So welcome back. I promise to stroll through the elements of rapid psychological first aid. Before we take that stroll, I want to remind you of our context. What we are most concerned with in the wake of disaster is surge, the increased demand for mental health behavioral health services. The remedy, the answer to the problem that we've come up with is to build the community resilience from the inside out. This is a departure from historical methods as I've described earlier, where we would typically import professional mental health services. There is still a role for that, don't get me wrong. But what Hurricane Katrina taught us was that resilient communities are perhaps best built from the inside out. How do we do that? Why is this program designated for, primarily at least, non-mental health clinicians? Why are we designating this for public health professionals, for educators, especially first responders? Because you make up the fabric of the resilient community. You know the geography. You know the culture. You know the people. Now some will say there's an inherent flaw in your rationale. Because during a disaster first responders will be busy doing their primary jobs, and that is true. But that is why we also build the resilience in neighboring communities, such that every community will usually have a contiguous community. So what we do is, when a one community is affected, we draw upon the psychological first aid trained resources in the contiguous, or surrounding, communities. So think of it as a mutual aid process. Our goal is to have that mutual aid process extend across North America. And again, that is not to say that we don't import professional mental health clinicians. But their roles are more oversight and guidance. So again think of psychological first aid not only as form as individual crisis intervention, think of it in the broader public health perspective as a way of building community resilience. So I promised that stroll. So let's do that. The R you remember stands for rapport and reflective listening. The rapid model begins with establishing rapport and employing techniques that are sometimes called active or reflective listening. The goals are simple. Make a contact, provide an introduction. Who are you? What are you doing? Establish rapport. Use specific reflective listening techniques, which have been developed over the last 50 and 60 years, such as paraphrasing, to establish some degree of empathy. Remember that term, empathy. What is empathy? It's not sympathy. Empathy is perceived understanding. Empathy is feeling as one feels, as the other feels. It's not sympathy, which is feeling for someone. And what we have seen, what social science research has taught us, is that certain listening techniques actually build a psychological bond of empathy, and it builds it quickly. It's not just a technique. It's a ongoing process. It's not just a discrete phase, it's a process that you will use in the entire interaction. And by the way, If you are lucky enough to never encounter adversity, I will suggest to you that gaining rapport and reflective listening techniques are techniques of living. They are techniques of life. They make the world so much more interesting because you have the ability to not just sit across from someone metaphorically, but to sit beside them. So that life becomes a shared process rather than one that we bump into people as we go. So think of this first section, the R, as a life skill that is particularly useful in crisis, in the wake of adversity, but, but also as just a great skill to help with, golly, children, at work, almost anywhere you encounter another human being. So I mentioned that reflective listening consists of techniques, specialized techniques that can make listening more effective. It's sometimes called active listening. How does that work? How is that possible? It seems that reflective listening techniques derive much of their effectiveness from demonstrating that the person in distress is actually understood. Now don't dismiss the importance of understanding, because understanding often conveys trust. If you understand me, I'm more likely to trust you, and if I trust you, I'm more likely to be compliant. Pause for a minute, and think about disasters. Is compliance important in the wake of a disaster? I think of pandemics, where it is likely that more people succumb to the pandemic because of social conventions by not following guidelines on how not to spread the disease, rather than the inherent virulence of the disease itself. I am reminded and interesting picture of a cable car in San Francisco during the Spanish Flu. And it was just a placard on the side of the cable car and it said, spitting kills. Lets just say that was a form of early public health messaging. The point is, how do we prevent people from spitting? If people don't feel understood, if they feel that messages are coming at them without an understanding to whom the audience is, the message is not likely to be heard. It's not likely to be understood. Trust is not likely to be developed, and compliance will wane. So reflective listening techniques have been successfully used in a wide variety of applications, certainly in the counseling professions. In crisis intervention and psychological first aid as we are now demonstrating. But in parent child communications. In sales. And even in law enforcement, more specifically in hostage negotiations. In the 1980s for example, the field of hostage negotiations was found out of law enforcement. And when I ask my colleagues in law enforcement, what was the great breakthrough that aided people in releasing hostages unharmed, they generally smile and they say, oh, it's that psychology stuff. It's that active listening. I said, what are you, what are you speaking of specifically? And they would say, we found that when the law enforcement officer could form an empathic bond with the perpetrator, the likelihood of a successful release dramatically increased. What is that empathic bond? It's about being understood. Where does understanding start? You got it, listening. First question that students usually ask is, how do we start? And admittedly, getting started is often the most difficult part of the process. We begin by establishing rapport. We begin the conversation by establishing rapport as quickly as possible. In the wake of a disaster, in the wake of adversity, you will encounter people in acute distress. Psychological first aid is designed to provide acute assistance. In order to know how best to help someone in a crisis, you must observe, you must listen. What you say initially will obviously depend on the situation