior and feelings, she explains.

With EMDR, the client and counselor first identify the negative self-belief (e.g., “I could have done something more to save the person’s life”). The client then thinks about this distressing feeling while the counselor uses bilateral simulation such as eye movement, tappers or bilateral music. This technique allows clients to open a door between their conscious and subconscious minds so that they are able to figure out what happened and rewire the way they understand it, Medina-Wolf explains. By identifying the negative self-belief and reprocessing and desensitizing what happened, clients can come to terms with what occurred in a more rational way and are more in control of their emotions when they are triggered, she continues.

For example, Medina-Wolf used EMDR R-TEP with a Parkland student who felt guilty for not saving another student’s life. First, they identified the client’s negative self-belief (“I should have done something more to save the student”) and the positive self-belief she wanted to work toward (“I did the best I could”). Medina-Wolf used tappers to administer bilateral simulation, and after three sessions, the client was able to reach that goal. Her thought process was more rational, she believed she had done the best she could, and she no longer felt guilty for the person’s death.

Individuals who experience survivor guilt, complicated grief or extreme trauma reactions may not be able to organize their thoughts to tell counselors what they need, Glaser says. For that reason, she also recommends using mind-body techniques such as meditation and music therapy to regulate and ground clients. This helps them to process their story and recover the vocabulary to talk about their experience. In many instances, clinicians may need to take a layered approach — for example, doing CBT in conjunction with tapping, art therapy or brainspotting.

Glaser often reverts to something rhythmic to help ground clients. For example, she may have them tap the side of a chair or their leg in a rhythmic way or take them on a walk outside (if they feel safe doing that). This simple rhythmic work helps get clients through the initial acute stage so they can begin to hear the counselor and produce the language they need to tell the counselor what they are feeling, Glaser explains.

In session, Medina-Wolf uses aromatherapy, meditation, breathing techniques and a box filled with fidget toys, pencils and squishy toys that clients can grab and play with while they are processing the event. She also encourages clients to supplement therapy with activities such as running, swimming or cycling that encourage bilateral simulation. 

Reimagining guilt

The attachment system often confuses what is imagined and what is real after a traumatic loss or event, points out Armstrong, founder of the Institute for Trauma Informed Hypnotherapy. Thus, she finds the imaginal conversation technique helpful for calming clients’ attachment systems and rewriting the negative thoughts connected to guilt.

With this technique, Armstrong has clients close their eyes and imagine what the person who died would say to them now from a place of enlightened awareness. Would the person want them to be tormented? Would this person tell them they don’t deserve to be alive? Imagining these conversations often helps clients obtain resolution, she says.

Armstrong allows clients to take the lead on these conversations. If they struggle, however, she might say, “I’m imagining they understand that you feel regret and they appreciate how much you care, but they think that being stuck in this depression and guilt isn’t the solution. It isn’t the best way to honor them.”

Armstrong had one client whose mother died by suicide and blamed the client in the suicide note. Because the client had a complicated relationship with her mother, she had a hard time being able to think with a clear, stable mind about her mother. Armstrong told the client she could instead imagine the way she would have liked her mother to be. With clients who are spiritual, counselors can have them imagine a conversation with God and God telling them everything is OK and they are not responsible for what happened, she adds.

Armstrong also has clients write letters to the deceased about their feelings. Then she has clients write an imagined response from the deceased (using their nondominant hand so they are less likely to edit it with their intellectual mind).

Counselors may also need to help clients address another common symptom of survivor guilt: recurring nightmares. Armstrong finds imagery rescripting helpful here. The technique involves rewriting or changing the ending of the nightmare. Clients first describe the nightmare to Armstrong, and then she asks how they would want to change it.

Armstrong had a client whose son died by suicide. The mother felt guilty for not somehow preventing his death — which she feared had caused him to go to hell — and for cremating him when she wasn’t sure he would have wanted that. This guilt culminated in a nightmare in which her son was asking for help as he was being rolled into a furnace, but she was unable to move her body to help him.

Armstrong asked the client, “What do you wish you could do in the dream?” The client responded that she wanted to move and go to her son. Armstrong then asked her to close her eyes and imagine a new ending — one in which her feet could move, she possessed the superpower to leave her body and go to her son, or her son was able to walk to her. The mother closed her eyes and reimagined the nightmare: The son got off the gurney and met her halfway. Then he embraced her and said, “I love you, Mom. I’m sorry I didn’t get to say goodbye. I’m going to be OK.” This revision brought an end to the client’s nightmares.

Counselors should have clients imagine their dreams and the new endings as vividly as possible, Armstrong advises. It typically requires going over this new ending several times in session and having clients imagine it again before bed. “If you just talk about the ending without imagining it as best you can, it won’t work because your emotional brain needs that imaginal experience,” Armstrong explains. The emotional brain learns through experiences, not reasoning, she says, so counselors must have clients create an experience that will allow them to heal.

Turning pain into power

According to Glaser, survivor guilt is rooted in pain. She advises counselors to help clients realize that “guilt in any of its forms is not really productive” — either for clients, for those around them or for those who are gone.

