Tag Archives: Trauma and Disaster

Trauma and Disaster

The high cost of human-made disasters

By Lindsey Phillips March 1, 2018

The stories of the aftereffects of human-made disaster have become all too familiar: a refugee forced to make a dangerous journey to find a new home; the soldier deployed thousands of miles from home for months at a time; the person who finds his or her world turned upside down when a shooter enters the room and begins firing. It’s not surprising, then, that according to a report by the American Psychological Association, in 2017, 60 percent of Americans felt stressed about terrorism and 55 percent felt stressed about gun violence.

In addition, refugees fleeing war-torn countries have created an international crisis, and, among other things, they aren’t getting the mental health care they need. The International Medical Corps found that 54 percent of Syrian refugees and internally displaced populations in Syria, Lebanon, Turkey and Jordan suffered from severe emotional disorders, including depression and anxiety.

The increase in human-made disasters raises a question for counselors and others: Does the type of disaster — natural, human-made or technical — affect the severity of the trauma or the counseling approaches used to treat it? Devika Dibya Choudhuri, an associate professor at Eastern Michigan University, says sufficient research indicates that when human agency is involved, the disaster has a more traumatizing effect. Although natural disasters are traumatizing, there is often a huge response of communities taking care of one another, which tends to be a restorative factor, she explains.

“With human-made disasters … the aftermath is also conflicted,” says Choudhuri, a licensed professional counselor and American Counseling Association member who presented at the ACA 2017 Conference & Expo in San Francisco on group interventions in the aftermath of violence, terrorism and dislocation. “Most [refugees’] … traumatizing stories are not just [about] the original trauma. … The journey after is so profoundly traumatizing as well because not only are they ungrounded from the loss of home, but then all of these additional wounds are made. There is no safety anywhere, as opposed to that sense [after a natural disaster that] people are coming forward to help.”

Rebuilding trust, regaining control

Choudhuri, who worked with Cambodian and Bosnian refugees in the 1990s and has worked with Iraqi and Karen refugees since the 2000s, points out that survivors of human-made disasters are fighting on two fronts: struggling to survive in their environment and engaging in an inner conflict where the original strategies for survival during the trauma are no longer helpful. Thus, when it comes to trauma and human-made disasters, counselors should focus on restoring a client’s sense of control, not safety, she advises.

Hannah Acquaye, an assistant professor of counseling at Western Seminary in Portland, Oregon, works with refugees from war-torn countries such as Afghanistan and Iraq and parts of Africa. She finds that for refugees from countries where neighbors are fighting neighbors, the trauma is unique in terms of feeling a sense of betrayal. If the person holding the gun and causing the devastation is someone they know and used to play with growing up, then the trauma becomes especially troubling, she says. “It affects the way they trust people … and makes it harder to build a community back,” explains Acquaye, an ACA member whose research focuses on refugee trauma and growth.

Thus, rapport and trust are crucial for survivors of a human-made disaster. According to Mark Stebnicki, professor and coordinator of the military and trauma counseling certificate program in the Department of Addictions and Rehabilitation Studies at East Carolina University (ECU), empathy and listening are critical elements of establishing rapport and gaining the trust of these clients.

Establishing a therapeutic alliance can be problematic, however. Counselors often learn to build a therapeutic alliance by offering warmth and connection and by encouraging clients to tell their stories, Choudhuri points out. But for individuals who have experienced a “traumatizing offense through human agency … the betrayal and abandonment and loss of trust during the process gets triggered by the very warmth of the connection,” she explains. Counselors will often experience that after making a connection and getting the client to open up, the client never shows up again or ends up in the hospital, Choudhuri says.

Before uncovering the trauma, counselors must help rebuild and ground clients so that they will have resources to address the trauma, Choudhuri argues. “Rather than creating a therapeutic alliance, it’s about rebuilding the kinds of ways in which people can take care of themselves so that they don’t require the therapist to do that,” she explains. In fact, she advises that counselors should work with survivors of human-made disasters as if they will have only one session together. The first few sessions should focus on techniques that will help clients function in case they don’t return, she says.

One way counselors can help clients become autonomous is by providing them with tools to regulate their emotions. Somatic and emotion regulation techniques allow survivors of human-made disasters to notice their triggers on a sensorial basis and use their brain to counter this negative trigger, says Choudhuri, a certified eye movement desensitization and reprocessing (EMDR) therapist. In a sense, their brain becomes an ally, rather than an obstacle or hindrance, in their recovery.

One of Choudhuri’s clients suffered trauma after being held captive and tortured for several days. Smelling the cologne worn by one of his captors would trigger the client. After identifying this sensorial trigger, Choudhuri set out to counter it. She discovered that the client found lavender essential oil calming, so she directed him to take in the lavender scent anytime that he encountered the smell of cologne. The process works on two levels, Choudhuri notes, because “it’s addressing the sensorial piece, but it’s also giving control back [to the client].”

