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Crisis Debriefing Models
Assignment 02 SDEB02M
Candice Louise Janks
Due Date: 30th July
P.O Box 2004 Gallo Manor 2052 JHB
.......2 Mitchell’s Model……………………………………..4-5 Critical Discussion……………………………………………………………………….8 ........................2-4 The National Peace Accord Trust Model……………………………………………….....5-7 Conclusion……………………………………………………………………………………7 Bibliography…………………………………………………………………………………......................1 Table of Contents Introduction………………………………………………………………………………….
Initially developed for fire fighters. 1988. It can also be used for the victims involved in traumatic situations. Critical Incident Stress Debriefing (CISD) can be a valuable tool following a traumatic event. It is important to motivate the group by way of explaining what will occur in the debriefing so as to lessen anxiety and to establish a supportive. and a variety of other settings.S. 2) Fact Phase During this phase. the U. These include maintenance of confidentiality. Mitchell’s Model This model was originally developed for first responders in an emergency situation such as paramedics and fire fighters. 1) Introduction Phase The debriefer introduces himself and the process. Research on the effectiveness of applied critical incident debriefing techniques has demonstrated that individuals who are provided CISD within a 24-72 hour period after the initial critical incident experience less short-term and long-term crisis reactions or psychological trauma (Mitchell. the use of the Mitchell Model has been expanded for use in natural disasters. It consists of seven phases which are briefly elaborated on below. The NPAT model consists of four legs with the approach being an integrative one. the group members are asked to describe their role in the incident or event and from their own perspective. In the aftermath of any critical incident and/or traumatic event. school-based incidents. a few individuals provide core facts while others fill in the . The "classic" CISM model was developed by Dr. no breaks and no recordings/notes taken. 1994). using both psychodynamic and cognitive behavioural techniques. some facts regarding what happened. Jeffrey Mitchell of the University of Maryland for use with emergency services personnel. paramedics and police officers. military and survivors of terrorist acts. psychological reactions are quite common and are fairly predictable.2 Introduction Psychological debriefing is an important first step for helping people process their direct involvement with traumatic events and reflect on the impact. “Debriefing is a specific technique designed to assist others in dealing with the physical or psychological symptoms that are generally associated with trauma exposure” (Davis. Usually. including. non threatening atmosphere. in recent years. encourages but does not force participation and sets ground rules. 1998). The National Peace Accord Trust (NPAT) is a non-profit organization which is focused on healing and reconciliation in South Africa. Young. An explanation of both these models follows with a critical discussion regarding their effectiveness.
during and after the incident or event. 5) Symptom Phase This phase begins the movement back from the predominately emotional processing level towards the cognitive and thinking processing level.3 missing details. the group realizes they are not alone in what they have been feeling. The rationale is that it is sometimes too difficult to discuss feelings too early on and by keeping the first two phases general and factual allows the individuals to feel safe and comfortable before confronting the more sensitive and personal emotions felt during the incident or event. stress reactions and techniques to decrease stress are explored. The debriefer asks the group to discuss their first thoughts during the event or incident. The debriefer also prepares the . “What was the worst thing about it for you?”. emotional and behavioural signs and symptoms which appeared before. This realization is an important first step for many towards feeling better. The group is asked to describe their physical. cognitive. 4) Reaction Phase This phase is designed to move the group from the predominately cognitive level of intellectual processing into the emotional level of processing. “What did you do?”. Useful questions like. “”How did you feel in the beginning? And later?”. “What happened?”. The process of critical incident stress. The important questions to ask include. Not everyone will feel comfortable talking and answering these questions. 3) Thought Phase This phase explores the emotional aspects prompted by the event. Questions such as “What did you experience before the incident?” and “What are you still experiencing since the event?” are used to elicit responses. “How do you feel now?” This is the most intense and powerful phase as it becomes more personal and the group learns to deal emotionally with the event. “What went through your mind?” and “when did you first realize this was a critical incident/traumatic event?” usually prompt discussion and allows the group to open up once they realize they are not alone in their feelings. so it is emphasised that the important part of participation is being present and listening. As with the reaction phase. Some of the individuals will discover that their reactions are similar to others in the group. 6) Teaching Phase Information is exchanged about the nature of the stress response and expected physiological and psychological reactions to critical incidents and traumatic events. The introduction of missing facts helps correct any misperceptions. Some questions that can be asked include. “How did the incident/event end?”.