Medina-Wolf says clients often acknowledge being angry, depressed or anxious, even when guilt is the underlying cause of their problems, because it is more difficult to admit feeling guilty. “They feel like if they say it out loud, then maybe they are guilty,” she observes. “The guilt is so deep and they’re so [ashamed] of it because they’re so confident … in that negative distortion that it’s literally killing them from the inside.”

It matters where that guilt is coming from, Medina-Wolf continues. Do they think they didn’t do enough? Do they feel they are a bad person who shouldn’t have survived? Counselors can help clients process exactly what they are experiencing and identify the underlying cause of the guilt, she says.

Often, the guilt is based on a fear of not knowing how to go back into a world they no longer trust, Glaser says. So, instead, they hold on to the guilt and the awful feeling of responsibility. “When we understand that, we can start to make some inroads,” she continues. “We can help the client know where it’s coming from.”

Armstrong points out that pain is also a way for some clients to maintain a bond with their loved one, especially if they experienced the death of a child or someone’s death by suicide. Clients may assume that living without the pain would suggest their loved one’s life wasn’t important, she explains.

She encourages clients to honor their loved ones by letting their importance stay alive in a positive way. Armstrong provides a personal example: Her husband enjoyed watching Atlanta Braves baseball games with his mother, so after she died, he and Armstrong continued to go to games to honor her.

One of Armstrong’s clients had a son who died of an overdose. The client’s happiest memory was of camping in the Grand Canyon with his son, but after his son’s death, the father’s sadness and guilt stripped him of his motivation to hike and camp. Armstrong asked the client to imagine whether his son would want his father to stop hiking to prove his love for him or whether he might prefer that his father do something that served as a positive reminder of their time together. After the father’s perspective was changed through this imagined conversation, he took a small step forward by going hiking. Eventually, the father and his wife planned a trip to the Grand Canyon in their son’s honor and spread some of his ashes there.

Armstrong also recommends using the making living stories technique, in which she invites clients to bring in photos or share stories about the deceased. However, she has found that if she asks clients to tell her a story about the person, their minds often go blank. So, instead, Armstrong will ask about the deceased loved one’s favorite music or food, about a trip the client took with the person, or even what annoyed the client about the person. These silly or trivial questions often end up producing the best stories, she says.

Armstrong also prefaces this technique with the phrase “when you are ready” to ensure that discussing the loved one won’t create additional pain for the client. Counselors can put the invitation out there, and when clients are ready, they can work together to find ways to remember the loved one, she says.

There are times when the attempt to turn pain into something positive can result in others feeling even more guilt. For example, the media often praises survivors or those who have perished in mass shootings for their bravery, such as in the case of Kendrick Castillo, a student who died trying to subdue an active shooter in his school in Colorado this past May. Glaser acknowledges the desire to honor those who perform heroic acts, but she also notes this action can create something of an expectation among adolescents that it is their responsibility to react bravely and save others during a school shooting. It can also exacerbate survivor guilt among those who followed safety protocols and hid behind their desks.

Armstrong is impressed when survivors take a horrible situation and become empowered, such as with the Parkland students’ gun violence advocacy work. However, she also acknowledges that survivors sometimes need to work on healing themselves first.

One of Armstrong’s clients had a daughter who died of a childhood cancer. Soon after her daughter died, the hospital and cancer community approached the mother about having a fun run in honor of her daughter and to raise money to battle the specific type of cancer. Her daughter’s death was too fresh though, and the mother ended up experiencing survivor guilt for not wanting to help create a fun run in her daughter’s honor.

To help the client, Armstrong had the mother imagine what her daughter would say about the situation. Armstrong knew a little bit about the daughter’s personality, so she mentioned the daughter would probably say that even she didn’t have time for a fun run because she was still learning to navigate the afterlife. This helped the client put her guilt into perspective and focus her energy on healing herself.

“You don’t have to be a hero,” Armstrong often reminds clients. “If you decide to do something later, then that’s awesome. But [honoring a person’s life] may just be in little simple ways — I’m just going to take more time to appreciate a sunny day, be kinder to people or not take things for granted.”

Compassion for self, not just others

Often, it’s easier to offer compassion to others rather than to oneself. This may be especially true for counselors. Super, an ACA member who presented “The Shared Trauma of School Shootings and Their Impact on Counseling and Education” at the ACA 2019 Conference in New Orleans, admits he wasn’t good at self-care during the recovery after the Pulse shooting. As one of the coordinators of the grassroots recovery effort in Orlando, Super spent the majority of his time at different counseling centers helping survivors and supervising counselors, and at the end of the day, he often had nothing left in him to tend to his own self-care.

Months later, as he was researching and presenting on his personal experience with this large-scale traumatic event, he realized how it had affected him. “Those thoughts [of ‘it could have been me’] start coming to you, that guilt of ‘this young person … just lost their life and I didn’t.’ I think that is probably a quiet voice that sat in the back of my mind through the entire process.”

Super also witnessed counselors who experienced guilt over not feeling prepared enough or not knowing enough about trauma and the LGBTQ+ community. Other counselors felt guilty that they didn’t help with the recovery efforts because life got in the way or because they simply weren’t ready and needed to take care of themselves first, he adds.

Super would pay close attention to how counselors were responding — for example, if they didn’t want to meet with clients or walked off by themselves — and check in with them. He and the other two organizers weren’t able to be in contact with all of the mental health providers offering assistance, so they also trained counselors to be aware of colleagues’ behavior and check in with them as needed.

