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

Recent Publication

2011-11-15T10:28:00.002Z

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

REVIEW

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.

COMMUNICATION

2011-08-12T15:45:00.007+01:00

Exercise in Helpful Active Listening

Complete the following sentences.

I feel frustrated when you.......

I feel happy when you......

I feel rejected when you.....

Listen to your partner/friend/relative share their experience of frustration/happiness/rejection or whatever they are feeling.

Set a time limit of five to ten minutes each.

Ask questions for clarification only, do not interrupt until they have finished speaking.

Try to understand the feelings that they are expressing. It is not always about the issue that is at the surface, but respect it if they say that it is.

Draw out the other person's feelings. Ask them "how do you feel about that?"

or repeat some words "you feel angry about that" to show them that you heard what they said or just be silent, caring and attentive.

When the person speaking has finished they will hopefully be able to tell you that they felt listened to, tell you what helped about the way in which you listened and that they felt understood.

Reverse roles then and repeat the exercise so that both people have a chance to speak and be heard.

It may be tempting to interrupt the speaker but just remember that each person will have a chance, and it feels good to be able to speak knowing that you will not be interrupted. This exercise is done with mutual respect, and without accusations. Using "I statements" saying how you feel only ensures the safety of this exercise.

GRATITUDE

2011-05-10T14:47:00.007+01:00

Developing a Habit of Gratitude and Appreciation
Bill O'Hanlon, www.billohanlon.com

There are three types of appreciation:

1. Highlighting Gratitude to Oneself: Note to oneself things that one can be grateful for on a weekly basis

2. Savoring: Note to oneself or others what one appreciates aesthetically, like a beautiful sunset, a good meal, and so on

3. Expressing Gratitude to Others: Express appreciation to those people one values and is grateful to

Noting to oneself the things one appreciates

Some people do this daily, some people do it weekly, but developing a habit of gratitude and appreciation can be helpful.

One could note the things one appreciates about the day or the week as a way to do this.

One could also focus on the people one appreciates.

One could also note the things that others are struggling with and use that as the basis for appreciation and gratitude. Things like hearing about or noticing that others don't have enough to eat, don't have a place to live, are dealing with with serious illness or loss and so on.

Savoring the present

This usually involves attending to your sensory experience (sights, sounds, smells, touch and tastes) in the present.

Another element of savoring is not to multi-task. Do and notice just the thing one is involved in or doing. This might mean turning off the television or not reading while you are eating and instead focusing on the taste, texture or smells of the food you are eating.

Expressing gratitude to someone

Positive psychology researchers usually recommend writing a "Gratitude Letter" to someone to whom you are grateful and have never fully expressed your appreciation. They also recommend you be present when the person reads the letter. If that's too difficult, they suggest being on the phone or on a Skype video when the person reads the letter.

Try writing your own gratitude letter to someone. Be as specific as possible about the things you are grateful for and appreciate about them and/or what they have done for you.

BOOKS

2011-03-24T11:14:00.004Z

"THE MOZART EFFECT" by Don Campbell

"Offering dramatic accounts of how music is used to deal with everything from anxiety to cancer, high blood pressure, even mental illness, "The Mozart Effect" reveals how exposure to sound, music and vibration can have a lifelong effect on health, learning and behaviour. Whatever your music taste, Don Campbell explains how to make "The Mozart Effect" work for you. Effects include:

Using sound and music to stimulate memory

50 common ailments for which music can be used as treatment or cure

Easy-to-follow exercises to help you raise your spatial IQ, sound away pain, boost creativity and make the spirit sing."

"MUSICOPHILIA" by Oliver Sacks

"Tales of Music and the Brain"

"Oliver Sacks' compassionate, compelling tales of people struggling to adapt to different neurological conditions have fundamentally changed the way we think of our own brains, and of the human experience. In "Musicophilia" he examines the power of music through the individual experiences of patients, musicians, and every day people.....Our exquisite sensitivity to music can sometimes go wrong: Sacks explores how catchy tunes can subject us to hours of mental replay......yet more frequently, music goes right: it can animate people with Parkinson's disease who cannot otherwise move, give words to stroke patients who cannot otherwise speak, and calm and organize people whose memories are ravaged by Alzheimers's or amnesia. Music is irresistible, haunting and unforgettable, and in "Musicophilia" Oliver sacks tells us why."

Bereavement

2010-05-02T17:55:00.000+01:00

Bereavement or mourning is a process not a state, which occurs after the loss of a loved one. Grief refers to the personal experience of the loss. Bereavement or loss can occur for many reasons. It can happen the death of a spouse, child, parent, sibling, close friend, or after a miscarriage. It can happen due to the loss of the expectation of how your life was going to be, through career loss, financial trouble, infertility, family, relationship or marital break-up.

