An attack by dogs (or a dog bite) can be traumatic because it is often a sudden, savage, unpredictable, random act of violence which overwhelms a person's capacity to take control and cope, and subsequently master the feelings aroused by the attack. It isn't about how savage or life threatening the attack was but more about how the individual responds to the situation. It is not simply being bitten by a dog, that causes emotional turmoil. Whether it does or whether it doesn't depends on how the situation is appraised and how the dog bite victim rates their ability to deal with the event. The goal of counselling a Dog bite victim is to encourage, normalize and validate the emotional response and healing process and to re-empower the victim and help them to regain control. Once they control their fears they can reconnect with dogs. Unless the victim clearly provoked the attack it is very important to be on the victim's side rather than look at what they did or did not do. It is important to stress that it was a random act of violence and that you are very sorry it happened. Trying to rationalize the bite and look at the role the victim played in the attack will only victimize and disempower them more, and stir up other negative emotions such as guilt. Never, ever blame the victim - it is a golden rule. At a later stage, one can look at educating the dog bite victim on reading dog's behavior and recognizing warning or threatening body language or situations, as well as  educating them with regards to protective and preventative measures or strategies (such as making sure that dogs are restrained or contained when entering someone's premises; or asking permission to pet a strange dog).



Dog bite victims need support to help them minimize the stress of the event. They need emotional support and resources to help  improve their coping strategies in the here and now. It is important to limit the after-effects and maladaptive stress symptoms  by providing support and helping the dog bite victim process the event  in order to minimize "baggage" and prevent further psychological scarring (such as the development of a phobia of dogs or Post Traumatic Stress Disorder and other anxiety disorders) "The only thing we have to fear is fear itself" (Franklin D. Roosevelt) They need to be able to share their experience, feelings and fears in a safe, caring, empathic, compassionate and nonjudgmental environment.


The crisis and trauma is most acute when the dog attack has taken place in the past 72hours. Counselling in the first 72hours is aimed at diffusing the situation.Immediately after an attack it is important to evaluate the dog bite victim's safety. The dog(s) responsible need to be contained and restrained. Explain the need for medical attention and help the victim get the care (s)he needs.  Wash your hands and then rinse the wounds under hot running water for at least five minutes as soon as possible. Clean the bite with hot soapy water and disinfect it with an antibacterial agent like F10, iodine or a saline solution. Put an ice pack on wounds that are swelling and a compress on wounds that are bleeding (once you have properly flushed the bites). Elevate limbs with bites to try and minimize swelling  If the bite has broken the skin or is a severe crush wound, the victim will need proper medical attention. Bites generally are not stitched unless very severe or if the healing will cause unsightly scarring (especially if it is a bite to the face). This is so that the wound can be flushed and left open to drain naturally   If the skin has been broken the risk of infection is much higher and the victim must have a Tetanus vaccine or booster (if they haven't had one in the past 5 years) and a course of Anti-biotics. In addition Tetanus Immune Globulin may be suggested if the person is not sure when they had their last Tetanus vaccine or it was several years ago. The greatest concern is developing Rabies which is almost always fatal. If the bite or even scratches, break the skin and you are not sure of the dogs Rabies vaccination history (and especially if there are multiple bites from multiple dogs) it is essential to have Rabies Vaccines and Rabies Immune Globulin (RIG). The Series of Rabies Vaccines are given on the day of the attack and again on the 3rd, 7th, and 14th day after exposure (a 5th does used to be recommended but this is no longer the case) The Vaccines offer protection within two weeks of being administered. The Rabies Immune Globulin is injected at the bite sites (and what is left over is given into the buttocks) provides immediate antibody protection against rabies. People who have received previous Rabies vaccines (eg vets) do not need RIG they just need a couple of vaccines (on the day of the attack and then on the 3rd day afterwards). For more information, read: <http://www.uptodate.com/contents/patient-information-rabies-beyond-the-basics?source=see_link>


