As therapists most of us have been exposed to both cognitive therapy and motivational interviewing as models for helping people become more functional in their lives. When we are doing critical incident responses, we are definitely not doing therapy. Research clearly shows that the vast majority of people who experience disruptive events do not need therapy. The core message we should be sending is that people are having expected reactions to an event that are temporary. The message that people are strong and have a natural resiliency is at the heart of any good critical incident response.
But are there some things in our clinical toolbox that reinforce this core message? I think so. We have long known that disruptive events can cause stress. We know that two people can go through the same event and have very different stress responses to it. Does this mean that one person is strong and the other one weak? Absolutely not. What we generally find is that the self-messages, the self-talk, the meaning a person gives to the event largely determines the degree of stress experienced. The more negative the self-talk or meaning, the more disruptive, while the more neutral to positive the less disruptive. If one tells oneself that “I almost died! How horrible! What would my family do? This place is not safe! I am afraid to work here! I can’t handle it!” leads to one set of experiences and if stuck will prevent the employee from returning to work, perhaps anywhere.
The other extreme might be the person who says “I almost died! But I am still alive how wonderful! Wow that was quite an experience! I will have some stories to tell to my friends about this one!” leads to a different experience, one that might lead to an increased awareness of the important things in life, and a commitment to living differently in a positive way.
So what techniques can we dig out of our clinical toolkit? In Motivational Interviewing a key concept is developing discrepancy between what we say we want and what we are doing to get there. In a similar vein, in Cognitive Therapy we want to challenge a person’s way of thinking about something by asking for the evidence that their thought is accurate. These seem to me to be ways of reminding people to look at how they have successfully handled difficult events in the past. What things did they try that did not work so well? Let’s do more of the former and less of the latter!
When we are working with groups, having people share these coping skills enhances everyone’s learning both on things to try, and perhaps things not to try.
When we are giving ideas for possible stress management techniques, how do you frame them? Do you come from the position of EXPERT? Or information sharer? Both Motivational Interviewing and Cognitive Therapy promote that the latter style is most effective in building self-efficacy and promoting confidence in their natural resiliency.
As an information sharer, I frequently couch my suggestions using words like “other people who have been through similar events have told me that some of the following ideas were things that worked for them!” This promotes the idea that others have taught us things that are helpful, it is not necessarily our advanced degree or book learning. We are NOT the experts in what will work for them, we only have information to share that other people have found helpful and told us about it.
Staying out of the “Expert” role (good adherence to Motivational Interviewing principles) and yet giving the impression that we are subject matter knowledgeable is sometimes an interesting challenge. It is a skill that probably has more to do with how we deliver our educational points than what we actually say.
So helping people look at a disruptive event from a slightly different perspective, one that emphasizes their natural strengths, builds on that with perhaps some new ideas on managing the reactions to this specific event, and challenging negative self-talk helps people move forward.
Isn’t that what we are doing in critical incident response?
About the Author: Dennis Potter is a licensed social worker, certified addiction counselor and a Fellow, by the American Academy of Experts in Traumatic Stress. Dennis helped to form one of the first community based Crisis Response Teams in the country, and was a founding member of the Mid-West Michigan CISM Team and the Michigan Crisis Response Association. Since 1989, Dennis has helped to train many of the CISM teams in Michigan and in 24 other states.
Dennis has conducted or consulted on all manner of traumatic events for communities, businesses, schools, police, fire and emergency services personnel, the U S Post Office, and community mental health agencies. He is frequently called upon for consultation after particularly difficult events. In addition to his trauma response experience he has received training and supervision in Cognitive Therapy from the Beck Institute in Philadelphia, PA and participated in train the trainer courses in Motivational Interviewing. He is a national and international presenter and trainer. He has presented at the last 10 International Critical Incident Stress Foundation (ICISF) World Congresses and was awarded the ICISF Excellence in Training and Educations Award at the ICISF 2011 World Congress. He has provided motivational training to a variety of mental health, substance abuse agencies and businesses. In addition, he has provided training in both Latvia and Denmark.