People don’t often think about the need for counseling supervision during a collective trauma, Super points out. “But if you have counselors out there, you really need to have supervisors who are debriefing or helping process emotions for those who are providing services in the moment,” he says. He advises counselors and supervisors to make time for self-care. Talking about their feelings with another counselor, a supervisor or someone they trust will help counseling professionals recharge, and it will minimize the residual effects down the road, he notes.

Compassion also helps clients reframe their own guilt. Armstrong stresses the importance of providing psychological first aid — which includes making the person feel supported and safe — immediately after a traumatic experience. Armstrong has had sessions in which a client cried the entire time, and she felt guilty for not doing enough — only to discover that the client thought the session was extremely helpful. Outside of the counseling space, clients typically have to hold it together, she points out, so they often appreciate having a space where they can break down and not worry about others.

Armstrong also worked with a client who dealt with survivor guilt after the 2012 mass shooting in a movie theater in Aurora, Colorado. The client had been watching a movie next door and, on her way out, almost tripped over a woman who had been shot. She didn’t know how to help the woman, so she simply held her hand and called the woman’s mother. Discussing this with Armstrong, the client said, “All I could think to do for the gunshot victim in the parking lot was to sit there and hold her hand. I am in the health care field, and I felt completely incompetent.”

Armstrong reassured the client that she had done something valuable by offering the shooting victim compassion and psychological first aid, but the client still felt guilty for not doing more. While the client described the event again, Armstrong held her hand, which created an experience to demonstrate the power of compassion. When the client finished her story this time, she noted how the simple act of Armstrong holding her hand had helped her get through the story and made it seem less scary.

A few months later, the client ran into the woman she had helped after the shooting. The woman told her that the kindness of a stranger holding her hand was what replayed in her mind — not the horror of the event.

Armstrong acknowledges that counselors frequently worry about not doing enough, not knowing what to say to clients and not being able to rid them of all their pain. “At the end of the day,” she says, “it’s just us being able to sit with [clients] through all of the confusion and the heartache that heals them.”

For many survivors, the weight of survivor guilt is heavy. But counselors can operate as levees to prevent the weight of this guilt from crushing those who survive.

 

****

 

Read more in an online companion piece to this article, “Doing the groundwork after a large-scale traumatic event

 

****

 

Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

 

Letters to the editor: ct@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.

Doing the groundwork after a large-scale traumatic event

By Lindsey Phillips June 24, 2019

Finding and helping people suffering from survivor guilt, PTSD and complicated grief can be challenging after large-scale catastrophic events, which are becoming more common. According to Mother Jones, since 1982, there have been at least 110 public mass shootings across the United States.

John Super, one of the coordinators of the Orlando recovery effort after the 2016 Pulse nightclub shooting in Orlando, Florida, acknowledges the sad reality that it’s not if collective trauma happens but when it happens, so counselors need to be prepared and adequately trained for crisis response.

Super, coordinator of the Community Counseling and Research Center and a lecturer of counselor education at the University of Central Florida, points out that the underlying thoughts and feelings of survivor guilt are the same regardless of the type of loss. However, he adds, large-scale traumatic events carry their own additional stressors: the lack of privacy, communal trauma and the increased fear for one’s safety in public areas (such as being afraid to go to the grocery store).

Because people are in a state of pain, dysregulation, fear and distrust, they put up walls, notes Melissa Glaser, a licensed professional counselor (LPC) in private practice in Connecticut. Glaser, a consultant and public speaker on trauma and relevant clinical applications, served as director of the Newtown Recovery and Resiliency Team following the mass shooting at Sandy Hook Elementary School in 2012. “Lots of times people in helping professions, particularly clinicians, come into a situation like [a mass shooting] where there’s collective community trauma or even coming into situation where you’re working with individuals that are in the throes of their grief — complicated grief and trauma reaction — and you think that you’re going to be welcomed with open arms,” she says. “And often the opposite is true.”

Super was surprised that people weren’t showing up to the grief counseling centers after the Pulse shooting. Instead of getting angry, Super and his co-coordinators reconceptualized what their response would look like, and they literally started meeting the clients where they were. Counselors went to the blood donation lines and handed out water bottles. They attended the vigil and watched for people who were having severe emotional reactions.

The Pulse nightclub in Orlando, Florida, pictured after the shooting that killed 49 people and wounded 53 in June 2016.

They even went to local bars. A few days after the shooting, a local LGBTQ bar contacted Super asking for counselors to come to the bar because people were using alcohol to self-medicate. “Receiving that call was the lightbulb that went off,” he says. “What we found was some of our most productive counseling work happened in those environments.”

After the 2018 shooting at Marjory Stoneman Douglas High School, Luna Medina-Wolf, a licensed mental health counselor and the owner of Helping Moon Counseling in Florida, and the other therapists found themselves frustrated because they couldn’t access the survivors. The school system, with its background check and credentialing procedures, would not let them in. They decided to turn this frustration into action and figure out what they could do. Medina-Wolf, president of Professionals United 4 Parkland, reached out to Deb Del Vecchio-Scully, an LPC and trauma specialist who helped with response and recovery after Sandy Hook. Del Vecchio-Scully guided them through the process of organizing a recovery response and suggested they accumulate a list of mental health professionals who could help if the need arose.