Choudhuri also finds that traumatic resilience is important when working with survivors of human-made disasters. Many resourcing and grounding techniques that counselors use can also make clients more resilient in the face of ongoing trauma, she notes. For example, Choudhuri finds the container technique helpful for her clients: She tells clients to think of a container with a secure lid (e.g., a jar, a jewelry box) and then to use that container to mentally store the parts of the trauma that get in their way and prevent them from moving forward.

Group work is another resource that can help survivors of human-made disasters rebuild a sense of trust. At the same time, Choudhuri says, “group work is really challenging, particularly for [people] who have had human-made disasters, because other human beings are a source of threat [to them].”

In fact, Choudhuri is careful to avoid touching clients who have been hurt by other human beings. Instead, she teaches clients how to give themselves a comforting touch. For example, she uses the butterfly hug method (clients cross their hands over their chest and alternately tap their hands to a heartbeat cadence) while she facilitates thoughts of being safe and loved. This technique works well with children and is one that clients can do themselves when they are upset, she adds.

Rather than asking individuals to share their trauma in groups, Choudhuri suggests having them process it in a way that allows group members to provide comfort to each other, thereby helping restore a sense of control, trust and efficacy. For example, counselors could have individuals teach each other how to engage in deep breathing. “It allows for people to feel empowered to … not just be on the receiving end but also on the giving end,” Choudhuri explains, “and then they’re giving something that they themselves are learning, which helps them learn it better.”

From Stebnicki’s perspective, groups not only allow counselors to identify people who need more individualized treatment but also provide a safe space to verbalize and normalize survivors’ feelings (e.g., anxiety, depression, grief, sleeplessness) about an event and prepare them for the forthcoming weeks. “If you get [clients] to open up and share feelings [in a group], then the group itself is your own best source of support because they can normalize what that scary event was like,” he says.

Bridging cultural differences

Stebnicki acknowledges that working with people who are culturally different from the counselor can be challenging. Clients who are refugees, immigrants and asylum seekers may pose an even greater challenge because American counselors are often far removed culturally from individuals from war-torn countries such as Syria and Afghanistan, he adds. But successful treatment relies on understanding clients’ cultures and how they heal, he asserts.

In some cultures, counseling as generally practiced in the Western Hemisphere doesn’t exist, so counselors shouldn’t force clients to share their stories, Acquaye says. Instead, counselors should focus on providing a safe, supportive environment and inform clients that they are in the moment with them, she advises.

Stebnicki, a member of both ACA and one of its divisions, the Military and Government Counseling Association, says that he distinguishes between civilian and military responses to human-made disasters. “Military is a culture unto itself,” he says. “Military personnel experience person-made disasters differently in that instead of detaching, isolating, running and going into shock like civilians do, they adapt and survive, and they aggress … [not] stress.” Unlike civilians, who typically respond to a shooting by running away, military personnel are generally running toward the gunfire, he points out.

At the same time, civilians and military personnel experience similar physiological, psychological and emotional responses to human-made disasters. However, military personnel also experience ongoing trauma stressors (such as multiple deployments) and generally do not undergo the full range of posttraumatic stress disorder (PTSD) symptoms until after their deployment or military service ends, Stebnicki says. Thus, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders “measures PTSD, but mainly in civilian life because it doesn’t take into account this … repeated exposure to trauma which military [personnel] are exposed to,” he argues.

In addition, military personnel often cannot easily take advantage of mental health services in the same way that most civilians can because of the stigma that military culture places on it, Stebnicki says. Using these services can sometimes put their security clearances at risk, cause them to get demoted or have others in the military lose faith in them and their ability to lead, he explains.

Despite these difference, many counselors try to treat military personnel as civilians and do not recognize the distinctions between civilian and military mental health, Stebnicki says. To help address this issue, he developed the certificate in clinical military counseling at ECU. The course trains professional counselors on some of the unique cultural differences in diagnosis, treatment and services for members of the military.

Making meaning of human-made disasters

In the face of a human-made disaster or a large-scale political event, people often feel helpless, like a small cog caught in a big wheel, Choudhuri says. In such cases, the counselor’s aim is not to help clients find an answer to existential/spiritual questions of why the disaster happened but to help them figure out a meaning to these events that they can live with, she says.

Meaning making should also involve some degree of personal growth, Stebnicki notes. He says that counselors can determine whether clients have experienced posttraumatic growth by their actions: Are they taking their medications? Are they going to counseling? Have they reconnected socially? If the answer is no, then there is no growth, he says.

The counselor’s job, Stebnicki contends, is to provide tools and resources to help clients take responsibility for finding meaning and growing from the trauma. However, he points out, growth is painful, so counselors must prepare clients to take small steps toward identifying ways of feeling safe and ultimately finding meaning.

