As a psychotherapist with more than 30 years of experience in mental health, currently working in the EAP field, I was very excited about the opportunity to receive training in critical incident stress management. The fact that my training was going to be provided by Jeffrey Mitchell himself only added to my sense that I was going to increase my therapist tool kit substantially.
The training itself exceeded my expectations and I was pleased to see the obvious attention toward the basic tenants of developing therapeutic rapport and the systematic use of crisis intervention techniques. Additionally, I was, quite frankly, in awe and humbled by Jeffrey Mitchell’s intense experience in responding to the immediacy of human suffering and his clear compassionate dedication to decreasing its impact.
As a mental health professional who has seen the rise and fall of psychological theories, techniques and practices, I’ve been encouraged of late by the current focus on trauma informed care. Supported and advocated by the Substance Abuse and Mental Health Services Administration, SAMHSA, the trauma-informed approach is described as a “delivery of behavioral health services includes an understanding of trauma and an awareness of the impact it can have across settings, services, and populations.”
In a training manual supported by SAMHSA, entitled, Trauma Informed Care Behavioral Health Services, it is noted that trauma informed care or, TIC, “is a strengths-based service delivery approach that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological and emotional safety for both providers and survivors and that creates opportunities for survivors to rebuild a sense of control and empowerment.”
The marriage of TIC and CISM seemed perfect to me—a match made in heaven with real world applications to help those who’ve experienced trauma, both in the immediate aftermath and in the future, through the recovery process.
The honeymoon, however, did not last as I came upon the few paragraphs in the manual that specially addressed CISM. I was, quite frankly, stunned by both its brevity and short-sightedness. I sensed immediately the negative bias when the description of the purpose of CISM was described as “. . . to provide psychological closure.”
I was left wondering if I had I missed that in the class that I was going through at the moment of reading those lines. I had not heard Jeffrey Mitchell use the phrase, and was fairly sure that no one, other than talk show psychologists, let the word “closure” pass their lips anymore.
It’s not often the case that one gets to take a question or concern directly to the source, so I was eager to take this issue to Jeffrey during our final session. To be clear, the idea that there is a disconnect between the world of psychology and CISM was not news to me.
I can recall the time when the conventional wisdom in the mental health community was that stress debriefings could traumatize clients and the Mitchell model was being abandoned. Like my fellow therapists at the time, I cannot tell you where this information came from and no one that I knew could cite the research that pointed this out. It had all the substance of Bigfoot, but all the influence of a rumor too tantalizing not to be true.
Added to the, we might be making things worse” notion was the professional turf war of, “Who do these trauma people think they are trying to heal people so quickly?”
Sadly, the idea remains that psychological first aid is best dispensed by those schooled in psychology and removed in time and distance from the actual event. This was directly expressed by the following lines from the TIC manual:
A one-session individual recital of events and expression of emotions evoked by a traumatic event does not consistently reduce risk of later developing PTSD. In fact, it may increase the risk for adverse outcomes. Perhaps CISD hinders the natural recovery mechanisms that restore pre-trauma functioning (Bonanno, 2004)
As a card carrying member of the psychotherapeutic community who has seen, first-hand, the healing benefits of CISD, I’m advocating for a reexamination of how to best serve those exposed to traumatic events.
Suggesting that CISD “hinders” a natural process of recovery is akin to suggesting that CPR could hinder the prognosis of heart surgery. As someone who, over 30 years of clinical practice, routinely met with people who could not even remember what pre-trauma functioning looked like, I’m all in favor of the, seemingly self-evident, notion that earlier response leads to better outcomes.
I feel better prepared and equipped to meet my clients where they are, to borrow from an age old therapeutic maxim, having had CISM training as part of my professional development.
That the trauma informed care movement would use outdated and misrepresented research to cast a shadow over CISM suggests that they are in fact misinformed.
I suggest that the psychology community is in need of education on the purpose, application and benefits of psychological first aid. Given the current state of terror-induced trauma across the globe, there has never been a better time to drop professional turf squabbles and finger pointing. If we really want to empower people to regain a sense of safety we need a truly collaborative effort to improve their functioning when their “natural mechanisms” have been overwhelmed by life events.
Mike Verano is a licensed therapist, EAP clinical team coordinator and certified approved CISM instructor. He has over 30 years experience in the mental health field. He has had articles published in national and international magazines and is a regular contributor to the online cancer magazine CURE.