Medina-Wolf reached out on social media to her connections and asked for trauma-trained therapists who could donate their time. Within three hours, she had 100 emails. To avoid being overwhelmed, she created a Google spreadsheet to track the names, specialties, credentials and phone numbers of the mental health professionals.

She discovered another therapist had started a similar list, so they combined their lists and eventually created the nonprofit Professionals United 4 Parkland. Through this collaboration, they have provided training sessions for therapists, parents, and educators and staff at Stoneman Douglas.

Medina-Wolf advises mental health professionals to come together, figure out existing gaps and ways that they can help, and reach out to community organizations to offer assistance. “This is a long-term healing process,” she says. “So, if [community organizations] won’t need you in the beginning, they will need you moving forward.”

That’s what is happening in Parkland now, she adds. After the initial shock, the community has had time to reflect on the long-term impact of this trauma, so they are reaching out to mental health professionals and figuring out a way to work together. For example, the first training they had for the teachers and staff at Stoneman Douglas was done independently from the school, but in January, the school reached out and requested that they host a training workshop as part of the school’s planning day. Medina-Wolf notes that they purposely called the workshop a retreat, not a training, to help reduce the stigma attached to mental health issues. The retreat included gifts, therapy dogs, breakout sessions on coping skills (such as meditation), and strategies on how to handle students and future drills.

Glaser, author of Healing a Community: Lessons for Recovery After a Large-Scale Trauma, also recommends collaborating with other professionals and organizations. “We have to get rid of the territorial aspect that the work can bring sometimes and bridge those gaps and be collaborative because one person or one organization can’t meet all the needs,” she says.

Glaser and her staff developed relationships with other professionals so they could appropriately direct those needing help. Providers would tell them when they had openings, the insurance they accepted and the therapeutic approaches they used, and new providers would provide a presentation on their services and even practice some of their techniques on Glaser and her team.

Glaser warns that clinicians can do more harm than good if they send clients to the wrong practitioner or if therapists promise things that they can’t deliver, which only undermines trust in all mental health professionals.

Glaser also stresses the importance of being hands-on and following up with clients. Because a traumatized brain can be extremely disorganized, counselors can’t simply give out phone numbers and a list of resources, she stresses. Sometimes, they have to make that call themselves and follow up with clients after they have had an appointment.

At the ACA 2019 Conference in New Orleans, Glaser spoke with school social workers from Parkland who were frustrated by their inability to help with the emotional aftermath after a lockdown drill because it wasn’t a priority to the administration. Glaser agrees that clinicians could do a better job with debriefings after a drill, and she also shared in their frustration with dealing with resistance from organizational leaders.

In fact, Glaser learned the importance of educating community leaders during her work with the Newtown community. She would invite the heads of organizations and school administration to participate when she brought in an expert or held a workshop on the importance of mental health efforts.

“We as clinicians now have the responsibility of educating from the top down,” Glaser says. “We can’t expect that the people that are following [safety] protocols and putting those measures together are necessarily well-versed in the clinical implications. So, part of our work now has to be to teach all of those involved.”

 

****

Look for a companion piece to this article, “Relieving the heavy burden of survivor guilt” in the July issue of Counseling Today magazine.

Related reading, from the Counseling Today archives:

 

****

 

Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editor: ct@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.

The gifts of volunteering as a disaster mental health counselor

By Suzanne A. Whitehead February 19, 2019

I was presenting at the Western Association for Counselor Education and Supervision Conference in Santa Rosa, California, on the evening of Nov. 8, 2018, when the urgent call came. The American Red Cross was frantically looking for certified disaster mental health counselors to help with what appeared that it might become a large disaster due to the wildfires that had sprung up near the areas of Chico and Paradise, California. (This would later be named the Camp Fire.) I responded that I could be there on Nov. 11 to help out as much as possible. I had been watching the news reports while at the conference, and I could tell the situation was growing dire.

As I left the conference, being held about an hour west of the fires, that Saturday evening, the acrid smoke filled the air and pellets of ash hit the roof and sides of my car as I made my way south. I live in the Central Valley of California, about 2.5 hours south of the fires and Santa Rosa. All the way home, the smoke lingered in the air like a very dense fog, yet I knew it was far worse.

I raced back to Sacramento (1.5 hours north) the next morning to go to the American Red Cross headquarters to get my assignment. The fires had been raging and spreading for more than 3 days at that point. The skies above were thick with smoke, and I wondered what I might be getting myself into.

A decimated landscape along Highway 33 in Ojai, California after recent wildfires.

As I approached the Red Cross headquarters, I encountered a scene of organized chaos. I had an appointment with our area chief, but finding her took some time. When we finally met, she ushered me into a side office and gave me an assignment to one of the nine shelters opened in the fire areas. She also gave me several breathing masks, some bottled water and a “Go with God” message. There was no time for idle chatter.

I swallowed hard and drove the extra hour north. As I progressed, I couldn’t help noticing that fewer and fewer cars were headed toward the wildfire areas; many, many more were leaving. I had volunteered with the Red Cross along the Gulf Coast for two weeks in 2005 after Hurricane Katrina. After that experience, I also served as a disaster mental health volunteer in the wake of several local disasters on the East Coast, where I lived at the time. So, I already knew what to expect when it came to “shelter life,” but at the same time, I also was aware that each disaster — and each set of life circumstances — is unique. I braced myself for the possibilities, knowing I had to be strong.