Acquaye actively celebrates her clients’ small victories because she believes it encourages them. She had one client who was a refugee who was depressed because she didn’t know how to communicate in her new culture. Acquaye asked her to try to leave her apartment each day and walk around for five minutes. When her client was successful, Acquaye jumped up and down in front of the woman to celebrate her progress. Taking this small step forward helped her client begin to sleep regularly again, Acquaye says.

Choudhuri looks for ways to address clients’ despair without trying to change their beliefs about what happened. She finds EMDR helpful because it allows people to process internally without having to give the counselor details about their trauma. At the same time, clients are able to arrive at a meaningful narrative about their experience. “It may not be my answer, but it’s their answer,” Choudhuri adds.

Choudhuri provides an example of a Syrian refugee who participated in EMDR therapy that involved drawing and processing his trauma. At the end of the session, he said that regardless of the terrible things that had happened to him, he realized that every night has a morning. “It wasn’t that he got an answer or that he had a solution,” Choudhuri says, “but he got what he needed — hope.”

For many clients, spirituality plays a large role in meaning making. If the client’s and counselor’s spirituality differ, then the counselor should find common ground to discuss spirituality, Acquaye advises. The majority of her clients are Muslim and Acquaye is Christian, so in session, they discuss the general concept of God and who is in control of everything. “We can’t explain why people do what they do, but we can hold on to somebody who is greater than people and know that some good may come out of that,” she explains.

Self-care and counselor fatigue

Clients’ stories of trauma, suffering and loss can take a toll on counselors, resulting in counselor burnout, compassion fatigue or empathy fatigue. The cumulative effect of seeing multiple survivors of human-made disasters and other traumas can start to deteriorate counselors’ spirit to do well and damage their own wellness, Stebnicki notes. For that reason, counselor self-care must become a priority when working with survivors of human-made disasters.

Stebnicki differentiates between empathy fatigue, a term he coined, and other fatigue syndromes such as burnout and compassion fatigue. He explains that empathy fatigue results from a state of physical, emotional, mental, spiritual and occupational exhaustion that occurs as the counselor’s own wounds are continually revisited through a cumulation of different clients’ stories of illness, trauma, grief and loss.

The major difference between these types of fatigue syndromes is that empathy fatigue has an added spiritual component, Stebnicki notes. Horrific experiences such as genocide and torture go beyond the range of ordinary human experience and affect the mind, body and spirit, he explains. Thus, it is crucial that counselors are properly trained to be empathetic and compassionate, he says. In addition, because people experience and define spirituality in their own individual ways, counselors must understand their clients’ views of spirituality to assist them in cultivating hope and psychosocial adjustment to their trauma.

Acquaye acknowledges that she didn’t initially realize how much the stories of her refugee clients would affect her. If counselors are struggling with counselor fatigue, they need to seek help to avoid harming their clients, she advises. “It’s not about me. … If I claim I’m an advocate for my refugee clients, then I should get over myself and ask for help, so I’ll become a better person for them,” she says.

Choudhuri says counselors must also guard against making another common mistake. Because refugees often have little meaningful support, they are incredibly grateful when they do receive it, and there can be a danger in that for counselors. “If [counselors] work long enough with [refugees], it gets really easy to feel like a savior,” Choudhuri admits.

“One of the things that trips [counselors] up is this belief of indispensability — that there is nobody else, so I have to keep doing it even if I don’t want to,” Choudhuri adds.

She also finds that working with clients who have survived a human-made disaster can bring out something of a competitive nature in counselors: They assume (often incorrectly) that if the client can deal with the trauma, then they can too because they are the counselor.

Among the possible signs of counselor fatigue syndromes that Stebnicki notes are having diminished concentration, feeling irritable with clients, feeling negative or pessimistic, and having difficulty being objective or compassionate. “We’re good as counselors at giving advice to others and helping facilitate self-care strategies, but we don’t do it ourselves. We need to take our own best advice and get help,” he advises.

Stebnicki has found peer support helpful when dealing with fatigue syndromes. He and other colleagues meet once or twice a month to vent and share their stories. In fact, he notes that it is common to have ongoing peer support on-site for counselors and first responders at large-scale human-caused disasters. These support groups allow counselors to discuss what they saw, how it affected them, how they are responding and how they are going to overcome it, he says.

Acquaye is thankful for her supervisors and own personal counselor who help her guard against burnout. “I have to remind myself all the time that I’m not God … so I can’t carry my client because sometimes the stories are so heavy that you can’t sleep at night,” she says. She realizes that carrying the burden of her clients’ stories will serve only to make her negative and ineffective as a counselor.

