An Overabundance Of Counseling?

The New York Times, April 23, 1999

By Sally Satel

Sally L. Satel, a psychiatrist, is a lecturer at the Yale School of Medicine and a senior associate at the Ethics and Public Policy Center.

Shortly after the police, paramedics and television crews screeched onto the scene at Columbine High School, the grief counselors arrived. Coming in by the busload, such experts are now a fixture of tragedy’s aftermath in America.

Many people, including President Clinton, who spoke of dispatching teams of counselors, assume that they are essential in traumatic situations. Trained in a technique called grief work, which says that the healthy response to trauma is to “work it through” and find “closure,” counselors urge the victims to take several steps. First, they must focus on the awareness of mental pain. Second, they must express their emotions. And third, they must talk about it. And talk. And talk. The problem is that this doesn’t always work. An emphasis on experiencing psychic pain can make some people feel even more vulnerable and out of control. Forced ventilation makes little sense for those whose ordinary coping style is to remain calm, maybe too calm for some people’s taste, and spring into purposeful activity, like organizing fund-raisers for victims’ families.

Others, like Susan Cohen, who lost her only child in the bombing of Pan Am Flight 103 over Scotland, just want to be left alone. Writing in Time a few years ago, Mrs. Cohen called grief counselors “ambulance chasers.” She said that the man assigned to the Cohens showered them with cliches about hope, quizzed them on their daughter’s hobbies and simply wouldn’t go away, even when her husband insisted on their privacy.

Perhaps this counselor was unusually clumsy, but even so, evidence suggests that grief work can sometimes do more harm than good. “There is surprisingly little evidence that talking about trauma in its immediate aftermath is particularly helpful,” says George A. Bonanno, a research psychologist at Catholic University. “A number of studies even show that expressing or talking about painful experiences can lead to further emotional difficulties.”

Dr. Bonanno isn’t saying that those who want to talk about their grief should be discouraged from doing so, only that a one-size-fits-all response to disaster and loss is naive.

So why do we impose that? Is it because we, the unafflicted, feel helpless and simply need to “do something,” as my colleague David Fontes believes? Dr. Fontes, a Sacramento psychologist, was called in to help with the Northridge, Calif., earthquake of 1994. “Yes, of course professionals can be helpful, but we shouldn’t be intrusive,” he says. “We should be available, maybe set up a tent where people can seek us out, but not burst onto the scene as white knights who are going to save these people from their misery.”

And then there’s the commodification of grief. The Grief Industry is apparently booming: bereavement books, grief chat rooms, expensive workshops in grief education and exams for certification. You need us, the experts say. But do we?

Most people, in fact, are quite resilient and don’t need registered experts to deal with anguish. Are our priests and rabbis not up to the task? Are our families’ instincts to comfort not keen enough? The deployment of counselors — a well-meaning effort, I wholly grant you — sends an odd message: that people are too fragile to soothe and strengthen themselves.

Add to the tyranny of experts the tyranny of the news media and you have an unholy therapeutic alliance. While grief counselors push people toward open self-expression, the microphones are on and the cameras rolling. Making agony so public is unlikely to help their “clients.”

As a therapist, I find this especially unnerving. One of our tasks is to help our patients protect their dignity. Even more important, as numerous studies have confirmed, is that the repeated communication of intense sadness or distress can actually drive away loved ones, the people we depend on after the experts have packed up their manuals and gone home.

Qualified counselors can be a great help to those who seek them out. I strongly encourage having them available on the scene and afterward. But Grief Workers Inc. can’t help by presuming that there’s one set prescription, imposing rules for mourning and telling people how they are going to feel. Communities have long had rituals for coming to terms with calamity. Grief counseling should not automatically become one of them.