 

In the shelter

As I approached the shelter, I again encountered organized chaos. The air was sooty and couldn’t be escaped, either in your car or in the buildings. I was stationed at an old fairground that had been turned into a makeshift shelter. A large building housed a common area, a kitchen and a gymnasium that had been turned into the sleeping quarters. There were two sets of bathrooms, but they featured cold water only – and no shower facilities. For showers, the Red Cross had placed trailers outside that contained three showers on each side for the “residents” to use. There were also dozens of people staying in their cars, in tents, in campers and in recreational vehicles, all surrounding the main shelter. These were the survivors who had escaped with their animals but were not allowed to bring them into the shelter.

As I entered the main hall, crowds were everywhere, lining up to get food, clothing, toiletries, diapers, wipes, supplies and water. I could hear the sense of panic and distress in the voices around me, and the looks on the survivors’ faces told of their immense grief and shock. I made my way over to where the two other disaster mental health counselors were located, inside the gym turned sleeping quarters. They filled me in on some of their areas of concern — and the individuals whom they were concerned about. Every cot was filled, with the distance between each being about 2 feet. My disaster mental health colleagues thought we had in excess of 125 survivors inside. They estimated at least another 75 or so people outside. I knew that we had our hands full because the need was tremendous.

By Nov. 11, the disaster had grown to a Level 5, one of the highest levels the Red Cross declares. It would later grow to a Level 7, the highest level possible, based on loss of life, the number of people affected, duration and overall cost. I started mingling throughout the crowd and saw a tremendous outpouring of distress. Many survivors were simply “walking wounded,” too much in shock to say much and still just trying to absorb all that had happened to them. Many asked me to help them find their loved ones; others cried over the fear that they had lost their precious pets.

I quickly found the list of referrals and resources to hand these survivors, but many didn’t even have a phone or the numbers of loved ones to call. The fires had spread like no one could remember, raging at their backs as they tried to flee. They had time to gather little beyond the clothes they wore. They shared stories of racing through the burning brush with the flames licking their cars as they fled.

Others spoke of quickly abandoning their vehicles when they got stuck in a standstill traffic jam on the few small roads that led to their once beautiful towns. They left their cars with few or no belongings, running along streets, paths and through the forests to escape on foot. When they spoke, their eyes lit up with fear, as if reliving the nightmare.

 

Personal encounters

You do a lot of psychological first aid as a disaster mental health volunteer in the first few days after a disaster. You mentally sort out those who seem to be coping, albeit shakily perhaps; those who don’t talk at all, keeping it bottled inside; and those who are clearly in great distress. You look for support systems of any kind and try to surround them with those who still have some “reserves” to give.

I encountered people from every walk of life during those first few days in the shelter, including those who were desperately poor to begin with. The stories of rescues and heroism made my heart skip, reveling at the strength of the human spirit. There were so many older adults, with walkers and wheelchairs, frightened and seemingly all alone. They struggled to remember phone numbers, addresses and the medications they needed — all common artifacts of trauma and disaster situations. We were eternally blessed at our shelter with several wonderful nurses on staff and a physician. They were a godsend, especially when the norovirus invaded the shelter a few days later. It wasn’t the best time to try to quarantine vast amounts of people, and yet there we were.

For many, the shelter offered a brief respite as they gathered their senses and financial resources, decided which relative or friend to travel to, and filled their gas tanks or purchased their plane tickets. The main hall meeting room was filled to capacity at meal times. The food was prepared at a central location in town and transported to all the shelters via the huge Red Cross emergency response vehicles.

People of all walks of life slowly began to reach out to one another; donations of food, clothing and supplies poured in; and no one was turned away. Friendships began to emerge by the fifth day, and a few smiles began to peer through the depression. The wildfires were still raging, and everyone instantly stopped what they were doing when the fire marshals came in each day to give their updates and reports. You still couldn’t go outside safely without a breathing mask on, and by this point, the acrid smoke and soot were in our hair, clothing and lungs.

And so it went. The days went by with little word about the survivors’ homes. There was one small television in the gym/living quarters, and the “residents” huddled there whenever a news report came on. I began making mental notes of the individuals I was most worried about: the young man who was clearly going through withdrawal of some kind; the older adult women with walkers and canes who were frightened easily and tired quickly; the caring gentleman who reached out to others but quickly escalated to outbursts of anger when he felt distrust; the man recovering from a recent stroke and estranged from his family, wishing now that it wasn’t so.

There were stories of heartache, pain, remorse, forgiveness, bravery, heroism and hope. All the while, I knew that this could happen to any one of us, in a heartbeat. When these people had awoken that fateful morning, they had no warning of the impending doom, no way to prepare and just barely enough time to get out of harm’s way. The fragileness of humanity struck me as I tried my best to help those in dire need. Given the same circumstances, I wondered how I would react.

 

What’s left behind

By the following weekend, Nov. 17, the only residents left in the shelter were the truly needy. These were the poor souls who had lost everything in the fires — they had no resources, no home owners insurance, nowhere to go, no one to go to. A feeling of great malaise and sadness had come over the group, and we did our best to try to restore hope.

