A large number of counsellors have volunteered to be available for survivors and firefighters at Grenfell tower, but whats the evidence for talking therapy?
In the aftermath of shocking violence and loss of life, its understandable that people want to reach out and help. Whats less clear is the best way in which to do this.
In the wake of Grenfell Tower, 300 counsellors have volunteered to be available for survivors and firefighters to give free therapy should it be wished for. This offer of help is deeply compassionate. It also needs careful thinking through.
There is good evidence for talking therapies. But if a talking therapy has the power to help, it can also have the power to harm, and the human instinct to offer support needs to be weighed carefully against the mixed evidence available on early post-trauma intervention.
About 30-40% of people will show ongoing mental health difficulties after a trauma, including hallmarks of post-traumatic stress disorder (PTSD) such as flashbacks, increased anxiety and avoidance of talking about or remembering the event. For the majority, specific mental health problems do not develop. Talking therapies might not be needed or wanted by everyone.
Studies suggest some interventions might be harmful. The World Health Organisation has a specific recommendation against one type of post-trauma debriefing and the National Institute of Clinical Excellence recommends watchful waiting for a month before offering talking therapies.
Dr Vaughan Bell, NHS clinical psychologist and neuroscientist at University College London, urges caution: The best thing to do is when youre feeling shaken up, is spend time with friends and family and people that you find supportive, said Bell. Debriefing after an event is a good thing, but not if its Critical Incident Stress Debriefing. At best we know its useless and at worst we know it does harm.
Critical Incident Stress Debriefing, sometimes called Critical Incident Stress Management, is a structured seven stage process offered soon after trauma, taking people through a detailed narrative of the event and their thoughts and feelings. This is different from the more colloquial use of the term debriefing, which usually involves people involved in a trauma getting together more informally and running through what happened, checking everyone is ok and whether there are any learning points.
Bell references some of the studies on Critical Incident Stress Debriefing which suggest that it slows peoples recovery. Whilst it can look like the intervention is helpful because people say they like it and are recovering eventually, these studies indicate it might prolong distress.
The exact mechanism for this slowing isnt clear, although Bell thinks its likely that it affects encoding of trauma memories. The ability of our brains to store trauma memories neatly, in a way in which they dont pop out in flashbacks or intrusive images, is a key process which seems to go awry in PTSD, so any intervention which interferes with this is problematic.
For Bell, the implications are worrying: We have a long history of poorly prepared but well-intentioned mental health professionals going into situations where theres been a lot of trauma and essentially making things worse These are not the sorts of things where you can just turn up and use standard counselling skills We know from experience that things can go quite wrong when that isnt supervised and managed.
Bill Yule, Emeritus Professor of Applied Child Psychology at the Institute of Psychiatry, thinks it is a mistake to let this get in the way of offering any help. He thinks evidence of harm from early interventions is flawed, although he does agree with Bell that it is crucial to have a coordinated and evidence-based response.
People need their basic needs to be looked after straight away, said Yule, who thinks there should be access to humanitarian assistance from the get go That does not mean individual treatment or even group treatment. It does mean supporting the survivors right from the beginning. Yule thinks there should be one-stop shops giving help and advice on a range of services and he also thinks we could learn from the Scandinavian model of professionally-led peer support, where groups of families have guided discussions every few weekends for months after a disaster, to connect and to help each other.
Dr Amy Hardy, research clinical psychologist at Institute of Psychiatry, added that any response should be individualised: Peoples ability to adapt to traumatic experiences depends on their available resources. Do they have existing mental health or substance use problems? What other stresses do they have in life? How do they cope with difficult emotions? Do they have people they can confide in and rely on for help? Difficulties in these areas can make it harder for people to adjust to whats happened and means they may be more likely to experience post-traumatic stress, she said.
The residents of Grenfell are certainly experiencing other stresses, both emotional and practical, and the practicalities cannot be underestimated. Many survivors of Grenfell Tower are still without permanent accommodation. Its great to offer talking support if its needed, evidence-based and well-delivered, but even the best talking intervention will only be properly accessible if other more basic physical needs are met. Its unfair to expect people to talk about difficult and upsetting things when they still dont have a comfortable home to feel safe in and when in a sense the traumatic event is still ongoing.