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Accompany survivors; do not intrude

/ 08:39 PM November 25, 2013

“Several ‘Yolanda’ survivors were given food, which is good,” says my psychologist friend. “But while they were eating, social workers peppered them with questions from a list. Can’t they at least wait for the survivors to finish their meal? Many of the survivors didn’t even want to talk, but they (social workers) insisted [on getting] answers.”

Filipinos are generous and, after Supertyphoon “Yolanda,” the outpouring of help has been heartwarming. However, if we are not trained, sometimes our efforts can do more harm than good.

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Take Critical Incident Stress Debriefing (CISD), which was likely what the social workers were doing. CISD has already been discredited by the World Health Organization (WHO).

“WHO warns against organizing one-time psychological debriefing of the general population as an early intervention after exposure to trauma,” says Regina Hechanova, Psychological Association of the Philippines (PAP) president. “Based on evidence, this kind of debriefing might be counterproductive and could slow down natural recovery.”

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PAP is asking psychologists, counselors and other mental health providers NOT to use CISD at this point. PAP has observed that it makes survivors more agitated.

Psychological first aid (PFA) is more helpful for trauma survivors. Like physical first aid, urgent needs are met first, like safety and efficacy.

Ideally, PFA providers must have attended training in disaster mental health and also know how the local command structure works. Usually they are frontline workers, such as disaster response workers who are part of organized emergency response teams, which unfortunately are not yet strongly established in the Philippines.

“PFA needs to be given in coordination with other groups that can address the other needs of survivors like medical attention, shelter and so on,” says Hechanova.

She also recommends that psychosocial intervention be not treated as a one-time thing. Some people may need more specialized help like trauma counseling at a later time.

PAP and the Philippine Psychiatric Association (PSA) will soon come out with a list of clinics and centers that can provide free counseling to survivors.

Nonintrusive, respectful

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If you want to help, think of the Hippocratic Oath: First, do no harm. Clinical psychologist Honey Carandang says, “Accompany survivors, be sensitive to their needs, do not intrude, do not impose.”

Jane Bergado Flores, an Ateneo de Manila University graduate student in clinical psychology, has counseled victims of natural disasters. In the aftermath of the worst typhoon ever, she shares strategies with those who want to help.

Nonintrusive means you don’t violate a survivor’s space and impose your help. Initiating contact involves “just being there,” which emphasizes careful observation and responding to survivors in a respectful way.

Do not pressure survivors to reveal their stresses and emotions—many are not willing or ready to do so.

But many survivors will start narrating their frightening experiences. Respectfully acknowledge their experience, but carefully remind them that you also want to know what they need most at present.

Some children and adolescents will not have words to describe their feelings and may resist talking about how they feel. Do not ask them to talk or share their feelings. Stay at the sidelines—the show is not about you. But be ready when someone needs a sympathetic ear.

For children and teens, distracting activities will sometimes be more calming than conversation, for example, drawing, listening to music, reading and so on.

Restore a sense of safety

Stay calm. People take their cue from and are affected by how others are reacting. By demonstrating calmness and clear thinking, you can make survivors feel they can rely on you. Others may follow your lead, remaining focused, even if they do not feel calm, safe, effective, or hopeful.

Instead of trauma counseling, which is not appropriate on the frontline, provide survivors necessary and accurate information about the disaster and what is being done for them, to give them a sense of direction.

Feelings of distress and anxiety are reduced when they feel safe and supported and when they know how to address their needs and concerns.

Survivors need to know what services are available. They need to know what forms of assistance are available, where and how they can get these. Anxiety among survivors is frequently caused by uncertainty or lack of information.

Orientation is helpful when survivors are very agitated, crying intensely, or seem to be losing touch with their surroundings.

Ask them to listen to and look at you. See if they know and can consciously say who they are, where they are, what time of day it is and what is happening. Keep an eye on them and refer them to specialists as soon as possible.

If you have training, you can teach them relaxation methods (such as deep breathing).

Develop efficacy

Encourage survivors to talk to those who are coping relatively well. It is reassuring and comforting to interact with people with similar experiences.

Show sincere interest, undivided attention and care. Show respect for their reactions and unique way of coping. Do not deal with them based on your expectations and judgments.

Think of positive ways to deal with their personal situation and assure them they can recover from the disaster.

Young children and adolescents look to adults for cues on safety and appropriate behavior. It will be helpful if they are placed with calm and stable adults. Let children talk and play with other kids.

Look for signs that certain persons may hurt themselves or others (for example, the person expresses intense anger toward self or others, exhibits extreme agitation). Seek immediate support for containment and management.

E-mail the author at blessbook@yahoo.com.

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TAGS: column, critical incident stress debriefing, Learning, psychological first aid, queena n. lee-chua, Social workers, survivors, trauma counseling, Yolanda
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