At a Casualty or a Trauma unit, information about the animal(s) who bit the victim may be required. This is generally just to elicit whether Rabies prophylaxis is necessary. This is not reported to animal authorities. Part of empowering the victim is giving him/her the choice about whether to report the bite or attack. That decision needs to belong to the victim. There are advantages and disadvantages to reporting the attack. Dog attacks fall under the Animal Matters Amendment Act which is up to the Police to enforce, so you need to report the attack to your nearest police station. They in turn will contact the animal authority (SPCA) to investigate. Reporting the attack may re-empower the victim and make them feel they are taking control over the situation. The survivor could be protecting others from attack or substantiating another report of the same dog(s) having bitten or attacked before. The dog bite victim could be reclaiming their power and being socially responsible in making sure that no other innocent victim falls prey to that type of attack again. The disadvantages to reporting a dog bite or attack are that often it is just a random once off reactive bite and possibly the dog bite victim may have inadvertently provoked the attack or bite. Often the dog(s) and owners are known to the victim and it makes reporting uncomfortable to say the least. Also our laws and policing system are inept, so investigation and  prosecution are highly unlikely. It is up to the police and animal authority rather than the dog bite victim whether to go ahead with prosecution. It may also add more stress to have to go through the lengthy court process and rehash the bite/ attack events over and over. For more information, read:  http://www.nspca.co.za/page.aspx?Id=117&CateId=158&Category=ANIMAL%20MATTERS&SubCateId=347&SubCategory=Problem%20Dogs>


Rather than report the attack to the Police who then alert the animal authorities  (SPCA), many victims choose to rather seek personal compensation from the dog's owners. If the dog bite or attack occurs on someones's property and they are insured, this is covered by their household liability insurance, so sometimes it is seen as a way to get compensation without publicly or financially attacking or embarrassing a friend or neighbour. The onus is on the victim to prove the attack, so it would be necessary to save all medical reports and preferably take photos (or get other evidence) to prove the injuries sustained. The victim should decide whether this is an avenue he/she wishes to pursue in order to re-empower him/herself, and/or protect others.


In helping a survivor of a severe dog attack or bite it is important to assess if (s)he is in an acute or non-acute crisis. If the victim is emotionally overwrought and feeling like they are out of control, falling apart or having a breakdown, the priority would be to stabilize them.


Allow the expression of feelings, but try to change the focus to immediate and present needs and circumstances rather than on focusing on the distressing feelings. Try to direct the conversation to less upsetting topics like present needs e.g. thirst or hunger, long enough to help the person regain a sense of control.


Begin to educate the victim on how to manage strong, overwhelming feelings by staying in the present, being in the "here and now".  Strategies include such things as instructing the person to open their eyes and look around them and actively observe what is around them - they can list what they see, hear, smell etc. Touch things around them and notice how they feel, the texture, or eat something and notice the different tastes. They can turn on the tap and run warm water over their hands or stretch or do some deep-breathing or yoga. Repeating a safety or coping mantra also helps e.g. "My name is __________; I am safe right now. I am in the present not the past. I am located in _____________ and the date is _________. I can cope right now, this feeling will pass." 

I suspect that a dog attack or dog bite traumatized victim may go through similar stages in their healing to the stages of bereavement or mourning (Elisabeth Kübler-Ross). They may go through one or more of the stages, and may swing backwards and forwards between the stages. It is important to support and validate the feelings  (and healing process) in order to help the victim to heal. The first stage is shock or Denial - this happens immediately after the attack and often the victim cannot believe this has happened to them and is in shock. There's disbelief that the attack occurred and a desire to move on quickly and with minimal fuss. Denial shuts people down and prevents healing and serves to compounds defensiveness and results in avoidance, compromising the person's ability to communicate and process the trauma. 

But it's human nature to want to understand the how and why in order to process and "file away" the trauma. It is difficult to make sense of what is often a random and unprovoked act of violence. This is where the next stage of Anger happens. Bearing in mind, in any state of attack we have two options, fight or flight, this is where we turn to FIGHT as a way of dealing with the pain. Here the victim wants to take control, possible get revenge or extract retribution or compensation. This is often a defense against feelings of victimization, disempowerment, helplessness and hopelessness. It should be encouraged as it is better to turn anger outward and direct it at the source (the dog or dog owners). Anger mobilizes energy and re-empowers the victim. 

