Counselling for Psychological Trauma
Psychological trauma may be thought of as a particular kind of crisis. As with all crises, the reaction to the triggering event is a very individual thing. While there are some events that practically anyone would find traumatic, such as being involved in a natural disaster, serious road traffic accident, or terrorist atrocity, other events may be experienced as stressful by some but traumatic by others. Trauma results from a degree of stress that completely overwhelms the person’s ability to process it at the time. People’s resilience or vulnerability to experiencing something as traumatic differs widely and the support a traumatised person receives after the event is a significant factor in how well they are able to deal with it and recover from what they’ve experienced.
A person who has just suffered a traumatic event may feel like they are in crisis and need help to regain a sense of stability and safety. Where there is a history of repeated trauma or abuse, the person’s baseline anxiety levels may be high so that it doesn’t take much extra stress to tip them over a threshold into crisis. Secondary trauma can also overwhelm a person’s normal adaptive coping mechanisms. This is where you have not experienced the traumatic event yourself, but have had contact with it as a friend or relative of the primary victim, or as a witness or helper for them. Sometimes, a traumatic reaction can develop just through feeling an emotional connection with a traumatic event – the feeling that “that could have been me.” This can even happen by connecting with the incident and those affected through the television, radio and newspapers.
Symptoms Characteristic of a Trauma Reaction
The main symptoms are intrusions, avoidance of reminders of the event(s), distress on contact with reminders, hypervigilance, and disturbances in cognition and mood. These are described in more detail on the EMDR page.
Crisis Interventions for Trauma
The same basic principles of treatment for personal crisis as noted above are also appropriate for people who have been traumatised (Flannery & Everly, 2000):
- Treat as soon as possible after the traumatic event.
- Stabilisation, i.e. cessation of escalating distress, so the affected person can begin to function independently again.
- Facilitate understanding of what has happened by encouraging the person to recount the events, express the emotions, and understand the impact of it. Personal preferences about this, and one’s individual coping style are always respected.
- Working with the person on problem-solving to enhance independent functioning.
- Encouraging self-reliance in assessing problems, developing practical solutions, and putting them into action.
In addition, research shows that for people who have been traumatised, and especially in the immediate aftermath of trauma, it is important to build a sense of physical safety to help reduce the biological arousal and distress that trauma creates (Hobfoll et al., 2007). Actively working on learning how to reduce the heightened state of arousal helps with calming and grounding, and may also help with sleep difficulties. The normal sense of self may be shattered by the experience of trauma, so it is important to build and support this through re-establishing the basic routines of daily life, encouraging connectedness with friends and family, and fostering hope for the future.
EMDR for Acute Stress Disorder
In the immediate aftermath of a traumatic event, symptoms of an acute stress reaction may be present. The symptoms are similar to those of PTSD with some dissociative symptoms in addition. This is a natural and normal reaction to the experience of trauma, and in most instances it will gradually calm down and fade away within a few days or weeks. There has been a great deal of debate in the trauma literature over whether to actively treat for trauma at this early stage. Watchful waiting has been advised for years in the expectation that, in most cases, symptoms would subside naturally, but there is also research which demonstrates good outcomes through early intervention in this acute stage. The benefits of this include a more rapid amelioration of symptoms and a reduced risk of developing PTSD at a later date. A special protocol for using EMDR as an early intervention has shown good results (see, for example, Shapiro, 2012).
For clients who may be interested in EMDR therapy in the days or weeks after experiencing a trauma, the advisability of this can be discussed in the initial assessment session.
Mental Health Crisis
If you are experiencing a mental health crisis (e.g. thoughts of serious self-harm or suicide, disturbed behaviour, psychosis) and you need urgent assistance, please make contact with one or more of the following agencies, who will be able to help you.
Contact a trusted friend or family member.
Samaritans: Freephone 116 123. Call them any time. You don’t have to be suicidal to use their service.
SANEline: A specialist mental health helpline. Dial 0300 304 7000 between 4.30 pm and 10.30 pm each evening.
Papyrus: Freephone 0800 068 4141. Supports teenagers and young adults who are feeling suicidal.
If you think you may self-harm or act on suicidal feelings, or have already done so, go to any hospital A&E department. If necessary, dial 999 for an ambulance.
NHS 111 Service: For non-urgent medical help, dial freephone 111 (24 hour helpline).
See your GP. Emergency appointments may be available. If out of hours, there is usually an answerphone message telling you where you can get help.
If you already have contact with mental health services, phone your Community Mental Health Team (CMHT) or your crisis team if you have one. If you have a care plan or crisis plan, check it for who to call in a crisis.
National Domestic Violence Helpline: Also links to Refuge and Women’s Aid. Freephone 0808 2000 247 (24 hour helpline).
Rape Crisis: To find your local services dial freephone 0808 802 9999 (daily, 12-2.30 pm, 7-9.30 pm).
Alcoholics Anonymous: National helpline is freephone 0800 9177 650.
Narcotics Anonymous: National helpline is 0300 999 1212 (10 am – midnight, 7 days a week).
Mind: A national UK charity with comprehensive information about being prepared for and dealing with mental health crises, including how to get urgent help. For their Infoline, dial 0300 123 3393 or text 86463 (9 am – 6 pm, Mon to Fri, except bank holidays).
Make an Enquiry
If you would like more information about psychological therapy and how we may be able to work together to address your concerns,
you are warmly invited to call, email, or message me through the form on the Contact page.
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Everly, G. S., & Mitchell, J. T. (2008). Integrative crisis intervention and disaster mental health. Ellicott City, MD: Chevron.
Flannery, R. B., & Everly, G. S. (2000). Crisis intervention: A review. International Journal of Emergency Mental Health, 2(2), 119-125.
Greenstone, J. L., & and Leviton, S. C. (2011). Elements of crisis intervention (3rd ed.). Belmont, CA: Brooks-Cole, Cengage Learning.
Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J, … Ursano, R. J. (2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry, 70(4), 283-315.
James, R. K., & Gilliland, B. E. (2017). Crisis intervention strategies (8th ed.). Boston, MA: Cengage Learning.
Yeager, K. R., Burgess, A. W., & Roberts, A. R. (2015). Crisis intervention for persons diagnosed with clinical disorders based on the stress-crisis continuum. In K. R. Yeager, & A. R. Roberts (Eds.), Crisis intervention handbook: Assessment, treatment, and research (4th ed., pp. 128-150). New York, NY: Oxford University Press.
Yeager, K. R., & Roberts, A. R. (2015). Bridging the past and present to the future of crisis intervention and crisis management. In K. R. Yeager, & A. R. Roberts (Eds.), Crisis intervention handbook: Assessment, treatment, and research (4th ed., pp. 3-35). New York, NY: Oxford University Press.