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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
This timely book provides current research and skill-building information on Disaster Mental Health Counseling for counselors, educators, students, and mental health responders in agencies, schools, universities, and private practice. Recognized experts in the field detail effective clinical interventions with survivors in the immediate, intermediate, and long-term aftermath of traumatic events.
This extensively revised edition, which meets 2016 CACREP Standards for disaster and trauma competencies, is divided into three sections: Disaster Mental Health Counseling Foundations, Disaster and Trauma Response in the Community, and Disasters and Mass Violence at Schools and Universities. Real-world responses to violence and tragedies among diverse populations in a variety of settings are presented, and responders share their personal stories and vital lessons learned through an "In Our Own Words" feature. Each chapter contains discussion questions and case studies are interwoven throughout the text.
- Requests for digital versions from ACA can be found on www.wiley.com
- To purchase print copies, please visit the ACA website
- Reproduction requests for material from books published by ACA should be directed to [email protected]
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Seitenzahl: 876
Veröffentlichungsjahr: 2017
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CONTENTS
Cover
Title Page
Copyright
Dedication
Foreword
Preface
About the Editors
About the Contributors
Acknowledgments
Section 1: Disaster Mental Health Counseling: Foundations
Chapter 1: Understanding Disaster Mental Health
In Our Own Words: Ground Hero: A Story of Compassion Fatigue After September 11th
Chapter 2: Disaster Mental Health Counseling: Skills and Strategies
In Our Own Words: Interventions With Children After the Earthquake in China
Chapter 3: How the Brain and Body Change After a Disaster
In Our Own Words: Inadvertently Studying Trauma for 35 Years
In Our Own Words: Evergreen Got Slammed
Chapter 4: Assessing the Needs of Disaster-Affected Persons
In Our Own Words: A Strange Beginning
In Our Own Words: The Emotional Roller Coaster of Surviving Superstorm Sandy
Chapter 5: Compassion Fatigue: Our Achilles' Heel
In Our Own Words: Two Decades of Compassion Fatigue Treatment, Prevention, and Resilience
In Our Own Words: Confessions of a Trauma Responder
Chapter 6: Ethics Narratives From Lived Experiences of Disaster and Trauma Counselors
In Our Own Words: Evolving
Section 2: Disaster and Trauma Response in the Community
Chapter 7: Responding to Mass Violence and the Pulse Nightclub Massacre
In Our Own Words: Self-Care and Guilt in the Wake of the Orlando Shooting
Chapter 8: Counseling Veterans and Their Families
In Our Own Words: Wounds You Cannot See
Chapter 9: Children and Adolescents in Disasters: Promoting Recovery and Resilience
In Our Own Words: Helping Children Heal
Chapter 10: Counseling Survivors of Hurricane Katrina
In Our Own Words: Weren't You Scared?
In Our Own Words: When Are We Going Home?
Chapter 11: Counseling Refugees
In Our Own Words: Trauma Counseling as Social Justice
Chapter 12: International Deployment and Disaster Mental Health Counselors
In Our Own Words: A Day in the Life of a Relief Worker: Expect the Unexpected
Section 3: Disasters and Mass Violence at Schools and Universities
Chapter 13: School Disaster Mental Health
In Our Own Words: I Never Thought I Would Become So Focused on Disaster and Trauma
In Our Own Words: From Clifton High School: Fifteen Years After September 11
Chapter 14: Disaster Recovery in Newtown: The Intermediate Phase
In Our Own Words: Reflecting on the Sandy Hook School Shooting
In Our Own Words: Focus on Faith Not Fear
Chapter 15: School Shootings in Perspective
In Our Own Words: Recognizing the Importance of Crisis Intervention
Chapter 16: University Disaster Mental Health Response
In Our Own Words: Prepare for the Worst, Then Do Your Best
Chapter 17: Disaster Mental Health and Trauma Counseling: The Next Decade
In Our Own Words: “I Discovered Within Me an Invincible Summer”
Appendix A: Disaster, Trauma, and Crisis Competencies in the 2016 CACREP Standards
Appendix B: DSM-5 Diagnostic Criteria for Acute Stress Disorder and Posttraumatic Stress Disorder
Appendix C: Mass Trauma Counseling Ethical Guidelines
References
Index
Technical Support
End User License Agreement
List of Tables
Table 1.1
Table 2.1
Table 2.2
Table 4.1
Table 4.2
Table 5.1
Table 7.1
Table 9.1
Table 13.1
List of Illustrations
Figure 1.1
Figure 3.1
Figure 3.2
Figure 3.3
Figure 3.4
Figure 7.1
Figure 9.1
Figure 9.2
Figure 12.1
Figure 12.2
Figure 13.1
Figure 13.2
Figure 13.3
Figure 13.4
Figure 13.5
Figure 13.6
Figure 14.1
Guide
Cover
Table of Contents
Begin Reading
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Copyright © 2018 by the American Counseling Association. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the written permission of the publisher.
American Counseling Association Foundation
6101 Stevenson Avenue, Suite 600 | Alexandria, VA 22304
Associate Publisher | Carolyn C. Baker
Digital and Print Development Editor | Nancy Driver
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Copy Editor | Tyler Krupa
Cover and text design by Bonny E. Gaston
Library of Congress Cataloging-in-Publication Data
Names: Webber, Jane, editor. | Mascari, J. Barry, editor.
Title: Disaster mental health counseling : a guide to preparing and responding / Jane M. Webber and J. Barry Mascari, editors.
Description: Fourth edition revised. | Alexandria, VA : American Counseling Association Foundation, [2017] | Includes bibliographical references and index.
Identifiers: LCCN 2017003894 | ISBN 9781556203619 (pbk. : alk. paper)
Subjects: LCSH: Disasters—Psychological aspects. | Disaster Victims—Counseling of—United States. | Victims of terrorism—Counseling of—United States. | Crisis intervention (Mental health services)—United States.
Classification: LCC BF789.D5 D565 2017 | DDC 363.34/86—dc23 LC record available at https://lccn.loc.gov/2017003894
For our colleagues who continue to do unselfish acts that improve the lives of often anonymous people without asking for recognition or reward.
And for our students who energize us with their empathy and compassion, and delight in seeing our names in print,
We are indeed fortunate to love the work we do and do the work we love as servants to humanity, leaving our legacy to the next generation of counselors.
Foreword
Charles R. Figley1
I live across from the London Avenue Canal in New Orleans, one of the four drainage canals and one of two ruptured (in two places) in the wake of Hurricane Katrina in 2005. At least 1,245 people died, with total property damage of more than $108 billion. The lower parts of the city flooded and left a muddy mess; thousands of folks had homes that marinated in floodwaters for weeks. The disaster was the costliest natural disaster and one of the deadliest in U.S. history; yet, the flooding could have been prevented with proper preparation and maintenance. The same can be said for disaster mental health: Proper preparation and maintenance/training can increase mental health resilience.
