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Send in the counsellors

Counselling has been prescribed for the grieving children of St George's School. But is it needed? Mary Braid reports
Their arrival - usually en masse - is now part of a well-established ritual. Hard on the heels of the reports of a horrific death, the politicians' expressions of revulsion and public soul-searching, an army of trained counsellors descends, now as much a part of proceedings as the chorus in a Greek tragedy.

Thirty counsellors are guiding children and teachers through trauma and grief at St George's School in London after the murder of headmaster Philip Lawrence last week. On their first day back at school since he was stabbed outside the gates, children reported that they had been encouraged to write letters to the popular headteacher's family. They said it had helped them.

Similar teams, with similar strategies, were there to help after the death 18 months ago of Nikki Conroy, stabbed by a masked man who burst into Hall Garth School in Middlesbrough during a maths lesson. A small team of psychologists is still working with traumatised pupils. Counsellors were on hand when four teenagers from a Plymouth comprehensive drowned on a supervised canoeing trip across Lyme Bay in March 1993, watched by their helpless friends, and when 12 pupils from Hagley School died in a minibus crash on the M40 near Warwick in November 1993.

Michael Stewart, director of the Centre for Crisis Psychology, cringed this week at the media representations of "The Counsellor" as some sort of trauma stormtooper, poised and ready for the Big One, who swoops and vacuums up all those sad, bad and negative feelings, leaving the traumatised feeling clean, whole again and able to carry on.

The media, Mr Stewart argues, is giving a distorted picture. He says the counsellor is either depicted as an SAS-style troubleshooter or some woolly, ineffectual, professional tea-and-sympathy giver. "It is about as real as Raquel and Curly getting married in Coronation Street. It is fed to the public as a sort of dramatic entertainment, but this is real. These people have suffered and they have needs. Counselling has been recognised for its value in the last few years, but there is a danger that it will be seen as some quick fix."

And counsellors have other reasons to worry about the public perception of them. For there are those like Simon Wessely, reader in psychological medicine at King's College Medical School, who are dubious about the whole "profession". They ask: what exactly do counsellors do behind the closed doors or school gates to aid the painful but entirely natural process of grieving? How effective are their methods - acquired without the extensive training given to psychologists - which have become a panacea for all trauma and disturbance?

Michael Wright co-ordinated Cleveland Council's response to the killing of Nikki Conroy in front of her classmates. In the late Eighties, after a series of disasters including Bradford and Hillsborough, the Government encouraged councils to set up multi-disciplinary teams to deal with such crises. Thus at Hall Garth, Cleveland was able to call on 30 counsellors who followed a well-tested and systematic programme to help the school recover.

In the first 24 hours they were simply "good listeners", comforting and accepting whatever reaction the children presented, from tears, to anger, to withdrawal. But within a few days - five days is the recommended limit - a "debriefing session" was held in the school coffee bar for the 25 11- and 12-year-olds who were in Nikki's class when her killer burst in. Three male members of staff - the class teacher and the two teachers who overpowered the man after the attack on Nikki and two other girls - were included.

Mr Wright says the process of "debriefing" is scientific, and based on the work of John Mitchell, an American fire chief-turned-psychologist who studied techniques used by an American historian interviewing soldiers after the Second World War. He discovered that those who had been interviewed suffered less trauma than those who had not.

The theory is that a full and consistent account of the shared experience must be put together and accepted by everyone involved. Gaps can mean harmful distortions later. After the facts have been established, the story is gone through again and people talk about what their emotions were at the time. Then events are recounted a third time, with everyone sharing what they were thinking, as opposed to feeling - which might, for example, elicit "I thought we were all going to die", as opposed to "I was scared". The idea is to show that no matter how bizarre they consider their own emotions and thoughts at the time, their responses were perfectly normal. The whole process is preventive, designed to minimise the possibility of disturbance weeks, months or even years down the line.

"For some, a traumatic event can remove all sense of security," says Mr Wright, one of thousands of counsellors who have received training at the Centre for Crisis Psychology. "Simple things they took for granted, like opening a door, become impossible. Then a smell or noise can trigger a reaction years later. Flashbacks, dreams and nightmares are common.

"The debriefing is very structured. Getting together everyone who was involved in the incident is the key. They have shared a common experience."

At Hall Garth, the most common concern of the children was what would happen to the man who killed Nikki. The policeman in charge of the operation was asked to answer their questions.

The children also wanted to discuss whether they would go to Nikki's funeral. Most wanted to attend, but only a third had been to one before. The local vicar was brought in to talk to the children about it.

The crisis team's involvement was short-term. The long-term work, under the school's educational psychologist, was passed on to those who had had a longer involvement with the school. It continues today.

For some, counsellors say, a trauma uncorks a past tragedy which has been long buried but which must then be dealt with.

Hall Garth's tragedy had a ripple effect which extended well beyond the school gates, among people who did not even know the victim. Mr Wright says that an existing client he had been seeing, who had been sexually attacked some time before, reported stopping her car and being physically sick by the roadside when she heard the news of the attack on the radio.

Mr Stewart believes that the children and staff at schools hit by tragedy are highly resourceful. Any help offered has to be with the full co-operation of those who know the school community and all its characters. "Experience shows that a low-key, well-planned approach is vital," he says. "One that does not undermine the school or exaggerate the problem."

But Simon Wessely remains dubious. He says that the few studies there have been on psychological debriefing, carried out on troops, suggest that it makes no difference. "Most people exposed to trauma get over it anyway, so they appear to do well with counselling. But you cannot tell if it really did them any good. What is important is whether it reduces long-term illness, and there is no evidence of that.

" 'Does it work' is not the right question. It should be what is it, and what is it treating. It may even interfere with our natural coping mechanism. Yet it has become a panacea. It has filled a gap that psychiatry is being forced to withdraw from to concentrate on the mentally ill. Business is booming for counselling. But I have tried without success to come up with a definition of what it is that is more than banal."

He believes that until we know what it is and what it does, counselling must be suspected of unjustifiably draining money away from other services. Every day he deals with traumatised road accident and rape victims who have not received conventional psychological treatment that would have helped. Yet counselling marches on. He suspects that counselling builds up dependency and may weaken people's reliance on their own natural abilities to cope.

Practitioners remain convinced that it works. Tony Goodman, a social worker who helped to co-ordinate the response to the Hagley School minibus tragedy, which had just two survivors, says that his team was based at the school for several weeks after the crash. More than 150 children took up the team's offer to talk. He says that two years after the tragedy a few people are still receiving help.

"Oh, it does work. There was a lot of need. A lot of children lost more than one friend," he says.

"I do think that people need a lot of assistance. Tragedy causes immense pressures. They need a lot of help, and usually it's welcomed. So long as it is sensitive and negotiated."