Terrorism and Disaster by Ursanom Fullerton, and Norwood- Chapter 11:
This chapter begins by discussing the challenges faced by clinicians during large scale adversities. The issues discussed include the effect of the adversity on the clinician, the inability to conduct intensive therapy due to the number of people traumatized, and the inability to cope with one adversity due to more impending adversities, inability to distinguish pathological help-seeking from typical help-seeking during times of adversity. The question of weather clinicians should be employing a typical degree of empathy arises with consideration of the effect on the clinician of working with highly traumatized clients. In contrast, the chapter discusses the great necessity, and the high benefit, of clinicians working actively in times of crisis. Benefits discussed include the effect of early treatment despite rolling adversities, and the heterogeneity of groups affected by these crises. The chapter suggests that the goal of therapy during mass trauma should shift away from treating psychopathology and towards optimizing recovery and encouraging clients’ own strategies.
The chapter proposes that client conditions during adversity are influenced by novelty of the stressful situation , resources, and inner states of mind.
The chapter discusses issues surrounding the standardization and ad hoc responses used by clinicians in such situations. Examples include the unnecessary use of sedatives and medications. The question of being able to differentiate between those showing distress and those who would best benefit from early treatment for possible PSTD is discussed. Surveys of Israeli suburbs affected by trauma showed varying degrees of some, but not all, PTSD symptoms. Other important findings include that PTSD symptoms were distributed unequally, that many cases of PTSD expression were not as disabling as typical clinical cases, and that fears were not as generalized as clinical cases. One important factor is the degree to which clients are incapacitated by their symptoms, which varied significantly.
The question of PTSD symptoms being partially adaptive is argued, the main argument being that PTSD symptoms could help individuals recruit support and that some PTSD symptoms may help to transform intrusive memories into electively accessible memories.
The chapter also discusses the evolution of an individual’s response to traumatic events and how treatment must evolve in accordance to the clients evolution. The chapter splits up these “phases” of evolution.
In addressing the “impact phase”, the chapter discusses the typical individual’s initial reaction to traumatic stress, including altruism, goal-direction, and modulation. This section also discusses cases of severe reactions that require hospitalization and use of tranquilizers. In the “early responses” section, the chapter discusses adaptation to life after trauma, including the concept of delayed secondary stressors, and continuity of care. A large range of possible outcomes and post-initial reaction are mentioned. In the “Return to life” section, there is a high emphasis on CBT and pharmaocotherpay.
It is also discussed that modification to therapies during ongoing conflict has the potential to be highly beneficial. The end goal of these therapies is described as healthy fear as opposed to no fear. Many survivors do not seek help or discontinue professional help early on. Lastly, the chapter draws connections between an individual’s recovery and constructed life narrative.
Psychological Effects of Catastrophic Disasters by Leon A. Schein, Henry I. Spitz, Gary M. Burlingame, and Philip R. Muskin:
This chapter opens with a statement that trauma therapists can benefit from becoming proficient in multiple areas of treatment, and that this could allow trauma therapists to use the versatility of their skills to cater to specific situations. The chapter discusses the elements of group psychotherapy that are most beneficial to trauma treatment, mostly centered around member interaction. A stated goal for this chapter is to bridge the apparent gap between the literature of trauma treatment and the literature of group therapy, and to encourage the integration of group therapy principles with trauma treatment. It is argued that group treatment is shown to be more resource efficient compared to other methods. When the number of people in need of group therapy exceeds the numbers of professionals available, this method allows clients to receive treatment when they otherwise would not receive treatment. Additionally, the chapter points out that this method has shown to be equally effective as other methods, despite claims of it being “watered down”. Notably, the leader of the group must be prepared to manage strong reactions of members that may interfere with recovery.
The chapter breaks down the domains that contribute to therapeutic gain as such: formal change theory, member and leader characteristics, small group-processes, and group structure.
The chapter also discusses the methodological problems in regards to group treatment literature, such as self-disclosure, leadership, and group processes. It goes on to discuss the developmental stages that such groups go through; engagement, differentiation, work, and termination.
Another factor discussed was member to member feedback, which is one of the most potent aspects of group therapy. The intricacies of feedback such as balancing of positive and corrective feedback are critical to the discussion. The chapter proposes a “gold standard” for group based trauma treatment protocol, which later leads into a discussion of possible directions for future research and training.