This fourth edition builds on lessons from 9/11, Katrina, the Sandy Hook Elementary School shooting, and other tragedies. In this newly named book, Disaster Mental Health Counseling: A Guide to Preparing and Responding, there are original and revised chapters that serve as additional evidence to the first edition published by the American Counseling Association (ACA) Foundation, which remains a classic book critical to practitioners, practitioner educators, and scholars.
Jane M. Webber is a nationally known leader in trauma and disaster education, training, and practice, and she is a seasoned and certified Disaster Response Crisis Counselor in New Jersey—the first such state credential in the country. Dr. Webber served as Associate Editor of the Journal of Counselor Preparation and Supervision (published by the North Atlantic Region Association for Counselor Education and Supervision), ACA North Atlantic Region Chair, and a member of the ACA Governing Council, and she currently serves on the ACA Trauma Interest Network Leadership Board. As ACA Foundation Chair in the aftermath of 9/11, Dr. Webber advocated for creating the groundbreaking ACA Foundation book, Terrorism, Trauma, and Tragedies: A Counselor's Guide to Preparing and Responding. She served on the advisory committee that developed trauma-informed education competencies in the 2009 Council for Accreditation of Counseling and Related Educational Programs (CACREP) Standards, the first such effort in the world that is now the standard of practice.
J. Barry Mascari is also a nationally known leader in trauma and disaster education, training, and practice. Dr. Mascari was a long-time member of the State of New Jersey's counselor licensing board for 10 years and was chair for 8 years. This experience, together with serving as president of the American Association of State Counseling Boards in 2006–2007, has strengthened his influence on state and national standards. He completed service on the CACREP Board when disaster and trauma response were again included in the 2016 Standards.
In 2009, Webber and Mascari published an article that has been widely read explaining the implications of the new CACREP standards for disaster, trauma, and crisis counseling for counseling professionals. Who knows better? Their conceptualizations in collaboration with dozens of experts have served as an important map to the postmodern era for both understanding trauma in general and recognizing that disasters are separate events leading to individual and mass trauma. Moreover, crisis counseling is based on an understanding of both the context of the crisis that caused the trauma and the application of neurobiological and relational knowledge about traumatic stress and resilience to it.
Webber and Mascari's careers have each spanned more than 45 years, and together they have conducted more than 120 disaster mental health and trauma trainings and workshops across the country. They have consistently advocated for disaster and trauma skills to have a central and pivotal role in counselor training as well as in counseling and mental health professions. In this revised edition, Webber and Mascari continue to promote general guidelines in developing disaster and trauma curricula that they make available to readers on a dedicated website supporting this book. These guidelines are converted to learning objectives for trauma-competent counselors. They emphasize that trauma-informed courses, training, and supervision always start with the following objective: “Understand the principles and purposes of disaster response, trauma counseling, and crisis intervention and their differences.” This book carries the reader through the chapters that collectively note the importance of disaster- and trauma-focused ethical guidelines, disaster response organizations, and markers for demonstrating competencies as practitioners (i.e., disaster response, trauma counseling, and crisis intervention). Other topics include networking, interprofessional collaboration with responders, and guidelines for educators preparing to teach this counseling specialty in classes.
This extensively revised and expanded edition integrates principles and new understandings about neurobiology's impact on disaster and trauma to improve resilience and to promote trauma recovery. Webber and Mascari properly apply evidence-based practice to trauma response that is stage and context/hazard specific so that counselors can respond effectively to those individuals affected by mass violence and terrorism. Such a response must be appropriate for vulnerable populations and communities, require multiple options that are the best fit in practice, and connect to local and cultural strengths in response to posttrauma community needs. At the same time, disaster mental health professionals need to care for themselves and fellow trauma workers to build resilience to compassion fatigue and other unwanted consequences of helping others. Webber and Mascari continue to raise trauma awareness by sharing the narratives and lived experiences of therapists and disaster mental health responders. They also prepare for the future by using web-based knowledge and multimedia approaches to teach about the above matters and to disseminate needed information rapidly.
The London Avenue Canal can provide some comfort to those of us living nearby. We can also expect that this book, in its fourth edition, will continue to serve as the critical guide to disaster and trauma education and practice for many years to come. Such a guide will make all of us more resilient to trauma by knowing we are not alone.
Note
1.
Charles R. Figley is the Paul Henry Kurzweg, MD chair in Disaster Mental Health, at Tulane University, New Orleans.
Preface
In the 8 years since the publication of the third edition of Terrorism, Trauma, and Tragedies: A Counselor's Guide to Preparing and Responding, the landscape of disaster has rapidly changed. While parts of the country experienced repeated natural disasters by devastating storms, fires, and floods, other places were in shock from intentional and often random shootings that inflicted enormous suffering, injuries, and deaths.
Advances in disaster mental health (DMH) counseling have unified what was a patchwork of well-meaning compassionate practices into a distinct counseling specialty with a formal body of knowledge, standards, and protocols. Since 9/11, milestones in the development of DMH counseling include the standardization of training and responding by the Federal Emergency Management Agency; the infusion of disaster, trauma, and crisis competencies in the 2009 Standards of the Council for Accreditation of Counseling and Related Educational Programs (CACREP); and the expanded role for counselors in DMH preparation, response, and recovery at the local, state, national, and international levels. To emphasize this comprehensive proactive approach to preparation and response, we have revised the title of the fourth edition to Disaster Mental Health Counseling: A Guide to Preparing and Responding.
The original book published in 2002 provided urgently needed resources for counselors in the aftermath of 9/11. In the second edition in 2005, we continued to provide information and practices for the long-term recovery after the terrorist attacks. The third edition in 2010 added lessons learned after Hurricane Katrina and the tragedies at Virginia Tech and other universities.
In this fourth edition, we have revised and expanded the book to achieve four major goals. First, with the collaboration of 27 contributors, we have developed a graduate counseling textbook and resource of current DMH and trauma knowledge and practice that addresses the CACREP 2016 Standards for graduate training. Second, we provide practical DMH skills and strategies for counselors and mental health professionals working in a range of settings: agencies, schools, universities, private practice, and international deployment. Third, we have created a compendium of state-of-the art information, research, resources, and practices in DMH counseling for professional development and training. Fourth, we have shared the learned experiences of responders in the field that reflect the expanding professional scope and roles of DMH and trauma counselors. The fourth edition continues to infuse an experiential approach that blends DMH and trauma concepts and practices with the practicality that has been this book's signature. Each chapter includes case studies and questions for discussion.
