Welcome. In this video we will talk on debriefing. As well as defusing, debriefing is a technique which can be found inside the critical incidents management techniques conceived by Mitchell and Diregrov. This is a toolbox in which there is the mobilization of the resources, defusing, debriefing and many others which you are learning this week. Unlike defusing, debriefing is a more structured technique that has come concrete stages which must be followed and doesn't have an immediate answer. It's a technique which should be applied 24, 48, 72 hours after the critical incident but never after 12 weeks. It wouldn't be effective. About this we must remark it's a technique which has been a bit controverted, there are studies for and against debriefing's effectiveness. Well, what will we say? We will say this technique is effective only if it is correctly applied. In some of his articles Mitchell says that, although it's true that there are studies which point out debriefing isn't effective, these studies aren't made with the rigor they should have regarding the debriefing application. Because usually it's hard to apply it correctly or because of other reasons. But well, it was important to remark this point, we think debriefing is effective as long as it's applied properly. It's a technique similar to group defusing. It could also be applied individually in some cases but initially, as we will explain it today and generally it's a group technique. It is very important to make a good selection of the group. We will take into account which has been these persons' living, these people who make the group, the degree of affectation is also very important. We won't put people with different affectation levels inside the same group. And we won't make groups of more than 15 people. We would make sub-groups, we wouldn't put so many people together. What does debriefing allow us to do? Debriefing allows us to give support and comfort. It allows people who have had a traumatic incident to order the facts, fill memory gaps and begin processing everything that happened. It's not a heal, it's not a remedy, it's not a magic wand, no. In fact, usually the debriefing effects can be seen after a few days. When the brain is able to go on somehow and process everything we have lived. We've said debriefing is a group technique and in this case it has a driver, someone who guides this process. Although in defusing it might be the boss, the group coordinator, the person who was in charge or any person who was responsible in that moment. In the debriefing it's recommendable that the person who guides the group in this process is a professional, an expert psychologist in emergencies who has clear how is this process. Debriefing is a technique a bit difficult, it isn't easily applicable and if we don't have its stages clear and we can't manage and contain people's emotion, expressions or reactions are a bit complicated. So we have said that there will be a person who guides the process and then there can be one or two assistants. These assistants will be one or two, and we will distribute the tasks but they will mostly manage the fact that in example no one comes into the room, and if someone leaves the room assisting him individually. As you have seen debriefing is a technique a bit more strict than defusing and it has some rules. To being, during debriefing once we begin there will be no interruptions. It's a session which can be extended for a bit more time than defusing. We will never be, it will depend, we will never be there for a whole afternoon, but it will depend mostly on the kind of group we have, the level of affectation and the amount of people in the group. But well, we have said that once the debriefing begins it won't be interrupted. What does this mean? This means that once the debriefing begins no one will enter the room. If someone needs to leave he will be able to, but no one else will go in. People who need to go out because they feel upset, because it means too much for them, they will leave and one of our assistants will go with him or her and help them, even give them some advice if they want to go in again, how he should do it, or if he doesn't want to go back to the room, the posterior monitoring they must do. In this sense no one will be able to go in, they will be able to leave. But we ask to, in example, shut the cell phones down, or not speak, speak on turns, not interrupting people and a basic rule in debriefing is that we can't judge. In debriefing everybody has the option to speak, it's not mandatory, it's an option we give to the participants. Although we make clear that sharing things with the group will be really good for them, but they aren't obligated. The only things that are mandatory is not judging the narrations the other participants are making and especially not interrupting them. Let's enumerate the debriefing stages. We said debriefing is a technique which has certain stages, it's very structured and these stages must be followed. There will be an initial introduction stage in which the process will be explained, we'll see it now. A stage in which we will tell what happened, another one in which we will describe the feelings, another one in which we will describe the emotions, a reformulation stage, in which we will summarize all this, a stage to reinforce people who have participated and finally the closure with the following needed. Let's begin. During the