Wednesday, May 27, 2015

Universal Counselling: Value??

Warning on use of disaster counselling
Therapy may halt recovery, says expert
Jo Revill, health editor
Sunday 11 January 2004 16.56 GMT Last modified on Friday 7 May 2004 16.56 BST

http://www.theguardian.com/society/2004/jan/11/disasterresponse.medicineandhealth

Counsellors who rush to help distressed people following disasters such as 11 September may do more harm than good. Ways of dealing with the emotional fallout of traumatic events should be urgently reassessed, a leading psychiatrist said yesterday.

Evidence is emerging from historical archives and more recent events that civilians are remarkably resilient during adversity, which tends to unite people, boost community morale and reduce the number of people committing suicide.

Simon Wessely, professor of psychological medicine at King's College London, wants a reappraisal of emergency responses to disasters. He called for resources such as psychotherapy to be directed towards people who become really ill and unable to work, rather than offered to everyone.


In a forthcoming editorial in an American journal, he will criticise the way hundreds of counsellors were brought in to help those who saw the planes crashing into the World Trade Centre in New York and the Pentagon in Washington.

Early studies had suggested that 44 per cent of all Americans experienced 'substantial stress' following the 11 September 2001 atrocity. Their symptoms included difficulty getting to sleep or concentrating. But a paper measuring people's reactions two months later showed that the number had halved.

Another study, carried out solely among New Yorkers, showed that the rate of 'probable post-traumatic stress disorder' (PTSD) fell from an initial 7.5 per cent of the population to just 0.6 per cent six months later.

Wessely believes it is very difficult to take the symptoms commonly seen after disasters, such as upset, anxiety and difficulty sleeping, and conclude that they are the start of a psychiatric disorder.

'The problem we have with a lot of post-disaster interventions is that we tell people it is normal to feel upset when bad things happen, and then we also suggest a whole variety of therapeutic treatments. What we should be concerned with is the few people who don't recover, who find themselves unable to keep a job or look after their families, not the majority who will experience transient distress.'

Wessely insists he is not anti-therapy, and points to overwhelming evidence that some treatments, such as cognitive behavioural therapy, applied to disorders such as PTSD, are highly effective. He wants a reassessment of the current vogue for 'debriefing', when a counsellor talks someone through their experience.

'The prevailing view is that talking about trauma has to be better than bottling it up,' he said. 'But there isn't any evidence, on the basis of studies carried out so far, that this is true for everyone.


'For some people, not talking may be better than talking to a stranger. This may actually impede the processes of recovery that use your own social networks, such as family, friends, priest or doctor.'

It was the 'father of sociology', Emile Durkheim, who first argued that, during periods of external threat, society would become more cohesive and suicide rates would decrease. There is preliminary evidence that in the UK the number of people taking their own lives fell after 11 September 2001. Suicide rates for that month were significantly lower than any other months that year, and lower than the numbers in any September over the previous 22 years. A similar decline was seen after Princess Diana's death in August 1997.

One who argues strongly against Wessely is Phillip Hodson, a fellow of the British Association for Counselling and Psychotherapy, which has 20,000 members. He says the view that much of the therapy offered is a waste of time is simply wrong.

'We remain a very puritanical society, assuming that everyone can be resilient and robust in the face of adversity,' Hodson said.

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