At the end of each chapter, we present brief personal stories called “In Our Own Words” that are free of the constraints of formal writing and research. These narratives and essays in the authors' own voice reflect their journeys through disasters, traumatic events, and real-world experiences. In addition, new and updated chapters by internationally recognized clinicians, trainers, and responders working in the field add a contemporary global perspective that addresses refugees and complex humanitarian crises.
We will also have two companion resources available to instructors in winter 2017: (1) a dedicated website to access chapter outlines, test questions, and resources, and (2) a curriculum guide for use in addressing the 2016 CACREP Standards. For further information, contact the editors at [email protected].
Section 1: Disaster Mental Health Counseling: Foundations
In Chapter 1, “Understanding Disaster Mental Health,” we (Jane M. Webber and J. Barry Mascari) describe the importance of DMH as a counseling specialty and define disaster stages of recovery and roles of DMH responders. In Chapter 2, “Disaster Mental Health Counseling: Skills and Strategies,” we (Jane M. Webber and J. Barry Mascari) and Julia K. Runte explain the differences between traditional clinical mental health counseling and DMH counseling, and we describe psychological first aid and crisis counseling, with a focus on somatic techniques for stabilization. In Chapter 3, Carol M. Smith describes “How the Brain and Body Change After a Disaster,” providing both a scientific and practical understanding and application to somatic treatments. In Chapter 4, I (Jane M. Webber)—with Mike Dubi, Julia K. Runte, and Mindi Raggi—offer methods for “Assessing the Needs of Disaster-Affected Persons,” focusing on psychological first aid and PsySTART, the American Red Cross All Hazards Color System. We address criteria for acute stress disorder and posttraumatic stress disorder as well as intermediate and long-term interventions. In Chapter 5, “Compassion Fatigue: Our Achilles' Heel,” J. Eric Gentry, Anna B. Baranowsky, and I (Jane M. Webber) examine the negative impact on DMH counselors who work with trauma- and disaster-affected persons, and we present a model for compassion fatigue recovery. We also describe the positive effects of resilience and the potential for posttraumatic growth. In Chapter 6, “Ethics Narratives From Lived Experiences of Disaster and Trauma Counselors,” Vilia Tarvydas, Lisa Lopez Levers, and Peter R. Teahen develop disaster-focused ethical standards and illustrate applications through personal narratives of lived experiences in humanitarian crises.
Section 2: Disaster and Trauma Response in the Community
In this section, we focus on DMH counseling with several populations. In Chapter 7, we (Jane M. Webber and J. Barry Mascari) and Samuel Sanabria address the growing DMH response to mass bombings and shootings in “Responding to Mass Violence and the Pulse Nightclub Massacre.” In Chapter 8, we (J. Barry Mascari and Jane M. Webber) and Mike Dubi focus on “Counseling Veterans and Their Families” during stages of deployment, with a focus on reintegration. We address the critical role of civilian counselors working with veterans—especially National Guard and Reserve members returning from Iraq and Afghanistan and experiencing multiple deployments. In Chapter 9, Jennifer Baggerly presents developmentally appropriate interventions after disasters for “Children and Adolescents in Disasters: Promoting Recovery and Resilience.” In Chapter 10, “Counseling Survivors of Hurricane Katrina,” Barbara Herlihy and Angela E. James continue to chronicle long-term disaster and trauma recovery through the experiences of four survivors in New Orleans.
In Chapter 11, Rachael D. Goodman, Colleen K. Vesely, and Bethany Letiecq examine the multiple issues and needs of “Counseling Refugees” and follow the stories of two women who experienced the traumatic impact of war and political conflict through violence, trauma, separation from family and home, physical injury, and sexual abuse. In Chapter 12, “International Deployment and Disaster Mental Health Counselors,” Karin Jordan outlines the DMH hierarchy of needs and describes stages and challenges of international disaster response in the context of the tsunami response in Sri Lanka.
Section 3: Disasters and Mass Violence at Schools and Universities
In Chapter 13, we (J. Barry Mascari and Jane M. Webber) develop the evolving role of counselors in “School Disaster Mental Health” as they engage in comprehensive planning, prevention, and response to natural disasters and human-caused violence. With more school shootings occurring in recent years, two new chapters specifically address this topic. In Chapter 14, Deb Del Vecchio-Scully and Melissa Glaser chronicle “Disaster Recovery in Newtown: The Intermediate Phase,” examining multilevel family and community interventions after the shootings at Sandy Hook Elementary School. In Chapter 15, Richard Reyes chronicles and analyzes from a law enforcement perspective the proliferation of school violence in “School Shootings in Perspective.” In Chapter 16, Gerard Lawson describes the development of crisis and long-term response with a focus on the shooting at Virginia Tech in “University Disaster Mental Health Response,” offering lessons learned for preparation, crisis intervention, and recovery in higher education settings. In Chapter 17, “Disaster Mental Health and Trauma Counseling: The Next Decade,” we (J. Barry Mascari and Jane M. Webber) provide our perspective on the importance of integrating DMH and trauma counseling practice because DMH cannot be adequately addressed without understanding the impact of trauma. As this specialty continues to grow, we offer recommendations for future development.
In Our Own Words
At the end of each chapter, we honor counselors' personal stories and their journeys as disaster and trauma counselors through “In Our Own Words.” In the tradition of the first three editions, the fourth edition gives testimony to the commitment of counselors in responding to disasters and tragic events and their lived experience. In Section 1 after Chapter 1, Tom Query reflects on compassion fatigue in “Ground Hero: A Story of Compassion Fatigue After September 11th.” After Chapter 2, Emily Zeng updates her experiences in her native province in “Interventions With Children After the Earthquake in China.” After Chapter 3, Carol M. Smith describes “Inadvertently Studying Trauma for 35 Years,” and Robert G. Mitchell shares his first-hand account of the tornado's impact in “Evergreen Got Slammed.” After Chapter 4, Mike Dubi describes his career direction in “A Strange Beginning,” and Juneau Mahan Gary describes “The Emotional Roller Coaster of Surviving Superstorm Sandy.” After Chapter 5, J. Eric Gentry and Anna B. Baranowsky chronicle their professional journeys in “Two Decades of Compassion Fatigue Treatment, Prevention, and Resilience” and “Confessions of a Trauma Responder,” respectively. After Chapter 6, Peter R. Teahen reflects on “Evolving.”
In Section 2, after Chapter 7, Samuel Sanabria shares his reactions as a responder in “Self-Care and Guilt in the Wake of the Orlando Shooting.” After Chapter 8, mental health counselor Rachel Oelslager shares the tragic death of her veteran husband in “Wounds You Cannot See.” After Chapter 9, Jennifer Baggerly describes her journey in “Helping Children Heal.” After Chapter 10, Barbara Herlihy and Angela E. James present their own survival experiences in New Orleans in “Weren't You Scared?” and “When Are We Going Home?,” respectively. After Chapter 11, Rachael D. Goodman reflects on “Trauma Counseling as Social Justice.” After Chapter 12, Karin Jordan describes her DMH experiences abroad and their personal impact in “A Day in the Life of a Relief Worker: Expect the Unexpected.”
