In light of events
fifteen miles away (Baltimore) to 10,000 miles from my doorstop (Nepal), this
essay titled, "Individual and Collective Crisis/Trauma Intervention and
Debriefing: Ten Steps and Strategies," clearly has immediate relevance
and application. Actually, the impetus for the article occurred last week
when a friend and colleague (originally from Nepal) asked me to talk briefly
about stress and trauma on a strategic planning phone conference with other
Nepali-born individuals.
Always appreciate any
ideas or feedback. If you think it works
for any of your publications or for public transmission, please use or share.
Thanks,
Mark
~~~~~~~~~~~~~
Individual and Collective Crisis/Trauma
Intervention and Debriefing:
Ten Steps & Strategies
The
devastating earthquake, with its mounting death toll, and the life-and-death
challenge of speeding relief throughout Nepal, especially in more remote areas,
clearly is the immediate national crisis.
The destruction, disruption, and dislocation is generating human,
societal, and cultural tragedy and trauma of epic proportions – be they personal,
family, societal, cultural, and archeological.
However, today, right now, and as the proverbial dust settles, many will
need more than food, clothing, shelter. Also
vital: psychological counsel, emotional grieving,
and gradual healing; so too fostering stress resilience and hope as well as ongoing
peer and community support and sustenance.
The critical task: not just repairing and restoring homes and
shrines but also rebuilding and reintegrating hearts and minds!
And
these physical and psychological resources and responses are not only crucial
for those in Nepal. The trauma and
lingering uncertainty, especially for the safety and well-being of family and
friends, is right at the doorstep of people of the Nepali Diaspora thousands of
miles from ground zero.
Before
listing key intervention tips, it’s necessary to define two terms – Crisis and Trauma:
1) Crisis:
is a critical event or experience that triggers feelings of threat and loss
while also challenging the individual’s, family’s, and/or social
group-community’s coping resources and capacity for action. Crisis also involves a time-limited period of
“danger” and “opportunity.” Systems are motivated
to regain physical and psychological control; they are more open to
reaching out for resources and unconventional problem-solving structures and
strategies. Individuals and groups are
more ready to grapple with feelings of loss and grief and receive vital emotional
support. However, a lack of support for engaging
meaningfully with such acute pain and problems in a timely manner can lead to
regressive or maladaptive coping (e.g., increased drinking or drug use) and stress
or trauma-induced mind-body illness.
2) Trauma:
is a state of both overwhelming emotional and physiological arousal combined
with intensely negative cognitive processing. According to the experts, trauma can occur from a one-time event or an ongoing
experience, including trauma based on the nature of one’s role-relationship to
the stressor, e.g., ground zero victim, the family members of a victim of
violence, the second-hand trauma of witnesses to grisly violence, or the impact
on individuals working with trauma victims.
Trauma effects can range from being numb or immobilized to a state of
panic, as well as feeling helpless and hopeless. And sometimes the reaction can be delayed;
hence, Post-Traumatic Stress Reaction.Trauma effects can range from being to numb or
immobilized to a state of panic, as well as feeling helpless and hopeless. And sometimes the reaction can be delayed;
hence, Post-Traumatic Stress Reaction.
And
responding effectively to both Crisis and
Trauma is complicated by the fact that previous emotional experience with
separation and loss, illness and/or disability, helplessness and hopelessness
are, sometimes powerfully, at other times subtly, rekindled adding to the
intensity of the present-day crisis and/or trauma fires.
Ten Individual and Collective Crisis/Trauma
Intervention and Debriefing Steps & Strategies
1.
Acknowledge Stressful Feelings. During a crisis, while wanting to immediately
swing into action, at some point, sooner rather than later, it’s important to
take an honest psychological self-inventory.
Not addressing acutely intense or prolonged stress or depressed feelings
is inviting mind-body health issues, even illness down the road. Of course, a certain amount of stress during
trying times is natural and even useful, stimulating focus and determination. Extended hypervigilance without sufficient support
is the problem!
2.
Quickly Connect with Others. Both for support and problem-solving information
reach out to trusted or credible resource people and organizations. By its nature, crisis problem-solving means
plunging into unknown or uncertain waters.
Partnering with people more familiar with the experience, or at least
with managing crisis or trauma emotions, is vital. This is no time for Lone Rangers and Rambos
or Rambettes.
3.
Appreciate the Time-Limited Nature of Crisis. During this period of acute
uncertainty and threats to survival, people will typically open up to new
ideas, approaches, and actions, especially if guided by knowledgeable and purposefully
reassuring leaders or guides. Crisis is
a “no exit” challenge: an individual or
group will either take positive or proactive problem-solving steps or they will
hide out or freeze into self-defeating and escapist adaptations. (Hence the previous mentioned “danger” and
“opportunity” crossroads of crisis. And
the danger is not just external; see #4.)