Many counselors are drawn to working with refugees because they want to help, but before jumping in, Acquaye says, counselors should understand what their strengths and limitations are. “Ask yourself [if] you have enough strength for the kind of stories they will throw at you. [If not], it doesn’t mean you are not good enough. It just means that that is not your area,” she says. “When it comes to refugee work … you are going to go through the trauma yourself, so you have to ask yourself, ‘Do [I] have what it takes to go through that?’”

Lessons learned

How can counselors prepare to handle the specific needs of survivors of human-made disasters? “Training to be trauma informed becomes key. … There shouldn’t be counselors coming out of counseling programs who don’t have a basic understanding of trauma,” Choudhuri asserts. Yet, she finds that counselors often report not knowing how to deal with trauma and disaster mental health.

Choudhuri thinks that one area of disaster mental health where training needs to improve is clinical competency. Often, counselor educators aren’t practitioners, which can be problematic because they don’t see the chronic nature of clients’ issues and thus don’t prepare adequately, she contends. She argues that counselor educators should stay clinically active — perhaps even working with survivors of human-made disasters — to keep their finger on the pulse of what is happening.

Of course, Acquaye admits that counselors are never likely to have all of the training they need to handle disaster mental health straight out of school. Many of the skills must be learned on the ground. She recounts a time when despite her training on refugee trauma and posttraumatic growth, a client’s story scared her to the point that she was shaking. She had to remind herself that even though she had no idea how to treat the client’s many issues on the spot, she needed to start by listening to the client and then figuring it out as she went along by researching and assessing the client’s needs.

What people consider to be trauma or traumatizing changes over time, Choudhuri notes, so the symptoms that veterans displayed after the Vietnam War are not the same ones that soldiers returning from Afghanistan and Iraq have displayed. Today, counselors also have to take into account the fact that there is more aggression digitally, and digital aggression distances people from the trauma, she adds. For example, drone warfare has changed the rules of war, allowing people to kill from a distance. This makes killing more impersonal and affects the mental health of drone pilots differently.

“As conflict becomes handled differently, [so does] the kinds of betrayals and ways in which people can be hurt electronically. … [People’s] sense of danger and risk become different than if somebody broke into [their] house. They’re related, but they’re different,” she says.

One mistake that counselors often make when working with clients is expecting a more intense early disclosure of the traumatic incident, Stebnicki says. Stebnicki worked as a member of the crisis response team for the Westside Middle School shootings in Jonesboro, Arkansas, in 1998. In the aftermath, he witnessed a counselor go up to a student, take him by the shoulder and almost shake him to force disclosure of what the student had just experienced. Counselors must remember that everyone heals at his or her own rate, so survivors of human-made disasters may not want to discuss their experiences immediately after the event, he says.

Stebnicki has also found that people’s experiences vary based on their proximity to the disaster’s epicenter. “We all differ in stress and trauma in terms of the pattern, the frequency, the exposure, the magnitude/intensity. So, in other words, we all turn our stress response on differently,” he says.

In working with refugees, Choudhuri has learned that counselors can’t assume to know the trauma. One of her clients had been married off by her parents while in the refugee camp to a man who raped her. Was the worst part of her experience being in the refugee camp, losing her home or being raped? Choudhuri discovered that for the client, it was that her parents didn’t love her enough to have chosen a better husband for her.

“It wasn’t the violence that drove her from her home, it wasn’t the destruction of her life as a schoolgirl, and it wasn’t even the brutality of her experience in the marriage,” Choudhuri says. “It was the sense of being betrayed by her parents.” Thus, counselors should remember that the focus of the work is not about the trauma but about the client, she adds.

Choudhuri has also observed that although disaster mental health professionals have developed ways to work with people immediately after a disaster, they often fail to implement this guidance back home. She argues that counselors don’t respond to the ongoing, everyday disasters happening in their backyards — the microaggressions and microassaults that wear people down as they try to overcome obstacles of systemic racism, chronic poverty, violence and substance abuse — in the same manner as they respond to large-scale events.

“If we can point to the singular event, we can be horrified by it and [respond] with compassion and helping, but when we live in it, we numb ourselves … to it because we feel helpless,” Choudhuri says.

“It’s difficult because we all want a place of safety … so it’s easier to go away somewhere and work on [disaster mental health] and then come back [home] and be safe,” she points out.

Counselors need to resist the urge to let trauma and disaster response fade into the background because of the discomfort these events can generate, Choudhuri argues. Instead, they must keep disaster mental health in the foreground and help rebuild communities and individuals affected by disasters, including those less obvious disasters happening in counselors’ backyards.




Lindsey Phillips is a freelance writer and UX content strategist living in Northern Virginia. She has a decade of experience writing on topics such as health, social justice and technology. Contact her at lindseynphillips@gmail.com or through her website at lindseynphillips.com.

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.

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.