In Section 3, after Chapter 13, I (J. Barry Mascari) chronicle my professional career path in “I Never Thought I Would Become So Focused on Disaster and Trauma,” and Joel M. Baker updates his reflection on “From Clifton High School: Fifteen Years After September 11” about the death and legacy of his brother-in-law. In Chapter 14, Deb Del Vecchio-Scully and Melissa Glaser share their reactions in “Reflecting on the Sandy Hook School Shooting” and “Focus on Faith Not Fear,” respectively. After Chapter 15, Richard Reyes describes his experiences as a police officer and his commitment to “Recognizing the Importance of Crisis Intervention,” and after Chapter 16, Gerard Lawson reflects on his own experiences and reactions at Virginia Tech in “Prepare for the Worst, Then Do Your Best.” After Chapter 17, I (Jane M. Webber) share my professional and personal counseling journey in “‘I Discovered Within Me an Invincible Summer.’”
Moving Forward
Since 2009, CACREP has provided standards for disaster and trauma response for counseling programs and continues to confirm the importance of disaster and trauma preparation for counselor trainees in the 2016 Standards. This fourth edition gathered evidence of these developments that have significantly raised the level of DMH counseling, knowledge, and best practices for counseling professionals and for the people we serve. As we continue to share in this important DMH counseling project, we welcome your thoughts and suggestions (send e-mails to [email protected] and [email protected]).
—Jane M. WebberandJ. Barry Mascari
About the Editors
Jane M. Webber, PhD, LPC, DRCC, and J. Barry Mascari, EdD, LPC, LCADC, DRCC, hold New Jersey Disaster Response Crisis Counselor Certification and serve on New Jersey's disaster mental health response team. Together, they are leaders in disaster mental health and trauma counseling training and practice and popular national presenters who have delivered more than 250 national, international, and state workshops and conference sessions. They are accomplished writers (together and individually), publishing groundbreaking articles such as “CACREP [Council for Accreditation of Counseling and Related Educational Programs] Accreditation: A Solution to Counselor Identity and License Portability Problems” ; “Critical Issues in Implementing the New CACREP Standards for Disaster, Trauma, and Crisis Counseling” ; “Moving Forward: Issues in Trauma Response and Treatment” ; “Salting the Slippery Slope: What Licensing Violations Tell Us About Preventing Dangerous Ethical Situations” ; and “Lessons Learned, The Best Laid Plans: Will They Work in a Real Crisis?” They are editors of the third edition of the American Counseling Association (ACA) Foundation book Terrorism, Trauma, and Tragedies: A Counselor's Guide to Preparing and Responding and primary authors of the New Jersey School Counselor Initiative: A Framework for Developing Your Comprehensive School Counseling Program, sharing the 1992 American School Counselor Association Writer/Researcher of the Year for the first edition. They authored the NJSCA School Counselor Evaluation Model, the first professional association model approved by the New Jersey Department of Education. Drs. Webber and Mascari have been quoted on disaster and trauma issue in the national media, recently in Counseling Today and CNN Online, as well as on National Public Radio. Together they anchored the ACA's full-day learning institute on disaster response and have championed bringing disaster and trauma skills to school and mental health counselors. In addition to being long-time professional colleagues, Jane and Barry are married and have four children—combined.
Jane M. Webber, PhD, LPC, DRCC, is a Lecturer in the Counselor Education Department at Kean University (Union, NJ) and is a New Jersey Licensed Professional Counselor. She was a member of the ACA Task Force for Crisis Response Planning and served on the Advisory Committee for Emergency Preparedness for the 2009 CACREP Standards. Dr. Webber was Guest Editor of the Traumatology Special Section of the Journal of Counseling & Development (Summer 2017) and was primary author of the Journal of Counseling & Development article “Traumatology Trends: A Content Analysis of Three Counseling Journals 1994–2014.” As ACA Foundation Chair during September 11, 2001, she advocated for the ACA Foundation publication Terrorism, Trauma, and Tragedies: Counselor's Guide to Preparing and Responding, and she coedited the second and third editions.
Dr. Webber is a former Chair of the ACA Foundation, North Atlantic Region; International Committee; Human Rights Committee; and the Public Awareness and Support Committee, as well as a member of the Governing Council. She was a National Assembly Delegate of the National Association for College Admissions Counseling, National Membership Chair, and Member of the Bylaws Committee. She is a life member of Chi Sigma Iota.
Dr. Webber is former President of the New Jersey Counseling Association, the New Jersey Association for College Admission Counseling, the New Jersey Association of Counselor Educators and Supervisors, and the New Jersey Association for Specialists in Group Work. She worked for more than 35 years as a college counselor, school counselor, school counseling supervisor, and private practitioner. She has published numerous articles and chapters on disaster mental health, trauma counseling, sand tray therapy, and school counseling—including “Integrating Sand Therapy Into Trauma Counseling: Historical Influences” —and she coauthored “Healing Trauma Through Humanistic Connection” in the award-winning book Humanistic Perspectives on Contemporary Counseling Issues.
J. Barry Mascari, EdD, LPC, LCADC, DRCC, is Chair of the Counselor Education Department at Kean University (Union, NJ) and is a New Jersey Licensed Professional Counselor and Licensed Clinical Alcohol and Drug Counselor. He has more than 30 years of counseling-related experience in schools and outpatient treatment, and he participated in the development of the New Jersey Department of Education (NJDOE) student assistance counselor certification. He was a member and Chair of the New Jersey Professional Counselor Examiners Committee (the state licensing board) for 10 years and a former President of the American Association of State Counseling Boards (AASCB), New Jersey Counseling Association, and New Jersey Mental Health Counselors Association. With Dr. Ed Stroh and Nancy Marie Bride, he lobbied for licensure in New Jersey for 20 years and coauthored the licensure bill that was finally passed in 1993.
Dr. Mascari is considered the “father” of 20/20: The Future of Counseling, a collaborative initiative between AASCB and ACA that resulted in the common definition of counseling. He was among the founders of the New Jersey Council on Divorce and Family Mediation, and he coauthored the seminal work Family Mediation: An Idea Whose Time Has Come. He has appeared on numerous radio and television shows, including the Sally Show, Soap Talk, 48 Hours on Crack Street, Straight Talk, the WNET special Teens in Turmoil, and National Public Radio. Dr. Mascari was a NJDOE trainer for Intervention and Referral Service and continues to host trainings at Kean University for New Jersey school districts. More information can be found at https://sites.google.com/a/kean.edu/j-barry-mascari/.