It is also important to highlight what other responses the individuals could feel in the future and how long these responses should carry on for before they subside (generally about six weeks). rather it is normal in the face of abnormal circumstances. “How do you feel at the moment?” and “What did you learn from the session?”. 2) Normalising the Symptoms The most important message to get across is that the individuals are experiencing normal responses and reactions to an abnormal experience. the re-telling of the story allows for identification of thoughts and feelings. 1) Re-telling the Story The purpose of this leg is to alleviate anxiety caused by the event or incident and to provide a safe environment that is non-threatening to the individual whilst he/she tells his/her story regarding the trauma. . The main purpose is to ensure that emotions are not raw when the individuals leave. “What support is available?”.4 group for possible future reactions. 7) Re-entry Phase This is the final phase which allows the group to expand on relevant points they feel are important and to answer questions. A summary is given and the debriefing is concluded. In the first leg. The National Peace Accord Trust Model This is an integrative model which utilizes both psychodynamic and cognitive behavioural counselling techniques. It is encouraged to not only recount the experience but re-live it in this environment in order to reduce reoccupation with the event or incident and to allow for emotional expression. emotions and sensory associations are explored and discussed. There are four legs to this model which are outlined briefly below. Factual details as well as thoughts. Many individuals may fear they are going crazy or losing their minds and the debriefer needs to reassure everyone involved in the incident or trauma that this is not the case at all. Questions that can be asked include. Individual follow ups and referrals can be addressed and the debriefer must be available after the session in case someone from the group feels too vulnerable to ask anything during the session. the debriefer helps the individuals accept and understand these responses. This all serves to normalize the stress and coping response and provides the basis questions and answers. In this leg. This model is still widely used today and many new models have been developed using the Mitchell Model as a basis.
If not. rather than the debriefer arguing the point for them. allows for these feelings to be expressed as it suits the individuals. The debriefer encourages support systems and social networking to restore the coping capacity of the individuals. coupled with a positive support system will benefit the individual immensely and ensure healthy healing. Understanding the scenario and asking the right questions should provide the insight the individuals need in order to restore self-esteem and recognition that they responded appropriately in the circumstances. The National Peace Accord Trust model on the other hand. It is important for the healing process that individuals come to positive conclusions about their actions. Asking how the individual usually deals with stress will provide insight into how this person will cope following the experience. Encouragement to utilize one’s own coping mechanisms and behaviours. Depending on the individuals involved in the debriefing and the actual trauma that occurred will play a significant role in how the debriefing should be navigated. It is generally a way for the individuals to regain control in the memory/fantasy of the incident or event. When involved in a debriefing it is impossible to separate the individual phases as neatly as outlined by Mitchell. . depending on the needs of the individual involved. Other types of referrals can also be made.5 3) Addressing Guilt: Re-framing guilt/self-blame Feelings of guilt may be directly or indirectly expressed and the debriefer must be aware of the cues given by the individual. Every case and each person is unique and the debriefing should be structured in such a way to allow that individuality to run its course. Critical Discussion of both Models I would like to highlight advantages and disadvantages regarding both models from my perspective. This is the leg where all the “what if’s?” emerge and need to be discussed. These support systems will differ depending on the individual and it is important to determine if healthy support systems exist. 4) Encouraging Mastery This final leg prepares the individuals to regain normalcy in their lives after the incident or event. Individuals move from facts to feelings ad reactions and then back again continually through the debrief. the debriefer can refer to the individual to support systems that have experience with the kind of incident or event that took place. Structure is incredibly important in debriefing sessions but I personally believe that the Mitchell model is too structured and needs to allow for some flexibility. Guidelines as provided by both models are vital however Mitchell’s model does not allow a place for thoughts and emotions until phase 3.