According to Elisabeth Kubler-Ross the five stages of grief are:

1. Denial and isolation.

2. Anger.

3. Bargaining.

4. Depression.

5. Acceptance.

According to Worden (1982) after one sustains a loss there are certain tasks of mourning that must be worked through for balance to be re-established and for the process of mourning to be completed. These four tasks are the following:

1. To accept the reality of the loss.

2. To experience the pain of grief.

3. To adjust to an environment in which the deceased is missing.

4. To withdraw emotional energy from the deceased and reinvest it.

The overall goal of bereavement counselling when someone has died is to give the bereaved person time to talk about their loved one, to talk about their feelings of loss, to work in time towards a place of acceptance, and to help them to see that it is possible to continue on in life without forgetting their loved one, and knowing that they will always have a place in their life.

Imagery For Relaxation

2010-05-02T17:53:00.000+01:00

Give your mind positive images and caring, encouraging self-talk, and change worrying thoughts to helpful healing thoughts. Positive images raise energy levels. Negative images produce gloomy moods and tired muscles. To be able to use the mind effectively it needs to be quietened, you cannot relax if your mind is jumping hurdles.

Form a clear image of a pleasant scene. Include images from other senses. If everyday thoughts come into your mind, just note them mentally and let them pass, don’t hang onto them, bring your attention back to the chosen image.

Include images from all of the senses:-

See the shapes and colours

Smell the scent of flowers

Feel the grass beneath your feet

Hear the birds singing in the trees

Taste the salt air on your lips

1. Sunny beach

2. Field of wild flowers

3. Cool forest

4. Clear stream

5. Sloping hill

6. A vase of flowers

7. A picture or a painting

8. Trees blowing gently in the wind.

9. A favourite room in your house.

10. A garden you know well.

11. Go for a walk in your mind.

12. A harbour with boats on the water.

13. Use your ears and listen to the sounds around you.

14. You are on a mountaintop on a tropical island. Below there is a tropical rain forest, The morning rains are ending. In the distance there is a white, sandy beach and a palm tree.

15. Imagine a tree filled with song birds. The birds fly away from the top branches, then the next branches, and so on until there is just one bird left. Concentrate on this bird until it flies off, then look at the branch it was sitting on and focus on just one lovely pale green leaf.

These are only suggestions. If these do not work for you, make up your own scene or try an alternative method of relaxation.

Breathing Exercises

2010-05-02T16:27:00.000+01:00

The Way we breathe influences the way we feel. How we feel influences how we breathe. Breathing correctly can produce feelings and states of mind that combat stress. Relaxation gives your body time to rest and repair, physically and mentally. It reduces the heart rate and if practised regularly, will lower your blood pressure.

Correct breathing is slow and regular. Inhalations should be comfortable and natural. Nasal breathing is more effective in producing calmness. By watching your breathing a stillness can be experienced. This is often associated with feelings of calmness and restfullness. Prolonged exhalations in particular produce stilling effects. Conscious slowing of your breathing will produce calm.

Breathing to release tension

Sit or lie in a comfortable position with your arms and legs uncrossed, your spine straight and your feet on the floor. Take a few moments to get yourself as comfortable as you can. Let your body go loose and heavy; Let the chair, bed or floor support the weight of your body completely. Close your eyes. Breathe easily and normally, don't force your breathing. Concentrate on your breathing for a few moments. Choose one of the following methods of relaxation: -

1. Breathe in deeply into your abdomen. Put a hand on your stomach until you can feel it fill up. Count to four as you inhale. Let yourself pause for two seconds before you exhale. Count to six as you exhale. Continue breathing in this way for five to ten minutes. Notice your breathing gradually slowing, your body relaxing and your mind calming as you practice this breathing exercise.

2. Think, “breathe in relaxation.” Pause for two seconds before you exhale. Breathe out from your abdomen. Think, “breathe out tension.” Become aware of any tension in your body as you inhale. Let go of tension as you exhale.

3. Think of one word that you associate with being relaxed. The word may be something like 'calm', 'peace', 'sunshine' or even 'relax' itself. It doesn't matter which word you choose as long as it is one word that means relaxation to you. Say your word to yourself each time that you breathe out. So, breathe in, breathe out and say the word in your mind. As you breathe out visualise yourself breathing the tension out of your body.

4. Visualise yourself breathing in a favourite relaxing colour and breathing out a colour that you might associate with stress.

Let yourself relax like this for 5 to 15 minutes. When you have finished relaxing allow yourself to slowly come to; never jump up too quickly during or after relaxation.