About the Contributors
Jennifer Baggerly, PhD, LPC-S, RPT-S,
is Professor of Counseling, School of Human Services, University of North Texas at Dallas. She is a former chair of the Board of Directors of the Association of Play Therapy.
Joel M. Baker, MA, LPC,
is Student Assistance Counselor, Clifton High School, Clifton, New Jersey. He is also a member of the Imagine Foundation Board in Westfield, New Jersey.
Anna B. Baranowsky, PhD, CPsych,
is Clinical Psychologist and Founder/Director, the Traumatology Institute in Toronto, Ontario, Canada. She is a Diplomate and Board-Certified Expert in Traumatic Stress through the Academy of Experts in Traumatic Stress.
Deb Del Vecchio-Scully, MS, CMHS,
is Owner, The Mindful Counselor, a wellness consulting service and private practice in Newtown, Connecticut, specializing in trauma counseling. She served as Clinical Recovery Leader, Newtown Recovery and Resiliency Team.
Mike Dubi, EdD, LMHC,
is Counselor in private practice and President of the International Association of Trauma Professionals. He is a Diplomate and Board-Certified Expert in Traumatic Stress through the Academy of Experts in Traumatic Stress and is a retired associate professor, School of Psychology and Behavioral Sciences, Argosy University, Sarasota, Florida.
Juneau Mahan Gary, PhD, DRCC,
is Professor, Counselor Education Department, Kean University, Union, New Jersey, and Coordinator, Counselor Education Program, Kean Ocean Campus, Toms River, New Jersey.
J. Eric Gentry, PhD, LMHC,
is Owner of Compassion Fatigue Unlimited and Vice President and Founding Board Member of the International Association of Trauma Professionals. He is a Diplomate and Board-Certified Expert in Traumatic Stress through the Academy of Experts in Traumatic Stress.
Melissa Glaser, MS, LPC,
is Counselor in private practice, Newtown, Connecticut, and Community Outreach Liaison to the communities of Newtown and Sandy Hook, Connecticut. She was a member of the Recovery and Resiliency Team.
Rachael D. Goodman, PhD, LPC,
is Associate Professor, Counseling Education and Development Program, George Mason University, Fairfax, Virginia, and President-Elect of Counselors for Social Justice.
Barbara Herlihy, PhD, LPC,
is University Research Professor, Counselor Education Program, University of New Orleans, Louisiana.
Angela E. James, MEd, LPC-S,
is Doctoral Candidate, Counselor Education Program, University of New Orleans, Louisiana.
Karin Jordan, PhD, LPC,
is Director, School of Counseling, and Interim Associate Dean, College of Health Professions, University of Akron, Ohio, and Coordinator of the American Counseling Association Traumatology Interest Network.
Gerard Lawson, PhD, LMHC,
is Associate Professor, Counselor Education Department, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, and President of the American Counseling Association.
Bethany Letiecq, PhD,
is Associate Professor and Academic Program Coordinator, Human Development and Family Service, George Mason University, Fairfax, Virginia.
Lisa Lopez Levers, PhD, PCC-S, LPC, CRC,
is Professor, Counselor Education and Supervision Department, Duquesne University, Pittsburgh, Pennsylvania.
Robert G. Mitchell
is Vice Mayor, Pamplin City, Virginia.
Rachel Oelslager, MA, LCPC,
is a Clinic Coordinator, Positive Recovery Services, Germantown, Maryland.
Tom Query, MDiv, LPC,
is Counselor Supervisor, Therapist, and Director, Wellspring Counseling Center, Roswell, Georgia, specializing in gender and sexuality.
Mindi Raggi, EdD, LCSW,
is Social Worker in private practice, Pennsylvania, specializing in rape trauma and sexual assault. She is also affiliated with the Penn Foundation for Behavioral Health.
Richard Reyes, PhD,
is Police Officer and Certified Hostage Negotiator with the Paterson, New Jersey, Police Department.
Julia K. Runte, MA,
is Second-Grade Teacher, Multicultural Division, Soong Ching Ling School, Shanghai, China.
Samuel Sanabria, PhD, LMHC,
is Associate Professor, Counseling Program, Rollins College, Winter Park, Florida. He is also affiliated with Two Spirits Health Services, Orlando, Florida, a nonprofit organization dedicated to providing mental health and related services to the LGBT community.
Carol M. Smith, PhD, LPC,
is Professor, Counseling Department, Marshall University, South Charleston, West Virginia. She is also a member of the American Counseling Association Traumatology Interest Network Leadership Board.
Vilia Tarvydas, PhD, LMHC, CRC,
is Retired Professor, Rehabilitation and Counselor Education, The University of Iowa, Iowa City.
Peter R. Teahen, MA,
is Government Liaison Officer, American Red Cross Crisis Response Team.
Colleen K. Vesely, PhD,
is Assistant Professor, Early Childhood Education and Human Development and Family Service, George Mason University, Fairfax, Virginia.
Emily Zeng, PhD,
is Licensed Psychologist, New York City, serving children and families with special needs. She was associated with the Yeshiva China Earthquake Relief Project and is a native of Sichuan, China.
Acknowledgments
The fourth revised edition has been the collaboration of 27 authors, and we thank all who have contributed to this edition. We are grateful to those pioneers whose work has guided our journey and our stories, especially Janina Fisher, Babette Rothschild, Tom Query, Steve Crimando, Charles R. Figley, Eliana Gil, and Bessel van der Kolk.
This book would not be possible without the vision and commitment of the American Counseling Association Foundation and its response to the needs of counselors after September 11, 2001. We have been privileged to work with Carolyn Baker and Nancy Driver of the American Counseling Association and express our thanks for their patience and direction. We are especially appreciative of the ongoing support and assistance of Carol Gernat, whose advice and direction have kept us on track. We also thank our daughter Julia K. Runte for her discerning research and editing, and her optimism. We are grateful to Bobby Kitzinger and Rebekah Pender, our colleagues at Kean University, for their encouragement and cappuccino conferences during these semesters of teaching and writing. Finally, we thank all our adult children for their support and tolerance for our almost constant work on this project.
Section 1Disaster Mental Health Counseling: Foundations
Chapter 1Understanding Disaster Mental Health
Jane M. Webber and J. Barry Mascari
Disasters have wreaked havoc in people's lives since earliest times. Hurricanes, fires, and earthquakes are among catastrophic natural disasters that occur throughout the world, and people living in vulnerable geographic areas face the potential of disasters, such as tornadoes and wildfires, as a daily threat. Human-caused disasters (e.g., wars, political conflict, mass violence, and catastrophic accidents) have also deeply affected individuals and communities. The September 11, 2001, terrorist attacks shattered Americans' sense of safety, dramatically changing their world view so that if you see something, say something is a continuous civic responsibility. The long-term psychological impact on survivors and families of victims continues even 15 years after the World Trade Center tragedy (Fetchett, 2016). Schools and universities, historically considered places of safety for children, are now targets for shooters, and lock-down drills are standard practice in elementary and secondary schools. Furthermore, the plight of Syria's people during the current civil war has been called the “largest humanitarian crisis since World War II” (Clay, 2017, p. 34). Civil war and persecution have affected more than 20 million refugees and 40 million people internally displaced in Syria, Afghanistan, Iraq, Somalia, and other countries. Social media, electronic communication, and continuous television coverage instantly bring these disasters into people's living rooms.
