JSV:What do you perceive as the most important factors for clinicians/professionals, including non-mental health personnel, to consider when intervening on behalf of a survivor of a traumatic event?
DM: I think that the task of the health care provider changes in terms of when they intervene. If it is soon thereafter, then there are a number of emergency requirements. Moreover, the signature of the event becomes important as to how one would intervene. At first, it is important to make sure that people have information and that they are safe. The clinician or health care provider may act as a support agent and make sure that survivors are protected from the media and well-wishers who could make things worse. There is an immediate crisis that needs to be addressed. Then there is a second phase that has to do with education about the impact of the trauma. Education about PTSD and discussion about adaptive and maladaptive coping responses, while normalizing and validating the nature of people's reactions become important. As one proceeds, especially if the impact of the trauma occurs over a prolonged period of time, a major concern is that health care providers often leave the scene too soon (i.e., see the research by Pennybaker). There are also concerns about potential secondary victimization and later on, anniversary effects. This is especially the case if the victimization experience is of intentional human design as compared to a natural cause. There is often an increased likelihood of anger that has to be addressed. How does one make sure there are no comorbid reactions such as addictive behaviors, depression, anxiety attacks and the like? It is important that mental health personnel recognize that people don't heal easily. You don't cure PTSD. You don't stop the memories. In fact there is some research that suggests that the more you intentionally try to stop traumatic memories, the greater likelihood that they are going to increase in terms of their intrusiveness. Therefore, the question is how do you help individuals transform memories? How do you help people find meaning in such events? How do you help them transform their pain into a "mission?" This is all subsumed under the constructive narrative perspective. If one sees the task of the health care provider in this broader view, then what you do right at that time of the event is only one small parcel of the total intervention.
JSV:As you are aware, The American Academy of Experts in Traumatic Stress is a multidisciplinary organization with more than one hundred professions represented. The Academy recognizes that traumatic events are an unfortunate part of the human experience that professionals and workers from many fields work with on a regular basis. What do you see as the major advantage of an organization such as the Academy that is dedicated to increasing awareness and ultimately, improving the treatment for survivors of such events across such an eclectic group?
DM: Well, I think that providing an umbrella organization that will facilitate dialogue as you do both in your journal and in other events is a valuable service. What the physician, the emergency worker, and the psychotherapist have in common and how interventions can be coordinated across disciplines is a valuable service. Such a dialogue should result in better treatments for survivors and for those who provide such services.
©1998 by The American Academy of Experts in Traumatic Stress, Inc.
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