Superstorm Sandy. Newtown. The Pulse nightclub. Counselors were there to help people through all of those disasters, plus countless others, both natural and human-caused, through the past decade.
Disaster mental health counseling has grown and become more standardized in the process. With each disaster, practitioners learn the subtleties of what survivors and communities most need, both immediately after the fact and in the later aftermath.
With that in mind, the American Counseling Association published an updated edition of Disaster Mental Health Counseling: A Guide to Preparing and Responding this year. The book shares insights from counselors who have served on the ground in disaster-relief efforts in a variety of situations, from work with refugees and veterans to school, university, community and international settings.
Counseling Today recently sent the book’s co-editors, Jane M. Webber and J. Barry Mascari, questions via email to learn more. Webber and Mascari are licensed professional counselors and counselor educators at Kean University in Union, New Jersey. The couple are married and present together often on disaster mental health, crisis response and trauma counseling.
Q+A: Disaster mental health counseling
Responses co-written by editors Jane M. Webber and J. Barry Mascari, as noted
As specialists in disaster mental health, you give presentations and trainings on this topic often. What are some common questions you get from attendees? What are people most concerned or curious about?
Mascari: The ripple effect of the growing body of evidence gets questions from various audiences, including law enforcement. So many people are interested in learning emotion regulation, and we are getting more requests to address techniques to help counselors prevent vicarious traumatization. One of my favorite questions related to these techniques is, does this stuff really work? Then they tell us how amazed they are.
Webber: Over the years at Learning Institutes on disaster mental health counseling [at ACA’s annual conference] and state trainings, one question arises quickly: What do I say or do next? Especially after events of mass violence, responders ask, how do I respond in moments of crisis or terror?
Many are fearful of retraumatizating survivors or asking intrusive questions. Counselors also ask how to integrate trauma assessment and counseling with psychological first aid (PFA) as nonintrusive, compassionate lurkers while being alert to survivors in need. Probably the question most often asked is how to respond to families after mass shootings or bombings, particularly when children are killed or injured.
Disaster mental health is becoming a more prevalent and growing focus within the counseling profession. Besides your book, what resources would you recommend for counselors who want to “come up to speed” in this area – especially for counselors who did not cover this topic in graduate school?
Mascari: Taking online courses from the Federal Emergency Management Agency (FEMA) for sure. Also, there are a lot of online programs and great books. Many of the important works have not hit the journals but are in paperbacks that appear every day. Counselors cannot operate without being trauma informed and, at best, I would certainly like to see all our colleagues become trauma competent.
Everyone works with trauma survivors. [But some practitioners] either don’t look for or ask about trauma and then treat symptoms that could be more easily resolved if the causes were addressed.
Webber: I agree with Barry: ICS 100 (Incident Command System) and ICS 700 (National Incident Management System) are FEMA organizational courses [that can help] counselors know what to expect at any disaster site anywhere in the country. The Psychological First Aid Online course provides foundational knowledge and skills for delivering PFA in the immediate aftermath of a disaster (learn.nctsn.org). A must is to download the Psychological First Aid: Field Operations Guide to your laptop. Resources and handouts in the guide’s appendices are invaluable, especially the charts with what to say to people at different developmental levels (children, adolescents, adults). Also, the TIP 57: Trauma-Informed Care in Behavioral Health Services manual is our go-to book for trauma-informed counseling. All are free.
Do you feel the average counselor practitioner is adequately prepared for the possibility of a disaster — either natural or human-caused — occurring in his or her community? Generally speaking, is there a “that could never happen here” mentality among counselors, or a healthier viewpoint?
Mascari: No! There are many skilled, well-meaning counselors who could not serve alongside other mental health responders just because they do not have the basic knowledge expected of the American Red Cross or FEMA.
PFA, the preferred FEMA modality immediately after a disaster, is not counseling in the traditional sense. Therefore, being trained to respond as part of a recognized unit means following established protocols and putting away some of the more invasive counseling techniques. This is based on the idea that people are experiencing a normal reaction to an abnormal event, and that the majority of people return to normal in a relatively short time … My students often say that they feel like their skills have been “dumbed down” [for PFA] at first, then they realize these are valuable tools and incorporate them in their counseling.
As far as the head-in-the sand view, I don’t think most counselors see it that way. We do need to do more from a leadership level to make disaster and trauma more of a priority and more central to what we do. Many times, I look at what I know and what I can do and feel like, “If I only knew this when I worked with clients a few years back.” The new skills promise “better, stronger, faster” in terms of treatment and recovery.
Webber: The misbelief of “that could never happen here” has been destroyed by the deaths of students and teachers across the country [in school shootings]. Like suicide prevention and intervention, every counselor must be trained and prepared for disaster and mass violence that might occur in our communities and schools.
Much has changed – in the counseling profession and the world at large – since the last edition of this book eight years ago. Briefly, tell us what it took to update the material and why you felt it was worth rereleasing this text now, in 2018.
Mascari: The update was a huge undertaking, basically a redo and reconceptualization of the chapters and the style of the book. It is more scholarly and evidence based and not as raw as the articles that came from the heart and experiences in the earlier book. The field is becoming professionalized, and it appeared to be time to change the focus. Our [ACA VISTAS] article on the Council for Accreditation of Counseling and Related Educational Programs (CACREP) Standards and disaster received a large number of reads, so we know other counselor educators are struggling to include these standards in their teaching. The book brings everyone up to a new standard.
Webber: We all [the book’s close to 30 contributors] worked as a mini think tank with much discussion and debate to document the rapid growth of this counseling field. It was challenging for our authors to revise and update chapters seamlessly into the book and to emphasize the critical relationship between trauma and disaster counseling.
PFA has been a vital development for disaster response. Yet, for a few years, trauma counseling and disaster response were split. We have reintegrated the practice of trauma and disaster counseling to move the profession forward.
What interests you, personally, in this topic?
Mascari: My interests are described in the book (in a section of chapter 13, “In Our Own Words: I Never Thought I Would Become So Focused on Disaster and Trauma”), but briefly: I have been responding to disaster and traumatic events throughout my career, before there was a name for this type of work.
Webber: For me, trauma-informed practice has been an ongoing commitment since I was chairwoman of the ACA Foundation during Sept. 11. Responding to disaster survivors is an existential risk that defines who I am as a counselor. I can choose to respond with courage or shy away from helping. Disaster training is essential for our profession to stay on the cutting edge of mental health counseling, especially in an era of mass violence.
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Disaster Mental Health Counseling: A Guide to Preparing and Responding, fourth edition, is available both in print and as an e-book from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-347-6647 ext. 222.
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