In times of crisis and disaster, Fred Rogers (2013) reminded us, “If you look for the helpers, you'll know that there's hope” (0:51). Counselors and disaster mental health (DMH) professionals are these helpers. The enormity and ubiquity of mass tragedies underscore the need for trained and ready DMH responders in the “era of mass violence” (Mascari, Webber, & Kitzinger, 2015). Although they might not be able to volunteer or deploy to distant sites, all counselors and mental health professionals should be prepared and ready to assist those affected by mass traumatic events, particularly in their own communities. In this chapter, we describe the organized response to disasters and examine the role of DMH counselors in response to various types of disaster and mass violence events. We follow the development of DMH counseling as a professional specialization as well as advancements in national training, preparedness, and response.
Protect, Direct, Connect
In August 2005, thousands of people huddled in the New Orleans Superdome or were stranded and desperate on the roofs of buildings surrounded by rising floodwaters from levees breached by Hurricane Katrina. Individuals were better able to cope and survive if they could (a) protect themselves from danger and trauma in a shelter or a safe place; (b) direct their attention to immediate priorities of food, water, and medical needs and restore a sense of hope and meaning; and (c) connect to family and friends for support. These three priorities reflect the purposes of DMH and psychological first aid goals and tasks (Crimando, 2009; Myers & Wee, 2005).
Terrorist attacks in France (Paris and Nice), at the Boston Marathon, and the Inland Regional Center in San Bernardino, California have heightened individual and community fear, increasing Islamophobia in the United States and abroad. An atmosphere of dread pervades American daily routines at athletic events, concerts, schools, and universities. With growing numbers of events-turned-violent at the Las Vegas music festival, Orlando nightclub, and the Ariana Grande concert in Manchester, England, “the expectation of psychological trauma and posttraumatic stress disorder is now part of our national consciousness” (Reyes & Elhaida, 2004, p. 399). Disaster, crisis, and trauma counseling skills and response are now an essential part of counselor training and practice (Council for Accreditation of Counseling and Related Educational Programs [CACREP], 2016).
Types of Disasters
How people view disasters and traumatic events influences their reactions. The United Nations defines a disaster as “a serious disruption of the functioning of society, causing widespread human, material, or environmental losses which exceed the ability of affected society to cope using only its own resources” (United Nations International Strategy for Disaster Reduction, 2009, p. 9). The International Federation of Red Cross and Red Crescent Societies (2016) echoed the United Nations' description, adding the qualifier “a sudden calamitous event” (para. 1). A disaster frequently follows a crisis or an emergency when “people are unable to meet their basic survival needs, or there are serious and immediate threats to human life and well-being . . . normal procedures are suspended and extraordinary measures are taken in order to avert a disaster” (World Health Organization, 2003, p. 3). Crises are often explained in terms of the Chinese character that is the combination of two characters: danger and opportunity. Thus, a crisis is a highly distressful event or time when people are overwhelmed and cannot function with normal coping skills. A crisis might lead to an emergency or a disaster that affects many people. Disasters can be categorized by factors such as demographics, geography, culture, cause, or impact—economic, political, ecological, health, social, technological, or human (Pearce, 2000).
Natural Disasters
Natural disasters are classified by weather (e.g., storm, snow), earth movement such as earthquakes; or biological or ecological impacts such as global warming, rainforest destruction, or pandemic (Tracy, 2012). These events share similar elements, but the impact of each is unique, and the response depends on past disaster experiences, population, preparation, federal and state support, and resources (Norris, 1992; Pynoos, Steinberg, Schreiber, & Brymer, 2006). Although the impact of disasters is high, their occurrence is low; some geographic areas—for example, a valley may be vulnerable to flash floods, or a plain may be subjected to frequent tornadoes—are at higher risk. For such areas, perceived threat, preparation, and early warning systems for evacuation or taking shelter are key tasks for risk reduction. Disasters are also described as slow-onset or rapid-onset, predictable (e.g., blizzard, hurricane) or without advance notice (e.g., earthquake), and with immediate impact (e.g., deaths by flooding and drowning) or long-term consequences (e.g., chemical or oil contamination, radiation). In Table 1.1, disasters are categorized as natural, human caused, or with human influence.
Table 1.1 Types of Disasters
Natural Disaster
Human Caused
With Human Influence
Flood, tsunamiEarthquake, aftershockHurricane, tornado, superstorm, cyclone, typhoonThunder, rainstormSnowstorm, ice storm, blizzard, avalanche, landslideFire, wildfire, forest fireExtreme temperatureVolcanic eruptionLandslide, mud, rockFallen tree, debrisLightning strike, meteoriteFamineDust stormDisease, pestilence, pandemic, epidemic, fatal illnessUnexpected or unexplained death, injuryBridge, road damage
War, military conflict, political takeover, invasionHostage takingTerrorist attackRiot, mob, stampede, accidental mass violenceAggression, physical attack, shooting, stabbing, torture, homicide, genocideAssassinationBombing, explosionAircraft crash, as a weapon, hijackingContamination; exposure; poisoning of water, food, medicine, airNuclear, chemical, biological weapon attackTechnology, cyberweapon attackChemical, industrial accident, oil spillLarge train, ship, road accidentMass suicide, suicide pact
Pollution, ecosystem impact, deforestationDam, levee breech or damage, with floodingBridge, road damageGlobal warmingRadiation leak, nuclear accident, reactor meltdownFire by arson, accidentalMine fire, collapseLack of immunizationHazardous wasteGas leak, explosionElectrocutionTransportation accident with aircraft, bridge, ship, tunnel, train, autoBuilding, structural collapse; power plant accidentExposure to toxin, toxic pollutionComplex humanitarian emergencyDisplacement, relocation, resettlement, migration, asylum, refugee crisisEconomic decline, collapse
Note.
For additional information, see J. Halpern and Tramontin (2007), Mascari and Webber (2010a, 2010b), Substance Abuse and Mental Health Services Administration (2014), Tracy (2012), and Webber and Mascari (2016).
