Tuesday, November 15, 2011

IACP Workshop Review Publication

Workshop review published in the Autumn 2011 edition of Eisteach the Journal of the Irish Association for Counselling and Psychotherapy.


Title: South East Regional Critical Incident Stress Debriefing (CISD)

Venue: Brandon Hotel, New Ross, Co. Wexford.

Presented by: Peter Ledden RPN MIACP MLBCAI Director of Abate Counselling and EAP Limited Dublin. Accredited Supervisor IACP LBCAI.

Date: 15th May 2010.

Peter began this very interesting and informative presentation with a brief history of Critical Incident Stress Management (CISM) and the ABATE organization. He defined critical incidents as very traumatic incidents which “are unusually challenging events that have the potential to create significant human distress and can overwhelm one’s usual coping mechanisms.” Peter adds that this occurs temporarily following the incident and that individuals can be assisted with early intervention. Peter stressed the importance in CISD of being a Manager first and a Counsellor second. Practical issues have to be dealt with first and this demands assessing, planning, implementing and evaluating. Critical Incidents which Peter has assisted with include the Dublin Bus crash on Wellington Quay in 2004, the Asgard sinking, the Aer Arann plane crash in Connemara and the recent Dublin Street Riots.

Defusing and Debriefing are two techniques which are used in CISM. “Debriefing (CISD) is a structured, small group crisis intervention process”. The goal is to lower tension and mitigate a small group’s reaction to a traumatic event. It should only be attended by people who were directly involved with the critical incident. Individuals should be grouped according to their involvement where possible e.g. all fire personnel together, and he stressed the importance of not leaving anyone out. CISD is usually provided between 24 and 72 hours after a traumatic event. However, CISD is not professional counselling nor a treatment for post traumatic stress disorder.

Defusing is a shortened version of the debriefing, provided within hours of a traumatic event. It usually takes 20 – 45 minutes, whereas debriefing usually takes 2-3 hours. Defusing must be provided within 8 hours of an incident, and ideally within one to two hours after the incident. Defusing must be conducted by trained CISM team members only.

Peter presented the SAFE-R Model (G.S. Everly 1995) of CISD which involves:

1. Stabilising the situation.

2. Acknowledging the crisis.

3. Facililitating understanding

4. Encouraging effective coping techniques.

5. Restoration of independent functioning.

The documentation provided by Peter describes the impact of acute stress after a critical incident. According to this there are three phases in the process leading to recovery:

The acute stress phase “begins at the moment of the impact of the critical incident and most of the common symptoms of acute stress manifest within the first twenty-four to thirty-six hours. Although this is the briefest phase, it is also the one that causes the most distress”. There are physical responses, psychological responses, emotional responses and behavioral responses. We experience the world through the five senses and smells that people smelled at the time of a critical incident can have the power to re-activate or re-trigger the feelings that were experienced at a later time. It is helpful to explore this.

“The awareness phase follows the initial overwhelming shock and may last for just a few days. However, the timing of any of these phases is dependent of the severity of the critical incident and the individual’s unique response to loss and acute stress”.

The re-entry/integration phase is a time for cognitive reframing if useful to facilitate closure, and to foster group cohesion if necessary. A person may wonder “how long will I feel like this?” and this is a good time to discuss this. It is helpful to end on a positive note on how well they dealt with the situation to safely land them back in a better frame of mind than when they came in.

“People usually begin the process of acceptance and integration within three to four weeks after the critical incident and gradually begin to know that they can not change what happened but they can find the strength and courage to learn to live with what happened and ensure that unnecessary side effects are prevented.” Peter used the phrase “Beehive Effect” to describe the collective unconscious defense mechanism soemtimes exhibited by emergency services when they close ranks as a group after dealing with a critical incident.

Peter was very skillful, clear and easy to listen to and covered a lot of very useful material during the workshop.

In the afternoon ten volunteers from the group took on the roles of people affected by a workplace trauma and enacted a debriefing. This was very skillfully managed by Alice McLouglin in her role as the debriefing manager.

Peter said that he is passionate about this work and this was very clear to all of us. Peter finished the workshop with a feedback session from the group. Peter’s clear and detailed presentation was appreciated by all of the group.

Monica Jackman M.I.A.C.P.

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