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.