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Narrative Therapy Dissertation
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PART ONE |
A Narrative Approach to Critical and Sub-Critical Incident Debriefings |
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A Dissertation by Joel Fay |
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ABSTRACT A Narrative Approach to Critical and Sub-Critical Incident Debriefings Joel Fay American School of Professional Psychology
Occasionally individuals experience traumatic, critical events that challenge their understanding of their world and their place in the world. This understanding has been referred to as a worldview. As a result of their traumatic encounter a person may have difficulty integrating their worldview as they wish it would be and their worldview according to their experience. Sometimes, in part because of this divergence between belief and experience, a problematic story develops which often fails to account for non-problematic aspects of their critical incident involvement. Although many departments are beginning to recognize and respond to a Critical Incident (CI), there are few procedures in place to identify and respond to sub-critical incidents. A sub-critical incident can be defined as an event that may not be perceived as traumatic by a majority of officers, but which has emotional impact on an individual due to the meaning a person ascribes to that event. Narrative psychological theory would postulate that officers develop a story about themselves and their reactions to a critical or sub-critical incident. Officers may see themselves as heroes or cowards depending on the meaning they attribute to their experience of a critical event. They construct a self-story to make sense of all experiences, including those that do not make sense. Officers may select out aspects of the critical incident that conforms to their dominant problematic story and overlook or minimize aspects that do not conform. Narrative therapy utilizes an approach often referred to as externalizing conversations. This approach allows a person to view the problem as a separate from herself making it easier to recognize, understand and protest its influence. Externalizing helps people avoid becoming overwhelmed by a problem. When utilized in a Critical Incident Stress Debriefing (CISD) context, the problematic behaviors and the meanings attributed to those behaviors are identified as belonging to the critical incident and not the officer. This study resulted in the formulation of a narrative intervention called Narrative Interventions for Critical Events (N.I.C.E). The intervention, utilizes aspects of narrative and social psychology, and allows for a new non-problematic story to develop by helping an individual assign a different meaning to his/her role in a critical event.
CHAPTER I
INTRODUCTION
Civilians have seldom understood the real danger inherent in police work. It has never been particularly hazardous to the body, not since Sir Robert Peel first organized his corps of bobbies. This line of work has always been a threat to the spirit." Joseph Wambaugh (1987)
A. BACKGROUND AND PURPOSE
It is obvious to most observers that police work is stressful and unpredictable. Officers must have the emotional resources to perform multiple tasks without losing control in the face of physical threats. They need to exhibit dominance, assertiveness and at the same time, restraint and empathy. They must be able to complete their tasks despite provocation, ambiguity, and the ever-present threat of psychological or physical injury (Shusman, Inwald, & Knatz, 1987; Silva, 1990). While most people do not seek crises in their lives, police officers respond to and immerse themselves daily into the chaos and confusion of other people's lives, and by doing so they put themselves at risk of becoming victims of traumatic incidents. Yet, they do so willingly and without hesitation. One only needs to stand back and watch officers responding to a call of a "man with a gun" to appreciate their coping abilities. Because officers comfort trauma victims and operate in the wake of traumatic events, it should be expected that they will be exposed to the problematic and undesired effects of stress (Harris, 1995). The National Organization for Victim Assistance (NOVA) identifies nine categories of trauma workers. Law Enforcement personnel and firefighters are listed as immediate responders and trauma workers (NOVA, 1991, as cited in Harris, 1995). There are many definitions of stress; there many definitions about how stress relates to police work. Kolbell defined stress as a condition that arises when a person experiences a demand that exceeds his or her real or perceived abilities to successfully cope with the demand, resulting in disturbance to his or her physiological or psychological equilibrium" (Kolbell, 1995, p. 31). In law enforcement, stress can assume other meanings. For instance, McGrath's definition of stress is a perceived imbalance between what is required of the officer and what he is capable of giving, under conditions where failure may have dire consequences (McGrath, 1992). In law enforcement, stressful or traumatic incidents are often referred to as critical incidents. A critical incident is any situation faced by an officer that causes him to experience unusually strong emotional or physical reactions. These reactions may have the potential to interfere with the officer's abilities to function either at the scene or later in life (Mitchell, as cited in Clark & Friedman, 1992). The reactions are a normal person's response to an abnormal event (Everly & Mitchell, 1997), although due to officers' training, belief and experience they may believe the opposite to be true. A critical incident can also be a time when an officer's expectations about his ability to handle stressful situations are called into question (Mitchell, 1990b; Ryan & Brewster, 1994). The officer's reaction to this event may also interfere with his family life (Sheehan, 1990; Hartsough, 1990). It is important to keep the definition of a critical incident flexible because of the varying effects an incident has on different officers (FBI Bulletin, 1996). The following events are typical of those that may cause unusual distress for emergency personnel (Mitchell & Bray, 1990).