Strike when the ego is hot!
4. Be Aware of Unconscious Intrusions. The acute stress of crisis generates cracks
in our psychological defenses. These
defenses normally keep at bay painful memories and feelings. However, under intense and unrelenting
pressure, cracks emerge and subterranean emotions and images, memories and
dreams often appear adding to stress levels and heightening a sense of
confusion or disorientation. Sometimes
people mistakenly believe they are going crazy; or can’t explain their own
coping. The confusion is a natural
component of emotional crisis flooding.
For example, a week after 9/11, a friend, a former artillery officer in
Vietnam, was perplexed by his lingering angst.
Certainly he had seen mayhem and destruction before. I suddenly recalled a tragic piece of his past
family history, perhaps a contributing factor to his current dis-ease: “Hadn’t you lost your first wife in a house
fire; and your personal rescue attempts were unsuccessful?” Momentarily startled, John poignantly said,
“I hadn’t thought of that!”
5.
Understand the Key Components of Grief and Trauma Debrief. For both powerful loss and trauma, the
classic model of grief has relevance: there are the initial stages of shock,
sadness and or despair, rage, guilt, (or, for example, “survivor’s guilt” for
those in the Nepali Diaspora), ambivalence, and/or withdrawal, etc. Then, through time, chemical rebalancing, and
emotional support, as energy, confidence, and possibility levels increase, the
process typically progresses into refocused attention, focused aggression or
determination, individual and collective problem-solving, relief and,
hopefully, hard-won acceptance of the loss.
While still painful, memories are no longer paralyzing or inducing panic
states. New lights on the horizon of
hope may finally be sighted.
During
times of crisis, an individual may have the capacity to quickly engage with
grieving. In contrast, someone in the
throes of trauma may need to move more slowly through the healing stages. Of course, for both pathways it’s not a
linear evolution. One may take steps or
stages forward and then fall back, needing more than once to rework and
reintegrate sobering, troubling or frightening thoughts and feelings. Also, with Post-Traumatic Stress, effective
coping during the crisis period now starts to unravel. Once our survival guard is down, especially after
prolonged and draining vigilance and tragic loss, then exhaustion, high anxiety,
rage, despair, and/or depression may take over.
Finally, research reveals that early childhood separations, losses,
exposure to violent incidents, and other adverse, trauma-inducing experiences appear
to be correlated with adult PTSD-like reactions.
6.
Grasp the Individual Nature of Grief and Paths of Healing. There is not one way to grieve; each person’s
process is unique to his or her bio-psycho-social-cultural nature and history. Consider these approaches or styles:
a)
Cognitive or head – trying to make immediate intellectual sense or order of the
experience
b)
Affective or heart – needing to experience and express the array of grief
emotions
c)
Sensual – needing to be touched or stroked, held and hugged
d)
Social – needing to share ideas and/or emotions with others, especially those
who can truly relate
e)
Action – regaining a sense of purpose and emotional control by taking action
plans and steps
f)
Reflective – needing time alone to meditate upon and often creatively express
pain and meaning; the process may be reinforced interacting with nature, e.g., a
number of Veterans have engaged in hiking the Appalachian Trail as part of
their trauma recovery process.
Ultimately,
reconciling or integrating head and heart, body and spirit along with restoring
a sense of hope and new possibility, perhaps even new partnerships, and
creative outpourings are some of the byproducts of a healing grief experience.
Finally,
there’s no absolute time frame for moving through the grief stages. Don’t accept when people say some variation
of, “It’s been a couple of months now; stop looking back; stop dwelling on the
past; time to move on with your life, etc.”
In fact, some powerful losses are never completely mourned. Eventually, life again feels worth living,
but there will always be “grief anniversary” moments and memories. The only caveat: a month after the critical
incident, if you are still stuck in the same dark emotional hole, (a shorter
time frame, of course, if disruptive health or suicidal issues emerge) strongly
consider contacting a professional health and/or mental health provider.
7.
Consider these Two “Grief Dynamic” Passages and Reach Out for TLC:
a) There’s a real difference between feeling
sorry for yourself and feeling your sorrow.
When you are feeling sorry for yourself you typically blame others. When feeling your sorrow you have the courage
to face your pain. And there are times
in life when we all need to face our sorrow! And
b) Whether the loss is a key person, a desired
position, or a powerful illusion, each deserves the respect of a mourning. The pit in the stomach, the clenched fists
and quivering jaw, the anguished sobs prove catalytic in time. In mystical fashion, like spring upon winter,
the seeds of dissolution bear fruitful renewal.
