The Agenda

The Pros and Cons of Emergency Grief Counseling

In Redirect, Timothy Wilson, a psychologist at the University of Virginia, identifies “story editing” as one of the main ways people make sense of their lives and overcome challenging circumstances. The following is drawn from a Scientific American interview of Wilson:

We all have personal stories about who we are and what the world is like. These stories aren’t necessarily conscious, but they are the narratives by which we live our lives. Many of us have healthy, optimistic stories that serve us well. But sometimes, people develop pessimistic stories and get caught in self-defeating thinking cycles, whereby they assume the worst and, as a result, cope poorly. The question then becomes how to help people revise their negative stories.

One approach is psychotherapy. Cognitive behavioral therapy (CBT), for example, which is designed to identify and change people’s negative thinking patterns about themselves and the social world. CBT is an effective way of helping people, especially those with serious problems such as depression or anxiety disorders. But social psychologists have discovered another approach that is simpler and can help people with less serious problems. I call this “story editing,” because people are encouraged to edit their personal stories in beneficial ways. [Emphasis added]

Wilson’s book came to mind in light of Ramesh Ponnuru’s latest Bloomberg View column on sensible measures designed to reduce the number of mass shootings and to deal with their consequences. One of the proposals Ramesh references, however, is in tension with one of Wilson’s core arguments:

Noah Pozner’s family also proposes that the government fund school-security reviews and upgrades, and augment emergency grief counseling. (From the memo: “After Noah’s death, family members underwent an initial extended and horrible period without any mental health assistance.”) 

Redirect opens with a discussion of Critical Incident Stress Debriefing (CISD) sessions: 

The premise of CISD is that when people have experienced a traumatic event they should air their feelings as soon as possible, so that they don’t bottle up these feelings and develop post-traumatic stress disorder. In a typical CISD session, which lasts three to four hours, participants are asked to describe the traumatic event from their own perspective, express their thoughts and feelings about the event, and relate any physical or psychological symptoms they are experiencing. A facilitator emphasizes that it is normal to have stressful reactions to traumatic events, gives stress management advice, answers questions, and assesses whether participants need any additional services. Numerous fire and police departments have made CISD the treatment of choice for officers who, like Gary Felice, witness horrific events—indeed, some departments require it. It is also widely used with civilians who undergo traumatic experiences. Following the September 11, 2001, terrorist attacks, more than nine thousand counselors rushed to New York City to help survivors deal with the trauma and prevent post-traumatic stress disorder, and many of these counselors employed psychological debriefing techniques.

Wilson contrasts CISD with another approach, closely related to the idea of story editing:

Instead of asking Officer Felice to relive the trauma of Tommy Schuppel’s death, suppose we let a few weeks go by and see if he is still traumatized by the tragic event. If so, we could ask him to complete, on four consecutive nights, a simple exercise in which he writes down his deepest thoughts and emotions about the experience and how it relates to the rest of his life. That’s it—no meetings with trained facilitators, no stress management advice—just a writing exercise that Felice does on his own four nights in a row.

As Wilson explains, the most common intuition is that early intervention and the help of a trained professional is vastly preferable to a simple unsupervised writing exercise that happens after the fact. It turns out, however, that CISD seems to “freeze” memories of the traumatic event in question, impeding the “story editing” that is an essential part of recovery from trauma:

In 2003, after reviewing all tests of the effectiveness of psychological debriefing techniques, Harvard psychologist Richard McNally and his colleagues recommended that “for scientific and ethical reasons, professionals should cease compulsory debriefing of trauma-exposed people.” Unfortunately, this message has not been widely disseminated or heeded. In 2007, after a disturbed student at Virginia Tech University killed thirty-two students and faculty, students and emergency workers underwent stress-debriefing techniques similar to CISD.

The writing exercise appears to yield superior results:

This technique, pioneered by social psychologist James Pennebaker, has been tested in dozens of experiments in which people were randomly assigned to write about personal traumas or mundane topics such as what they did that day. In the short run, people typically find it painful to express their feelings about traumatic experiences. But as time goes by, those who do so are better off in a number of respects. They show improvements in immune-system functioning, are less likely to visit physicians, get better grades in college, and miss fewer days of work.

My concern is that “emergency grief counseling” is very attractive as a political proposal, as it aligns with our commonsense intuitions and it aligns with the interests of professional counselors, for whom legislation that enshrines the importance of emergency grief counseling and provides funding for it would be a major victory, despite the fact that there is good reason to believe it will prove ineffective relative to a low-cost alternative. This example is of particular interest to those of us who favor a leaner, more efficient public sector.

In a similar vein, voters enthusiastically backed “three strikes laws” backed by correctional unions with a direct material stake in their passage on the grounds that more punitive policies certainly seem like a good way to fight crime. But we have good reason to believe that these laws have actually exacerbated crime relative to the alternative of increasing the police presence in high-crime neighborhoods by, among other things, reducing the stigma associated with incarceration.  


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