To question the need for counselling

Citation

Wilson, H.C. (2007), "To question the need for counselling", Disaster Prevention and Management, Vol. 16 No. 3. https://doi.org/10.1108/dpm.2007.07316caa.001

To question the need for counselling

A recent article in the New Scientist (3 February 2007, pp. 40-3) raises the question of whether there is a need for widespread counselling in the wake of a disaster.

I had no idea that counselling for PTSD was so widely used and that its use was so controversial. Treatment for, and attitudes towards, PTSD have changed since the First World War when soldiers with shell-shock and who refused to return to active duty were summarily court-martialed and, if found guilty, were executed. In modern society PTSD is a recognised condition (I hesitate to refer to it as an illness as I am far from qualified to make that judgement).

It is a well-accepted fact that in the wake of a disaster certain survivors develop PTSD which, even with therapy, can last for several years, whilst others never develop the condition, or if they do then the love and care of their family members can reduce the effects and duration of the condition.

The main thrust of the argument in the New Scientist article is not that PTSD does not exist, or that there is no need for treatment to be available to survivors or those affected by that disaster. The thrust of the argument is about the quantity and quality of the treatment. For example, that there are “disaster-chasers” who go around touting their counselling services in a manner very similar to “ambulance-chasers”. The thought that those affected by a disaster are being stopped in the street and being told that they need counselling to prevent/cure PTSD absolutely horrifies me. If, as reported in the article, this does occur it then shows an absolute lack of that sensitivity that true counsellors are renowned for, and that this lack of sensitivity will negate their role as counsellors.

One of the points raised in the article is that PTSD counselling is frequently used immediately after the onset of the disaster, as occurred after 9/11 and whether this is the right approach as many people who suffered mental trauma as a result of the disaster appear to recover without counselling, leaving a much smaller number who are in dire need of such counselling. This could be viewed as being akin to the difference between feeling depressed and suffering from depression and where anti-depressants need to be prescribed as a treatment. One of the best remedies for feeling depressed is to unburden oneself to a loved one or close friend, whereas this would be of little therapeutic benefit to those suffering the agonies associated with clinically defined depression where therapeutic intervention is required.

One last point I would like to raise from the article, although there are many other equally pertinent points raised, is the use of counsellors who neither are fluent in the local language nor have an understanding of the local customs, as occurred in Sri Lanka after the 26 December 2004 tsunami. Can someone explain to me how one-to-one counselling can be done through an interpreter?

As I say, this article raises many other issues that surround counselling in the aftermath of a disaster and is well worth reading.

H.C. Wilson