The next stage is Bargaining. In terms of dog bite victims this is where the victim would be thinking things like 'as long as I don't go near (a specific breed of dog)' or 'as long as I don't wear (whatever clothes or perfume etc they were wearing on the day of the attack)' or 'as along as I don't behave (in a certain way towards dogs)'... I will be safe and will not be attacked again. This is the stage where peculiar phobias and obsessive or avoidant behaviors or rituals could become a problem, as the victim tries to take control of what probably in fact was a random, unpredictable, unprovoked act of violence. This is where it should be useful for the dog bite victim to talk to a animal behaviorist or experienced dog handler or trainer so that they could provide good routines and practices to follow when approaching, meeting or handling animals. A basic understanding of animal behaviors and being able to "read" an animal and evaluate body language will be a fantastic stepping stone in allowing the victim to reagin a sense of control, understanding and connection to dogs.(S)he will be comfortable interacting if (s)he knows how to communicate and understand the communications and warning signals of canines... for more read: <http://doggonesafe.com/resources/Online_course_info/BL_basics_demo.pdf> 
<http://www.friendsofthedog.co.za/shelter-dogs--i-am-really-going-to-bite-now.html> ; 
 <http://drsophiayin.com/resources/video_full/why_dogs_bite1> How to Greet a Dog - Updated Version> < The Young Person's Guide to Woofs and Growls This colourful cartoon poster show children how to safely interact with dogs> and< Talk Dog! Dogs communicate largely using body language. Use this poster to learn how your dog feels and what they are trying to tell you.>
 
The next stage the person may go through is Depression. This is when the person experiences sadness or loss. Often the person has previously had good relationships with animals and they mourn the loss of feeling at ease and confident in their encounters with dogs. They second guess their ability to interact with animals. Many people experience a loss of freedom - there are dogs behind every gate and around every corner, so this inhibits the victims social and outdoors activities, and further isolates the victim. This results in feelings of despair - helplessness and hopelessness. The reactions and associated feelings to current  losses and fears may bring up previous "unfinished" business and trigger memories or feelings with regard to other losses which haven't been properly dealt with. Again building social skills and communication (both with humans and with dogs) will mean that the person can re-enter homes, parks and even their neighborhoods streets with the skills and renewed confidence to interact with dogs and their owners.

The final stage is that of Acceptance. This is peaceful resolution and where the victim accepts what has happened and make peace with it, and is able to move on. "God grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference" (the Serenity Prayer)

Trauma counsellling with someone who is a compassionate expert in both human and dog behavior would be highly recommended. It's been shown that as few as 3 trauma counsellling sessions are enough to re-establish a sense of equilibrium. The stress and trauma can be contained and the person will soon be functioning well again. Longterm effects and ongoing anxiety is less likely and the relationship between man and "his best friend" won't be forever compromised and fear will be replaced with respect….Of course one would never underestimate the therapy of a dog. Contact Paws for People Therapy Dogs in order to book a session of counselling and de-sensitization or the Pet Education and Anti-bite program for schools with Lesley de Klerk <lesley.deklerk@pixie.co.za> 082 901 8267.

Trauma counselling should happen a few days after the event once the acute crisis has been diffused. It is  brief counseling consisting of only a few sessions where the focus is on debriefing the dog bite victim and helping to contain them and helping them to regain their equilibrium thereby minimizing the psychological damage and building up internal coping resources and external sources of support (such as support groups or books or referrals to other experts). The victim will be encouraged to share the traumatic attack with the counselor and re-live and "process" the experience. 

Questions will be asked to help him/her remember the specific facts and circumstances. Questions to elicit facts include things like: 'Tell me about what happened to you' ; 'How long did it last?' ; 'How many dogs attacked you?';  'What breed were they or what did they look like?'; ' How did they behave before, during after?'; ' What did you see/ hear/ smell/ taste, touch/ do?'; ' How has the dog bite affected your life: work/ family/ relationships/ perceptions of self/ your perception of others/ others perception of you,/ who you are?'; ' How has this effected your view of dogs?'; 'Do they behave differently around you?'; ' Are you different with them?'; ' How has it affected your relationship with your domestic animals at home?' 

