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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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