Healthcare Training Institute - Quality Education since 1979
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Carol Fizer worked with rescue workers at the World Trade Center following the September 11th attacks. She is an Independent Clinical Social Worker in the greater Boston area. Carol trained with the International Critical Incident Stress Foundation and Smith College School for Social Work.
A debriefing is essentially a highly structured conversation, which moves from
the cognitive to the affective and back to the cognitive level, from person to
person around the group. This is done in a series of seven steps:
Beginning the Meeting: I walked into the meeting room to see nine tired-looking men and one woman. They ranged in experience from young newcomers of the department to seasoned veterans of thirty years. The mix was about half and half. There was minimal conversation, but a lot of cigarette smoking and coffee drinking. Randy, the peer leader, and I worked out who should take the lead. I leapt in with a brief introduction that we were here because of Sean and Michaels death. I briefly explained that everything that was said was confidential, that we were here for them, and what was happening to them. There was some grumbling from an older man about psychological crap, which I just chose to ignore.
Something was Wrong: We initiated a round-robin style group discussion by giving each person the opportunity to speak about when they first realized something was wrong. Each person gave his or her perspective. The general consensus in the group was that during the fire quite a bit of time elapsed before fellow firemen realized Michael and Sean were missing. In fact, it had been at least fifteen minutes after the building evacuation was called since there was so much confusion between the four different companies.
First Thoughts: A second round focused on the first thoughts which popped into their minds after realizing that the two were missing. The responses ranged from who was going to tell their wives to what they would do without them. Several men said nothing.
Sadness, Guilt and Anger: Feelings started to emerge and the conversation focused on how hard it was to go to the funeral and go to work without Sean and Michael. There were feelings of guilt when no one realized that Sean and Michael had been caught in a quick burn. Sadness for their families surfaced, and Julia cried as she talked about seeing the kids at the funeral. The guilt emerged and the focus switched to what could have been done differently. I gently reminded the group that this was not an operational critique, and again talked about how sad it was to lose someone in this way. Ralph turned away, hiding his tears. There was an immediate group response in terms of several people talking about their sadness. The group stopped. I asked what was going on that had stopped everyone in their tracks. A younger firefighter said he really thought their deaths were stupid, they had been doing something risky and left them with this mess. The group tentatively talked about their anger for the guys who left us. The group went back and forth between sadness, guilt, and anger, until they all seemed somewhat relieved.
Behavioral Changes: I summarized the feelings they had talked about and moved on to ask them about changes in their behavior and feelings during the past week. I heard complaints of sleeplessness, preoccupation with how we could have done it differently, and fears about the next time the bell rings. Another person kept wondering whether it could be himself the next time. A joke about nightly trips to the bar made me concerned about Jons increased drinking as a response to the situation. Randy addressed the feelings and behavior as a normal reaction to a major loss in their lives that not only affected their work lives, but also their personal lives. Its like losing a family member, so you are going to feel this way. I interjected specific, concrete ways of handling these types of uncomfortable feelings for example, talking to buddies and family members, as well as doing the activities that help them feel good. These were stressed as ways to get through the next week. The group then spontaneously planned a memorial for Sean and Michael. The group decided to hang Sean and Michaels pictures in the kitchen, a place where they both liked being. As we ended, I thanked them all for being there and left the door wide open by giving them each our cards for further assistance if they or their families needed it. We said goodbye. As the group lingered to talk, I approached Jon, the person who joked about drinking. He quickly told me that he had not been to an AA meeting, but promised to go at the end of his shift. I told him I would check in with him the next day.
The Seven Stage Critical Incident Stress Debriefing, described by Mitchell in his 1983 article, has been shown to help individuals, like this group of firefighters, move from a traumatic situation back to work life. The debriefing is a group crisis intervention, a healing conversation, not psychotherapy and, when used correctly, shows the potential for reduced symptomatic behavior.
This is a brief overview of debriefing (CISD) which used with other interventions (CISM) can be potentially powerful in helping a wide variety of populations through traumatic situations with a reduced potential for long range symptoms.
NOTE: sentences and phrases are in bold type, in each Section of this Manual, for the purpose of highlighting key ideas for easy reference.
QUESTION 5: When a clients condition indicates that there is a clear and imminent danger to the client or others, the certified counselor must do what? To select and enter your answer go to Test.