It was a normal process and cycle, one I had witnessed after Hurricane Katrina so many years prior, and I was mentally prepared for it. However, these are human lives you are working with, and to say it doesn’t pull at your very soul would be a lie. People wanted and deserved answers, yet few were forthcoming because it was deemed unsafe to return to what remained of their homes.

The fires were mostly contained by this point; the grizzly, heart-wrenching job of finding the missing was well underway. The numbers feared missing had gone from an early count of 20 or so to well over 800, and then back down to less than 100 eventually. The residents cried at every news update and mourned the loss of their dear pets much more than the loss of belongings. Repeating their stories of survival to all who would listen was therapeutic and helped to alleviate some of the general malaise. It was a necessary element for returning to any sense of “normalcy.”

Nov. 18 arrived, and I had to return home, 2.5 hours south. I am a counselor educator, and my university had been closed for several days due to the horrid air conditions; we would remain closed until after Thanksgiving. Yet, there these people remained, trapped in a place they could not leave.

I felt great sadness as I left the shelter that evening to return to my home. I was reminded again and again of how very fortunate I am in life, and I felt blessed that I could be there to give solace to a few dear souls. I was not able to get the smell of smoke out of my hair and clothes for days — and out of my car for weeks — yet I was the supremely fortunate one.

It is so very true that disasters bring out the very best and the very worst in people. I chose to focus on the very best, and I witnessed it over and over. Just as when I deployed with Hurricane Katrina, I learned so very much about myself on this assignment. As a disaster mental health volunteer, you dig deep into your soul and discover what is truly important in this life. Just as with my Katrina experience, I received so many thank-you’s and bless-you’s this time that I was humbled to my core. The survivors told me I had given them so very much, but especially a sense that someone deeply cared about their plight. I am truly the lucky one, however, because giving our time and talents is such a precious gift to share.

The crisis of the wildfires in Northern California has now left the airwaves, but it still looms large. The American Red Cross continues to request assistance there; the need will go on for months, if not years, as the towns of Chico and Paradise try to rebuild.

If I can do anything now, it is to encourage professional counselors to volunteer with the American Red Cross. The trainings are easy, and most can be completed at your own time and pace. The need is tremendous because there is no shortage of disasters in our world. To volunteer, you need to be a clinical mental health counselor or a certified/credentialed/licensed school counselor. It just may be the most precious gift of your lifetime to give, and I can’t encourage you enough.

 

 

****

 

Suzanne A. Whitehead is the program coordinator and an assistant professor of counselor education at California State University, Stanislaus. She is a licensed mental health counselor, national certified counselor and licensed addiction counselor. She has volunteered with the American Red Cross since 2005. Contact her at swhitehead1@csustan.edu.

 

****

 

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

 

****

 

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: Enough: A call to action

By Cheryl Fisher July 20, 2018

“Thou shalt not be a  perpetrator, thou shalt not be a victim, and thou shalt never, but never be a bystander.” ― Yehuda Bauer

 

The sun warmed my body. Blissfully fatigued following several laps around the pool, I stretched out on the chaise lounge chair. I sipped my cool lemonade and haphazardly lifted my phone which had been vibrating endlessly. Who on earth was trying to reach me? I had prepared my clients for weeks regarding my vacation. I had set my away message on my phone. Who could possibly need me right now? My eyes squinted at the list of messages. “Are you ok?” “Where are you? I am worried?” “Please tell me you are safe?!”

My lazy summer mental fog abruptly dissipated as I sat up in my chair and began to read through the barrage of inquiries. What on earth is going on? I quickly tapped my responses. “I am fine. At the beach. What is happening?” I read the responses over and over waiting for the punch line, but there was none. My beloved community of Annapolis joined the ever-growing fraternity of gun violence and those men and women who reported the daily news were the target this time. The Capital Gazette was under attack with several fatalities and multiple injuries.

Reaction

I have been a counselor for twenty-plus years. I am a volunteer for the American Red Cross disaster mental health team and Maryland Responds Medical Corps. I have been deployed and provided crisis intervention to victims, and offered crisis debriefing to first responders. Professionally, this work is not new to me. However, to watch the devastation and suffering of my community from one hundred miles away was excruciating. I watched as the first responders whom I had brought homemade cookies to during the holidays risked their lives to enter the building under attack. I witnessed people I know being escorted from the building — the same building I had visited a week earlier for an endodontist appointment. I observed the swift and definitive execution of the emergency plan play out on national television. including scenes of the ambulance taking victims to the emergency room where I had served as an on-call counselor for 10 years. These were my people! The agony was palpable even from the safety of the beach. Rumors flooded social media, and I waited for news of missing persons.

I took inventory of my internal status. I am, after all, a therapist. I felt frightened for the families who had to sit with so many unknowns about the well-being of their loved ones. I felt helpless being so far away. I felt angry that we continue to experience this type of violence. Enough is enough! It is past time for counselors to make decisions and act.

Action

Counselors have a unique role following a disaster in that we are called to help heal a community’s trauma. We counsel survivors and families and debrief first responders. We help bring agency back to a community that may feel disempowered and devastated. The safety once experienced, crumbles and we aid in the creation of a new normal.

