Debriefing

You are likely to be the only onsite interventionist leading this effort. This is a big difference between CISM interventions and Onsite Services. CISM uses a team approach. In some debriefings there may be as many as 4 team members working with the group. EAP Onsite Services generally uses one, more if the event is large scale. Although this is not recommended, it nonetheless is a reality in EAP practice. It also speaks to the level of experience one needs to take on this role. If you can bring an assistant the better the outcome for the entire organization.

Group Debriefing

Group debriefings are recommended when an event had the capacity to produce a critical incident stress response within individuals. The goals is to mitigate the reactions through intervention that events like these can create. Onsite debriefings used by the EAP follow Mitchell's model in theory:

The goal is to move employees through a process that starts as a cognitive exercise, eases them into a more emotional stage and returns them to a cognitive state of mind. It is precise by design and not a free form group. Counselors who have tried to use a more group therapy model (out of their own comfort) will lose control of the group. There is the potential for over exposure and retraumatization in a free-form group format.

Group size should range between 3-15 with 8-10 being optimal. Two groups of seven is far better then one group of fourteen, but the workplace may not be able to support it. You will be moving in a clockwise manner so by the time you work around the circle and get back to the first person again to begin the next step, there shouldn't have been too much idle time for that person. That is why groups cannot be too large for this process to work. If they are sitting and waiting, they will reconstitute, deteriorate or become disruptive.

Groups need to be homogeneous. Do not mix management with employees or even HR. Address this upfront when putting the intervention together. Management/HR may try to come in late and sit in the back. If this happens the group must be stopped and the person asked to leave. Let them know you will speak to them after the group. Do not mix departments. It is ok to ask in the introduction if there are any levels of management sitting among the group. If you need to ask a manager/HR person to leave the group, do it with tact and professionalism.

Introduction

Who you are, your credentials and qualifications are presented to verify why they should listen to you. Humorous ice breakers are inappropriate. However some self disclosure about your reactions to the event may help set the stage for the sharing to come. If there are deceased, know their names.

Describe the benefit of the intervention. Why and how it works. Let them know that while participation is always voluntary it is strongly encouraged if not for your own assistance, but for the help of others.

Describe the role of confidentiality. How it applies to the information shared and your ethical/legal commitment to it. Let them know that management will be interested in how the group goes and that an overall process report would be provided, but that nothing specific or any information attached to a particular person. Ask if there are any questions about this.

Please request that nobody leave during the meeting and if they believe they will need to or cannot stay throughout the entire group, they should be asked to leave and you can speak to them afterwards. Cell phones off. If some of this seems rigid, consider the ee who is discussing his/her experience, full of emotional content and a group fully engaged in her story. Consider then an assistant knocking on the door, coming in, and letting a group member know that there is an important call holding for them. The employee asks for a message to be taken. The assistant makes a face and states that it really is important and insists you take the call. The employee, truly conflicted, looks at you for guidance. The employee then excuses self and leaves. All eyes return to you and the employee who was in mid story. You will try to start again, but remember this employee may come back and interrupt the flow once again. Employees need to complete the cycle of the group, that is, return to the cognitive stage of the group process before they exit.

It is true that business does not stop because the company is offering onsite services. You do, however, need to protect the integrity of the group.

Once the group has confirmed their understanding of the intervention, you can move to the Fact Phase.

Fact Phase

First Responders work with facts and try to remain and operate within the "fact world". It is safer there. Employees will have fewer facts or just a smattering depending on when and where they were when the incident happened. Fact gathering is an important phase to give perspective to the breadth of the event, but it most be collected carefully. There have been techniques used in debriefings like "Paint the Picture" and others. This process is designed to take the collective experience and create a timeline. This process, however, can become problematic. Employees may be hearing new information. For some this may be helpful in a clarifying way, but for others it may generate a new emotional reaction and potentially a re-traumatization. For this reason, as group leader it may be of benefit for you to start with the facts as you know them and start the group with a question, Are these the facts as you know them and what are or were your first thoughts about the incident. By presenting it this way, I am combining the first two cognitive phases to strengthen the groups internal processes. I do not want to get to emotional reactions which "new facts" may stimulate. Work clockwise giving each participant an opportunity to speak. Review the facts and move to the Thought phase.