I would follow a model that was designed for such an instance.6 Another difference between the two worth mentioning is the fact that Mitchell’s model was designed for emergency responders and the debriefing was constructed for group settings. allows for an increased receptiveness because there is a better understanding for all parties involved and it is easier to establish rapport and influence productive communication. The level of detail regarding sensory impressions which is apparent in both Dyregrov’s and the National Peace Accord Trust’s models is lacking in Mitchell’s model. except that it is the individual’s responsibility to contact the debriefer for another session. Even though the principles can still be applied. Mitchell’s model starts the debriefing at the scene of the incident or event whilst both Dyregrov’s and the National Peace Accord Trust’s models start before the experience. deserves a mention now. What Dyregrov’s model has that both the abovementioned models are lacking is personal sharing of experience on the part of the debriefer. Additionally. There is greater emphasis on normalization of responses. Dyregrov’s model provides information in the last phase regarding when a person should be seeking additional help. The National Peace Accord Trust conversely was developed for individuals who were survivors/victims of trauma. I strongly feel it would be almost impossible for them to reach out again once “the door was already shut”. By providing a personal history of one’s own experience regarding the event or incident. The dynamics and structure of a group environment will be completely different to that of a one-on-one. there is very little about what an individual should do if his/her symptoms have not dissipated after six weeks. Atle Dyregrov modified Mitchell’s model and although not discussed previously in this paper. with groups and if I was to debrief an individual on his/her own. feelings and thoughts which are important for the individuals involved in the debriefing. I think this is very important to be communicated right from the start. In Mitchell’s final phase. This is an attempt to reduce self-blame and to bring about a sense of normalcy. I would personally utilize a model that was developed for use with groups. The healing effects of a positive support structure is well documented and play a crucial role in providing additional help after a trauma. For more sensitive and vulnerable individuals. This should be more clearly emphasised in Mitchell’s model. On the other hand. Both of these models can be used in different situations than what they were originally intended for but I question how well that is actually implemented. . both of which is vital for healing after a trauma and which is lacking in Mitchell’s model. Should a person’s symptoms still persist he/she might be hesitant to ask for another session as he/she may feel embarrassed and may be under the impression that the debriefing was concluded and there is no going back. Mtichell’s model fails to emphasize the importance of a support structure which is apparent in both the National Peace Accord Trust’s and Dyregrov’s models.
All that being said. however. many of the models that came into existence would not have been possible as this was the starting point from which others followed. I prefer the fact that the model is flexible and it is not so rigid in its structure. help to pre-empt its damaging effects. . I believe the option should be given if they would prefer a group or one-one-one session. Mitchell’s model was originally developed for emergency personnel to alleviate the effects of stress after the incident or event took place. I favour this model because it is geared for individual one-on-ones rather than group sessions which would be more likely the case with the traumatic events in this country. the first in debriefing sessions. A brief look at Mitchell’s model.7 Finally. It is understandable why this model works so well in group settings as the emergency responders are called out as a group. It doesn’t matter which leg is approached and utilized first. However. and thus. The emphasis on support structure is important to me because I strongly agree about its vital role in the healing process. If it wasn’t for Mitchell’s model. It is important to always be aware of where the newer. that emergency services should teach techniques to be used on anticipating stress. and the National Peace Accord Trust’s model which is based in South Africa highlight many similarities and common threads which are vital in debriefing after a trauma has occurred. It is a South African run non-profit organization which means they understand the needs and difficulties of those they are trying to assist. as long as all legs are used in the debriefing. It has been suggested. The model used by The National Peace Accord Trust is definitely my preference. updated and potentially better models originated from. This model was designed to be used with people who would potentially face trauma on an ongoing basis and this should have been addressed more fully by Mitchell. I cannot discredit how well thought out Mitchell’s model is and how much further knowledge and understanding we have gleamed from the work he did. It might be difficult for some individuals to speak openly in front of their peers and provisions should be made for this. I would consider using the model in a group setting with individuals I felt would benefit from the rigid structure rather than be hampered by it. some important differences were discussed as well which I believe indicates how much has changed and developed since Mitchell’s time. There are most definitely merits to both models and I strongly believe there is a place for both of them in the world of debriefing. Conclusion Debriefing models have evolved and multiplied since the time of Mitchell and this demonstrates how important these models are to enhance the debriefing sessions.
com/2011/03/critical-incident-stress-debriefing.10.paho. .htm http://www.za/history. A.org/english/ped/stressmgn7. Inc http://www. J.html http://onlinelibrary.251. (1988).com/index_files/DefuseDebrief.com/doi/10. Stress: The history and future of critical incident stress Young. A.criticalincidentdebriefing. Responding to communities in crisis. The American Academy of experts in Traumatic Stress. NOVA. National Organization for Victim Assistance. A Guide to Psychological Debriefing: Managing Emotional Decompression and Post-Traumatic Stress Disorder. (1998) Providing Critical Incident Stress Debriefing (CISD) to Individuals and Communities in Situational Crisis. J.eyeofthestorminc.C.8 Bibliography Davis. D.org. (1994).peaceaccord.27442/pdf http://www. (2007).blogspot. Jessica kingsley Publishers. D. 1. Washington.pdf http://www.4. Mitchell.htm Kinchin.1576/toag.com/ http://charactertherapist.wiley. UK. M.
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