Posted by: counselorcarmella | November 8, 2012

The Vital Role of Psychological First Aid and Crisis Response Counseling

My heart goes out to those who are still reeling from the damage done by  Hurricane Sandy. I pray for their  physical, financial,  emotional, and spiritual   needs.  I’m thankful for those who are  there to help, including  my colleagues who are trained crisis response counselors. Those  going through this life-changing experience are dealing with  devastating losses,  grief,  stress, and  disrupted routines. Along with  medical personell, clergy, volunteers, and other  professionals,  specially trained counselors are a vital part of disaster response teams. 

In a crisis response situation, the counselor is asked to come to  the location of  the crisis event    soon after it has taken place. Crisis counselors or those providing  psychological first aid  might be asked to provide help at a service center or first aid station, family  assistance center, or other temporary site where  food, water,  basic medical care, and information are  provided.   They might be  placed at a school, hospital/ER, church,  respite center for first responders, or in other settings.   They jump on a  plane and  may land in an area where there is no  air conditioning, heat, or electricity, where people are  wounded and upset, and  where  various  agencies with  various agendas are  on the scene, as well. They have to work  respectfully and cooperatively with others as part of a team. They’ll be working alongside  emergency workers,  military personell, employers, clergy, and  community leaders. They have to establish working relationships of respect and trust with   people  who can help them understand and connect with those they are there to serve. They have to gather accurate information about what has happened and  what will be happening as quickly as possible so that they can interact appropriately with those they are there to help. 
The purpose of bringing in the counselor during this time is to  make initial contact so that  those who need  support and information will be open to receiving it either sooner or later. They are available to those impacted by the disaster and to  first responders who  may need additional  attention as they address the  emergency  medical and safety needs of the community. This type of  intervention is about going to the scene of a disaster, crisis, or tragedy  and  meeting those impacted where they are  literally and emotionally. They are intervening during a crucial time in these people’s lives so that, hopefully,  those involved will not  develop long-term  issues like PTSD, depression,  or other  difficulties due to being overwhelmed by what they experienced.   
This is a short term intervention rather than an ongoing relationship. There isn’t a whole lot of time to build rapport and establish trust.  The counselor who comes in as an “outsider” has to be respectful and not push  his/her presence on  other people. He or she is there to “check in” with  people, to  say who they are and  simply that they are here to help. Counselors doing this work need to be able to relate to  individuals from various  educational, cultural, and  occupational backgrounds. If the counselor can connect with an individual, or group of individuals, that are already considered trustworthy, this can  serve as a bridge to help them connect with a community that might be more closed off.  Rapport can also begin by simply making eye contact, offering a bottle of water, a teddy bear, a   snack, or  practical information. The counselor can be a source of accurate information about   safety and  resources. 
Counselors know that  the people they’re  interacting with  may be  going without sleep, food, or hydration.  They know the  effects of the fight or flight experience.  They know people need to feel safe in order to begin to regroup after a crisis. He or she can help to  create a physically safe environment away from   scensory stimuli that remind people of what has happened, away from those who are  injured or extremely distraught, and away from  the media.   The counselor  communicates  in words, body language, and actions a tone of reassurance and   stability.  Whether or not people want to interact directly with the counselor, they  can be comforted simply by  observing his/her demeanor and calm but confident  interactions with others. This may help someone who is hesitant to eventually feel more comfortable approaching the counselor. 

Counselors doing this work are focussed on practical needs, solutions to  current problems,  and being strengths-focussed. They  know how important it is to  be calm and genuine as they relate to  those they are  there to help.  They serve as  educators as well as providers of  emotional support. They use concrete language rather than  “therapy jargon.”

The counselor doesn’t assume he/she knows what is needed, but  asks, “What can I do to help you right now?  What do you need right now?”  This is a genuine request from someone who  isn’t going to judge or make assumptions. Most of  our outpatient clients have food, shelter, clean clothes, and  transportation.  In a disaster or crisis situation,   immediate physical needs often have to be addressed first.

The person  being asked may want access to a phone to let their family know they’re okay, for example. They may just want a bottle of water or  something to eat. They might need a towel or blanket. They may want a quiet place to sit down for a few minutes.  They might just want to go home and hug their kids. They may want to speak to  a priest, minister, or other spiritual  advisor. They might want to be able to clean up and change clothes. They might just want to know facts about what has happened or is going to happen so they  won’t be surprised by something else unexpected.  The counselor’s job is to help them   get what they  say they need whenever possible, as quickly as possible. 
Sometimes, the counselor is asked to meet with small groups of people who shared specific experiences. Counselors leading such meetings have to do their best to assure confidentiality and privacy.  They know that  they  may be viewed with suspicion and may not be trusted if members of the group are worried that they’ll  “report back” to superiors or employers. The counselor can let group members know that they are not required to talk and that   the counselor is there to provide  relevant information, answer questions, and  to  help make sure  everyone is  doing okay under the circumstances. 
In group situations, counselors know that some people are going to shut down or turn inward.  Others will be more verbal and emotional. A general invitation can be given  for someone  to start the  ball rolling by  sharing something about what  they’re going through.  The counselor can  say things like, “A lot of people in situations similar to yours have told me they feel… that the hardest part is… what  upset them most is…” and then  invite  members of the group to elaborate.   They can  begin with physical symptoms such as not eating or sleeping, being jumpy,  etc.  since many people are more comfortable  talking about physical  rather than emotional experiences.  This may  break the ice and allow for further dialogue about  emotional reactions, as well.