My first act was to contact Maryland Responds to see if we were going to deploy. The local Warmline — a non-emergency helpline that offers immediate counseling or referral services — had begun advertising grief counseling services and I knew that the first responder employee assistance programs would soon reach out for aid in debriefing the responders. However, like many communities, the Annapolis area is tight-knit, so the traumatic effects of the tragedy would be widespread. One of the local mental health networking groups spearheaded the creation of a list of providers willing to volunteer both medical and mental health services over the next several weeks. Clinicians from all over the county responded, zealous to do their part to help in the recovery effort. As clinicians, we know that initially there are rituals, memorials, vigils and casseroles that remind us of the solidarity of experience in these losses. However, when people attempt to resume their previous lives, they trip over metaphorical landmines that they don’t expect. Counselors can help clients to anticipate and disarm the mines.

Change

On February 27, ACA adopted a resolution supporting and highlighting the role that school counselors and other professional counselors play in addressing the anxiety, stress and trauma students experience after a school shooting.  The resolution also calls for adequate federal funding for research into the public health impact of gun violence and evidenced-based strategies for preventing and addressing gun violence.

In an Annals of Epidemiology article published in 2015, researchers Jeffrey W. Swanson, E. Elizabeth McGinty, Seena Fazel, and Vickie M. Mays reviewed research on the relationship between violence and mental illness. They found that the presence of mental illness is not an effective predictive factor for violence against others. Instead, they advise policymakers to focus on evidence-based risk factors such as previous violent behavior. They advocate for “time-sensitive risk assessment for violence as the foundation of evidence-based criteria for prohibiting firearms access, rather than focusing broadly on mental illness diagnoses and a record of involuntary psychiatric hospitalization at any time in one’s life.”

The authors’ conclusions highlight the need to train all mental health providers in violence assessment. The use of evidence-based criteria — rather than a diagnosis of mental illness — to prohibit firearm access requires a change in current policies and procedures. Saying “enough!” in the face of gun violence is neither a partisan statement nor an opposition to the Second Amendment. It’s a call for an end to the death and trauma. Gun violence permeates our society in multiple ways — not just in mass shootings but also through gun-related crime and suicide. Complex issues surround this violence, but there are definite steps we as a society can take such as reexamining gun control policy, demanding further research on predicting violent behavior, addressing insufficient access to mental health care and reducing the stigma attached to seeking care.

As counselors, we are trained to be value-neutral. We support the goals of our clients even when they directly oppose our own beliefs. We offer a non-judgmental presence. Regarding mental health care accessibility and gun violence, we need to dare to have an opinion. We need to know the platforms of our representatives and have their office number on speed dial. We need to use the strength of our collective voices and demand change.

Conclusion

Annapolis, Maryland, USA downtown view over Main Street with the State House.In the wake of the attack, I heard my community’s resounding cry of solidarity with all the victims of gun violence. Naptown Strong! We love you, Annapolis! And just like every other school, church, concert, movie theater and community affected by gun violence, we are striving to put the pieces back together from a horror that will forever inform our narrative. Enough is enough! Prayers and thoughts must be followed with action!

Annapolis and the Capital Gazette will not be defeated by violence. In the immediate aftermath of the shooting, the staff at the Gazette refused to be silenced. “I can tell you this: We are putting out at damn paper tomorrow,” tweeted reporter Chase Cook. And they did. Let us all be inspired by the courage and the conviction of these journalists.

 

****

Resources from ACA relating to gun violence and trauma for, both counselors and consumers: counseling.org/knowledge-center/gun-violence-trauma-resources

 

 

****

 

Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy: and geek therapy. She may be contacted 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.

 

Behind the book: Disaster Mental Health Counseling: A Guide to Preparing and Responding

Compiled by Bethany Bray July 2, 2018

Superstorm Sandy. Newtown. The Pulse nightclub. Counselors were there to help people through all of those disasters, plus countless others, both natural and human-caused, through the past decade.

Disaster mental health counseling has grown and become more standardized in the process. With each disaster, practitioners learn the subtleties of what survivors and communities most need, both immediately after the fact and in the later aftermath.

With that in mind, the American Counseling Association published an updated edition of Disaster Mental Health Counseling: A Guide to Preparing and Responding this year. The book shares insights from counselors who have served on the ground in disaster-relief efforts in a variety of situations, from work with refugees and veterans to school, university, community and international settings.

Counseling Today recently sent the book’s co-editors, Jane M. Webber and J. Barry Mascari, questions via email to learn more. Webber and Mascari are licensed professional counselors and counselor educators at Kean University in Union, New Jersey. The couple are married and present together often on disaster mental health, crisis response and trauma counseling.

 

Q+A: Disaster mental health counseling

Responses co-written by editors Jane M. Webber and J. Barry Mascari, as noted

 

As specialists in disaster mental health, you give presentations and trainings on this topic often. What are some common questions you get from attendees? What are people most concerned or curious about?

 

Mascari: The ripple effect of the growing body of evidence gets questions from various audiences, including law enforcement. So many people are interested in learning emotion regulation, and we are getting more requests to address techniques to help counselors prevent vicarious traumatization. One of my favorite questions related to these techniques is, does this stuff really work? Then they tell us how amazed they are.

