What are the Risks of Critical Incident Stress Debriefing?
Critical Incident Stress Debriefing (CISD) is a psychological approach that was once used by clinicians to help first responders immediately after a traumatic critical incident, such as traffic accident or rail disaster. Critical incident debriefing was often provided in a group setting. People shared their experiences of the trauma incident, which was meant to provide immediate stress relief and support to people who were distressed.
This model is now out of favour because talking about a trauma event can traumatise or re-traumatise other members in a group. People experience traumatic events differently. How a person responds to a traumatic event depends on their specific role in the event, their physical distance from the event, their personal life experiences, and how they make sense of the event and personal supports. Hearing other people’s personal trauma experiences can cause distress and harm to others in a group who were less involved or felt less affected.
Say No to Critical Incident Stress Debriefing
When I started my career, over 30 years ago, we used the critical incident stress debriefing approach. I used it after 911 when people targeted specific community groups in Sydney with racial abuse. But I don’t use it anymore.
Even now, some managers ask clinical supervisors to provide critical incident group debriefing as it’s an approach that has been used for a long time and was familiar to a lot of us. This is what I say:
- Do not use Critical Incident Stress Debriefing: This outdated approach to debriefing after a critical incident workplace event has since been replaced by the Psychological First Aid model. Psychological First Aid provides practical support after a traumatic event such as a workplace accident.
- Establish regular group supervision sessions: Team members working in mental health and trauma may find it useful in future to talk about their work stressors in regular ongoing group support/debriefing sessions. Debriefing is often incorporated into regular group supervision discussion.
Psychological First Aid
Psychological First Aid is now the recommended approach to support people after a trauma event. This might include a workplace accident or large-scale event. Psychological first aid is a practical approach that focuses on the ‘here and now’. It helps to decrease people’s initial distress and create a sense of safety and security immediately after a traumatic event and in the next few days and weeks.
You don’t need to be a clinician to provide practical psychological first aid. Community volunteers can be trained in the approach. However, clinicians are often employed to provide psychological debriefing to first responder organisations or they are engaged as part of a coordinated emergency response to large scale disasters.
Psychological First Aid includes:
- Looking to see who needs assistance.
- Providing a sense of comfort and support.
- Creating a sense of safety and calm.
- Listening to the needs of the people affected by trauma.
- Attending to immediate physical needs e.g. Does a person need a drink or to eat? Do they need a change of clothes or a lift home?
- Providing practical information and advice.
- Linking people with support services and connecting people with each other.
When clinicians provide psychological first aid, they may also provide education about the nature of trauma, including signs and symptoms a person may experience at the time of a trauma event or over time. Clinicians do meet with people one-on-one after a trauma event to provide psychological first aid, but they don’t provide trauma counselling. They often organise a follow-up phone call and may organise or suggest a counselling referral.
Further Information and Training
Training in Psychological First Aid is available to community volunteers as well as clinicians. Some training providers include:
- Phoenix Australia – Centre for Post Traumatic Mental Health www.phoenixaustralia.org/
- Australian Red Cross www.redcross.org.au
- Lifeline www.lifeline.org.au
For further information on Psychological First Aid, refer to:
Psychological First Aid: Supporting people affected by Disaster in Australia by Australian Red Cross and Australian Psychological Association.
About Melinda Austen
Melinda Austen is a clinical supervisor and workplace and leadership coach with over three decades of clinical experience working with refugees, asylum seekers, Defence veterans, Police and couples. She now helps the helpers. Melinda supports colleagues, including social workers, clinicians and other professionals such as lawyers and allied health who work with vulnerable clients. In her supervision and workplace coaching practice at person2person Consulting, she is driven by a desire to help people foster healthy, productive teams and thrive in their work. www.person2personconsulting.com