| One
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!
Return to
The American Academy of Experts in Traumatic
Stress Homepage
Please visit this page again. More articles
will appear here shortly.
|
