Therapists can traumatise the victims, too

When tragedy strikes, teams of counsellors are on hand. But a friend can often be more valuable than an over-eager professional rushing in to help, says Emma Daly
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The Independent Online
It's good to talk, they say, especially if you have experienced some horror - a traffic accident, a plane crash, rape, bereavement. We mostly accept that theory, consigning the stiff upper lip to history. But new research suggests that encouraging the victims or survivors of a traumatic event to discuss it soon afterwards with a counsellor may actually do more harm than good.

A team of psychiatrists in Cardiff, led by Dr Jonathan Bisson, looked at 110 burns victims, half of whom agreed to an hour-long session of counselling within a week of their accidents. A quarter of those who agreed to talk later suffered symptoms of post-traumatic stress disorder - including recurring nightmares, depression, irritability, isolation - compared with just nine per cent of the second group.

So should we take the Princess Royal's advice, given last year to a Victim Support conference, to buck up and use our common sense rather than accept professional help?

No, is the short answer, according to Dr Bisson. "I was very saddened by the way [the Princess Royal] came across," he said. "I would argue that we should focus on providing the types of talking therapy that are going to work, delivered by people who are adequately trained."

The Cardiff study used a technique known as "debriefing", which involves taking the subject through their thoughts and feelings at the time of the traumatic event. It is widely used among the emergency services to provide a sense of support and to alert people to the kinds of feelings they can expect to encounter in the future, according to Dr Margaret Mitchell, Reader in Psychology at Glasgow Caledonian University.

In Britain, "there has certainly been an embracing of this intervention by many employers and institutions as a way of recognising that employees have been through a rough time."

But while we can all see the benefits of letting it all hang out, there may be some who have good reason to bottle up feelings, at least for a while.

Susan went to see a counsellor shortly after her father died. "It was about five weeks after he died, but it was too soon to start saying goodbye," she says. "And I found it ridiculous and embarrassing to try and conjure up the ghost of my father. I found I physically couldn't say `goodbye'."

As Dr Bisson notes: "It is becoming increasingly standard to offer some form of counselling ... I think the problem, at least at the moment, is that we aren't actually sure what form of talking therapy is best, and when to do it.

"The big question is whether we should be going in and advocating that everybody is counselled following a traumatic incident. It may be that some individuals cope better by talking with their families."

Dr Elizabeth Campbell of Glasgow University is also concerned about the idea of one-stop shopping. "The problem with some debriefing strategies is that ... they have assumed that it's a standard package that you can deliver to everybody, irrespective of their circumstances."

This is a mistake, says Dr Campbell, if only because some people do not suffer trauma as a result of a terrible experience. They may not even need counselling. Others don't react until some time after the event.

We all know people who go back to work straight after a bereavement because they need to lose themselves in activity for a while before they can stop and take the time needed to grieve for their loss. And some people do just cope better on their own, or with friends, or with others who have shared their experience.

Many war reporters, for example, are deeply affected by the horror and the terror of the scenes they witness, but most prefer to discuss their feelings with their colleagues who might share them, rather than with a professional who cannot be expected to understand the experience.

In Bosnia, for example, last spring, I spent three days wandering through mass graves, finding bones and clothes and blindfolds in the earth and identity cards scattered nearby. On one day we visited a hillside where clothed skeletons - those who tried to flee from Srebrenica but were caught - lay in the grass and on the dirt road.

That night, a plane carrying the US Commerce Secretary, Ron Brown, crashed in Dubrovnik. We drove overnight to get there, and interviewed witnesses and Mr Brown's colleagues.

I then returned to Sarajevo for the re-burial of a pair of lovers, the city's Romeo and Juliet. My flat-mate and I referred to this string of events as the week of death. I chose to deal with the feelings of horror and helplessness in the face of such suffering and such brutality not by going to see therapist but by spending a weekend with my boyfriend, a war photographer.

I told him about my week, I cried and cried, and I felt better. He knows how it feels, for he has seen worse. I went home feeling fine, and able then to provide a shoulder for my flat-mate to cry on. We had spent those grim 10 days together.

But friends can't always help. And grief is not necessarily dealt with quickly. Jonathan Bisson sees the value, for example, of the Dunblane Support Centre, which is open to all comers at any time for counselling or just a cup of tea. And some of those affected by the continuing horror of the murder of 16 children and their teacher have taken weeks, months, to seek help. Since March, the centre has seen 3,000 visitors and taken 10,000 phone calls, which tend to come in waves. There was a surge in demand around the time of the memorial service for the Dunblane victims and the end of the Cullen inquiry, for example.

There is no call for a return to repression in the Cardiff study, the results of which mirror at least two other projects, but rather a suggestion that more research into our emotional and mental needs. The son of Rachel Nickell, who witnessed her murder on Wimbledon Common, is said by his father to talk about everything but the actual attack - and perhaps there is good reason to defend himself from re-living the horror, especially at his age. Perhaps some adults, too, need to protect themselves with selective memories, at least for a while.

"There might be an urge to send in some kind of counselling storm troops and say "we're here and we'll talk now" and that may not be suitable. There is still a lot of work to be done on what is needed and when,'' says Dominic O'Ryan, research psychologist at the Institute of Psychiatry in London.

Ann Pearston, the public face of the Snowdrop campaign against handguns, has visited the Dunblane drop-in centre in the past. "I personally believe that talking things out is a wonderful therapy, but people have got to come to it in their own time."