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Article Excerpt
Formal psychological debriefing in the wake of a traumatic experience seems to have no impact on the development of posttraumatic symptoms. This article addresses whether a more appropriate alternative would be a less-structured, more flexible humanistic approach to crisis counseling that encourages the use of trauma survivors' natural coping skills.
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Crisis intervention counseling is based on the premise that psychological intervention during or in the proximal aftermath of a traumatic experience can help not only to stabilize the client and improve the client's present level of functioning but also to reduce or prevent future psychological distress (Brewin, 2001; Deahl, 2000; Kanel, 2003; Myer, 2001; Richards, 2001). Intervention methods frequently include a structured procedure or guided process called psychological debriefing, whereby trauma survivors express their thoughts and feelings about the traumatic event (McNally, 2004; McNally, Bryant, & Ehlers, 2003). However, meta-analyses (e.g., Van Emmerik, Kamphuis, Hulsbosch, & Emmelkamp, 2002) and an extensive review of the literature on the effectiveness of psychological debriefing (McNally et al., 2003) have found very little evidence to suggest that early intervention prevents or attenuates the development of later symptoms of posttraumatic stress. In fact, in some cases, debriefing has been found to actually increase the likelihood of posttraumatic symptoms (Hobbs, Mayou, Harrison, & Warlock, 1996).
The debate that has emerged from these findings has focused on various methodological problems and on whether it makes sense to evaluate psychological debriefing as a stand-alone intervention. Most empirical investigations into the effectiveness of psychological debriefing have been field studies that have not included the use of an experimental control group. Of those studies that have used randomized controlled trials, nearly all have failed to demonstrate a clear benefit of debriefing (McNally et al., 2003), with intervention groups and control groups reporting equivalent posttraumatic symptoms. Proponents of psychological debriefing have responded to these results by claiming that psychological debriefing is only one component of a comprehensive approach to crisis management and that it is meaningless to evaluate the effectiveness of this one component as a singular intervention strategy (McNally et al., 2003). At the heart of this debate is the issue of whether psychological debriefing might be a waste of resources (Brewin, 2001; McNally, 2004). Given the lack of empirical support for psychological debriefing as a preventative, perhaps it would be wiser to channel resources toward the amelioration of posttraumatic symptoms, once they develop, through empirically validated psychotherapeutic approaches such as cognitive-behavioral therapy.
Trauma survivors who have undergone psychological debriefing usually report that they found the experience to be helpful (McNally et al., 2003). Both common sense and a humane sensibility suggest that it is wrong not to offer some form of intervention after a traumatic experience. The question is just what the nature, focus, and scope of such an intervention should be. Structured debriefing methods assume that there is a standard way in which people experience and recover from trauma. But each event is unique, and each person's reaction to trauma is distinct. Also, there is a complex interaction between the event and the person who experiences the event. Indeed, the identical physical event experienced by any two people may be traumatic for one person and not for the other. Perhaps one aspect of the problem with psychological debriefing is that the methods typically used are not flexible enough to accommodate the idiosyncratic nature of this interaction.
This article is organized into three sections. First, I provide a rough outline of the typical approach to psychological debriefing and discuss some of the conclusions that have been drawn from the results of empirical investigations into the effectiveness of this approach. Second, I provide a rationale for a broadly humanistic, person-centered approach to trauma intervention as opposed to the more structured approach that is commonly used. Finally, I offer a brief sketch of what a humanistic approach to trauma intervention might entail.
PSYCHOLOGICAL DEBRIEFING
Approaches to psychological debriefing vary in terms of whether the intervention involves a single session or multiple sessions and whether the intervention is administered immediately after, concurrent with the trauma, or at some later time (Deahl, 2000). The most popular method, critical incident stress debriefing (CISD), is a highly structured, single-session group approach that is designed to be implemented shortly after the...
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