Crisis counselors  don’t try and make people talk and definitely do not insist that they tell/relive  the details of what they have experienced.  This is true whether they are talking with a group or  with just one person. They want to be available if someone  does want to talk and  want to be able to give their undivided attention  to anyone who seeks them out, even if its just for a few minutes. They do listen if the person they’re talking with expresses a need to   put words around the details of what they just went through,  or  to describe thoughts or feelings. The counselor seeks to  listen without conveying shock or  personal reactions and keeps the focus on the person who is sharing.  The counselor  shows respect and offers reassurance that reactions are “normal” and  nothing to be ashamed of.
It can help group members to know that peers are experiencing similar reactions. This can help group members seek each other out for support and  to feel less isolated. The counselor in this setting should  be sensitive to the  relationships that  may already exist   among the  people involved.  In addition to family connections, They  may have their own subculture and  norms as a community.   We need to  allow them to educate us about  the sources of support they already  have and are comfortable making use of.  Same goes for the coping skills, routines, and rituals that  may already be in place. Crisis  counselors encourage people to support each other and  may give them some pointers about how to do so. 

These people’s lives have just changed dramatically and they’ve gone through   massive biochemical changes in a short amount of time.  The counselor can help them understand  this process and how it impacts them physically, emotionally, and cognitively. The counselor can normalize physical and  psychological responses and let people know how they might feel in the coming hours, days, and weeks.  Basic information can be shared about post traumatic stress reactions, depression, and other  related topics that may be relevant.  Providing information doesn’t require that anyone share  personal thoughts and feelings if they don’t want to.


Someone might be concerned about a colleague, friend, or family member and may want information about how to help that person.  Counselors also can provide  information to  parents/caregivers about how children  of various ages might react, for example, and what to say or do to try and  help   them.  Children look to the adults around them to know if they’re safe and  if  things are okay. Adults being calm helps children to be calm. Crisis counselors   are often  called in to help employers know what to look for, and how to best relate to, their employees after an accident or act of violence. Clergy members often want this information, as well.   
If the person/group doesn’t want to talk or    doesn’t want immediate help, the counselor can simply make the introduction and  let him/her know where they’ll be.  Information can also be provided verbally and through handouts about where the person can seek help  down the road a little ways if they decide they need it. The counselor can reassure  people that they’ll be leaving information at a place where it is easily accessible and  who a contact person might be for  after they leave.  That person would have the information the counselor  was providing, as well.  

Counselors who help in these sorts of situations know that  dark humor may be a way of coping. They also understand that some people may become very angry or distraught.  A few individuals will need  immediate intervention  for safety reasons.  Counselors  are paying careful attention  to any signs that someone might be dangerous to themselves or to others.  They are listening to concerns individuals may voice about how a particular friend, family member, or colleague is behaving so they ccan try and  make sure that person is assessed and  that any  immediate safety needs are addressed. 


Certain individuals or groups will be at higher risk for  more significant difficulties. Examples include children, the elderly, those with  physical or psychiatric  disabilities or health conditions, those with  very limitted  socioeconomic resources, and those who have been through previous traumas. Those who  have a missing or deceased family member  will need special attention, as well. This doesn’t mean  stereotyping or excluding anyone else. It just means being able to assess and  know who/what to look out for   in particular. Trained  PFA counselors can identify expressions and body language that may signal that someone is  in  particular distress so they can try and engage that person.  They  may also help loved ones know  how to  provide comfort and   tips on   calming down, reestablishing routines, and  getting help if/when needed. 


Counselors in these settings are offering stabilization, choices, and  hope.  Counselors are not there to  make promises, give false reassurances,  or  to judge or  diagnose anyone. They aren’t there to prescribe  how people “should” be responding or  to  push agendas as far as what  those impacted have to do to “deal” with what has happened. They are respectful of the range of responses  people can have to a crisis and  to  whether or not those involved want  interaction with, or information from, a stranger.  They believe in  helping those involved  to maintain a sense of control and  dignity.  They offer choices and  don’t patronize. They try and help those involved focus on what  can be done to improve the situation rather than on  things that can’t be changed.
Psychological first aid and disaster response counseling is  challenging work.  It is also very rewarding. There are various approaches to crisis response.  Each type has  goals and steps that  clarify the process.  Each type also requires   those interested to participate in specific training.  Doing this work without  appropriate training and supervision is strongly  discouraged.  If you’re interested in this sort of work, you can google “psychological first aid” or “critical incident response”  or “mental health crisis  intervention.”  Organizations that provide training and  research on  various types of crisis response include
American Red Cross Disaster Services (ARC)

Crisis Counseling Assistance and Training Program


Federal Emergency Management Agency (FEMA)

International Society for Traumatic Stress Studies (ISTSS)

Medical Reserve Corps (MRC)

National Center for Post-Traumatic Stress Disorder (NCPTSD)

National Child Traumatic Stress Network (NCTSN)

National Disaster Medical System (NDMS)




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