Much has been said in the wake of the devastation of Hurricane Katrina and the subsequent flooding of New Orleans regarding what are the most appropriate approaches to Crisis counseling.  In response to some of  the “do’s and don’ts” about how to be effective in counseling Katrina hurricane and flood victims that have been made available on the APA website, we would like to offer some practical, tested guidelines, born from solid experience,  for psychologists engaged in this urgent work.

  It is perhaps a sign of how intently psychologists are striving to be as helpful as possible in this overwhelming catastrophe that some of us may be swayed from our knowledge and training, or momentarily confused, by the earnest, but questionable advice about how to counsel the Katrina victims that has recently appeared in the Washington Post, Newsweek and USA Today.  For example, one article on the APA website, Boodman, Wash. Post, 9-13-05,  stated that debriefing the victims was not helpful and in fact would only make things worse (e.g., “Most experts oppose these sessions as ineffective and potentially damaging”). Others have voiced grave concern about misunderstandings that would likely arise from the psychologists and the flood and hurricane victims coming from different cultural backgrounds which could interfere with effective post traumatic help.

We certainly applaud the value of encouraging resilience and pragmatic “solutions.”

 At the same time we believe this needs to be tempered with acknowledgement of and permission to voice the deep and universal human feelings that are sparked by such a catastrophe 

 From our extensive first hand experience as psychologists involved in catastrophic hurricane recovery, both as victims ourselves and as psychologists working with victims from a broad cross-section of cultures, we offer the following points as  “back to basics” reminders, and as a kind of antidote to the  “authoritative,” perhaps a bit shrill, advice in the recent media: 

1. Approach each person individually, just as we were all trained to do, and be guided by his or her level of functioning and needs at the time of your meeting.
2. De-briefing, meaning allowing the person to tell his or her story in their own words is helpful and appropriate if the client is ready to do so.
3. Some people will not be ready to share their traumatic experience yet, and as psychologists, we respect this.
4. Counseling can be effective across cultural boundaries if the counselors seek a nuanced understanding of the client’s perspective and are sensitive to how differences may impact communication.

Fuller discussion of the above points follows:

 1. Approach each person individually….

  Of course each person who was impacted by the Katrina disaster is an individual.  More than ever the cardinal rule of psychologists applies   LISTEN to the client who is in front of you.  Tune into their feelings.  Assess their state of being with all your clinical skills and intuition.  Be fully present as you sit with the person, and get a sense of what this person needs right now.    Is the task in this instance to primarily shore up shaky defenses?   Help sort through a morass of feelings to arrive at some understanding of their present state? Help prioritize thoughts and actions, or perhaps refer for medication.  Or is the person in need of a safe place to share moments of trauma or horror at whatever level is appropriate for them now.

These basic skills, which we psychologists have, are exactly what is needed.

 2. De-briefing is often immensely helpful…..

  If the person wants to tell what happened to them, they will tell it.  In our experience, people have very different timing as to when they want to share, depending on many factors, including their personality makeup, and the level of trauma they experienced.  .   When the individual feels safe enough to remember and to speak, it’s a little akin to a dam breaking.  All the details come readily and the client needs little prompting.  This process can be immensely relieving and an important step in healing, as we psychologists have long known. .

 3. Some people will not be ready to share their experience….

 As is always the case, coercion or pursuit of our own agendas to the exclusion of the client’s is unacceptable.  Some individuals may not be emotionally ready to unearth their painful feelings. At times it may be years.  In fact, recently an individual in treatment was able, for the first time, to speak of hurricane-related trauma which had been buried and festering for 10 years. In our experience, people with histories of severe or repeated trauma, as well as those whose pervasive style is one of intellectualization and repression, have a more difficult time sharing their trauma-related feelings.

 4.  Counseling can be effective across cultural boundaries:  Individuals in crisis need competent professionals who can help them to move through the myriad emotional challenges of survival after trauma.  It is clear that many of these services will be provided by persons of a different ethnic background.  However this does not have to be a barrier to the provision of essential mental health interventions.  Cultural competence in the provision of services starts with a willingness to learn from the other and an honest attempt to be aware of one’s personal values.  At the same time, attempting to be nonjudgmental and showing respect for the values of those you serve are key ingredients in successful cross cultural interventions. 

 To summarize, psychologists involved in treating victims of this great calamity need only to draw on the wisdom, empathy, and  human caring  that forms the foundation of our profession and long been the mainstay of the practice of psychology.  Though it is frightening to enter the terrain of this trauma, as psychologists we are well-equipped to navigate the path and be of great assistance.   

By        Dr. Ann Barnard  , Dr. Ilene Rothegeb, and    Dr. Rita Dudley-Grant

             Drs. Barnard, Dr. Rothgeb and Dr. Dudley-Grant are all psychologists in the U. S. Virgin Islands and survivors of Hurricanes Hugo and Marilyn.   Dr.Barnard is in private practice.  Among her specialties is the  treatment of trauma.  Dr. Rothgeb also is in full-time private practice and treats a wide variety  of clientele.  Dr. Dudley-Grant is the Director of Virgin Islands Behavioral Services with a part time private practice and has authored several articles on cultural competence in disaster response.