5 minutes with… Dr Noreen Tehrani

Noreen Tehrani, the Chair-Elect of the British Psychological Society's Crisis, Disaster and Trauma Psychology Section (launched just over a year ago) is passionate about making sure that people and organisations exposed to traumatic events get the best possible guidance, support and interventions to help them understand how traumatic events affect communities, organisations and individuals. 

Whilst a small minority of people exposed to traumatic incidents develop post-trauma disorders, the provision of a supportive initial response can reduce distress and provide opportunities to build future resilience and post-trauma growth.

What sparked your interest in trauma?

I joined the Post Office in 1991 as an occupational health psychologist. In the first week, I had to deal with a kidnapping of the family of a postal worker taken hostage by armed raiders. It then became apparent that this was not particularly unusual in the Post Office, so my first task was to design and implement a programme of trauma support to help employees deal with armed raids, violent attacks, dog bites and other traumatic incidents. 

At that time there was very little written about trauma in organisations. I found papers by Atle Dyregrov and Jeff Mitchell from which I created and introduced an organisational programme of trauma support. What I found particularly rewarding was the speed with which early trauma interventions reduced trauma symptoms.

Has the scientific approach to trauma changed in recent years?

The rapid advances in our understanding of the biological basis of trauma has been highly influential in increasing our understanding of the nature of traumatic stress. The discovery that trauma changes the operation of the neuro-endocrine system helped in the understanding of hyperarousal symptoms. 

Neuroimaging has started to map the brain structures and pathways involved in trauma responses. This has provided insight into many trauma responses, including showing how changes to the corpus callosum and prefrontal cortex of traumatised children predicts developmental problems.

Over the past 10 years, there has been a rapid increase in trauma interventions, leading to robust debate on the nature of evidence. The role of randomised controlled trials and the place of other forms of evidence is being examined, with the growing recognition of the importance of looking for clinically significant findings when working with trauma.

Is there a risk that psychologists can do more harm than good tackling trauma?

In my experience, there are two kinds of harm caused by psychologists working with traumatised clients. The first is by omission where a lack of recognition of the presence of the trauma results in the psychologist adopting an ineffective therapeutic model. 

Typically, clients become disillusioned when they see no reduction in their symptoms and as a result may refuse appropriate treatments when offered. The second type of harm occurs when the psychologist fails to follow one or more of the fundamental rules of working with traumatised clients, which include:

• recognising the importance of social support;
• providing for psycho-education;
• giving opportunities to make sense of the trauma story;
• building self-calming skills;
• showing respect and sensitivity to personal, cultural and social differences; and
• offering ongoing support.

Why are you particularly interested in secondary trauma?

Most of my work is in organisations, some of my clients are directly involved in dealing with disasters or exposed to serious physical or psychological abuse. However, many experience their trauma through engaging with primary victims of trauma as a rescuer, paramedic, law enforcer, advocate, teacher or humanitarian worker. 

The development of secondary trauma or compassion fatigue through vicarious experience is well established and requires organisations where there is a high level of risk of traumatic exposure to identify those workers particularly vulnerable. There is a need to ensure they are screened, educated and supported in developing essential resilience capacities. 

Psychologists working with trauma are also vulnerable, and I have recently contributed a chapter to a book on supervision for trauma psychologists, which sets out what good trauma supervision involves.

What are your hopes for the Crisis, Disaster and Trauma Psychology Section?

As a very new and highly ambitious section of the BPS we would like to encourage psychologists from other Divisions and Sections to work with us to provide answers to some of the most difficult questions that the world faces today including: How can we support traumatised refugees and victims of war.? Which early trauma interventions work best? What can we do to help victims of historic child abuse? Should psychologists be part of emergency planning? Is EMDR better than TF-CBT in treating trauma?

We cannot solve these problems on our own, so we decided to offer a series of trauma workshops as part of the professional development programme in the hope that others would join us to take part in this important work.