Trauma counselling would also look at the thoughts and behaviours during the attack, and subsequent to it. The sort of Questions that could be asked are: 'What were your first thoughts when the dog attacked?'; ' How did you explain the attack to yourself?'; 'What reason did you give yourself for what was happening?';  'Which of your values were shaken or challenged?'; 'How did your stereotypes help or hinder you?'; 'What difference did it make that the dog attacking you was a ____________breed?'; 'What difference did it make that the dog was a rescue/ shelter dog/ domestic dog/ stray dog?'; 'What difference did the size of the dog make?'; 'How did you decide on what to do?'; 'How did your thoughts influence your behaviour?'; ' How did your thoughts and behaviors help you survive?'; 'Do you think about things differently now?'; 'Would you react differently now?'; 'How is this affecting your everyday behaviour?'; 'What thoughts or behaviours /reactions regarding dogs/ their owners would you like to change?'; 'What needs to change to make you think about dogs/ their owners differently?'

Of course it is essential to focus on and validate feelings, and normalize them (put them in context) and the help the victim regain control over them and master feelings of stress, helplessness, fear and being overwhelmed or disempowered. Questions would include things like: 'What did you feel during the attack?'; 'What was the worst part for you?'; 'What were your fears?'; 'What made you feel: frightened/ helpless/ abandoned/ guilty/ out-of-control/ hurt/ frustrated/ angry/ sad/ relieved etc.'; 'How did your feelings change during the attack?';  'What have your feelings been since and what are they now?'; 'What is happening to your anger/sadness/guilt/fear?'; 'What are your feelings concerning the dogs/ the owners/ yourself?'; 'Has this touched on any other issues in your life?'; 'Did the attack remind you of any other events?'; 'Where (or with whom) is it easiest (or hardest) to discuss your feelings: work/ home/ friends/ dog experts etc.'

Physical symptoms and nervous reactions also need to be discussed, such as: 'What physical symptoms or reactions do you remember when you were attacked; increased heart rate/ dry mouth/ sweaty hands/ tightness in the chest/ shortness of breath etc?'; ' Were there more fight or flight reactions?'; 'What reactions happened immediately after... uncontrollable sobbing/ numbness/ shock/nausea/ fainting etc?' ; 'What physical symptoms have you experienced since the attack: hypervigilance or jumpiness/ too much or too little sleep/ less or more appetite/ are you using more cigarettes/ drugs or alcohol?'; 'Which symptoms do you still have presently and what have you done in order to cope?'

Part of the counseling would focus on the victim's internal and external resources and coping mechanisms and support. Encourage him/her to ask for help. Help them manage their time and only do the essentials (delegate other responsibilities) and efficiently organize their own duties. They need to exercise good sense in taking care of everyday needs - physical care - diet, exercise, good nutrition, rest/sleep, relaxation skills (maybe encourage them to learn deep breathing techniques … it would be important that a dog bite victim can control their breathing and maintain a calm state when approaching or being approached by dogs in the future). Systematic de-sensitization could be very useful in introducing the dog bite victim to dogs in a safe, consistent and controlled environment. Provide the dog bite victim with useful external resources which can be anything from books on dogs and communicating with dogs or handling/training them, to something like a support group or volunteer group that knows how to help victims or dog bites or people who are fearful of dogs but that works with animals so that the person learns dog handling skills and effective interaction and communication with dogs, rather than isolating themselves and developing a phobia of dogs. The more positive and rewarding experiences the person has with and around dogs the more (s)he will realize that a dog bite or attack is an uncommon unfortunate occurrence. Perhaps the person could become an extra hand at a puppy socialization class or join a dog walking group (e.g. Samantha Walpole's Weekend Woof Walks - contact <walpolesamantha@yahoo.co.uk> 083 775 1400)