DO WE SEND IN COUNSELORS TOO SOON?
A recurring theme in this blog is the damaging effects of Denial. Refusing to face challenges establishes an avoidance pattern totally incompatible with effective coping. You all know the routine. Someone you know has undergone some traumatic or upsetting event. You reach out to them and they respond, “I don’t want to talk about it!” Denial rears its ugly head. But is it ugly in this case?
Let’s fine tune our look at Denial and ask if it can ever be helpful in the coping process. For instance, consider horrific events like a mass shooting at a school (along the lines of Virginia Tech, Sandy Hook, and Columbine). In the immediate aftermath of such tragedies, we hear officials say something like, “Classes will resume after a day of remembrance. Counselors will be available for anyone feeling the need for help.”
Counselors will be available……..and fast (this is called Immediate Crisis Debriefing). After all, psychologists know that letting stress from a traumatic event fester can lead to severe emotional problems down the road. So we need to nip things in the bud right away.
Sounds good, but there is research showing that immediate crisis debriefing is often ineffective and in some cases even makes things worse for victims. How can this be? How can talking with a counselor about your anxieties resulting from a trauma you experienced not help you? Let’s consider two possibilities.
First of all, maybe the debriefing took place too soon. Whenever a traumatic event strikes us, our brain needs time to process the event. Sometimes for days we can be in somewhat of a fog over what happened. At a conscious level we seem to be denying the event when we say, “I don’t want to talk about it.”
At a sub-conscious level, however, once the emotional reactions begin to subside, our brain is processing and sorting and attempting to make sense of it all. Talking about it during that period may be quite ineffective because the cathartic restructuring of our thoughts resulting from the counseling is premature. The brain is not ready to process the healing.
A second potential problem with immediate debriefing is that it may give the victim a false sense of security. Thus, several weeks after the event you may say to a friend, “You know, you still seem a little out of sorts about it. Maybe you should see a counselor.” The victim responds, “No problem, I already talked to a counselor. Everything’s cool.”
But everything is not cool because the “counseling” took place before the victim was cognitively prepared to profit from it. In a sense, the counseling never took place. Unfortunately, the victim, feeling reassured from talking with a counselor, has trouble recognizing the coping problem.
All this raises the crucial question: When is the right time to encourage a victim of a traumatic event to receive counseling? One week later? Six weeks? Several months? Unfortunately, there is no absolute answer that would be appropriate in every case. That reality can make it difficult for a friend or relative to know when to reach out to a victim, and when to back off for awhile.
If the victim is a relative or a close friend, the odds are you will be able to sense that he or she is not progressing well following the event. Just remember, for a few days following the trauma that is to be expected. Once several weeks have gone by, however, and you still sense poor coping, it is probably best to get more forceful in getting the victim out of the denial and avoidance pattern that is still present. Again, there is no hard and fast rule to follow here, so you have to depend on your instincts. When we’re talking about a good friend or close relative you know well, those instincts can often be quite accurate.
One of my students told me a story that shows how easy it is to think you have “put a trauma to rest” in your mind. About four weeks after 9/11, this student went home for Fall break. She lived in New Jersey and the World Trade Center had always been plainly visible from her bedroom.
That night she crawled into bed and reflexively turned toward her window to say goodnight to the twin towers, her “guardian angels” since she was a child. “My God!” she said to herself, “they’re gone!” She was surprised at how startled she was because she knew they were destroyed in the attack four weeks earlier. “In a sense,” she told me, “I guess I had not really processed the reality directly, and at some level in my mind there was denial that the event occurred. It’s fascinating because I had talked about the event several times with my parents on the phone and I had obviously seen news clips on TV. But there had been no direct contact until that night in my bedroom. In that sense, I had not really directly experienced the reality of the event.”
My student was not suffering from PTSD, but her story illustrates the dynamics of recovery from trauma. At some level, and at some point in time, the victim must “establish contact” with the reality of the event. How this is done varies from person to person.
For some, mentally reliving or rehearsing an event and talking about it is sufficient. Others, however, may require something more tangible. Many Vietnam veterans find remarkably positive effects from visiting “The Wall” in Washington, just as survivors of the Orlando Pulse Club mass shooting find solace when standing next to the Club. WWII veterans have had similar cathartic experiences visiting Pearl Harbor or the beaches of Normandy. The grief-stricken can often cope with a traumatic loss better by visiting the grave of the lost one. Our blog posting of July 14, 2016 showed how a victim of a traumatic car accident was helped by visiting the accident site.
The important point here, however, is that “making contact,” whether mentally or physically present, is most likely to be beneficial when there is a time gap between the event and the safe contact. Time must be allowed for the mind to process the event. This processing delay may look like Denial to an outside observer, but it is absolutely essential before the mind can begin the healing process. If crisis debriefing takes place too soon, that healing is obstructed.
So when you see a friend troubled by an extremely upsetting event (and that can include a romantic breakup), and they don’t want to talk about it right away, give them a break. Grant them some “denial breathing room” for a period of time. That period will probably be longer for serious trauma, such as a rape or near-death experience, compared to milder events, such as a romantic partner announcing, “I hope we can still be friends.” In either case, however, allowing a victim some time to process the event will make your helping actions more effective.