Tales from my Professional Life

AN ORGANISATIONAL CLIENT - SCENES FROM A RAIL CRASH

In October 1999, just on the outskirts of London, 31 people died and hundreds were injured when a Thames Trains service went through a red signal and collided with a Great Western InterCity Express. It is not possible to doing anything more than roughly estimate how many people suffered serious emotional damage, either directly, (passengers) or indirectly, (relatives, colleagues, friends etc). The figures run in to at least the low thousands. In addition there major psychological effects that eventually emerged in some of the Emergency Service workers.

I was tasked to help two groups of passenger survivors, none of who had any significant physical injury. However they all felt sufficiently emotionally pained to prompt them to voluntarily take up the psychological therapy services that were on offer to all the directly affected victims.

In Group 1 there were 6 women and 3 men, of various ages and in Group 2 there were 5 men and 7 women. In neither case did I ever learn anything striking or of any significance about their backgrounds, origins or personal circumstances. We met in a small conference room in a hotel that had been requisitioned for the purpose. Their presenting emotional conditions ranged from anger, through deep sadness to ongoing terror. 

What can psychotherapists and counsellors offer highly traumatized victims such as these? These cameos will give you an idea about what I did in this particular case:

Group 1:

To begin with, I asked each participant to describe their entire day from when they got up on the morning of the crash through to when they got to whatever or wherever represented a safe place for each of them. I wanted each of them to tell me their story. This was not done on a one-by-one basis that started at breakfast time and went through to bedtime but one that was undertaken on a horizontal time-slice basis that took all of the participants in turn through the first segments of their day, then all of them through the second and so on. Although we wanted to hear from everybody, the trick was to keep the group focused on the individual task in hand whilst at the same time not wanting to suppress anybody’s need to urgently express themselves if necessary, whether or not it was their “official” time to tell part of their own story. What became obvious at an early stage was a need in some of the participants to deal with their own feelings by sabotaging the emotional “downloading” of other group members. For example:

Participant A – “As I cowered by the track side, I kept on worrying about getting home in time to pick up my dry-cleaning as I was going to a Parent/Teacher meeting the next day and I didn’t want to look scruffy and let my children down”

Participant B – “My immediate worries were for everybody else. I had already probably saved one guy’s life by dragging him clear and I knew that the most important thing was to care for the injured” 

 Looking at Participant A, I could see that she was starting to feel ashamed of herself. Possibly she was feeling personally diminished by only having such apparently trivial worries as how to collect her dry-cleaning when “Mr. Hero” was rushing round selflessly risking life and limb in the service of his fellow victims.  The danger was that Participant A, and possibly other group members too, would be silenced by their awe of Participant B’s apparent heroism. The essential element in working in this way with traumatized clients is to keep bringing them back to the “what were you thinking – what did that happening mean to you”? This is because such an approach is consistent with the classic principle of any cognitive therapeutic intervention in that the thinking precedes the reaction or the feeling.

Thinking, including maladaptive thinking is the cause of perceptions, emotions and emotional discomfort; it is not the result of inappropriate emotions or perceptions. In the case of the exchange reported above, by asking both A and B what their individual thoughts were, at the time that they each were referring to, we could get their responses into proportion. In addition, and probably most importantly of all, they could both learn to understand their own thinking and to normalize their own cognitions. As it happened, it turned out that A had been thinking about how the crash might affect her immediate family and B had been thinking that he was in immediate danger and so he found that displacing this fear into activity helped him to cope. It is clear from this example that the trauma therapist’s early stages interventions need to be targeted at continually “closing the loop”. This helped A and B to understand better how they had processed their own reactions to the crash and to find personal value and normality in them. Doing this helped both A and B plus eventually the rest of the group to move forward

Group 2:

This group of victims all described a very similar common scene from their experiences. The following is a composite of how all of them told their stories

“There was a huge bang; a huge jolt and the train went all over the place. I was thrown around all ways and there was an incredible noise level; screaming, crunching, banging, explosions and the sound of huge pieces of metal crashing together. It was like hell had opened up. Then it stopped and I found myself outside the train sitting on the track. There was a hush, no noise, and no sound at all. Then from one direction I heard a mobile phone starting to ring, and then from somewhere else another phone joined in, then another and then another and another and another. Gradually the air became full of the sound of phones ringing. It was the sound of life!”

This is a hugely dramatic story and, as some of the survivors talked about this experience it became clear that its power was putting all us, everybody in the room, back at the crash site. It filled our being and we all were there, at the actual event, at the actual time.

