This event was an opportunity for Dr Noreen Tehrani, at the time, Chair of the BPS Crisis, Disaster and Trauma (CDT) Section to introduce
some ideas about psychological trauma to London & Home Counties members.
It was held on 14 June 2018, the first anniversary of the Grenfell House fire. I'm sure, like me, many psychologists in the London area felt
frustrated and unsure how they could help given the magnitude of the disaster. Before reporting on the event, you may find the following
document produced by the CDT Section, to be useful.
Guidance for Counsellors and Therapists Wishing to Offer Support to Adults and Children Affected by Trauma
What can I do to help?
The urge to offer support to victims of disasters is very strong. However, when thinking about how you could help following a major incident
it is important that you consider your training, experience, resilience and availability. In addition, it is essential that whatever you do is
carefully recorded, managed and audited so that in the future it will be possible to assess and evaluate the outcomes of your efforts.
The following guidance is offered to anyone considering offering early post-trauma interventions or longer-term trauma therapy as a trauma
It is important that anyone offering psychological or counselling interventions for traumatised people has had training in dealing with trauma.
The British Psychological Society recognises three levels of trauma practitioners, each can offer support but need to be mindful of their
limitations and need for supervision and support.
1. Trauma Informed: Graduate level psychologists and accredited counsellors trained in the nature and impact of different psychological
They need to demonstrate an awareness of:
• Current research into psychological trauma
• Appropriate skills in responding to traumatic disclosures
• An awareness of cultural diversity
• Their limitations of their role and competency.
The trauma informed practitioner needs to be closely supervised and supervised by a Trauma Expert level supervisor.
2. Trauma Skilled: These include post graduate psychologists and qualified trauma counsellors who currently provide services to trauma
survivors using evidence based interventions.
The trauma skilled practitioners should demonstrate competence in:
• Undertaking trauma assessments and be competent in recognising the needs of survivors for trauma
• Case formulation and planning therapeutic interventions
• Ability and experience in working within agencies
• Adhering to the need for clinical governance and effectiveness monitoring.
These practitioners need to be in regular supervision with a Trauma Expert level supervisor.
3. Trauma Expert: These practitioners will have PhD status for their work in trauma. They will be Health & Care Professions Council members
and have a track record of working with trauma survivors including those with special needs.
The Trauma Expert practitioners should:
• Have national and/or international recognition in a specialist area of trauma interventions
• Be competent in dealing with simple trauma responses as well as work within their specialist area e.g. working with children, young people, disabled, complex trauma, refugees, traumatic grief
• Preferably be experienced in multi-agency working and/or working with emergency service personnel
• Provide tailormade assessments and interventions for a range of traumatised groups
These practitioners need to be in supervision and they may also provide supervision to others.
Working with major traumatic events can be extremely emotionally demanding for practitioners. Despite the wish to help others some people
do not have the emotional resilience to undertake disaster work. The risk of becoming a victim of secondary trauma or compassion fatigue
can be reduced if you have been through appropriate training, engaged in delivering an evidence based intervention, worked within a
supportive therapeutic team and are constantly monitored and supervised by a Trauma Expert.
Questions to ask yourself:
• Am I mentally prepared for what I might see, hear about or experience?
• Have I had enough training to allow me to deliver an evidence based intervention?
• Am I able to offer enough time to make my involvement worthwhile?
• Is my supervisor able to work with traumatic stress?
Personal resilience in disaster work is essential. People who have experienced significant trauma in their own lives may find that their
personal traumas are reactivated when they work with disaster victims and survivors. In addition, there is evidence to show that certain
people lack the personal resilience to undertake this kind of work. This includes people who are highly sympathetic, but may be prone to
compassion fatigue and secondary trauma.
Questions to ask yourself:
• Have I been through a recent trauma or a trauma like those I would like to help?
• Have I had any treatment for anxiety or depression in the past two years?
• Am I going through some form or adversity such as a relationship breakdown or bereavement in past year?
• Can I deal with listening to traumatic stories without becoming emotionally distressed?
Availability and continuity of care is paramount. It is not helpful to offer temporary or sporadic help. To be valuable you need to commit to
longer term involvement. Working at the scene is also not typically useful; you may need to work with clients within GP practices,
counselling services, within local authority or charity locations. Also, please remember that organising trauma interventions in a disaster
requires a lot of administration and the last thing that those responsible for the delivery of services need is to have people who are not part
of the delivery system. You may find that even if you have the skills and willingness to help your services are not required.
Questions to ask yourself:
• Am I prepared to work with others to provide the interventions or services that are requested by the organisers?
• Can I give an indication of how much time I am prepared to give to providing the initial and/or ongoing services?
• Would I be expecting to be paid for my time or expenses?
• How would I feel if I were told my services were not required or appropriate?
It is very important that services are coordinated. If you are to offer your services make sure that they are coordinated with others.
Seek out the lead agency for the incident and find your role in the overall response."
Disaster Response Network
At the June 14 event Dr Tehrani introduced the Disaster Response Network. Partly as a result of a request by the European Federation of Psychologists Associations, she is investigating the feasibility of setting up a process for BPS members to volunteer their services in a controlled way, if an event of the nature of Grenfell Towers re-occurred.
"The Australian Psychological Society (APS) established a Disaster Response Network (DRN) in response to the Australian Bush Fires in 2009 at which time the APS received calls from hundreds of its society members inquiring about providing additional support to assist with the recovery effort.