Mass Violence and Terrorism
Mass violence is an intentional attempt to kill multiple individuals that might stem from extremism or terrorism (Anti-Defamation League, 2016). Terrorists plan to disrupt normalcy by instilling psychological fear, vulnerability, terror, and powerlessness and by maximizing death as well as physical and economic destruction. More mass shootings have occurred in the United States within the past decade than ever. From 1966 to 2012, 90 mass killings were recorded in the United States, composing almost 31% of the world's shootings, and three fourths of the guns used were legitimately obtained (see Chapter 7 regarding the Pulse shooting in Orlando, and Chapters 14 and 15 regarding school shootings.). As members of emergency management response teams in their organizations and communities, counselors can take proactive steps to assess vulnerability, identify potential perpetrators with the help of the community, and raise awareness of the importance for individuals to be more mindful of their surroundings and to trust “the gift of fear” (De Becker, 1997).
Complex Humanitarian Emergency (CHE)
Disasters also include mass emergencies in which serious political, economic, and social changes deeply affect thousands of people, such as in Syria, Bosnia, Rwanda, or Kosovo. The World Health Organization (2016) defined a complex humanitarian emergency (CHE) as follows:
A humanitarian crisis in a country, region, or society where there is total or considerable breakdown of authority resulting from internal or external conflict and which requires an international response that goes beyond the mandate or capacity of any single and/or ongoing UN country program. (para. 29)
These social emergencies often reflect the impact of war with massive loss of life from murder, disease, and famine; displaced people in-country (often because of ethnic cleansing); and forced migrations to survive (Klugman, 1999). The exodus from Syria beginning in 2011 and escalating to crisis levels in 2015 and 2016 has forced people to undergo migrations from country to country with major loss of life and property, starvation, extreme suffering, and deprivation (European University Institute Migration Policy Centre, 2016).
A CHE can be categorized by war, refugees, disease, and hunger that require a political, social, and global response. CHEs are typically assessed by the number of (a) war casualties, (b) under-5 mortality, (c) under-5 malnourishment, and (d) displaced people (Keely, Reed, & Waldman, 2001; Moss et al., 2006). CHEs are not natural disasters, although they might follow extreme weather, hunger and famine, epidemics, pandemics, loss of community social services, and threat of danger. A natural disaster could also be used as a trigger for political, social, and economic crises with vulnerable groups, civil unrest, or war leading to a CHE. DMH counselors may deploy to disaster sites, refugee camps, relocation centers, and international advocacy organizations in resettlement areas (see Chapter 6 for DMH ethics in CHEs, Chapter 11 for counseling refugees, and Chapter 12 for international deployment.)
Disaster Myths and Realities
Since 9/11, beliefs about trauma and disaster and their effects on people have changed substantially. Until recently, DMH response was largely informed by personal experience and observation. S. Gold (2009) observed, “The entire field of trauma psychology is based on theory. The assertion—or assumption—that catastrophic events can have appreciable adverse impact on psychological functioning is itself a theoretical position” (p. 1). The specialty of DMH counseling has grown rapidly, developing into an evidence-informed body of knowledge and practice through extensive training, publications, and research.
Trauma is not an unusual occurrence, especially after disaster, and most individuals will experience one or more traumatic events over their lifetime (Bonanno, 2004; Briere & Scott, 2014). Prior to 9/11, many believed that most disaster-affected individuals developed psychopathological reactions and posttraumatic stress disorder (PTSD). The reality is that although “no one who experiences a disaster is untouched by it,” most people affected by disasters are resilient and do not develop PTSD (Centers for Disease Control and Prevention, 2005, para. 3). Many people return to their baseline functioning in a few days or weeks following a disaster. About 8%–12% of people may develop PTSD as a long-term result, and those who had experienced prior trauma or witnessed death or injury have a greater risk for developing PTSD, including first responders and military personnel deployed to war zones (Briere & Scott, 2014). Most postdisaster stressors immediately following a mass disaster are commonly experienced; thus, most individuals exposed to disasters have normal and expected reactions to an abnormal event (DeWolfe, 2000; Weaver, 1995).
In the aftermath of a disaster or mass traumatic event, survivors and witnesses experience a range of reactions that intensify the closer they were to the actual disaster site. Although television and media often catastrophize the psychological condition of survivors, most disaster-affected individuals are resilient and bounce back quickly, emerging from the traumatic event stronger than before the disaster. Although everyone is affected by a disaster, the majority are resilient and work together with neighbors and community members to recover, experiencing posttraumatic growth and a new sense of purpose rather than PTSD (Calhoun & Tedeschi, 2006).
The vast majority of trauma survivors are neither helpless nor superhuman. Instead, they are regular people who are coping actively and facing their challenges with integrity. Of course, in the midst of the chaos and turmoil, survivors endure tremendous torment, anguish, grief, fear, and rage. In the wake of catastrophe, they may find themselves unable to perform their jobs, concentrate on their studies, or handle the day-to-day tasks of living. They may feel alienated, confused, and overwhelmed. At the same time, most survivors are immediately demonstrating resilience by their initiative, fortitude, compassion, and sense of hope. (Echterling & Stewart, 2010, p. 83)
Disaster Recovery
Disaster recovery is composed of “an array of actions taken by individuals, community groups, local, state or federal agencies and other organizations to restore and rebuild physical, psychological, social, environmental and economic well-being of a community, region, state or nation” (Federal Emergency Management Agency [FEMA], n.d.-a, p. 6). The first individuals to respond are law enforcement personnel, firefighters, emergency medical workers, as well as active military and National Guard/Reserve personnel who secure the disaster area and make it safe. Second responders are American Red Cross local volunteers, DMH specialists, and others who provide psychological first aid, especially in the first 24–48 hours. Local residents typically rush to help in any way possible, especially when the magnitude of a disaster is overwhelming and those affected are injured and suffering. Neighbor-helping-neighbor describes the human capacity to help. For example, the film Boatlift (Rosenstein & Velleu, 2011) documented how volunteers with local boats rescued nearly a half million people from Manhattan on September 11 in less than 9 hours. The video is testimony to community resilience by ordinary people rising to serve in extraordinary times of crisis: “average people—they stepped up when they needed to” (Rosenstein & Velleu, 2011, 9:43–9:48). This volunteer effort was the largest sea evacuation in history.
All-Hazards Disaster Preparation
Disaster recovery requires a variety of actions coordinated across agencies and governmental levels to help rebuild affected areas. Critically important in minimizing the impact of a future disaster is the process of all-hazards preparation, the most comprehensive planning model for disasters. All-hazards risk analysis begins with identifying potential disasters likely to affect the area and then preparing to respond to each type of disaster. Some planning actions cut across many potential disasters, such as capacity preparedness, evacuation procedures, notification, and sheltering. Other actions are hazard specific and phase specific. DMH responses are also scalable and can be increased or reduced depending on the needs of survivors, the type and cause of the disaster, and the availability of resources (Crimando, 2009).
