Why Care About Debriefing Critical Incidents?

Interview with Andrew R. Laue, LCSW

What are agencies supposed to do when traumatic events happen to their workers? In my experience doing social work over the past three decades, this question has always hung in the background. Andrew R. Laue, LCSW has pioneered an innovative, embodied model of critical incident debriefing that integrates cutting-edge research on interpersonal neurobiology and trauma. Last week I reached out to him to talk about his work. I wanted to understand some of the differences between Critical Incident Stress Management (CISM), the approach familiar to most people, and his model. [This interview has been edited for length and clarity.]

First of all, Andy, why did you get into this type of work?  

I have suffered the impact of trauma connected to my work personally and have seen the deep impacts on some of my best colleagues. Chronic illness, stress disorders, substance abuse disorders, and relational stress are present in some of the most effective workers. Due to my efforts in developing interventions for these distressed workers, I emerged as someone who could be of support to teams in acute crisis. Without formal training in a CISM model I was asked to do debriefings with first responders, legal teams, jury pools, and medical staff in my community.  

Why did you think it needed attention or a different take?  

Agencies did not experience the local CISM team as responsive following a critical incident. When I began to understand the CISM model I realized it was developed in a period before some of the latest research on trauma and interpersonal neurobiology. Some of the CISM strategies risk re-traumatization when they are not implemented with a rich regulatory presence in the group interventions. They rely upon narrative reprocessing which at times can be re-traumatizing. Due to the absence of awareness of embodied techniques, the original models were not effective in touching the trauma that is stored in the body.

What was wrong with how organizations did critical incident debriefing?  

Typically the debriefing was offered with very little prevention or education work and very little follow up. The stand alone debriefing can be effective for some workers, but can create risk for other participants. We seek to present the debriefings with dynamic leadership that focuses on creating a regulatory environment, teaching body-centered awareness, and focusing on reprocessing for the purpose of resiliency building. 

I hear this question a lot when I talk to agency leaders: How do I determine if an incident is “bad enough” that I should slow everyone down and initiate a critical incident debriefing?  

There is not a discrete level of “bad enough” that determines the need for a debriefing.  Obviosuly dramatic acute incidents such as sudden death, suicide, violence in the work place, and catastrophic community events are situations when the need is obvious.  

But it shouldn’t stop there. We seek to create community resources or members within teams who are identified as secondary trauma responsive resources. They are available to staff to identify distressing events of many types that come up within the course of work. They are available to do more “experience near” debriefings. We have organized the debriefing process into discrete steps that can be used as appropriate for various settings. Having “experience near” resources that are familiar to workers increases the identification of secondary traumatic events and provides scaled resources. 

Does this criteria change for agencies that work with deeply vulnerable populations, like adults who are unhoused and struggling with addiction and mental illness, where the death of clients happens not infrequently?   

Yes. In settings of high distress, it is encouraged that regular secondary trauma processing resources are integrated into supervision relationships and regular team processes. This way when more acute or intense events occur there will be a dynamic team culture already activated that can make the positive impact of debriefings increase.

What are the main ways that organizations need to update their protocols and beliefs about critical incident debriefing?

Six big ideas come to mind:

  1. Challenging the idea that debriefings are single incident solutions to the secondary distress that human service workers encounter.
  2. Taking seriously the need to bring regular secondary trauma support into worker skill-building, supervision relationships, and organizational culture. 
  3. Engaging staff inside the agency to be resources for extreme distress and to be prepared to facilitate “experience near” debriefings. 
  4. Integrating the latest findings from trauma theory and attachment theory into the debriefing process. 
  5. Emphasizing resources that address the fact that trauma is stored in the body. 
  6. Realizing that resources of team and money spent on debriefings have huge pay off in terms of effective work culture and the reduction of worker recidivism. 

One question I hear a lot at agencies is: Can someone who is inside the agency or work group facilitate a debriefing? 

Yes, having specialists or specialty teams within organizations can be very effective in integrating experience near critical incidents. These workers should have access to regular training and support.  

What are the pros and cons? 

The dilemma of having on-site workers as debriefers is that they can be subject to carrying more of the burden of the trauma for the organization. They will need to be in dynamic support networks. Team-based approaches can be effective facilitating this. 


Andrew’s two-day “Train the Facilitator” workshop, Debriefing Critical Incidents, Creating Healing Spaces, will be in Portland in January 16-17, 2020. There is a generous discount for groups of three or more participants. 

REGISTER PORTLAND

OTHER WORKSHOPS

Clinical Ethics in Close Quarters: Navigating Dual Relationships, December 5, 2019 (Portland, Oregon)

Getting Unstuck: Expanding Use of Self in Trauma-informed Practice, February 17, 2020 (Portland, Oregon)

Sustaining Trauma-informed Teams: Tools to Create a Mindful Culture, March 6, 2020 (Eugene, Oregon)

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