It is now well understood in the literature, but not well understood by some helping professionals and volunteers who have not lived through a disaster with multiple deaths, that some aspects of normal counselling, psychotherapy and psychological debriefing can unintentionally retraumatise people and leave them considerably worse off than before the engagement.
Counselling and therapy in normal situations usually encourages people to address the pain in their lives, and work through it. However, in a post disaster situation, if people do not want to talk about the events of the disaster, it is better not to intrude. It is perfectly healthy for people to protect themselves. Helpful questions will encourage stories of survival, resilience and strength since the disaster rather than focus on their trauma or their symptoms. Masten (2001) summarises the point well:
Resilience does not come from the rare and special qualities but from the everyday magic of ordinary, normative human resources in the minds, brains and bodies of children, in their families, relationships and their communities. It follows that efforts to promote confidence and resilience of children at risk should focus on strategies that protect or restore the efficacy of these basic systems. (p. 227)
Shalev and Errera (2008) express a similar notion based on the work of Rutter: "Minor gains can, sometimes, launch a process of reconstitution. Often-heard expressions, such as 'I lost a son, but realized how many friends I have' can make the point: having friends cannot be measured against losing a son. However, the presence of a small 'but' is of essence, because it completely denies the totality of the loss. In evaluating people's inner resources following trauma one might wish to be tuned to the 'but'" (Shalev & Errera, 2008, p.157).
The World Health Organisation (WHO) strongly warns against the use of single session psychological debriefing. Much of the critical evidence on debriefing is quite recent, which explains why many well-meaning agencies and professionals who are not aware of this recent evidence, are still involved and without a doubt will continue to be involved in psychological debriefing. In summary WHO states that (a) emergencies are associated with wide distress and elevated rates of common mental disorders and trauma-related problems, (b) single-session psychological debriefing to the general population is not recommended as an early intervention and (c) a range of social and mental health interventions exist to address social and mental problems during and after emergencies.
The WHO report recommends that most presenting mental health problems during the acute emergency phase are best managed without medication following the principles of psychological first aid: listen, convey compassion, assess needs, ensure basic physical needs are met, do not force talking, provide and mobilise company from preferably family or significant others, encourage but do not force social support and protect from further harm. (WHO, undated).
Five Principles of Trauma Intervention
A very comprehensive and seminal review of the literature by a worldwide panel of experts (Hobfoll et al., 2007) summarises and analyses various studies and proposes a set of principles that guide the overall effectiveness of post disaster interventions. The interventions that were found to be helpful were grouped under the following principles, of those that promote:
* a sense of safety
* a sense of self collective efficacy
* connectedness and
For the people of Saleapaga relocating the main village inland after the tsunami provides a good example of promoting safety. In a short space of time many households had moved and relocated. There were very few roads and no water reticulation inland so these needed to be built. …