When Natascha Kampusch and the Fritzl offspring emerged from their dungeons and were duly handed over to therapists we nodded with approval. When an act of terrorism kills and maims we assume that survivors will need the help of professionals to sort out their traumatised heads.

Culturally we buy that because it is what we have absorbed over the past 20 years: that it's good to talk - even in Britain, where a taste for discretion and privacy has been part of the national character. That appreciation of backbone is one explanation for the glee with which some commentators greeted an American study last week which suggested that the people who do best after trauma are those who keep shtoom. What was not always made clear was that the 2,138 people canvassed for the University of Buffalo study were not, strictly speaking, likely to suffer trauma or need counselling. They had witnessed 9/11 on their TVs, but had not been in the twin towers or lost relatives or friends, so it is misleading to extrapolate from their responses that, after collective trauma, a stiff upper lip beats therapy.

Professor Chris Brewin, a clinical psychologist at University College London, says: “If people aren't directly involved in a traumatic event, we're talking about normal recovery processes. This is different from the therapy issue for people who are struggling to cope several months after an event.” The question the study does raise, but does not answer, is: when do you need therapy? When is professional help appropriate, and when should we realise that we don't need a talking cure because we're not broken? Given the ubiquity of professional emotional and psychological support and the credence given to it, might we have trouble making this distinction?

The psychotherapist Phillip Hodson, of the British Association for Counselling and Psychotherapy, is an advocate of therapy, but not “pointless therapy”. He advises considering professional help if your usual support systems of family and friends aren't working; if you're being mean to people you say you love; if you have a relationship problem that is going round in circles; if you have clinical symptoms and cannot function as you normally would; if you can't do your job; if you find yourself acting out of character in ways that alarm you; if you have a complex and long-lasting response to bereavement (turning a room into a shrine, say).

“We need to travel through life, to move on, and we all grieve or cope with stress in our own way,” says Hodson. “People talk about baggage; I'd rather talk about luggage. There's less of it and you can take it with you. If you didn't develop skills and resilience as an adolescent, you won't have the skills and resilience you need later on and may need some help. You don't normally need therapy after a bereavement or if you're unhappy.

“Life is full of unavoidable unhappiness and if you think that you should be in a permanent state of euphoria, you have misread the dictionary. Being blue is not a reason to seek help. Probably one of the biggest errors the therapy movement made was to support uncritical trauma counselling in the past.” He adds that the word depression is widely misused, as is counselling, especially as the latter has come to stand for any kind of advice, even though it is predicated on the idea that the unconscious mind influences behaviour. “It's a reflective process, not an emergency service. You can't counsel someone who's raving or in extreme distress; you have to access not only empathy and emotion, but also reason. Counselling is more than dealing with immediate disaster.”

If perceptions of counselling have become skewed, it is no wonder given the rapid development of the trauma industry in response to such tragedies as the Bradford fire in 1985, the sinking of the Herald of Free Enterprise in 1987 and Hillsborough in 1989. It became commonplace for survivors to be offered immediate counselling, sometimes by people who lacked the necessarily skills - a practice that suited insurance issues and the growing litigation culture, and the response to 9/11 in 2001 included such wild estimates as the notion that 80 per cent of New Yorkers would be affected by post-traumatic stress disorder (PTSD). This was later revised to 0.8 per cent of the population of Manhattan, suggesting that what had initially been observed was rational distress.

By July 2005, when London was bombed, the 400 people caught up in the incidents were offered screening (devised by Brewin) from six weeks afterwards, and those thought to have potential problems were referred for a clinical interview and counselling if necessary. Most psychologists now accept that it is inappropriate to offer therapy or counselling immediately after a trauma. In Skipton, North Yorkshire, the Centre for Crisis Psychology (CCP) has been involved in most of the widely reported catastrophes of the past 20 years and claims that “during the 1990s it became the premier UK company managing the aftermath of psychological trauma”. Its clients include blue-chip companies encouraged to understand that they have a legal duty of care to their staff, and holiday companies for whom sudden tragedies are an occupational hazard.

Keven Tasker, one of CCP's partners and a former social worker, says: “It's inherent in most people who have experienced trauma to want to talk about it, whether to a family member or a close friend or a health professional. It's cathartic. Through our own research we know that most people find intervention useful.”

What CCP offers initially to those with symptoms of trauma is not counselling but emotional first aid, Tasker says. “We help them to understand what they have been through so that they can put the pieces of the jigsaw together and understand what their reactions are about. They might feel nauseous or have headaches or be hypervigilant.

“Counselling is a contract to deal with a specific problem. It's a separate intervention, and if people experience severe trauma and develop PTSD, they will need it. They may have irrational fears or suffer from flashbacks, or they may be withdrawing from their normal environments. Many other people don't need counselling - they just need to understand that their reactions are normal and will eventually dissipate and they'll be fine. Around half the people involved in major incidents move on quite quickly.”

CASE STUDY: I try not to dwell on things

Richard Beeston, the Times Foreign Editor, has reported on conflicts in Lebanon - where he was abducted - Iraq, Bosnia and Chechnya.

I don't think I've suffered ill-effects; I'm of the stiff-upper-lip school. I was 21 when I first went to Beirut and when you're young you're selfish. You tend not to empathise with people; you have less at stake because you're not defending your home and children. Over time I have found that what makes a difference is having a stable home to come back to. You go to a violent, dangerous place and meet people who are suffering, then come back to Western comfort - to people you love and who love you, to something important outside your work. If I find something particularly hard, I spend a day fly-fishing to readjust my mind. I have occasionally had a nightmare, but I've succeeded in remaining detached. I've learnt not to dwell on things.

CASE STUDY: The counsellor suggested I was playing the system

Paul Davidson, 50, of Gateshead, Tyne and Wear, did not find counselling for post-traumatic stress disorder to be helpful.

When I was 3, growing up in a fairly rough area of Newcastle, I was thrown on to a small bonfire by some teenage boys. Although I wasn't badly burnt, that remains my earliest, most vivid and most terrifying memory. When I was 14 someone threw a firework down my jumper, which also caused me physical and mental harm. But the trigger to seek counselling was the death of my seven-month-old, who had a rare genetic condition, in 1998. I suffered the most terrible bereavement when he passed away. My GP confirmed post-traumatic stress disorder and referred me to a psychologist. I stuck out the 15 sessions but found them totally unhelpful. The cognitive behavioural therapy counsellor was stony-faced and often got angry, suggesting that I was playing the victim. I learnt that my life would not change if I just unloaded my problems on someone else. I had to rely on my in-built coping strategies and work things out for myself.

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