The Trouble with Treating Trauma

When disaster strikes, the arrival of ``trained counselors'' is as much a part of the theater of disaster as the arrival of the emergency services. What do these counselors actually do? Usually, they perform some form of what is called ``debriefing'' or ``critical incident stress debriefing.'' But do these sessions do any good?

Debriefing is invariably a short, usually single session, an intervention that is performed with as many of those caught up in a traumatic event as possible. It involves linking examination of the traumatic incident with education about the expected emotional responses and assurances that these are normal. The hope is to reduce acute emotional distress and prevent the onset of post-trauma psychiatric disorder.

Many organizations offer debriefing as part of their response to traumatic incidents - such as police officers involved in firearm incidents, or bank staff who witness robberies. In some institutions interventions are compulsory - perhaps out of a desire to reduce psychological distress, but also from a belief this will reduce exposure to litigation.

There are many reasons why belief in the effectiveness of debriefing has become so widespread. When facing disasters, all of us feel a need to do something. The idea that talking about trauma must be better than ``repressing'' or ``bottling up'' accords with a long tradition in psychological treatment - ``better out than in.'' Many people who have been debriefed judge the experience positively.