August 24, 2011
Talking it out: Sept. 11 brings changes in trauma counseling
As the nation steps back to remember the 10-year anniversary of Sept. 11, 2001, and the many lives lost and altered, mental health professionals step back to analyze lessons in trauma counseling that stemmed from not only that day, but traumatic events at all levels.
Briana Goff, a professor at Kansas State University's School of Family Studies and Human Services who studies post-traumatic stress disorder and traumatic stress, said that while the mental health model in use morphed after 9/11, tactics used then to help trauma victims are still used today.
"It started out as debriefing for providers, emergency personnel, police and people who witnessed the event immediately after the fact," Goff said. "We identify people who are at risk for long-term mental health issues. It's a support service, different than traditional mental health service in an office."
After 9/11, Goff said mental health workers realized they needed more of these kinds of interventions, which, aside from identifying trauma victims for traditional mental health treatment, give individuals an outlet to talk about their experience and find support.
"The model is different now in that it focuses on reducing the stigma of mental health trauma, normalizing what they are feeling and providing service to the masses," Goff said.
The mental health model used now at disasters or high-stress events is known as psychological first aid, called so because of its focus on immediate support, not necessarily on immediate counseling. Sometimes this support is needed further away than ground zero itself. Goff said secondary trauma can also affect those who were not directly involved in a traumatic situation, especially one as horrific as 9/11. This can include people who watched events unfold live on TV.
"People have very different memories of watching 9/11 events on TV -- seeing people falling or jumping from windows, others running terrified. It's very possible they were affected just by watching these types of terrifying scenes," she said.
Identifying people suffering from secondary trauma is the primary responsibility of some disaster workers, said Jacque Gibbons, a K-State professor of social work who works with the American Red Cross' mental health team in identifying disaster survivors for mental health treatment.
"We monitor and evaluate how disaster response staff are dealing with their experience, which is part of secondary trauma that may befall the helpers in these situations," Gibbons said. "Most, if not all, survivors of a disaster have some trauma. The key issue is really how they choose to deal with the trauma. If they get back into a stable routine and are able to move forward with local emotional support, they most likely will be OK."
Goff agreed, adding that she firmly believes in the resiliency of people involved in disasters and traumatic events. But while she believes there can never be too much support for survivors, she said it may be possible that those who were treated in a traditional mental health manner instead of the psychological first aid model following disasters like 9/11, Hurricane Katrina and the Greensburg tornado may not have been helped to the full extent.
"People want to be helpful, so they show up in their office clothes and they're just not prepared," Goff said. "You need to be in your tennis shoes and jeans. It's an organized response, but you have to be willing to sort through everything. You're not in an office asking people how they feel; you're handing out water and food -- that is mental health in disaster relief."
Gibbons said an important lesson Red Cross disaster response staff learned following 9/11 was that mandatory debriefing before leaving a disaster site was more harmful than helpful for many individuals.
"It forced them to revisit the trauma right before returning home," he said. "Subsequently, the mental health protocols changed to eliminate the mandatory debriefing. In the years since 9/11, there have been tremendous strides in the techniques for the treatment of psychological trauma."
Going back after a disaster and reviewing a community's own disaster plan is the best way to learn from mistakes or victories, Goff said. Every state has a disaster mental health team, and every disaster is different.
"It's trial by fire sometimes; each actual event shows the gaps in a plan," she said.
Many individuals may still be affected by the events of 9/11, whether they live in New York City or Kansas. Every anniversary is important, Goff said, but the 10-year anniversary carries an extra significance that provides an opportunity to revisit feelings and remember those who lost their lives or had their lives forever changed.
"It's healthy to look back and remember," she said. "The resiliency of humans has to be assumed. Everyone will be impacted, but we're not coming in and assuming a problem. It's saying, 'I know you're resilient, but how can we best get your feet back under you?'"