During
highly uncertain or stressful times, try finding a “Stress Buddy.” (The concept was derived from working with
military spouses. They would find a
supportive partner, a fellow spouse, when their soldier went overseas,
especially “down range, in harms’ way.”)
However, a “Stress Buddy” should provide a variation on traditional TLC: Tender
Loving Criticism and Tough Loving Care!
8.
Create a Safe Space whether In-Person or in Cyber. When trying to console or counsel others, as
much as possible, find a private place to share. Assure the person of your confidentiality,
unless the individual threatens self-harm or harm to others. In light of the disorienting nature of
crisis, try to be open to a wide range of emotional ventilation (along with
cultural variation) without critical judgment.
In my estimation, listening carefully to someone demonstrates real
respect.
Virtual
support systems are especially vital when trying to communicate with and
connect people separated by wide distances.
Of course, as more and more counseling services are provided
technologically, through phone, email, or Skype, extra effort must be made to
assure “message sent is message received.”
And to expedite effective and efficient group communication, whether involving
supportive or strategic planning services, whenever possible, an experienced
facilitator is wise.
9.
Keys for Comforting Others. While
most appreciate an attentive ear or a sturdy shoulder during times of
confusion, chaos, or crisis, reaching out or supporting others takes both some
science and art. Perhaps the most important quality is being
non-judgmental. Some make this mistake
with the best of intentions, e.g., when trying to reassure another claiming,
“Oh, you shouldn’t feel that way.” Or we
can unintentionally trivialize someone’s pain by saying, “I know how you
feel.” Unless you have truly walked in
another’s particular painful path, better to say, “I don’t fully grasp your
experience, (or ‘I can only imagine’), please help me understand.” Or, if you want to share, try saying, “I
don’t know if this is relevant, however, for me your story brought up this
thought or memory…” Again, after sharing
your idea or story, make sure you refocus ears and eyes, head and heart back on
the person in crisis or trauma.
The
communication key, of course, is not quickly offering advice, unless asked, (in
general, avoid, “Here’s what you should do!”); rather, ask sensitive questions
and listen reflectively. Check out
understanding by paraphrasing back to the person what you’ve heard. When emotions are particularly charged, check
out whether “message sent is message received.”
Finally, if giving advice, spoon it out in clear and concise, bite-sized
chunks for easier intake.
10.
Help People Find Purpose and Passion in Pain. Almost all of us want a
sense of meaning and purpose in our lives.
This can seem hopelessly lost in times of tragic loss and destruction. However, whether rapidly or patiently, enabling
those in the throes of crisis and trauma to begin to embrace their pain -- to
either open the emotional floodgates or to explore slow yet steady, gradual
grief-steps – often means helping individuals, families, and communities
discover unrecognized and untapped sources of strength. People may even regain or evolve a new sense
of passion, especially wanting to help others in their community; one emerging
from the trauma or crisis crucible may well seek a purpose larger than their
own safety and well-being. (And
remember, the root of “passion” is suffering,
as in the “Passion Play,” that is, the sufferings of Jesus or, more
generically, the sufferings of a martyr.)
As I
once penned:
For the Phoenix to rise from the ashes
One must know the pain
To transform the fire to burning desire.
Closing
Along
with traditional disaster rescue, resource, and recovery efforts, grief and
trauma intervention and engagement, especially during double-edged, “strike
when hot” times of crisis, can substantively assist overwhelmed individuals and
families, groups and communities.
Despite the immediate assault on a victim’s senses and sense of
identity, with timely and knowledgeable support we can learn and evolve
individual and collective stress resilience skills and strategies. We not only can survive the chaotic present
but often develop psychological attitudes and aptitudes – head and heart
muscles – that have us better prepared to survive, learn from, and creatively
adapt to future hazardous events and challenges.
Mark
Gorkin, MSW, LICSW, "The Stress Doc" ™, a Licensed Clinical Social Worker,
is a national keynote and webinar speaker and "Motivational Humorist &
Team Communication Catalyst" known for his interactive, inspiring and FUN
programs for both government agencies and major corporations. The Doc is a training and Stress Resilience Consultant for The Hays Companies, an
international corporate insurance and wellness brokerage group. He has also led “Resilience, Team Building
and Humor” programs for various branches of the Armed Services. Mark, a
former Stress and Violence Prevention Consultant for the US Postal
Service, is the author of Resiliency
Rap, Practice Safe Stress, and of The Four Faces of Anger.
See his award-winning, USA Today Online "HotSite" – www.stressdoc.com – called a "workplace resource" by National
Public Radio (NPR). For more info on the Doc's "Practice Safe Stress"
programs or to receive his free e-newsletter, email stressdoc@aol.com or call
301-875-2567.
