‘Trauma work is a search for meaning'

Ian Florance interviews Noreen Tehrani, a founder member of the Society’s Crisis, Disaster and Trauma Section and Deputy Chair of the Division of Occupational Psychology.

27 September 2021

I first came across Noreen’s work when I was joint editor of the book Emerging Conversations in Coaching and Coaching Psychology. Noreen wrote a chapter with David Lane, arguing that an understanding of trauma is not only an issue for clinical and counselling psychologists but that all practitioner psychologists should recognise trauma, and respond appropriately with individual and organisational clients. Her company, Noreen Tehrani Associates, offers trauma support services, psychological screening, and training to organisations and individuals. Noreen has helped in dealing with major disasters such as the London Bridge terrorist attacks and Grenfell Tower.

I asked her what drives her passion for this difficult area. ‘I work to make people and organisations well again. The people I see have been through a trauma; childhood abuse, traumatic loss of a loved one, life-threatening accident are examples. The trauma symptoms of many people prevent them from working, functioning socially or in their family. Over the years I have been approached to work with concerned individuals and organisations as diverse as banking and insurance, government, and emergency services.

‘Typically I start with screening questionnaires dealing with symptoms and coping capacity, followed by a full assessment covering personal history, background, employment, strengths and an outline of what happened. Feeding back these results is the basis for further discussion, though an acknowledgement of what they have been through may allow them to use their own resilience to move forward.

‘I chaired a Society Professional Practice Board working party on Psychological Debriefing in 2002 so I’m aware of the controversy surrounding the process. However, there is a role for this early intervention particularly when used with organisational groups. For instance, I worked with Public Health England on establishing the principles for an early intervention specially designed for emergency services. Debriefing principles are central to Trauma Focussed CBT (TF-CBT) where the traumatised person is gradually re-exposed to their trauma. Part of the TF-CBT process is to look for alternative endings or to find sources of support. I recall working with a police officer who had seen a young woman jump out of a building and land on the pavement in front of him. The officer was constantly having flashbacks and nightmares where he saw the woman’s face and open eyes looking at him.

I asked him what would have made the situation better at that time. He said she should have been shown more respect and covered up. I asked him what he could use to cover her. He said, “I had a blanket in the back of the police car”. I asked him to visualise the scene, get the blanket and cover her. Immediately, he seemed more relaxed. I told him that if he saw the face again to get the blanket.’

Explaining the biology of trauma
Eye Movement Desensitization and Reprocessing Therapy (EMDR) has received a lot of media coverage recently. ‘I was initially very sceptical of it. My preference is for a much more relational approach to trauma. However, after training in it, I found to my surprise, the technique worked well. There has been lots of discussion about what is the active element in EMDR but holding a person in a safe place and using bilateral stimulation in the form of eye movements, auditory clicks or taps, can help re-process painful trauma memories.’

Has trauma work changed since you became interested in it in the mid-nineties? ‘I started as a research biologist so was interested in the biology of trauma. We know more about how the brain works and the role of the amygdala, hippocampus, and pre-frontal cortex. Explaining the biology of trauma to clients seems to make things clear to them. The amygdala is the early warning system, which is constantly looking out for danger, but sometimes it overreacts to sensory information associated with trauma. For me this has revalidated Pavlov’s classical conditioning with a trauma response being triggered by the pairing of the trauma with a sound or smell present when the trauma occurred.’

Noreen describes her work in major disasters as largely organisational nowadays. ‘In a disaster you support a large number of people. Initially the support involves providing shelter, food, rest, and immediate social support. The next stage is to triage to identify those in greatest need and provide support for those involved in providing primary care as they can become secondary victims. Whenever I’m called to a crisis or disaster, I prepare myself carefully and take as much rest as I can between sessions. If I have been involved in dealing with a major incident over a number of weeks, it can take time to recover. After the 7/7 bombings in London I stopped doing any trauma work for two months to allow myself time to recover. Trauma work is not for everyone; before you get involved you must think about whether you can cope.’

‘I’m an insider-outsider’
‘My career has been guided by accidents and serendipity. A talk at school when I was 14 years old convinced me that I wanted to be a psychologist. My father said “No” since I would, in his words “end up working in an asylum”. My other love was biology so my first career went down that route.’

After several jobs, Noreen moved to the Hammersmith Hospital Postgraduate Medical School ‘where we did some really interesting research including organ transplants, contraceptive pills and testing plastic hip joint which we used to treat arthritic greyhounds from the local White City racetrack. ‘

‘After time off to have a family, it was difficult to find a suitable job. It was the Margaret Thatcher era, and I had been demonstrating against the cuts in early child education. I remember walking over Richmond Bridge thinking “I’ve never been to university”. I decided there and then to take Biology and Psychology at St Mary’s College, Strawberry Hill. I loved it. In my second year they wanted to close the psychology department, I was determined this would not happen and organised a sit-in and demonstrations. We forced them to call a meeting of the governors, chaired by the Bishop of London. I was asked to make a presentation to the governors and pleaded with them to keep the department open. The course was saved and a thank you letter from the Dean addressed me as Noreen Tyranny – a Freudian slip perhaps.’

Noreen’s love for psychology has never diminished and she has become chartered in occupational, health, trauma, coaching and counselling psychology. ‘I got interested in each area as the need and opportunity arose. I could have added forensic: a lot of my work is involved with criminal behaviour. I don’t feel a member of one group – I’m an insider-outsider. I love to attend conferences which mix different psychology specialisms.’

‘Overcoming fear of managing is critical to organising responders to major disasters. I also learnt this when I worked for Courage Managed Pubs. This was a strange role for me, as someone who is teetotal. Using what I had learnt in psychology I moved from being a temporary receptionist to Retail Operations Director in seven years. What I had learnt was the importance of managing through people, to support and motivate. You must understand the output of the process you’re managing but not the detail of how you get there.’

Noreen joined the Post Office in 1991, initially working in Occupational Health but then moving over to head up the new Employee Support Service. ‘I became involved in trauma psychology there. Robberies of Post Offices and attacks on Post Office staff happened regularly. I was also responsible for the wellbeing of the Post Office staff in Northern Ireland when the troubles were at their height. It was nerve-wracking when you heard that a hotel you’d stayed in a week before had been blown up. There was very little written about trauma psychology at the time – maybe three papers – but I used these as the basis for developing a training programme, filmed materials, and an approach to debriefing. I found this work wonderful: you could be creative and you could see positive results very quickly.

‘When I moved to head up Employee Support, my commercial experiences helped me to “sell” the benefits of psychology. I professionalised and “productised” wellbeing services, enabling different Post Office businesses to budget for our psycho-social services. My way of working and commercial approach did not suit everyone, and for a time I was exposed to bullying which lasted for around 18 months, but as with all of life’s experiences “what does not kill you makes you stronger”. I have written a couple of books on bullying using my experiences and those of others to deal with organisational bullying.’

After leaving the Post Office Noreen set up her own company and has become an acknowledged national expert in the areas of bullying, stress and trauma which is why we’d asked her to co-write the chapter in the book I mentioned at the beginning.

Our meeting took place outside the café in Marble Hill Park, St Margarets, a welcome change from long Zoom sessions! As we got up to leave, Noreen restressed a core point. ‘Trauma work is a search for meaning. If a person can understand the experience, they will get better.’