Thought Phase

This phase begins to attach thoughts to facts. "What were your first thoughts when you learned or acted on ..." Listen, paraphrase and thank them for sharing. Move to the next person with the same question. Be systematic. Remember you are not a therapist here. Listen for themes. You will hear them and begin to normalize. You will see the emotional content just below the surface. Your instinct as a counselor will be to have them continue speaking and express the emotional piece. Instead stick with the process with a statement like, "I see this is beginning to bring up some feelings. We will get to them, but for now I want you to hold onto them." Move to the next phase.

Reaction Phase

We have now moved to the emotional piece of the cycle. You will spend the most time here. The group's adhesiveness is likely to show. Let everyone go at their own pace. No need to push or probe. They will get to a point where its enough and that's the time for your to reflect, normalize and move to the next person. If they cannot stop or move to other "like" experiences, they must be reeled in with some education on how this event "can trigger memories of other events" or an acknowledgement of the benefit of additional resources. People may want to leave during this time (drinks of water). Discourage this and remind them it is helpful to all if they remain, but recognize that this person is struggling. Have tissues, watch out for junior therapists, or codependent personality types, fixers, and monopolizers.

Impact Phase

You will begin, if you haven't already, start to normalize the aftereffects that a stress response can produce. Recapture what has already been shared and normalize. It is ok to let them know of some other common reactions they may experience, but no need to go through the list. If you have a handout on these, mention it and remind them that this is an inclusive list not a list of symptoms that everyone will get. Its aim is to educate on the totality of the stress reaction.

Teaching Phase

We continue to move out of the emotional domain back to the cognitive domain. You will be doing most of the talking. You will be talking about stress in general, resilience, coping skills, and additional resources.

Re-entry Phase

We want employees to begin to think about returning to the routine of life as it relates to work and home. Asking everyone, what comes to mind (cognitive) when you think about returning to your work routine or sitting in front of the computer? The importance of maintaining family routines and schedules. Now is the time to resume a sense of normalcy after just going through an abnormal experience. Remind them of the EAP's availability and role.

Wrapping up

There may have been issues that came up that there was an agreement to discuss with management. Remind the group of confidentiality and respecting each other's privacy and courage to share. Lead them to the handout table. There is no need to run right to the manager. Linger a bit for stragglers who may want some private talk.

In the weeks following September 11th, a regional EAP made heavy use of a particular provider in its counseling network for crisis stress
debriefing sessions for its large employer client. Despite claims that the provider was well known to the EAP and that the EAP had used and evaluated its costly services previously, it soon became evident that the provider lacked the claimed expertise. Employees in need did not receive the expert assistance they required until another provider was substituted several days later. Such incidents are not necessarily rare, and the cost in employee dissatisfaction can be high. It is in the employers’ interest to examine very carefully the competence and quality of the specialized services any EAP claims to provide before a crisis occurs.

Personalities/Roles will emerge during the intervention. These roles are likely what they play in the workplace. Some are accepted and by others some are not and can become a nuisance to the group. You will need to gauge the reactions by others to such roles and intervene when appropriate. Office roles will play out and employees may use the group as an opportunity to confront others where outside of the group it may not be politically acceptable.

Jr. Therapists- Will look to align with you. They will display their keen insight and look to control the group or speak for the group. This may seem like a comfort at first for your own stress, but you will need to "free" him/her from that role. A statement like, "Oh I see we have a Jr. Therapist in the group, very insightful. I'd like to ask you to hold off on that kind of feedback for now so that everyone gets a chance to see it for themselves, but thank you."

Codependents- they will feel everyone else's pain but offer little of their own. They are the first one to grab the tissues for another or comment that you do not have any and they will get them. They are rescuers, fixers, and may seem m/paternalistic. You are not going to change this nor should you try unless it disrupts the flow of the group.

Monopolizers- The event has triggered everything under the sun and will drain the group by the ongoing expression of their plight. Once you move from them they will bring the issues back to them. They need the audience and may resent you if you are too direct in your approach to restrict them. The group will look to you to do this and you need to, but remember, she has been impacted and needs an opportunity to participate.

Resisters- Won't speak, or participate. May make comments that undermine your efforts or the workplaces. They may also have been dramatically impacted by the event. They are struggling with their anger and this group is likely to be threatening to them. Respect their right to sit quietly. Demand the same respect to not be disruptive for the sake of others who may share a different opinion. I have never had to remove a resistive person, they eventually come around. Always make an effort to include and always respect their right to not participate.

Children and Disasters

Getting to the Traumatized

CRITICAL INCIDENT STRESS INFORMATION SHEETS

Nuts and Bolts-Talking with your Teen

Pets and Disasters

Steps to take when dealing with Traumatic Events

When Disaster Strikes- Volunteerism