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Outsourcing Compassion

When Herbert heard about throngs of therapists rushing to debrief New Yorkers after 9/11, he quickly organized 19 of the world's top researchers on trauma to publish a letter in the American Psychological Association's Monitor magazine. The letter began with the Latin words "Primum Non Nocere," the first tenet of medicine, "First, do no harm."

Herbert warns, "By trying to intervene, despite however well intentioned, by trying to intervene prematurely, we might actually cause more harm than good."

One of the people who signed Herbert's "First, do no harm" letter was Richard Gist, an academic researcher and a psychologist with the Kansas City Fire Department.

Gist says "Debriefing shows no effect at preventing post-traumatic stress disorder, a condition that most people would not acquire to begin with, and the majority of those who might actually experience distress at that level would still resolve over time. It will not prevent that, and indeed it might complicate recovery for some who would otherwise get better."

James Herbert cautioned colleagues in the mental health field to "First, do no harm" in trying to help 9/11 victims. Photo courtesy of James Herbert.

Gist soured on debriefing in the 1990s, when data from the United States and abroad started to pile up, showing adverse effects in some people. Gist says debriefing seemed especially problematic for people who cope by holding their feelings in. But the data wasn't reaching the corporate human resources managers who kept hiring debriefing teams. Gist explains, "The most basic problem is that critical incident stress debriefing was developed as a product, as a package, to be marketed and sold again and again."

That debriefing "product" was developed by Jeffrey Mitchell, former Maryland firefighter and paramedic. He wanted a way to help emergency workers handle the extreme stress of their jobs. Mitchell has defended his approach, saying that the crisis intervention companies who adapted debriefing for the workplace often misuse his technique. For example, he says, groups of people who didn't share the same level of exposure to trauma or experienced different kinds of trauma were debriefed together, and that's the wrong thing to do.

After the September 11 attacks, major publications picked up on the "First, do no harm" letter, and a scientific argument over debriefing spilled into The New York Times and The Wall Street Journal. Bruce Blythe, who ran the nation's largest crisis intervention company using such debriefings, found himself on the defensive.

He remembers, "I was in denial. When I first started out, we had a lot of people say, 'It's so good. We're so glad that the company came in and showed that they care.' People would talk about it and would say that it's really helpful to know that other people were feeling the same way they were. But what we didn't realize is that some people were distressed by what they heard. Some people just don't want to hear other employees describing what a corpse looks like."

Bruce Blythe of Crisis Management International, which has recently changed its practices in light of the scientific controversy over debriefing. Photo courtesy of Bruce Blythe.

Blythe needed to figure out what to do, so he approached debriefing's biggest critics, including Gist. Blythe says they began a debate over email. Blythe says Gist told him, "Group debriefings may feel good, but someone bringing doughnuts in the morning into the break room feels good too, but not necessarily good for you."

Blythe says he thought, "Wow. Maybe because these things do feel good doesn't necessarily mean it's good for people. So [Gist's] the person that really turned me around. We met in the middle. He was saying that it's better to do nothing than do group debriefings, I was saying there's a social expectation, there needs to be something done."

So, Bruce Blythe recruited Richard Gist as an unpaid consultant to retool the debriefing method. They got rid of the practice of rehashing the trauma story. Instead of handing out a list of symptoms, they explained to people how to stay resilient, and how to find support systems. They called their new approach "group resiliency briefings." Blythe's company, Crisis Management International also merged with Bob VanderPol's company Crisis Care Network, which now runs the trauma response side of the business.

Gist says the emphasis is on being positive and practical and sticking with what's been proven to help people in a crisis. "It's important for the whole sake of our discipline, and our responsibility to the public, that we get back to our empirical roots and that we be able to demonstrate that the things that we bring with the best intention of our hearts also provide the best help to the people we attempt to serve," says Gist.

But like its predecessor, group resiliency briefing does not have the kind of scientific track record critics of the original debriefing approach would like. No one can say for sure whether resiliency briefing works either. Meanwhile, many employee assistance companies still offer the original form of incident debriefing. In any case, as one 9/11 survivor said, the outsourcing of compassion is here to stay.



Back to: Trauma and the Brain