itself. But generally speaking, I suggest that you introduce yourself in a respectful manner. Explain who you are, what you're doing and then ask an initial question. When you ask a well-phrased question, a person in distress derives a sense of value, and participation in the solution of their own problem. Rather than having someone just show up in their face and say do this, do this, do this. I've been to 36 countries, six continents. Many of them far many more times than once. Regardless of culture, regardless of language, regardless of religion, recovery from disaster, recovery from adversity, ultimately come from within. Our job is to give people the jump start that they need. Some need more, some need less. But the jump start begins with understanding as best we can. And there's the empathy again. The great 20th century physician Henry Murray once said, there is nothing so powerful as a well-phrased question. Why could that be so? What does a well-phrased question really get you? It gets you Insight into the person. It gets you insight into their needs. It tells them that you are interested, rather than just showing up telling people what to do. It says, you are valuable. I'm here to help you, but I need your assistance to help you. I want to help you most effectively. In order to do that, I need to know a little bit about who you are and what happened. But when all else fails, never forget the most well-phrased of all questions, how can I help you? When we analyze questions, it may be said that there are three types of questions. Close-ended, open-ended, and reflective listening paraphrase questions. What's a close-ended question? A close-ended question is a question that restricts the response options available. The most closed of all, as you might imagine, is the yes no question. Now, they're very efficient, they're good for us quickly establishing facts. Closed-ended question, are you bleeding? Are your hurt? Do you have a place to stay? Do you have resources? An open-ended question, however, a little less efficient but can be far more productive. They begin with the words such as what, why, how. How are you doing? Now, let's juxtapose that to the close-ended question, and think about the responses. I approach someone, and I say, "Are you doing okay?" Interestingly enough, experience teaches us, that even those who aren't doing okay will often say,"Yeah, I'm doing fine." And it's not that they're lying, or being dishonest. Often feel guilty for asking for assistance. But a way around that potential issue is to simply say rather than you doing okay is how are you doing. Now people can certainly come back and say I'm doing okay. Now the way of asking the same question is, Hey, what's going on? What's going on with you now? So these are good for filling in details and probing for further information. But don't forget a summary paraphrase. You may not have heard that term before so let me repeat it. Summary paraphrase. A paraphrase is where you take someone else's words, turn them into your words, and send them back. So summary paraphrase, taking someone else's words, rephrasing it. To rephrase the core content or sometimes the emotions into what is often a yes or no question, and sending it back for affirmation or modification. Summary paraphrases are almost magical. They have stems. Often the stem would be something like well, sounds to me like. Or, so in other words what you're saying is, or what I'm hearing you say is. Now be careful because these can be abused, these are like red flags. When someone hears too many of those terms they'll say, are you doing something psychological, are you practicing a technique on me? The key to effective listening and effective questioning is not to have it seem like a technique. It is not an interrogation, and I am speaking specifically to our law enforcement colleagues now. It is a conversation. The goal is ultimately healing, but initially it is to gather as much information as possible. Go back to the concept of empathy. Sit beside someone, metaphorically, not across from them. This is a journey. It is not a destination. So the summary paraphrase says some interesting things. The first and foremost goal of paraphrasing is to establish that concept of empathy. Remember, being understood, being understood is being appreciated. William James said, the deepest craving of human nature is the desire to be appreciated. In the darkest moments, sometimes it will be the darkest moment when you enter someone's life. All they need is to be valued, to be understood, to be appreciated. Sometimes words, sometimes a presence, will do far more than objective aid. But it has to begin with them. Sounds to me like this has been hard on you. So in other words, what you're saying is you've lost everything. I'm hearing you say this has been devastating. Once someone tells their tale of devastation or adversity, oftentimes caring people want to rush in and just fix it. I lost my house, this house has been in my family for 300 years. The naive response would be, perhaps there's insurance, maybe the insurance will cover the house. That may be true, and that may be the ultimate solution, but that's probably not what they want to hear right then. What they want is someone to sit beside them and say, so this has taken your breath away, you've lost more than a house, you've lost a history. Let's get a little more granular. Imagine yourself to be a mirror. Once engaged, the person in distress sends either a non-verbal or verbal message regarding their current state of distress. How you doing, might be the probe. As a human mirror, your job becomes reflecting back the person's emotional and or most salient cognitive content within the message. Simply said, the core of reflective listening consists of taking the other person's words, paraphrasing them, rephrasing them. Rephrase the essence of their message into your words and reflect them back. Since most messages have both an emotional and objective aspect, you must decide which aspect to reflect and when. Which one is most important? It's often a good idea to start with the emotion if it seems most salient, as is often the case in the wake of tragedy. We remember Aristotle, who said there are three elements to discourse. There's Logos, the logic, the rational mind. There's Ethos, the sense of credibility. Do you understand who I am? And there's Pathos, which is emotion. And Aristotle once said that the road to Logos and rational action is often paved through Pathos. We must sometimes bear witness to someone's distress, before they are ready to receive objective assistance. These techniques prove useful in that process.