Now let’s get back to therapeutic reality and let’s see if we can close the cognitive loop. Put simply, the story wasn’t true! The crash happened on a busy mainline train junction, under a crowded airport flight path and in a busy, heavily trafficked, London suburb. There was no silence! This means that those particular survivors’ stories existed only as a perception, a wrong perception even though it was an incredibly powerful one. What was the real situation? It had to be one of noise, shock and fear. Where did the belief come from that all was quiet? After all, this was real life at a major, and still ongoing, disaster. With hindsight, my best professional guess now is that this misperception probably had its origins in some erroneous thinking patterns, (cognitions), that if noise equals danger then silence equals safety. Therefore, in order to save themselves, my storytellers had to create their own reality because the real life situation that surrounded them was far too threatening.

My reparative task, as a therapist was to help these survivors discover their own realities and to become comfortable with it

AN EMPLOYEE’S PROBLEMS – DEALING WITH FEAR

Dean’s problems seem to have started when there was small fire at his firm’s main depot. He normally works from there and happened to be on site at the time the fire broke out. Dean, who is also a retained firefighter, helped to put the fire out. Nobody was hurt but at one time there seemed to be a good chance that the fire might rapidly spread and engulf a much wider area of the plant. Since then Dean had found himself feeling very anxious and angry whenever he had to go to the depot. He felt frightened, a bit sick, sweaty, and he could feel his heart thumping. As a result of all this, Dean tried to avoid going to that depot and a lot of the discord with his workmates arose out of their perception that he was “slacking off”.

At our first session, it seemed to me that Dean was suffering from a learned anxiety condition that was triggered by some automatic bodily responses that kicked in whenever Dean was exposed to the appropriate stimuli. In this case it appeared that realising that he was near to the location of the depot blaze that activated Dean’s emotional and physical reactions. With Dean’s consent, I contacted his GP to make sure that he did not have anything physically amiss that could explain his symptoms and to find out if he was taking any medication for any apparently unrelated conditions that might explain his anxiety reaction. I also checked out with Dean to make sure that he was not misusing any other substances, (including alcohol), that might cause him to feel excessively stressed. As there appeared to be no reason to think that Dean’s condition was anything other than psychological, I decided to use some psychotherapeutic desensitisation techniques to help Dean manage and control, his anxiety-based emotional dysfunctions and to offer him some supportive counselling while he came to terms with his problems.

The next two sessions seemed to progress quite well although I had a feeling that there was still something important that was being missed. I had no direct evidence for this; it was just a feeling that I had. At the end of session 3, I asked Dean if he was yet finding any benefits from our work together. He said that he thought that he might be getting a bit better but just as he was leaving, almost as an afterthought, he suddenly said, “…of course, none of all this helps with the screaming”. Although the session was actually over, I decided to give Dean another 10 minutes so that I could immediately respond to Dean’s “show stopping” statement. He told me that every night, when he went to sleep, he started screaming and shouting and that this was so bad that he and his wife slept in different bedrooms in different parts of the house. As he also told me that this had been going on for the last 25 years, I realised that this issue, although obviously very important, could be safely left to be dealt with at their next therapy session.

During the fourth session, I asked Dean to tell me more about his night-time screaming. It soon appeared that this behaviour had actually become quite normal for him and his wife and that they had long come to accept it as a routine part of life. However, as he told me all about his nightly disruptions it became apparent that Dean was actually starting to act in the here-and-now of the counselling room as if he was terrified of something. I challenged him about this and he said that he was only just then realising how scared he was. Being frightened had become so routine for Dean that he had actually forgotten about it. I asked him how long he had been so frightened and he said that he had felt that way for the last 25 years. Next I asked Dean to tell me where he was when he first felt so scared and he unhesitating replied, “the South Atlantic, 1982 when my ship caught fire”. It transpired that Dean had been a soldier in the 1982 Falklands War and that he had been one of the casualties from the Sir Galahad fire. I then realised that Dean was probably suffering from a long-term, major stress condition and that the recent fire outbreak incident at work and brought all of this extremely powerful emotional turmoil to the surface.

Dean told me that he felt so much better now that all this had come out into the open at last and that he was so relieved to hear that he had a diagnosable condition. He had long nursed his secret in case others found out that he was actually “worthless” or what he described as being “…just a weak and cowardly failure”. I therefore agreed to see Dean for 6 more treatment sessions with the proviso that we would use the last of those sessions as a therapy review to see how he was getting on and to talk about any other help that he might need.  We worked together for a further 6 weeks and during that time Dean started to find that his relationships with both his family and his workmates were becoming less fraught. He also stopped being so terrified.

