As survivors of Hurricane Katrina grapple with tremendous losses of homes, personal belongings and even loved ones, many will surely benefit from professional counseling to help them cope. The challenges ahead of rebuilding shattered lives are expected to greatly fuel the demand for psychological therapy.
For right now, though, the key contribution of mental-health counselors working with Katrina survivors is to provide them with support and information, experts say.
A wide range of responses — including anger, anxiety, sadness, depression, guilt and denial — are normal after traumatic events, and rushing to identify and treat patients who aren't "coping well" can prove tricky.
"Support is important but treatment is not appropriate at this point," says Patricia Resick, a professor of psychology at Boston University and a spokesperson for the National Center For Post-Traumatic Stress Disorder, a division of the Department of Veterans Affairs.
"For many people the event still isn't over," she says. People are still searching for missing loved ones, learning about deaths and wondering where they'll live or work.
For these people, Resick says, "grief is normal, big emotions are normal."
Not everyone can talk it out
Not surprisingly, many people will want to talk about their feelings, and counselors encourage that. But people should not be forced to have discussions they aren't ready for, experts caution.
Not everyone benefits from talking through their troubles at great length, and sometimes too much talk can even be harmful, says Joshua Klapow, a psychologist at the University of Alabama at Birmingham who is part of the American Psychological Association's disaster response network.
For some people, denial and avoidance, at least initially, can play an important role in getting better, he says. But being encouraged, or even forced, to retell unpleasant stories can make certain individuals even more distraught, particularly if long-term counseling isn't implemented, according to Klapow and other mental-health experts.
"You do have to be careful," says Klapow. "The challenge is you want to offer people an outlet to deal with their problems. But forced counseling or forced debriefing, there's no evidence that helps and it may be harmful because people have natural defense mechanisms that kick in to help us deal with trauma."
Some concern arose during the Sept. 11 attacks that some people at Ground Zero were being encouraged by counselors to retell their stories when they weren't ready.
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"It's never harmful to be available to listen," says Dr. Daniel Schechter, a psychiatrist at Columbia University in New York and co-author of the book "September 11: Trauma and Human Bonds."
"What's not helpful," he says, "is to force someone to debrief and go into detail about horrible experiences when they're not ready. It's best to follow the lead of the individual who's had the trauma."
Kids, in particular, could be at risk from a forced discussion that takes place in a classroom, for instance, and then doesn't include professional follow-up counseling, says Dr. Victor Carrion, a psychiatrist and director of the Stanford University Early Life Stress Research Program.
"Basically you are being left alone with all the thoughts of what happened," he says.
Denial has its place — initially
Of course, at some point people must figure out how to get on with their lives. And denial over the long-term is not an effective strategy, says Resick.
"You can't just shove something this big under the rug," she says. "The trick for us is to figure out who should we be tracking over the longer haul."
Many people will find their way with the help of social support and the passage of time. Others will struggle for long periods, even years.
"Everybody reacts differently," says Laura Merchant, a social worker and assistant director of the Harborview Center for Sexual Assault and Traumatic Stress in Seattle.
Mental-health experts particularly worry about people who are still not coping a month or more after a trauma, when a diagnosis of post-traumatic stress disorder (PTSD) may be made. PTSD is a potentially debilitating condition marked by nightmares, intense anxiety and feelings of despair and hopelessness.
For these people, counseling is highly recommended. Those with a history of depression, anxiety or prior PTSD are particularly at risk.
"If symptoms are still there after a month, then it would be helpful to be treated for the specific symptoms you're having," Merchant says.
Experts stress that people providing psychological services — including psychologists, social workers and nurses — should have training in crisis management.
Well-meaning volunteers, clergy and even some psychologists may make matters worse by providing misguided advice, Klapow says.
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