Critical Incident Debriefing

Catastrophes, whether by forces of nature (e.g., earthquakes) or man-made (e.g., shootings at a school or at the work place, war zones) result in devastating psychological trauma, in addition to any physical trauma. By definition, disasters impact more than just one or two people. An individual can either be a direct survivor of the event, or a witness to it, to suffer the impact of the experience. Often, affected individuals are only loosely connected by geographic area or random experience (for example, a bank armed robbery). Typically, the initial reaction is shock, which is followed by other psychological and/or physical symptoms (see my article on Post-traumatic Stress Disorder at this web site).

Because many individuals who share the experience are affected, an extremely effective way of offering initial psychological assistance (usually on site) is a specific and focused kind of group treatment known as "Critical Incident Debriefing (CID). CID is "psychological first aid." It targets the immediate experience and the immediate, commonly shared reactions. It is not "group psychotherapy" nor a substitute for individual psychotherapy. There may, or may not, be a need to follow up CID with ongoing psychotherapy, depending on an individual's coping abilities, prior experiences with traumatic events, and the extent of the event's impact on the person's daily life.

CID is also useful for those who experience "secondary post-traumatic stress"--the volunteers, rescue workers, medical and/or law enforcement personnel who may not have directly experienced or witnessed the devastating event, but who have been the ones working and helping at the scene shortly thereafter. Secondary post-traumatic stress is a real phenomenon and cannot be ignored.

Special training and professional certification in CID is required for a therapist to offer this kind of assistance.

Marleen Norman, LCSW, is a psychotherapist in San Francisco.