Doctors Response to Horrific events and counseling

Dr. Andy has an interesting article tells the story of those medical doctors who gave emergency care to vicitims of the London bombings:
http://doctorandy.blogspot.com/2005/09/medical-response-to-london-bombings.html

Those stories are interesting in their own right. But, he also brings up the issue: does "after the fact" counseling help in such cases? An article in the New England Jounral of Medicine suggests "not":
http://content.nejm.org/cgi/content/full/353/6/548
Part of the article reads:

"There have now been more than a dozen controlled trials in which people who have been involved in accidents and other traumatic events have been randomly assigned to receive or not to receive such counseling. The results have shown conclusively that such immediate psychological debriefing does not work. Those who received it were no better off emotionally than those who did not. Worse, the better studies with the longer follow-up periods showed that receiving such counseling actually increased the likelihood of later psychological problems. In fact, the people who seemed to be harmed by this intervention were those who had been especially upset at the time — precisely those who one might think ought to be treated.1 So whereas immediate post-trauma counseling may reassure the rest of us that something is being done, it does not actually help those who receive it.
Why doesn't it work? For some, such counseling is just too painful and comes too soon. It is also possible that warning people about potential symptoms makes them more likely to experience them. For some people, not talking is the most appropriate immediate response. Talking to a professional whom one has never met before and might not meet again may even get in the way of doing what comes naturally — talking with family members, friends, colleagues, religious advisors, or the family doctor. The people who know us best are likely to know what support we need and when we need it.
Asking people to talk about their feelings when they are still raw with pain is not always a good idea. The day after the bombing, all the television news bulletins showed footage of the father and the grandfather of 20-year-old Shahara Islam, who had gone to work on July 7 and hadn't been seen since. There we saw intense distress — the grandfather unable to articulate a coherent word, the father so distraught that it was uncomfortable to watch him. We didn't need to ask them how they were feeling. Five days later, it was announced that Shahara Islam had been killed in the bus explosion at Tavistock Square. Immediate counseling is not going to heal her family's grief.
Instead, what people need during the first few days is the support of their family and friends and assistance with information, finances, travel, and the planning of funerals. The most appropriate immediate mental health interventions are practical, not emotional.2
Many people who are now in distress and despair will heal with time. Others will not, and serious psychological illnesses such as depression and post-traumatic stress disorder will develop in some. Prevention of these disorders would have required avoidance of the doomed trains. But the illnesses can be treated, and there are already plans to provide treatment."