The Aims of the Australian Disaster Response Network is to:
• Support members who want to contribute to disaster response
• Provide advice to those interested in further training or experience in the field
• Support organisations seeking psychologists to work with communities and individuals affected by a disaster
The BPS CDT has developed advice and guidance on dealing with disasters but the development of a contact hub for psychologists to offer a disaster response would be a new initiative." Noreen issued a questionnaire to the audience "to assess whether there would be support from the creating of a Disaster Response Network in the UK".
In the UK such a network, as a service provider, would be managed by the Red Cross rather than the BPS. Noreen has discussed the formal involvement of BPS members with the BPS CEO, Sarb Bajwa.
Returning to the event itself, there were three presentations.
Sandra is a Chartered Counselling Psychologist registered with the HCPC with more than 20 years of experience in the field of mental health, working in the NHS, voluntary sector and in private practice. Her approach to therapeutic practice is integrative, informed by cognitive behavioural, schema and existential models, also incorporating systemic principles & motivational interviewing techniques
She has been working with survivors of Grenfell through Hestia Integrated Mental Health Service, a charity invited by by the Royal Borough of Kensington & Chelsea to provide integrated health and wellbeing services to residents affected by the fire. They provide: a therapeutic outreach service together with the NHS and voluntary partners; a counselling service for those temporarily housed in hotels; a community hub and multilingual support. They have reached counsellors through the Black & Asian Therapy Network and the Black & Asian Counselling Psychology Group.
Some of the challenges Sandra and her colleagues faced were:
Building trust. Given what the residents felt the authorities had allowed to happen, counsellors had to had attempt to build trust in what they were doing.
Confidentiality. Carrying out counselling in hotels, there was limited space and privacy was not always guaranteed. At times some clients had to speak about their difficulties in front of other residents. There were pros and cons to this. It did open some conversations about shared experiences.
Cultural challenges. Some residents were uncomfortable with males and females mixing in communal area.
Re-traumatisation. Being housed in hotels for an unknown time period, with a lack of clarity about the future added to the stress levels. Having to retrieve belongings from the scene of the fire, and the deaths, did not help.
Timings. Residents with children struggled to engage with the evening services. Some wished to attend the inquiry hearings but were unable to.
Operation of the counselling service. The provision of support was not perfectly co-ordinated so there was a lack of clarity around boundaries between service providers. Some people could make use of an on-call service while othere were expecting a full therapy service.
Hotel staff. Some of the hotel staff needed counselling too.
However counsellors did take a proactive approach to engage residents. There was good team working and co-ordination with other agencies and counsellors and therapists were provided with supervision.
Sandra described the therapeutic processes she made use of:
- A person-centred (Rogerian) / existential phenomenological approach.
- Restoring a sense of safety and stabilisation.
- When on call in the evening, referring residents to day time, full therapy services.
- Encouraging the establishment of pre-event routines.
- Providing information e.g. signposting practical housing and legal support .
- Reclaiming a sense of purpose and re-engagement, encouraging participation in spiritual beliefs .
Sandra raised several questions about how we should cope with similar events in the future:
- Should early interventions focus on treatment or support or both?
- Should we focus on relationships or therapuetic techniques?
- The problem of problematising the concept of trauma – post-traumatic growth emphasis, should we normalise the reaction to trauma vs viewing it as pathology (victims & services).
- Are we offering enough training to front line organizations or the voluntary sector to help them respond to such incidents?
- Are psychologists engaging sufficiently with policy makers in term of preparing? (emergency services)
- The Psychology of preparedness.
- Training of personnel who may be involved post disaster.
- Preparing & responding to emergency situations.
- Post traumatic growth – positive changes on an individual, organisational and societal level
Harika Basharan is a highly skilled senior Psychotherapist, Counsellor, EMDR Trauma Therapist, Yoga teacher and Yoga Therapist, experienced in working with individuals, groups and teams. She has a particular interest in body/mind medicine and brings a holistic approach to her work. Harika was involved in an innovative project both researching and promoting counsellors into primary care, training and developing multidisciplinary teams towards successful collaborative care. She now works as an independent practitioner and is used to facilitating people through personal and organisational change.
She too was involved in counselling Grenfell survivors. She described the range of responses from the community - in some cases withdrawing into itself, in other cases angry. She covered the approaches by therapists, adapting their professional personal and non-verbal communication, restoring a sense of safety, taking people through a long journey, helping people cope with the eventual withdrawal of services, and secondary trauma
Dr Noreen Tehrani
Dr Tehrani is a chartered psychologist with HCPC registration in the areas of Counselling, Health and Occupational Psychology. After a varied career in retail, medical research and as an organisational counselling psychologist, Noreen set up her own consultancy in 1997. It provides trauma services and training for organisations, practitioners and individuals, as well as trauma support and psychological screening.
Dr Tehrani's presentation was not specifically about Grenfell but about the psychology of trauma in general. She covered symptoms, PTSD, neural underpinnings, models of trauma support, psychologocal first aid, debriefing interventions, secondary trauma and compassion fatigue.
Feedback on the Event
On the whole, feedback scores were good for presentation, content and usefulness. Most attendees were pleased with the overall event. Some though, felt the content was too focused on Grenfell and trauma in the face of disaster and not enough on the psychology underlying trauma in general (as implied by the title). The branch should consider addressing this topic at another meeting. However the BPS and DCP do provide a number of CPD events in this area on an ongoing basis
This was a joint Event with the BPS Crisis, Disaster & Trauma Section. Many thanks to the speakers.
Dr James Barr, Chair, BPS LHC
Here are the slides and the questionnaire.
Sandra Mtandabari's Presentation
Dr Noreen Tehrani's Presentation
Reflections on the EFPA Crisis Disaster and Trauma Meeting. London 11-12 May 2018
Guideline for the treatment and planning of services for complex post-traumatic stress disorder in adults