Debriefing the Trauma Team: Taking Care of Your Own

One 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!