As counselors, we need to be prepared to respond to crises involving violence, whether outbreaks of violence between patients or self-inflicted violence, such as a suicide attempt. Here I will address how to respond to witnesses of violence in treatment centers even though they themselves may not have been the objects of the violence.

Those who are most affected by such incidences of violence are the survivors of past traumas, such as victims of family violence or of crime; those who witnessed acts of violence in the past; and those who have relatives, friends, or acquaintances who were the object of violence. When untreated, these people might develop symptoms of acute reaction to stress such as intrusive thoughts, fear, interruption of normal functioning, guilt feelings, sense of loss, and difficulty expressing emotions. For those recovering from addiction, symptoms of stress will most probably lead to relapses.

Some basic techniques that addiction counselors can use are:

• Expressing emotions, recognizing that they are a normal reaction to an abnormal situation.
• Remembering how one overcame adversity and trauma in the past.
• Talking with others about fears, forming discussion groups.
• Trying not to worry about that which you cannot control.

How to be a leader and create leaders
We now know that one way to prevent stress-related disorders is to take action, to help others, to exert leadership.¹ In crisis situations, the counselor must not only become a leader but also develop leadership qualities in each person affected by the crisis.
In times of crisis, human reactions are predictable. They range from experiencing emotions of fear, anger, rage, depression, numbness, the desire to help to the corresponding behaviors of escape, violence, lack of energy, indifference, and taking action to help others (Robbins, Madanes, & Pejcha, 2003). The task of the counselor as leader is to understand and anticipate these reactions in order to be able to direct others in the manner that is most positive to the common good (Robbins, 1991).

A counselor can emerge as a leader in a crisis situation by asking the following questions sequentially.

Question 1: Who needs help?
In a crisis situation, most people magnify the pain of what happened. This is a useful response when it prepares the person to prevent problems in the future, but it is a destructive response when the person concentrates in worrying about his or her own emotions. The first step for the counselor is to help each patient to identify, imagine, or find someone who is more in need of help than he or she is. The counselor gathers the group of patients and asks: Who needs help? Formulating the experience in this way is the first step to control individual emotions toward a shared communal purpose.

Question 2: What needs to be done?
This leads to the question: What can I do?

The counselor has the responsibility to (1) identify who can help and (2) find meaning and a source of power in whatever happens. For example, patients can be encouraged to create a safe physical area, to take care of those who are weaker, to create a discussion group, or to contact relatives and family members.

Shock, fear, and rage are emotions that we all feel in crisis situations. But there are other emotions that we need to develop and strengthen in our patients so that by serving others they can control their own emotions.

Question 3: What can I control?
The counselor must identify his or her own sphere of influence and the resources available to him or her as well as the sphere of influence of the patients and the resources available to them. When one feels restricted in the possibilities for action, it’s easy to fall into emotions of fear, guilt, and rage. If this occurs, instead of being able to help, there is an emotional breakdown. That is why it is important to identify what direct actions can be taken. The more common ones are to give material and emotional support to the victims and to organize discussion groups.

Then, the counselor must identify the possibilities for indirect action. How can I prepare myself to contribute to the prevention of future crises? Was the crisis due to lack of supervision? Could special attention to the needs of those involved in the violence have prevented the violence? What warning messages were not heeded? What conflict resolution methods could have been used?

Question 4: What can I do right now?
The counselor must see things as they are but he or she also must have a broader vision of how things should be for the common good. It is necessary not to repress emotion and yet to find the energy to act according to this vision.

Question 5: How can I control my own emotions and needs in order to be able to understand, anticipate, and influence the emotions and needs of others, and therefore be able to create new futures for each person and for the community?
Facing a crisis situation, each one of us assigns meaning to the events according to our primary needs and to the emotions that we are accustomed to experience. For example, for the person to whom a sense of security is essential, a crisis can be devastating. Instead, for the adventurer, the crisis could be seen as an opportunity for excitement and change.

In terms of emotions, when facing a crisis, the aggressive person will feel rage; the one who usually feels guilty will feel guilty; the depressive will feel sadness; the phobic will think of escape. So the issue is not that the crisis produces new emotions. The crisis exacerbates and exaggerates the emotions that each one tends to feel regularly.

In order to prevent stress reactions, it is necessary to help our patients understand that we don’t need to be victims of our own emotions — each one of us can choose the emotions that we want to experience and can determine their intensity. This is important because it is emotions that determine the meaning that we attribute to an attack and therefore the action that we are going to take.

It is the understanding of this process and the control of emotions that leads to personal growth and to contribution to the community. The model for this process is embodied by leaders such as Nelson Mandela and Victor Frankl who utilized extreme circumstances of imprisonment and torture to understand how to create meaning. When freed, they were able to apply this understanding to the creation of new meanings, future, and direction for others.

The model of the world
Each one of us carries in our head a model of what we believe the world is like; this model factors into how we respond to crisis. We build this model according to certain steps and in response to what happens around us. The steps are the following:

1. Something happens — a crisis — leading us to ask questions. Some ask: Who is to blame for this? Others: How is the director of this Center responsible for this? Are the counselors responsible? Or: Why didn’t this happen to me? Or: How can I help? Or: How can I contribute to the prevention of violence? The counselor needs to guide the patients to ask the right question — the question that will bring out each person’s strengths and serve the community best.

2. The question we ask will determine the focus of our attention. The one who asks who is to blame or who is responsible might focus on finding them and possibly seeking punishment. The one who asks why didn’t this happen to me might feel guilty or might feel a sense of superiority over those who were involved in the crisis. Those who want to know how to help might become volunteers. Those who focus on the problem of the violence prevention might become part of a committee or an activist group. After the counselor has helped each patient to identify their primary question, the counselor must guide each one to focus their attention on the best possible action that she or he can take.

3. What each person focuses on leads to assigning meaning. For example, this represents the force of evil and hatred; or this signifies that my efforts to get off of drugs are worthless; or humanity is condemned to suffer; or this is an opportunity for me to make a contribution to my community. The counselor guides each patient to find the most empowering meaning.

4. These meanings produce different emotional reactions: despair, compassion, hatred, guilt, rage, or empathy. Emotions become grounded in the body and lead to physical symptoms of stress or to physical well-being depending on which are the emotions experienced. Negative emotions always bring suffering to the person experiencing them.

When the counselor leads each patient to ask the right question, to focus attention on positive actions, and to find empowering meanings, then the emotional reactions that follow will be positive and lead to physical well-being, acting as a deterrent to substance abuse.

5. Emotional reactions lead to action and what the action will be depends on what is the emotional reaction. But there is no specific action that corresponds to a specific emotional reaction. For example, rage can lead to murder or can lead to making a contribution to a peace organization. Guilt feelings can lead to suicide or to acts of compassion. The counselor needs to carefully explore with each patient the range of possible actions and direct them to actions that will enhance their well-being and that of the community.

In summary, the counselor intervenes at each one of these steps, guiding the person in terms of what is the question, how to focus attention, what is the meaning, and what emotions to feel that will be conducive to taking positive action. As Madanes (1995) and Doheny (2002) have noted, today we know that taking positive action is one of the best antidotes to emotional disorders.

Cloé Madanes, HDL, is the Director of the Robbins-Madanes Center for Strategic Intervention in La Jolla, California. To contact her, visit www.robbins-madanes.com.

Editor’s note: If you liked this article, you will enjoy the feature article “Common Shock: Witnessing Violence in Clients’ Lives” by Kaethe Weingarten, PhD, published in the Febraury 2004 issue of Counselor. Find out why it is time to speak out about the demands of your work. It is available free in the archives of www.counselormagazine.com.

Footnote
1 In the aftermath of the attacks of 9/11, researchers used a questionnaire with more than 2,700 people that included a list of 14 strategies used to react to the attacks — strategies such as taking care of another person, doing something useful, donating blood, seeking emotional support, humor, acceptance, religion, emotional discharge, drug abuse, renunciation, seeking distractions. The interesting result is that those who responded by actively seeking action suffered significantly less symptoms of stress, even when they had a previous history of emotional disorders. These results were published on September 11, 2002, in the Journal of the American Medical Association.

References
Doheny, K. (2002, October 15). 9/11 trauma widespread months later. Health on the Net Foundation. Available: http://www.hon.ch/News/HSN/509015.html
Madanes, C. (1995). The violence of men. San Francisco, CA: Jossey-Bass.
Robbins, A. (1991). Awaken the giant within. New York, NY: Simon and Schuster, 1991.
Robbins, A., Madanes, C., & Pejcha, M. (2003). Neg otiating conflict: Leadership in times of crisis [Film]. (Available from the Robbins-Madanes Center for Strategic Intervention, 22223 Avenida De La Playa, Suite 105, La Jolla, CA 92037)

This article is published in Counselor,The Magazine for Addiction Professionals, June 2004, v.5, n.3, pp. 30-32.

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