Phases of Disaster Recovery
In addition to predisaster planning, disaster recovery is organized in five phases, as shown in Figure 1.1.
Figure 1.1 Phases of Disaster Recovery
Note. Reprinted from Training Manual for Human Service Workers in Major Disasters (2nd ed., p. 5), by L. M. Zunin and D. Myers, 2000, DHHS Publication No. ADM 90-538). Washington, DC: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. Reprinted with permission.
Phase 1. The impact phase begins when the disaster strikes, although the length of this phase varies from 1 day to several days according to the degree of advanced planning in the preparation or threat stage before the disaster occurs. Hurricanes might be tracked for a few days so people can prepare or evacuate, but earthquakes and human-caused disasters occur with little or no warning. Individuals have a range of posttraumatic reactions from shock, panic, and being overwhelmed and confused to maintaining control. In some disasters, the impact phase is extended—for example, extensive flooding from the levee breaches in New Orleans or from hurricanes in Florida.
Flood victims may be unique because their recovery can be thwarted as a result of a seemingly endless amount of time that flooding creates before cleanup can begin. Floodwaters sometimes take quite a while to recede and the extended agony of waiting to see what is left after your home has been under water for a month aggravates an exceedingly stressful emotional situation. (Feinberg, n.d., p. 2)
Phase 2. The rescue phase follows the immediate impact and is also called the heroic phase when people move from fear, disbelief, and shock to altruism and active helping. Neighbors share stories of survival, heroism, and lifesaving actions, and people outside the affected area rush in to volunteer and bring supplies and a helping hand. High levels of energy and activity buoy community hope and help to inventory the damage to begin cleanup and restoration.
Phase 3. This hopeful feeling continues during the honeymoon or remedy phase when volunteers and organizations donate food, clothing, and supplies in an extraordinary demonstration of generosity that lifts spirits and builds hope. Television and media personnel publicize the aftermath, and public officials make formal visits. Community members come together to share experiences, and many individuals return to their normal routines.
Phase 4. The disillusion phase begins as the honeymoon phase winds down. This period, which lasts from 8 weeks to 1 year, is often called the second disaster when responders and federal agency personnel leave the area, and the work of reconstruction has not yet begun or comes to a halt because of paperwork and lack of funding. Survivors may remain in shelters and trailers, businesses stay closed or remain destroyed, and many schools do not reopen quickly. Resentment, anxiety, and disappointment increase, and people feel abandoned and fatigued.
Phase 5. The recovery phase or reconstruction often begins in earnest after the 1-year anniversary when families and the community reflect and unite in the process of rebuilding. This phase can be brief or last for years, as in Haiti, New Orleans, or the Jersey Shore. Anniversaries, memorials, and the potential for other disaster events complicate and extend the recovery phase.
Phase Variability
The continuum of disaster recovery phases is not as neat and linear as Figure 1.1 might suggest. In reality, phases are complex, multidimensional, and overlapping, and they may vary from culture to culture (Neal, 1997). Many variables affect how survivors respond, including age, gender, type of disaster, cultural and spiritual beliefs, and previous experience with a disaster. Human-caused events that inflict serious physical harm or death severely affect survivors after impact; yet natural disasters can also bring fear of the event reoccurring, such as aftershocks or floods.
For example, before people could begin to return to their normal routine from the impact of Superstorm Sandy in New Jersey, a disabling early snowstorm followed and extended the impact phase. This surprise weather event magnified the impact of the superstorm because many residents were without heat and adequate shelter at a time when snow rarely occurs. Large groups of displaced people along the Jersey Shore had been housed outdoors in tents and were evacuated for a second time because of concern that the tents could collapse under the weight of the snow.
A priority in the Superstorm Sandy recovery phase was the boardwalk reconstruction in Seaside Heights and Seaside Park because residents relied on the summer tourist season at the shore for much of their annual income. Unfortunately, the newly built boardwalk with more than 50 businesses was destroyed a second time by an accidental fire caused by electrical wiring damaged by Superstorm Sandy floodwaters. Like New Orleans after Hurricane Katrina, Superstorm Sandy rebuilding became a long-term, multiyear recovery project, and with each warning of another potential hurricane or storm, residents' anxiety and fear escalated.
Disaster and Trauma Counseling: Intermediate and Long-Term Phases
Although the impact phase of many disasters is brief, lasting 1–2 days, the intermediate and long-term phases may extend indefinitely after catastrophic events. Many residents in New Orleans, Louisiana, experienced an extended impact phase as they waited in attics and on roofs to be rescued. Displaced residents stayed in overcrowded and underresourced shelters and temporary housing in the intermediate and long-term phases. Those affected most severely by Superstorm Sandy in New Jersey and New York were physically isolated without electricity, phone service, or heat for weeks and months. High-rise apartment buildings in Jersey City had no working elevators or lights in hallways and stairwells. Volunteers negotiated 20–30 flights of stairs with flashlights to bring food, medication, and blankets to residents. After such catastrophic events as Hurricane Katrina and Superstorm Sandy, FEMA-funded crisis counselors continued to work during the intermediate phase.
Community-wide recovery requires comprehensive interprofessional responses, and survivors often are involved in more than one level of intervention. McFarlane and van der Kolk (1996) found that “different treatments are needed at different stages of posttraumatic adaptation” (p. 572). Multiple interventions, instead of one prescribed approach, should be provided. In Newtown, Connecticut, recovery counselors developed multitiered recovery plans for each individual and family requesting assistance (see Chapter 14). Counselors should be prepared to provide support during anniversaries and memorials that may trigger strong emotions and traumatic memories.
National Disaster Response Structure
With the new reality of terrorism in the United States after 9/11, FEMA's role expanded from disaster readiness, prevention, response, and recovery to a broader responsibility that included homeland security and antiterrorism. FEMA provides a community approach to emergency management with five priorities: (a) be survivor-centric in delivery, (b) become an expeditionary organization, (c) build capacity for catastrophic disasters, (d) reduce disaster risk, and (e) strengthen the organization (FEMA, 2016). All aspects of disaster response are coordinated under the National Incident Management System (https://www.fema.gov/national-incident-management-system), and each incident follows Incident Command System structure and procedures. Each incident has a designated Incident Commander who is the point person for all other responsibilities, similar to the military command system. This common “structure is an antidote to chaos” that may occur in the aftermath of a disaster or mass trauma (Everly, Perrin, & Everly, 2008, p. 39). FEMA's free online courses, National Incident Management System IS 700 (https://training.fema.gov/is/courseoverview.aspx?code=is-700.a) and Incident Command System IS 100 (https://training.fema.gov/is/courseoverview.aspx?code=IS-100.b) introduce responders to the structural foundation of national disaster response.