introduction stage we try to explain participant people the rules, which are the ones we have previously said and to explain a bit how the exercise will work. In this introduction stage we must introduce ourselves, say our name, where we come from, which is our job and all the participants will introduce themselves so that everybody knows who is who more or less. A good way to start a debriefing would be, "Hi I'm Alicia Álvarez, I'm assistance coordinator in the crisis unit at the Autonomous University of Barcelona and I will guide you during this debriefing process, these are my colleagues Ingeborg and Emilia and they will be here to assist in any need that you might have during this exercise. In this exercise we will make some group narrations to try to organize the incident they have lived. Well, this would be a way to begin, it's getting adapted but it's very important that we let the limits clear and explain how the exercises dynamic will be. We will go on with the facts. This stage is basically about everyone explaining what happened that day or in that moment. It's about building a story from the moment before the critical incident happened to the moment when it's over, when they're in a safe place. It's about explaining only the facts, what happened. A facts narration would be: I woke up, I had breakfast, I went to work, they called me, they told me my mother died, I went to the morgue, I called my husband, I got home and I cried. Only the facts. This technique's difficulty lies in the fact that each of the three stages is based in making a narration separating facts, thoughts and emotions. It's very difficult especially if the person isn't used to making this division. Usually when we make a narration on something that happened to us we explain what happened, what we have thought, how we have felt, all together. In this case we must divide it so that we can make a full narration, see if all the reactions and thoughts we have had are normal and be able to begin creating. We were with the facts stage, we said that we must only explain what happened during all the process, but only the behaviors. What did we do, what happened, what did we do? We make a round, whoever who wants to participate does it, and who doesn't isn't forced to explain what happened that day. We remark the fact that they have participated and we go to the next stage which is the thoughts one. It's about elaborating the same they have just explained, but with thoughts. In example, I woke up, I thought I was waking up very early. I had breakfast and I thought it was delicious. I went to work. I thought I worked more and more every day, and this couldn't be. They called me and told me my mother had died. I thought this wasn't real, I thought they were wrong. I went to the morgue, I thought I had to call my husband. I called my husband. I thought I had to pick up the kids from school and go home, I got home. I thought of all that happened that day and I cried. Sometimes if the incident is a traumatic point and everyone in the group has lived exactly the same, it's useful to make a timeline, having a board or a surface in which we can draw a timeline and mark the events they are telling us. And this is important because sometimes people don't remember exactly the same. And thanks to everybody's memories we generate a memory and a history, a full explanation on the incident. Also the fact of having a written line, an established timeline, it makes that later, the narrations both on feelings and, as we will see next, emotions, become more fluid because people simply need to remember what they thought in every moment. This stage ends like the previous one, remarking the fact that they have participated and that they have shared these thoughts, and we go to the third stage. The third stage is explaining all the emotions they felt during this stage. Once again, I woke up, I was very tired, I didn't want to go to work, I got to work. I was apathetic, disinterested, they phoned me, they told me my mother had died. I felt a huge incredulity, when I got to the morgue I felt deep sadness and when I got home, the loneliness feeling and the pain were overwhelming. It's the same we have been building during the two previous stages, but this time we add emotions. It finishes like the previous ones, remarking, and then we get to the reformulation stage. Here, the person who is leading the process must put all the parts together and make a common account. The point is emphasizing that all the emotions and all the thoughts are similar, normalizing all the reactions the people who integrate this group have had in front of this stress situation to link it with the next stage, the reinforcement stage. Here we must reinforce all those behaviors or all the thoughts that have been normalizing. Such as asking which strategies in other occasions, or what have they used to go on in other occasions and reinforce these confrontation strategies which everyone has. It's the look towards the future, what are you going to do from now on, how will you face this? Gather it, correct all the inappropriate confrontation strategies and give an ending to the session, a last stage letting these people connected to a public health network or telling them how the monitoring will be, that they will receive a phone call after a week or that they can send a mail if they don't feel good or any existent mechanism placed to make a good monitoring.
