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  Psychological Response Stages of Post-Trauma/Disaster

(© Traumatology Institute Dr. Anna B. Baranowsky, 2002)

There are several stage systems from which to assess post-trauma/disaster response. One is drawn from Missouri’s well drafted “Guide to Disaster Recovery Program Design and Implementation: The Missouri Model Putting the Pieces Together” (Wilson & Sigman, 1996). The second model we will review is similar and comes from “Coping with Disasters: A guidebook to Psychosocial Intervention” (Ehrenreich, 1999).  This is an on-line source and is an excellent tool for Traumatologists.

Phases of Reaction to Disaster

  • Threat
  • Impact
  • Inventory
  • Note:  Phases are non-linear
  • Anniversary & Trigger Events
Recovery Phase Missouri Model Ehrenreich Model
1 Heroic/Honeymoon Rescue Stage
2 Disillusionment Inventory
3 Reconstruction Reconstruction

 

Phase 1

The survivor realizes they made it through the disaster/trauma. This is the stage where physical/physiological needs are assessed and present danger re-evaluated. Emergency management services may have been offered. The survivors are assisted in safety/resource stabilization efforts.

Phase 2

Losses become apparent over the following days, weeks, and months post-disaster/trauma. Consequences of the trauma are appraised. This is sometimes referred to as the stage of the “second-disaster” where disillusionment is felt.

Phase 3

At this stage, generally more than a year has past since the trauma and the survivor’s focus changes. They may no longer be provided with community-based resources for recovery. In many cases their life has been stabilized. However, this is also the time when some victims (approx. 25%) recognize that they are not recovering from the emotional impact of the trauma/disaster. Not all of those in need will reach out for assistance. This is where good community based service follow-up becomes important.

 

Projected Contacts by Phase for Intervention Type
(adapted Wilson & Sigman, 1996, p. 58)
Type of Intervention Phase 1 (N=1250) Phases 2 + 3 (N=936)
Recovery Education/Information 80% 50%
Community Organization 65% 44%
Community Resource Mobilization 50% 37%
Skill Building/Natural Group Interventions 35% 32%
Direct Interventions 20% 25%

Early Post-disaster/trauma interventions

These are very different than the types of services offered weeks, months, or years after a disaster and very much in line with moving toward a resource base to enhance recovery. Emotional recovery support programs include:

  1. Interventions need to fit the recovery phase.
  2. Establish a “community reach-out” plan so individual needs are recognized before they escalate.  Interventions are tailored to the individual.
  3. Utilize a wide-range toolkit for recovery:
  4. Psychoeducation - tell survivors what they might experience and how to get assistance, normalize trauma response.
  • Build skills for recovery using identified community resources and social buffer building.
  • Get the community involved in assisting the survivors and their families, friends
  • Use direct Critical Incident Debriefing methods for groups and individuals where appropriate.
  • Actively manage the care of individuals who are under your attention.  For example, this would mean you make sure you follow-up if a survivor you spoke with requested a referral for an individual trauma counsellor.
  • Community organization through the Emergency Site Management System if necessary or at a lesser scale advocating for the utilization of appropriate community resources.

 

Fitting Intervention To Phase Of Recovery
adapted from, Wilson & Sigman, 1996)
Phases Public Info Community Education Skillbuilding, etc. Crisis Counseling Recovery Counseling
Predisaster Planning X X X    
Impact/Heroism X X X X  

 

Honeymoon X X X X  

 

Disillusionment X X X X X
Reconstruction X X X  

 

X

 

Always consider fit to the recovery phase!

Footnotes: