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For Congresswoman Giffords, physical recovery may be just the start

Depending upon the extent of her physical recovery from the Jan. 8 shooting rampage in Tucson, Arizona Rep. Gabrielle Giffords may face psychological challenges, such as post-traumatic stress. Professor of Counseling and Applied Psychology Mary Ballou, co-developer of the Fink-Ballou Model of crisis intervention, discusses what might lie ahead for Giffords.

What are the potential psychological impacts for someone who has endured extreme trauma of this kind?
First, there would be her reactions to loss of physical or mental functions — sadness, anger, confusion — and the real trials she’ll face adjusting to whatever her new status is. In psychological terms, she also may have post-traumatic stress, such as intense fears when she hears a noise, or sees a crowd. To the degree that her family and professionals support her, some of that will be easier to cope with.
It’s further complicated because we don’t know what cognitive impairments she’ll have. Her cognitive recovery will be critical to things like memory and her ability to think through her emotional responses. The effort she’s going to have to make in recovery is another issue — sustaining the motivation and the follow-through to do the very hard work of recovery. Another level is interpersonal. Will her friends and constituents continue to be there for her after the media spotlight moves on? Will there be a continuity of support for her and what will that be like? Her reactions to changes (in interpersonal relationships) are going to matter very much.

Typically, when would psychological therapy start?
I’m sure they’ve brought a psychological perspective to her treatment already. It’s too early for one-on-one therapy, but are people thinking about the psychosocial aspects of her recovery? I think so. Rehabilitation medicine has progressed by leaps and bounds over the last couple of decades, and rehabilitation psychology is, I’m sure, part of the mix in her treatment.

The media has reported that Giffords probably has no memory of the shooting, and that nobody is talking about the attack around her. Is there a right time to share that kind of information?
There’s not a right or wrong time. Some time ago I did research and theoretical development around a model of crisis intervention, and it continues to be very viable. It identifies four stages that people in crisis go through, and the appropriate intervention at each stage. It’s not until the third stage, acknowledgement, that this kind of information is shared. That’s the point when the person is asking what happened to them. The person may still feel overwhelmed, but they are ready to deal with it. That’s also the stage where psychologically dramatic things happen.
It’s only at the final stage, adaptation and change, that what we think of as formal psychological counseling takes place. But for the congresswoman, that’s down the road some. Meanwhile, one thing that concerns me is this push for her to emerge from this quickly, that typically American quick-fix mentality. Will that serve her well or will it set up unrealistic expectations for her? My feeling is that that kind of social norm is not an asset for a person in crisis.