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classification of the most neglected people in
the aftermath of a traumatic incident is often
the team who went in to work with all the survivors.
They often fail to recognize the full impact the
event has on their own lives. We spend the majority
of our focus on the people directly involved and
impacted by the incident and fail to pay attention
to ourselves. Working in the area of trauma response
takes it toll on the helping teams in much the
same way as the event overpowered the people in
it.
After several years responding to traumatic events,
we began to be concerned that our most experienced,
and thus most called upon members, were gradually
leaving the team or talking in terms of being
"burned out." It was based in this knowledge
that Paul LaBerteaux, Psy.D. and I developed a
process to work with members after the event to
assure their own needs were addressed.
WHY DO IT?
When a trauma response team has finished its work
with the people involved in a critical incident,
they are normally tired and ready to return to
their own lives. However, they still have one
piece of work left to be done, namely to take
a few minutes to debrief themselves. Because they
have spent several hours being exposed to the
pain of the people involved in the event, they
too have potentially become affected by it. As
a result, members of the team may be having some
reactions to the debriefing.
Through the process of debriefing the response
team, you are working to accomplish three goals:
You are attempting
to prevent negative reactions such as vicarious
traumatization, cumulative stress and the effects
of negative self-judgment.
You are using this as an opportunity to teach
and reinforce skills for team members.
You are "practicing what we preach"
to people in the debriefing!
By assuring that a debriefing of the team is a
standard operating procedure for your team, you
are increasing their effectiveness and longevity
on the team. You are decreasing the chances for
any negative personal reactions by members of
the team and monitoring the team for any adverse
reactions. Lastly, like the debriefees, you are
preparing the team for re-entry into the world.
Normally the debriefing should be done shortly
after their work is done and before the team disburses.
If a team has been involved in a particularly
difficult debriefing or a series of defusings/debriefings/demobilizations
over a prolonged event response, the debriefing
might better be done within a few days. This will
allow the team an opportunity to process some
of the event on their own and then to finish the
work together.
We learned this after a team returned after spending
five days in the field working with hurricane
victims. The team leader instructed us that they
had "done everything we had taught them."
They talked every night, were able to get plenty
of rest and good food and, in general, took care
of themselves. Upon arrival in room, the team
leader said, "You have ten minutes. We are
tired and want to go home!" Two hours later
they were done. While they had in fact done all
the appropriate things out in the field, it was
not until they knew they were finished with their
work that they could begin to process the experience
and how it had impacted them.
While the "debriefing the debriefers"
process normally takes 15 to 30 minutes for "regular"
debriefings, it can be significantly longer for
particularly difficult or long situations.
WHO SHOULD DO IT?
Usually the team leader can lead the "debriefing
debriefers" process. Again, if the debriefing
team has been through a particularly difficult
or long event, their debriefing is best accomplished
by an experienced member who was not a direct
part of the debriefing. This allows all team members
to participate in the full experience of the debriefing
process.
HOW DO YOU DO IT?
The Debriefing Debriefers process uses a variation
of the International Critical Incident Stress
Foundation (ICISF) Model. It consists of three
phases, REVIEW, RESPONSE, and REMIND.
The REVIEW phase is essentially a combination
of the Introduction/Fact/Thought phase of the
regular debriefing. It utilizes questions designed
to have members think about and discuss the debriefing
and their participation in it. The following questions
are examples of this phase:
How did it go?
How do you think you did?
What "ditzy" thing did you do?
What themes emerged?
What was the participation level of the group?
During this phase, the leader can guide the discussion
into teaching what made the debriefing go well
or give examples of other ways to have handled
some aspect of the debriefing.
The RESPONSE phase is a condensation of the Reaction/Symptom
phase of the Mitchell Model and works to elicit
comments on the self-perception of the team members
and any concerns they may have about their performance.
The following types of questions seem to work
well:
What did you
say that you wish you hadn t?
What didn t you say that you wish you had?
How has this debriefing affected you?
What is the hardest part of this debriefing
for you?
During this phase, the leader guides some group
discussion of the members impressions. What usually
follows is reassurance by the team members that
no major errors occurred. This is also an opportunity
for the team leader and team members to reassure
each other that each individual contributed to
the process and to offer alternative methods for
handling problem issues.
The REMIND phase correlates to the Teaching/Re-entry
phase of the ICISF Model. Questions in this step
serve to help the team remember to do the same
sort of things that we encourage the debriefees
to do.
Is there any
follow up to be done?
What are you going to do to take care of yourself
in the next 24 hours?
What will it take for you to "let go"
of this debriefing?
By using this structured approach to debriefing
debriefers, trauma response teams are maximizing
the opportunities for teaching members new skills,
minimizing the chances for members returning home
distressed or full of self doubt and assuring
its members that they are valuable assets to the
team. Being involved in a trauma response team
ought to be a rewarding experience for all team
members. It is our responsibility to take care
of ourselves at least as well as we try to take
care of others.
If we believe in what we are doing for the individuals
we serve, we should believe in what we are doing
for the individuals providing the services!
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