* Death of a fellow officer * Serious injury to a fellow officer * Serious multiple- casualty incident/accident * Suicide of a fellow officer * Traumatic deaths involving children * Events that attract "excessive" media interest and public scrutiny * An event involving victims known to the officer * Exposure to infectious diseases * Litigation, charging commission or omissions * An event that has an unusually powerful impact on the officer
How a person reacts to these events, the meaning he attributes to his performance and the circumstances surrounding the incident can cause a psychological crisis. It is important to remember that a critical incident should not be defined in terms of the event but rather in terms of the impact it has on the individual (Bohl, 1995; italics supplied). An event that is less-than critical (sub-critical) can still have an impact on an officer's performance and functioning. Psychotraumatologist Pierre Janet wrote that it is how a person thinks about and reacts to a traumatic event that ultimately determines how quickly the person recovers from the experience (As cited in Everly, 1995). Psychological crises violate or contradict the beliefs a person has about the world. A crisis may shatter a person's assumptions regarding the world as a safe and orderly place. It may also challenge how a person evaluates his competency and gives rise to self-doubt (Everly, 1995). When a person is victimized, three basic assumptions or beliefs about the self and the world are challenged. They are the belief in personal invulnerability, the view of oneself in a positive light, and the belief in a meaningful and orderly world (Janoff-Bullman, 1985). When a person faces a loss, as in the loss of the feeling of invulnerability, there must be some adjustment in order to go on living. The interval between the recognition of the loss and the adjustment can be difficult with symptoms such as intrusive ideas and numbing of emotions (Horowitz & Kaltreider, 1995). Frankl (1959) felt that the failure to find meaning and a sense of responsibility in one's life lies at the root of psychopathology. Trauma challenges previously held assumptions, beliefs and understandings about the world and oneself in the world (Everly, 1995). In a critical incident, how an officer responds in one moment, might serve to define the entire event (FBI Bulletin, 1996). That meaning comes from the socially, and sometimes personally, constructed belief an officer has about the "correct" way to respond. It is the meaning that an officer attributes to an event that determines their behavior and reactions after the event. (White & Epston, 1990). George Everly (1994) provided another perspective when he stated: Practically speaking, there is simply no such thing as reality without considering the human perspective. (p. 178)
A CISD, now synonymous with a psychological debriefing, usually takes place 2-3 days after a suspected trauma-inducing event and is structured as a single group meeting lasting approximately two hours (Bison & Deahl, 1994). A CISD is run by a psychologist or other trained mental health professional and a member of a peer support team (Mitchell & Everly, 1996). There are a variety of CISD formats (Blak 1990; Bohl, 1995; Mitchell & Everly, 1995b; Quinn & Benner, 1993;). In general, these formats involve taking an officer through a number of stages designed to alleviate symptoms of stress and educate the officer about normal reactions to abnormal events. A detailed discussion of various forms of psychological debriefings is provided below. The San Jose Police Department (SJPD) reported that between 1972 and 1987 52 officers were involved in shootings and 17 of those officers subsequently left the department. SJPD did not have a CISD team in place during this time period. Since the inception of their CISD team, 122 officers have been involved in shootings and none of the involved officers have left the department (Benner, 1994). Reception of Mental Health Personnel by Police Officers: Officers are by nature suspicious of psychology professionals who are often seen by them as the enemy (Benner, 1982). These professionals are first encountered by officers when they apply for a law enforcement job. Subsequent contacts are at the request of the police department for a "fitness for duty" evaluation. Officers are concerned that mental health professionals who work for a police department will align themselves with the administrators who provide them with a job (Benner, 1982). Further, because the psychologists work for the police department, the holder of privilege is the department administration and not the officers. When officers are sent to a department psychologist they do not know what can be discussed in confidence. The issue of confidentiality is murky at best and varies from agency to agency (Super & Blau, 1997). Relationships between an officer and a psychologist are also strained when a psychologist is not familiar with police culture (Benner, 1982). Peer counseling can be described as a process whereby officers can talk about their feelings to another officer (Reese, 1984). The idea behind peer counseling is that an officer who has experienced a line-of-duty traumatic event can empathize with and validate another officer's reaction as being normal. Officers tend to trust other officers who have experienced a similar incident (Pastorella, 1990). Although peer counseling services and CISD's in general have been shown to be a very effective way to help officers, getting officers to accept the help has been difficult (Quinn, 1994; Violanti, 1995). Police officers have traditionally avoided seeking therapy or help. Officers tend to believe that other people can't really understand their problems and that "real officers" shouldn't have any problems (Linden & Klein, 1988). The issue of requiring an officer or making it optional for an officer to attend a CISD varies from department to department (Super & Blau, 1997). A formalized departmental understanding of the nature of stress and a departmental order requiring officers to attend a debriefing is preferred to waiting until the officer is calling for help (McMains, 1990). A study by Lt. Dirk Beijen, SFPD, (1995a) attempted to determine to whom a veteran police officer is most likely to turn for help. His results showed that 80% of the responding officers would seek help from a friend and fellow officer, but only 35% would seek help from a peer counselor. The majority of officers would, if necessary, seek out a friend for an informal debriefing. Informal discussions of traumatic events among emergency personnel have been going on for many years (Kaufmann & Beehr, 1989). Friends listening to, supporting and encouraging each other is an important part of reducing stress for officers (Mitchell, 1996). However, the police culture doesn't easily accept the open expression of feelings and emotions. Further complicating the situation is the internal, organizationally generated stress from the semi-militaristic environment in police departments. Policies, rules and political alignments within an organization make it important for an officer to choose his confidants wisely (Beijen, 1995b). Despite the best efforts of many dedicated police officers and police psychologists, police officers continue to commit suicide at a rate twice that of the general population (Gibbs, 1994; Beijen, 1995b; McCafferty, et al 1992). Psychological services have been developed to try to meet the specific needs of police officers but officers are still wary of utilizing professional psychological services (Benner, 1982). Police job related stress and trauma continues to impact officers, their families and taxpayers. What is clear is that officers need to talk about job stress and trauma and the people they prefer to talk with are their self-chosen colleagues and friends (Beijen, 1995a). For this reason further ways of addressing the impact of job stress need to be developed. The purpose of this study is to design a CISD model with the following attributes: 1) it can be taught quickly and inexpensively to officers, and 2) it would facilitate officers assisting their fellow officers in the processing of traumatic/sub-critical traumatic events.
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