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Section 13
Grief & Trauma: The Counselor's Role

Question 13 | Test | Table of Contents

When tragedy strikes, the counselors rush in. They offer succor, but their methods are up for debate. When the lord of the underworld snatched away her beloved daughter, Demeter was inconsolable. She wandered the world and in her misery allowed the fields to lie barren. In modern parlance, she was "in trauma." Today the Greek goddess of agriculture might have talked about her loss, vented her frustration and worked through her grief. Certainly, she would not have been left alone with her sorrow.

Tragedy is immemorial, but we have grown less tolerant of its psychic consequences. In Littleton, Colo., where Hades visited in the guise of two teenage boys, counselors spent 1,500 hours talking to students in the first week after the April 20 shooting. "The trauma is astronomical throughout this community," says Steve Poos-Benson, pastor of a church near Columbine High School. "It has affected even those who casually drive by." Oklahoma City, riven by catastrophes twice in the past four years, has settled into painful routine. At the Community Counseling Center, counselors who helped after the 1995 bombing of the Alfred P. Murrah Federal Building were called on again following last week's tornadoes. The American Red Cross, which has more than 80 counselors in the area, put its 2,000 mental-health officials on alert.

Where there is no consolation, there is now counseling. But is it necessarily helpful? The huge growth in such on-the-scene therapy has raised questions about the value of pouring out one's grief to the social workers, psychologists, psychiatrists and clergy who are invariably on hand at disasters to lend empathic support. If local resources feel the strain, the Red Cross, Salvation Army, National Organization for Victim Assistance and a host of other nonprofit organizations send in volunteers. During presidentially declared disasters, the Center for Mental Health Services contributes federal funds for counseling. It spent $10 million last year.

The notion of talking through trauma gained currency during World War II, when soldiers were "debriefed" on the beaches of Normandy. In the 1970s, Jeffrey Mitchell, then a paramedic and now president of the International Critical Incident Stress Foundation, developed one of the most popular debriefing models. Intended to be used in conjunction with other services, such as one-on-one counseling and on-scene support, Critical Incident Stress Debriefing is conducted in groups a couple of days after a disaster. Typical questions include "What were the first thoughts that raced through your mind at the time of the crisis?" and "What was the worst moment for you?"

After the Columbine High shooting, school psychologists employed a similar approach, not only with students from Columbine but with those at 12 nearby schools. "Debriefing is a therapeutic opportunity to get people to open up, ask questions and unburden the psychic pain they are carrying around," says Theodore Feinberg, a New York-based psychologist who flew to Littleton as part of a team sent by the National Association of School Psychologists.
But others wonder whether talk is truly the best remedy. British psychologist Simon Wessely reviewed half a dozen studies of debriefing last year and found that it had no effect. "People race into disaster areas, but there is no research that says people benefit from trauma counseling," according to Tana Dineen, a psychologist who wrote Manufacturing Victims: What the Psychology Industry Is Doing to People. "These counselors get people to talk about how upset they are, but they may be doing damage."

The trauma experts handle the immediate aftershocks of disaster.
Once they leave, grief counselors take over, providing longer-term help for those who have suffered a loss. The discipline of grief counseling was virtually unknown three decades ago. Today there's a national organization--the Association for Death Education and Counseling--that certifies grief counselors.

Most grief counselors rely on the seminal teachings of J. William Worden, a Harvard psychologist who published Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner in 1982. Worden identified four basic tasks of mourning: 1) to accept the reality of the loss; 2) to experience emotions connected to that loss; 3) to adjust to life without the deceased; and 4) to relocate the deceased in one's mind so that progress is possible. Though Worden hoped to inform mental-health counselors about bereavement, he didn't anticipate that his theories would give rise to a veritable industry of professional grief counselors. "I don't know what I've spawned," he says ruefully.

One such counselor is Alan Wolfelt, founder of the Center for Loss and Life Transition in Colorado, who describes himself as "a person who creates safe places for people to mourn." He argues that as life expectancy has increased, Americans have lost the "art" of grieving. "Our culture is full of buck-up therapists who want to move people away from grief," he says. "But you have to feel it to heal it. You have to go through the wilderness."

That kind of sound bite appeals to a generation raised on Oprah, but some psychologists are skeptical. George Bonanno, assistant professor of psychology at the Catholic University of America, studied bereaved individuals over 25 months. He found that those who focused on their pain, either by talking about it or displaying it in their facial expressions, tended to have more trouble sleeping and maintaining everyday functions. In other words, there may be benefits to the discredited practice of keeping a stiff upper lip.

Such misgivings should not cast doubt on the sincere goodwill of people who lend their help to survivors of tragedy. Even as many victims of last week's tornadoes declined help, counselors handed out leaflets and toll-free numbers "just in case." And some of those victims may need it. At nearly 140 schools in the Denver area, students have reported problems ranging from instances of regression (such as bed-wetting and wanting to share a bed with parents) to anxiety and depression. In Oklahoma City, victims of the 1995 bombing still undergo counseling (the Red Cross has 40 cases open), and at least six people closely linked to the carnage have committed suicide. Moved by Demeter's anguish, Zeus intervened so that Persephone could return to her mother for part of the year. Modern tragedies are not so easily repaired.
- Labi, Nadya; The Grief Brigade; Time, May 1999, Vol. 153, Issue 19.

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 225 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.

Personal Reflection Exercise #1
The preceding section contained information about the counselor's role in grief and trauma.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
Grief Support

- Sedaghati, S. A., Bera, R. B., & Baker, J. (2023). Grief Support. In StatPearls. StatPearls Publishing.

Peer-Reviewed Journal Article References:
Beller, J., & Wagner, A. (2018). Loneliness, social isolation, their synergistic interaction, and mortality. Health Psychology, 37(9), 808–813.

Bellet, B. W., LeBlanc, N. J., Nizzi, M.-C., Carter, M. L., van der Does, F. H. S., Peters, J., Robinaugh, D. J., & McNally, R. J. (2020). "Identity confusion in complicated grief: A closer look": Correction. Journal of Abnormal Psychology, 129(6), 543.

Captari, L. E., Riggs, S. A., & Stephen, K. (2020). Attachment processes following traumatic loss: A mediation model examining identity distress, shattered assumptions, prolonged grief, and posttraumatic growth. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.

QUESTION 13
What debriefing method conducted in groups gained currency during WWII and includes questions such as "What were the first thoughts that raced through your mind at the time of the crisis?" To select and enter your answer go to Test.

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