THE TSUNAMI – GOING BEYOND PSYCHOTHERAPY AND COUNSELLING

Christmas 2004 simply did not happen for me. I spent it as a member of a dedicated Reception Team helping the survivors of the Indian Ocean Tsunami who were arriving at London Gatwick airport. A special receiving area had been set up at Arrivals where, as they got off the plane, the returnees passed through an organised and orderly reception process that involved medical teams, social welfare teams, clothing and refreshment providers, showers, rest areas, access to phones/email and the help of transport specialists who organised their onward journeys. Of course, as this was the UK, at all stages there were copious amounts of tea available!

The interesting thing about working with these people was this: There were probably about 30-40 experienced “service providers” present, including doctors, nurses, paramedics, social workers, police, NGO “experts” and so on. However, as soon as any of the “customers” showed any form of overt emotion whatsoever, the cry went up, “get the therapists”! Why? What was everyone scared of? In the immediate aftermath of the disaster, before any proper organisation got going, these victims had been simply scooped up off the beaches and from the wrecked resorts, packed into the first available plane to anywhere and sent off. It was not uncommon to see people arriving still wearing their swimsuits and with no other luggage. One woman turned up wearing only her bikini bottom! What could be more natural than that as soon as they got home to the UK, and at last were starting to feel safe, that these people immediately began to react emotionally in very overt and initially inconsolable ways?

My deliberate response to this obvious psychological discomfort amongst the team was to take my co-workers to one side and quietly explain this very normal emotional healing process to them. I wanted to get it established and accepted that it was more than just “OK to weep” but actually quite a common human event and even a desirable one. Therefore the most helpful thing that they could do was simply to allow this natural healing progress to occur without pathologising either the returnees or their psychological reactions.

What was I doing? Was I giving my co-workers “therapy”, “psycho-education”, “normalisation permission” or whatever? I don’t know, but I do know that it worked and it was probably the most effective therapeutic intervention that I offered over the entire 10 days that we spent meeting the survivors. I know this because I could see the obvious benefits to the survivors and the positive changes in the Team’s attitudes. Would I do it again? I have no idea – it just seemed right at the time!

TRAINING STAFF TO COPE WITH EMERGENCIES

In the aftermath of the second Gulf War, a well-known, international petrochemical company who were concerned about terrorist activity, briefed me to run coping-strategy training courses for their European staff whose colleagues might suffer psychologically from possible terrorism-generated stress and trauma. The plan was to help the workers to help themselves. Most employees were keen to get involved but they mostly shared a general feeling of potential incompetence and impotence when faced with, what to them was the apparently impossible, or even overwhelming, task of dealing with overt human emotion. They were scared of being scared! I got the trainees to tell me about any real-life traumatic incidents that they had been involved with. My plan was to use these experiences as teaching tools. The following two exchanges show how I tried to respond to the trainees concerns. You can judge if, or even how, you might have done things differently:

Employee A told me:

“I was involved in a bad traffic accident. Although not hurt myself, several people were and the paramedics asked me to sit with one young chap who was quite badly injured and awaiting transfer to hospital. I suppose that I was with him at the roadside for about 20 minutes – it seemed like hours at the time. We chatted idly and then he asked me to ride in the ambulance with him. Altogether I was with him for about an hour. I’ve never felt so useless in my life! He needed urgent medical help and there was just nothing that I could do for him. I keep having nightmares about all this.”

In technical terms, my intervention could be described as psycho-educational. In reality all I did was to explain that the victim was simply asking for the immediate comfort of human contact. Therefore their “idle chatter” was exactly the sort of emotional help that he needed at that time. Far from being “useless” what Employee A was doing was some essential and skilful work that helped the victim cope with his fears and make some sense of his shattered world. If Employee A had really been so useless why would the victim have asked for his support during the ambulance journey? My input apparently helped because at a subsequent meeting Employee A told me that the nightmares had stopped.

Employee B told me:

“My neighbor was robbed at gunpoint and afterwards she became a changed woman. She was a different person; someone I didn’t know. She had huge mood swings; she lost all of her sparkiness and was quite aggressive to everybody.  One day she told me that she was terrified that she might be going crazy and I just didn’t know what to say to her. I was scared that anything that I did might make her worse”

This fear of insanity seems to be quite common in trauma victims who, at least in the short-term, find that their lives and their emotions have been distorted by their psychologically disruptive experiences. My usual intervention is to simply tell them that they are actually quite OK and that it is normal, even healthy, to react abnormally in an abnormal situation. I explained to Employee B that we all get crazy in crazy circumstances and that it usually helps trauma victims if we all openly acknowledge this. There was an immediate alteration in Employee B’s body language. I could see the changes take place. It seems that learning this simple fact made him feel much better about himself and he later told me that he now felt more confident about dealing with similar situations in the future if he had to.