Example

Christmas 2004 simply did not happen for me. I spent it as a member of a dedicated "Reception Team" helping the survivors of the Indian Ocean tsunami who were arriving at London Gatwick. A special receiving area had been set up at the airport where, as they got off the plane, the returnees passed through an organized and orderly reception process that involved medical teams, social welfare teams, clothing and refreshment providers, showers, rest areas, access to phones/ e-mail and the help of transport specialists who organized their onward journeys. Of course, as this was the United Kingdom, at all stages there were copious amounts of tea available!

The interesting thing about working with these people was this: There were probably about thirty to forty experienced "service providers" present, including doctors, nurses, paramedics, social workers, police, NGO "experts" and so on. However, as soon as any of the "customers" showed any form of overt emotion whatsoever, the cry went up, "get the therapists"! Why? What was everyone scared of? In the immediate aftermath of the disaster, before any proper organization got going, these victims had been simply scooped up off the beaches and from the wrecked resorts, packed into the first available plane to anywhere and sent off. It was not uncommon to see peo-

pie arriving still wearing their swimsuits and with no other luggage. One woman turned up wearing only her bikini bottom! Naturally, as soon as they got home to the United Kingdom, and could at last feel safe, these people immediately began to react emotionally in very overt and initially inconsolable ways.

My deliberate response to this obvious psychological discomfort amongst the team was to take my co-workers to one side and quietly explain this very normal emotional healing process to them. I wanted to get it established and accepted that it was more than just okay to weep, but actually quite a common human event and even a desirable one. Therefore the most helpful thing that they could do was simply to allow this natural healing progress to occur without pathologizing either the returnees or their psychological reactions. What was I doing? Was I giving my co-workers "therapy," "psycho-education," "normalization/permission" or whatever? I don't know, but I do know that it worked and it was probably the most effective therapeutic intervention that ¡ offered over the entire ten days that we spent meeting the survivors. I know this because I could see the obvious benefits to the survivors and the positive changes in the team's attitudes. Would I do it again? I have no idea-it just seemed right at the time!

Example

In the Gulf War, a well-known, international petrochemical company who was concerned about terrorist activity, briefed me to run coping-strategy training courses for their European staff whose colleagues might suffer psychologically from terrorism-generated trauma. The plan was to help the workers to help themselves. Most employees were keen to get involved but they mostly shared a general feeling of potential incompetence and impotence when faced with, what to them was, the apparently impossible, or even overwhelming, task of dealing with overt human emotion. They were scared of being scared! The following two exchanges show how I tried to respond to their problems and you can judge if, (and perhaps how), you might have done things differently:

Employee A

I was involved in a bad traffic accident. Although not hurt myself, several people were and the paramedics asked me to sit with one young chap who was quite badly injured and awaiting transfer to hospital. I suppose that I was with him at the roadside for about twenty minutes-it seemed like hours at the time. We chatted idly and then he asked me to ride in the ambulance with him. Altogether I was with him for about an hour. I've never felt so useless in my life! He needed urgent medical help and there was just nothing that I could do for him. I keep having nightmares about all this.

In technical terms, my intervention could be described as psy-choeducational. In reality, all I did was to explain that the victim was simply asking for the immediate comfort of human contact. Therefore their "idle chatter" was exactly the sort of emotional help that he needed at that time. Far from being "useless," what Employee A was doing was essential and skillful work in helping the victim cope with his fears and make some sense of his shattered world. My input apparently helped because at a subsequent meeting Employee A told me that the nightmares had stopped.

Employee B

My neighbor was robbed at gunpoint and afterwards she became a changed woman. She was a different person; someone I didn't know. She had huge mood swings; she lost all of her sparkiness and was quite aggressive to everybody. One day she told me that she was terrified that that she might be going crazy and I just didn't know what to say to her because I didn't want to make her worse.

This fear of insanity seems to be quite common in trauma victims who, at least in the short-term, find that their lives and their emotions have been distorted by their psychologically disruptive experiences. My usual intervention is to simply tell them that they are actually quite okay and that it is normal to react abnormally to an abnormal situation. I explained to Employee B that we all get crazy in crazy circumstances and that it usually helps trauma victims if we all openly acknowledge this. There was an immediate alteration in his body language. I could see the changes take place. It seems that learning this simple fact made him feel much better about himself and he later told me that he now felt more confident about dealing with similar situations in the future if he had to.

In both the first and the second examples, at no time was I presenting as an expert trauma therapist. I was just doing a bit of psychological handholding and I was not doing anything that any reasonably informed, concerned, person could not do. All that I was doing was helping, or encouraging, the members of the community to respond more confidently and more effectively to the needs of trauma survivors. In effect, I was helping to promote the concept of trauma therapy as being a community enterprise. So, if this means that sometimes I find myself making the sandwiches just to show that the response team cares enough about the survivors to worry about feeding them, then so be it. It is often claimed, although unfortunately never substantiated, that Freud once told a group of students that, "sometimes a cigar is just a cigar." True or not, it is a great story, so if our traumatized clients tell us that they only "need a smoke" then perhaps we should leave worrying about transferential analyses, core conditions, object relations, or any of our therapeutic whatevers until another time. Or, better still, perhaps-sometimes even forget about therapy altogether!

A REDEFINING CONCLUSION

There are already a number of community-based approaches to trauma relief in current use. Here are two popular examples:

The first example can be found in a process commonly known as "Critical Incident Defusing" (Mitchell & Everly, 2001). This is basically an emotional recovery process, which is usually most effective if those involved in a traumatic incident carry it out for themselves. This is because defusing is essentially a peer-supported normative process and so bringing in outside "experts" might unnecessarily exacerbate the situation. Defusing is a method of focusing postincident conversation and social interactions so as to ensure that everybody who was involved, or is otherwise affected, feels able to acknowledge and, if necessary, express their thoughts and feelings. In other words, defusing is a process that acts as an emotional, pressure-relief valve that reduces immediate psychological tensions and prevents accumulative stresses from building up.

The second example of trauma intervention as a client-led, community-centered, process can be found in the Psychological First Aid, (PFA), protocols, developed jointly by the U.S. National Child Traumatic Stress Network & National Center for PTSD (2006).

• Contacting and engaging the victims

• Helping the victims find safety and comfort

• Emotional stabilization

• Finding out just what the victims really need (everything and anything)

• Organizing practical assistance

• Connecting victims with own/local social support systems

• Providing the victims with information about what has happened to them, how it might affect them, (including psychological/emotional affects), and how to cope

• Developing links with welfare and health services in case of subsequent need

In sum, it should be noted that most, possibly all, of the components of both defusing and PFA are not essentially psychotherapeutic in nature but focus on meeting basic needs, (e.g., physical safety, interpersonal connectedness, support, normalization, encouraging postevent functioning, etc.). These services must be flexibly delivered, using strategies that meet the specific needs of the victims. As McNally, Bryant, and Ehlers (2003, p. 68), note, "the bottom line is that in the immediate aftermath of trauma, professionals should take their lead from the survivors and provide the help they want, rather than tell survivors how they will get better." So, given that there is a strong case for taking the supposedly expert trauma therapist out of the posttrauma scenario, does psychotherapy still have a part to play in the general care of the traumatized? Can therapists still be of use? Perhaps we might have to retarget our professional intentions and remodel our therapeutic activities. The sample interventions, which I have, described in this chapter, suggest that this very task-focused therapeutic evolution might well be achievable and possibly even desirable.

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