Webber: Over the years at Learning Institutes on disaster mental health counseling [at ACA’s annual conference] and state trainings, one question arises quickly: What do I say or do next? Especially after events of mass violence, responders ask, how do I respond in moments of crisis or terror?

Many are fearful of retraumatizating survivors or asking intrusive questions. Counselors also ask how to integrate trauma assessment and counseling with psychological first aid (PFA) as nonintrusive, compassionate lurkers while being alert to survivors in need. Probably the question most often asked is how to respond to families after mass shootings or bombings, particularly when children are killed or injured.

 

Disaster mental health is becoming a more prevalent and growing focus within the counseling profession. Besides your book, what resources would you recommend for counselors who want to “come up to speed” in this area – especially for counselors who did not cover this topic in graduate school?

 

Mascari: Taking online courses from the Federal Emergency Management Agency (FEMA) for sure. Also, there are a lot of online programs and great books. Many of the important works have not hit the journals but are in paperbacks that appear every day. Counselors cannot operate without being trauma informed and, at best, I would certainly like to see all our colleagues become trauma competent.

Everyone works with trauma survivors. [But some practitioners] either don’t look for or ask about trauma and then treat symptoms that could be more easily resolved if the causes were addressed.

Webber: I agree with Barry: ICS 100 (Incident Command System) and ICS 700 (National Incident Management System) are FEMA organizational courses [that can help] counselors know what to expect at any disaster site anywhere in the country. The Psychological First Aid Online course provides foundational knowledge and skills for delivering PFA in the immediate aftermath of a disaster (learn.nctsn.org). A must is to download the Psychological First Aid: Field Operations Guide to your laptop. Resources and handouts in the guide’s appendices are invaluable, especially the charts with what to say to people at different developmental levels (children, adolescents, adults). Also, the TIP 57: Trauma-Informed Care in Behavioral Health Services manual is our go-to book for trauma-informed counseling. All are free.

 

Do you feel the average counselor practitioner is adequately prepared for the possibility of a disaster — either natural or human-caused — occurring in his or her community? Generally speaking, is there a “that could never happen here” mentality among counselors, or a healthier viewpoint?

 

Mascari: No! There are many skilled, well-meaning counselors who could not serve alongside other mental health responders just because they do not have the basic knowledge expected of the American Red Cross or FEMA.

PFA, the preferred FEMA modality immediately after a disaster, is not counseling in the traditional sense. Therefore, being trained to respond as part of a recognized unit means following established protocols and putting away some of the more invasive counseling techniques. This is based on the idea that people are experiencing a normal reaction to an abnormal event, and that the majority of people return to normal in a relatively short time … My students often say that they feel like their skills have been “dumbed down” [for PFA] at first, then they realize these are valuable tools and incorporate them in their counseling.

As far as the head-in-the sand view, I don’t think most counselors see it that way. We do need to do more from a leadership level to make disaster and trauma more of a priority and more central to what we do. Many times, I look at what I know and what I can do and feel like, “If I only knew this when I worked with clients a few years back.” The new skills promise “better, stronger, faster” in terms of treatment and recovery.

Webber: The misbelief of “that could never happen here” has been destroyed by the deaths of students and teachers across the country [in school shootings]. Like suicide prevention and intervention, every counselor must be trained and prepared for disaster and mass violence that might occur in our communities and schools.

 

Much has changed – in the counseling profession and the world at large – since the last edition of this book eight years ago. Briefly, tell us what it took to update the material and why you felt it was worth rereleasing this text now, in 2018.

 

Mascari: The update was a huge undertaking, basically a redo and reconceptualization of the chapters and the style of the book. It is more scholarly and evidence based and not as raw as the articles that came from the heart and experiences in the earlier book. The field is becoming professionalized, and it appeared to be time to change the focus. Our [ACA VISTAS] article on the Council for Accreditation of Counseling and Related Educational Programs (CACREP) Standards and disaster received a large number of reads, so we know other counselor educators are struggling to include these standards in their teaching. The book brings everyone up to a new standard.

Webber: We all [the book’s close to 30 contributors] worked as a mini think tank with much discussion and debate to document the rapid growth of this counseling field. It was challenging for our authors to revise and update chapters seamlessly into the book and to emphasize the critical relationship between trauma and disaster counseling.

PFA has been a vital development for disaster response. Yet, for a few years, trauma counseling and disaster response were split. We have reintegrated the practice of trauma and disaster counseling to move the profession forward.

 

What interests you, personally, in this topic?

 

Mascari: My interests are described in the book (in a section of chapter 13, “In Our Own Words: I Never Thought I Would Become So Focused on Disaster and Trauma”), but briefly: I have been responding to disaster and traumatic events throughout my career, before there was a name for this type of work.

Webber: For me, trauma-informed practice has been an ongoing commitment since I was chairwoman of the ACA Foundation during Sept. 11. Responding to disaster survivors is an existential risk that defines who I am as a counselor. I can choose to respond with courage or shy away from helping. Disaster training is essential for our profession to stay on the cutting edge of mental health counseling, especially in an era of mass violence.

 

****

 

Disaster Mental Health Counseling: A Guide to Preparing and Responding, fourth edition, is available both in print and as an e-book from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-347-6647 ext. 222.

 

****

 

Follow Counseling Today on Twitter @ACA_CTonline and 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.